According to a lawsuit filed this month, Ron and Sarah Bowers bought their son a Subway sandwich in Lombard, Illinois on February 27. After eating it, he had agonizing cramps and diarrhea. According to the suit, what the couple really bought was a shit sandwich.
It had been contaminated with Shigella sonnei, a bacteria transmitted via the fecal-oral route and can cause vomiting, dysentery and death. Over 100 people claim to have been sickened at Lombard's Subway, according to attorney Drew Falkenstein, whose firm has filed suit on behalf of Ron and Sarah Bowers and two other customers.
We don't want to think about excrement. We don't want to see it, smell it or touch it. We definitely don't want to eat it with chicken teriyaki, on toast. Yet intestinal goings-on are in our faces everywhere these days, whether the news is about probiotics and prebiotics appearing in new food products or yet another outbreak of norovirus -- the painful gastroenteritis that is spread via fecally contaminated food, water and surfaces and has sickened thousands of cruise-ship passengers in eight unprecedentedly massive outbreaks so far this year.
And "poopular culture" is upon us: Witness Slumdog Millionaire's outhouse-plunge scene. Witness Oprah's "Everybody Poops" episode, in which Dr. Mehmet Oz avows that excrement should enter the toilet with not a plop but a swoosh "like a diver from Acapulco." In a scene from the forthcoming film Life As We Know It, a young mom portrayed by Katherine Heigl is interrupted by visitors while changing a diaper. "Sweetie," one of the visitors tells her, "you have shit on your face."
In a dirty, crowded world where germs are outsmarting drugs by leaps and bounds and our health care options may or may not be mired in red tape for years, we're being forced to face feces. Which is kind of a good thing. They're the ID cards our bodies issue, charting with terrifying accuracy where we've been and what we've done. The bowel knows.
Good Bugs vs. Bad Bugs
"A gram of feces can contain 10 million viruses, one million bacteria, 1,000 parasite cysts and 100 worm eggs," asserts Rose George, author of The Big Necessity: The Unmentionable World of Human Waste and Why It Matters (Metropolitan, 2008). She despairs over the fact that 2.6 billion people "have no access to any latrine, toilet bucket or box. ... They do it in plastic bags and fling them through the air in narrow slum alleyways." Four out of every 10 human beings, George laments, "live in situations where they are surrounded by human excrement."
In the developed world, our relationship with our bowels mostly entails controlling the flora that live in them. Lactobacillus. Peptococcus. Streptococcus. A hundred trillion microbes belonging to as many as 1,000 different species coexist at any given time in a single gut, which measures over three yards. What are they doing down there? Battling it out, rendering us well or ill.
Over 70 percent of the human body's immune cells are found in the gut's mucosal lining. A healthy gut means more immunity, and a healthy gut is a gut in which good bacteria outnumber bad. And they're all hitchhikers that rushed in from outside, mounting an invasion that began the instant our placentas broke. "We're all bacteria-free until then," says Emory University School of Medicine associate professor Andrew Gewirtz, the senior author of a study released this month on the effects of imbalanced gut flora. Once the placenta breaks, Gewirtz says, "the colonization begins."
Garnering such headlines in the mainstream media as "You can blame bacteria in your stomach for those unwanted pounds" and "Germs are making you fat," his study found that mice whose guts contained too many of the class of bacteria known as Firmicutes ate much more than other mice, experienced metabolic changes and became obese.
This finding undermines the assumption that obesity is driven by laziness and easy access to cheap fattening foods.
"You can't ask the mice" why they ate more, "but how much they ate was clearly not affected by price or marketing schemes," Gewirtz says. Instead, bad bugs can promote excessive appetite and fat storage. They can also make us sick in a million other ways.
The Business of the Gut
"Good bugs form an invisible barrier preventing pathogenic bugs to take root and multiply," says Ann Louise Gittleman, a doctor of holistic nutrition who has appeared on "Dr. Phil" and authored over 30 books including Fat Flush for Life (Da Capo, 2009).
She urges us to wage "the new germ warfare" that optimizes "the balance of power in what amounts to a huge fungi kingdom. We have to, because in our bodies we have more bacteria than we have cells."
Because of their crucial role in immune function, the bad ones "can turn into a source of bad health that can affect us from head to toe," creating not just irritable bowel syndrome, colitis and Crohn's disease but conditions such as nasal congestion, itchy skin, bleeding gums, acne and depression that we might not think had anything to do with our bowels, Gittleman says. Online, she sells stool-sample testing kits that come with vials and a discreet white box printed with the address of the lab that does the analysis.
"The intestine is an unappreciated organ. It's a beautiful membrane," asserts vegan physician Michael Klaper, who appeared in the PBS documentaries Diet for a New America and Food for Thought and has served as an adviser to NASA. "Think of all the intestine does while supporting a population of alien organisms. Miraculous things happen on our gut linings."
At True North Health Education and Fasting Center in Santa Rosa, California, Klaper and his fellow doctors supervise patients undergoing water-only fasts that can last up to 40 days. "Like other organs, the gut could use a rest. We're talking about 22 feet of small intestine. Its lining is a very active membrane and it needs a holiday sometimes, too.
