Fancy a di­ges­tive tract?

The Weekend Australian - Review - - Books -

What is one to call the stuff that comes out of our body and falls into the toi­let? It’s a per­pet­ual prob­lem, one a doc­tor faces many times each day. On a ward round last year one of my reg­is­trars bent over an el­derly pa­tient just back in his bed af­ter vis­it­ing the bath­room and sweetly asked him, “Did you do num­ber ones or num­ber twos?” He looked at her askance and grumpily boomed, “What is this? Kinder­garten?” I could barely stop my­self from cheer­ing.

But what should one say? We have stool, poo, shit, crap, fae­ces or (my per­sonal favourite, used by a 91-year-old pa­tient of mine) “one’s du­ties”. Gi­u­lia En­ders’s in­ter­na­tional best­seller Gut is all about what­ever-you-want-to-call-it: what’s in it and what it means; how it’s made and how to make it even bet­ter.

The gas­troin­testi­nal tract is to­day’s or­gan du jour: the slimy, writhing fo­cus of our quest for health, or ul­tra-health. Ac­cord­ing to En­ders, obe­sity, high choles­terol, chronic fa­tigue, arthri­tis and all man­ner of psy­chopathol­ogy could be caused by some­thing go­ing awry in our guts; or more specif­i­cally, some­thing go­ing awry with the teem­ing colonies of bac­te­ria that live there.

En­ders, a Ger­man re­search mi­cro­bi­ol­o­gist, ob­vi­ously adores her sub­ject mat­ter. The book, in this English trans­la­tion by David Shaw, is writ­ten in a friendly, en­thu­si­as­tic voice, bol­stered by hun­dreds of ex­cla­ma­tion marks and cute car­toons. En­ders’s pro­ject is to show how those es­sen­tial func­tions of the hu­man body that some peo­ple may con­sider un­seemly or un­speak­able are in fact won­drous and wor­thy of exultation. “Ev­ery time we go to the loo, it’s a mas­terly per­for­mance … burp­ing or break­ing wind might sound a bit gross, but the move­ments in­volved are as del­i­cate and com­plex as those of a bal­le­rina.”

En­ders turns the events that un­fold in our body ev­ery time we eat into a dra­matic al­le­gory. Body parts, plants and bac­te­ria are given agency: “What plants re­ally want is to re­pro­duce — and then along we come, and eat their chil­dren. In­stead of cre­at­ing an emo­tional scene, plants re­spond by mak­ing their seeds slightly poi­sonous.” Or, “When we take a sneaky bite of cake, we never hear the roar of ex­cited bac­te­ria in our gut as they glee­fully shout, ‘HERE COMES CA-A-A-KE!’ ” A pair of dys­func­tional sphinc­ters can be taught to “get to know each other again”. I found this nar­ra­tive tech­nique al­ter­nately en­dear­ing and ir­ri­tat­ing: is her aim to in­spire our en­thu­si­asm or tell a story for chil­dren?

Gut clearly and sim­ply ex­plains al­ler­gies, food in­tol­er­ances, con­sti­pa­tion, di­ar­rhoea, re­flux and vom­it­ing. It also con­tains much trivia: that mice can’t vomit, that pe­trels vomit on pur­pose. She in­forms us that if we stick our fin­ger up our nose we’ll find our nos­trils don’t end there. She ad­vises us to squat to defe­cate, leave our ton­sils in un­til we’re at least seven, de­liver our ba­bies vagi­nally and breast­feed them. Read this book and you will un­der­stand why you feel ter­ri­ble af­ter an al­co­hol binge, slug­gish af­ter a heavy meal and be­come sick when stressed.

But some­where along the way, En­ders’s pro­ject of elu­ci­dat­ing our in­ner work­ings morphs into a claim that the gut might be the con­trol cen­tre of our en­tire sub­jec­tiv­ity. That ab­dom­i­nal pain and nau­sea cause feel­ings of un­ease will come as no sur­prise to any­one, but En­ders pushes this cause and ef­fect be­tween what’s in the gut and one’s emo­tional state much fur­ther.

De­pres­sion, she claims, may be caused not by an “un­happy brain” or life cir­cum­stances, but by an “un­happy gut”. She cites small ro­dent stud­ies to hy­poth­e­sise that the kind of bac­te­ria we have in our in­tes­tine may even de­ter­mine our per­son­al­ity traits and our ac­tions: mak­ing us gre­gar­i­ous or timid, for in­stance. In­fec­tion with the Tox­o­plasma gondii par­a­site may cause a per­son to en­gage in risky or self-harm­ing be­hav­iour, or even to de­velop schizophre­nia.

To say that these claims are re­duc­tion­ist and fan­ci­ful is an un­der­state­ment. How­ever, it is un­der­stand­able that when some­one is com­pletely im­mersed in the study of one thing — as En­ders is with the in­testi­nal mi­cro­biome — it can be­come the cen­tre of their uni­verse, and seem the ori­gin and cause of all things. There is a sin­gle tem­per­ing sen­tence in the book, cau­tion­ing that “this ex­cite­ment about gut re­search could still fiz­zle and come to noth­ing”.

The fi­nal sec­tion of the book cov­ers pathogens (bad bac­te­ria) and an­tibi­otics, and the detri­men­tal ef­fect of both on the good bac­te­ria in our gut. En­ders sum­marises the ben­e­fits of pre­bi­otics and pro­bi­otics on pro­mot­ing or re­gen­er­at­ing this good bac­te­ria.

She ends on a com­pletely sound and un­con­tro­ver­sial note: good bac­te­ria gen­er­ate or un­leash vi­ta­mins, help us ab­sorb our food and pro­tect us from ill­ness. “We should feed them well so they can pop­u­late as much of our large in­tes­tine as pos­si­ble. Pasta and bread made of white flour on fac­tory pro­duc­tion lines are not enough. We need to in­clude real roughage, made of real di­etary fi­bre in veg­eta­bles and fruit … Our bac­te­ria will like it, and they will thank us with their good ser­vices.”

I don’t buy En­ders’s I-have-bugs-there­foreI-am story, her wild ex­trap­o­la­tions from rat to hu­man, nor her think­ing, feel­ing, free-willed bac­te­ria, but if this book con­vinces the pop­u­la­tion to eat more veg­eta­bles, she can use as many ex­cla­ma­tion marks as she likes.

The writer adores her sub­ject mat­ter

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