"The body is perfectly capable of going for weeks without food as you burn off your fat stores. Of course, it's no picnic. In the first few days, people are very energetic, as all the energy that would have been used to digest food is put to other purposes. At the end of the second week, they get very quiet, meditative. They're in a different space," said Klaper.
When it's over, "they're very light and clean, and we very gently re-feed them on highly diluted fruit juices and steamed vegetables." However long the fast lasted, refeeding takes half that long. "There's an art to it, of course," Klaper says.
How Did We Get So Messed-Up?
"In the old days, our ancestors drank water out of streams and wells. They ate fruit and vegetables harvested in gardens. They lived in close connection with the natural world, and part of the natural world would set up housekeeping in their intestines," he said.
Traditional diets lacking chemical additives kept their gut bugs in balance, "but modern life is an assault on our normal bacterial flora. We put five or six majorly disruptive substances down there every day."
The first of these is chlorine, found in tap water. "Okay, so we don't get cholera or typhoid. That's great. But every time you drink this water, you're drinking a chlorine-dilute solution," he said. That kills good bugs along with bad. Ditto phosphoric acid, a key soft-drink ingredient. "We're a nation of tea and coffee drinkers. What happens in your gut when you're constantly sloshing down a known bactericide?"
Sugar is yet another villain, as are antibiotics, which wipe out nearly every bug in sight -- which saves lives but leaves guts thinking What the hell?
And they do think, insists Chicago colon therapist Alyce Sorokie, the author of Gut Wisdom: Understanding and Improving Your Digestive Health (Career, 2004). "The gut is always speaking to us. It has more emotional receptor sites than anywhere else in the body. The gut is filled with neurons and neuropeptides, the same things that are in our brains, so it can take in information. It can learn. It can respond to events even more rapidly that our brain does," says Sorokie.
"You feel something in the gut, and the vagus nerve brings that 'gut feeling' up the spinal cord to the brain, and the brain makes up a story about it. The brain can always rationalize, but when we feel something in the gut, it's unedited. It's very primal. That's the gut's voice, and the more we don't listen, the louder it gets."
And that is why Sorokie says her clients get emotional during colonics, as filtered water flowing through a hose inserted into the anus bathes the colon, bringing out with it accumulated fecal matter that can be viewed through a clear portion of the mechanism, foot by wiggly, rubbery, slippery, corn-kernel-studded foot.
Releasing stored material from digestive tracts releases stored material from hearts and minds as well, Sorokie says.
"It lets everything come out. These clients say they wish they could bring the hose along with them to their psychotherapy appointments. Nobody wants to think, 'I harbor toxic thoughts and toxic waste within me,' but then there's a liberation: Here it is and there it goes. This was part of me, and now it's not," she said.
Short of anal hoses and doctor-supervised starvation, we can give our bowels a break by eating prebiotics. Found in dandelion greens, Jerusalem artichokes, chicory, milk and a few other natural sources, these are soluble fibers that we can't digest, but our beneficial flora can. In other words, prebiotics (which aren't alive) fuel probiotics (which are), making them more active and fighting-fit. So, eating prebiotics is like sprinkling fish-food into a tank full of hungry fish.
"Most people are already comfortable with the idea of fiber in their diets," says microbiologist Mary Ellen Sanders, who belongs to the International Scientific Association of Probiotics and Prebiotics.
"Now you can start to think of eating fiber not just for the traditional fiber effects, but to feed beneficial members of your bacterial community," she explained.
These communities, which are unique to each of us, remained almost a total mystery until recently. Only in the last few years has DNA research brought the identities and functions of much of this flora to light. Up to 80 percent of the various types of human bacterial microbes have still never been grown outside the body under laboratory conditions, Sanders says. "It will be very interesting to see how all this develops in the next five years."
In the meantime, she says eating probiotics and prebiotics "lets us feed the right microbes in the right way." As it would be difficult to eat enough chicory and dandelion greens to get the recommended five to eight daily grams of prebiotics, we can start looking for prebiotic-fortified food products and supplements, often identified by the presence of oligofructose and/or inulin on their labels.
We'll be seeing those words more and more, as products containing prebiotics are among the food industry's fastest-growing sectors. New ones keep popping up, such as the Jamba Juice frozen sorbet and yogurt bars that hit stores this month. The bars' marketing material promises that Coconut-Pineapple Passion Smashin' and its fellow treats-on-sticks "contain prebiotic fiber, allowing customers to satisfy their sweet tooth without feeling guilty."
One hundred trillion microbes are too many to kill, so we're never out of bugs. But when they go way out of balance, a new kind of therapy lets doctors recolonize patients' bowels with what Emory University's Andrew Gewirtz calls "cocktails of good bacteria."
As seen on "Grey's Anatomy" and in real life, the treatment is an extreme measure for people suffering from Clostridium difficile, a bad bacteria whose overpopulation causes debilitating intestinal infections when antibiotics wipe out the good bacteria that would normally quell it. (Clostridium difficile rates are skyrocketing in American hospitals these days.) Known as fecal bacteriotherapy, fecal transfusion or fecal transplant, the treatment entails inserting a healthy person's feces into the sick person.
Rich in good bacteria, these feces enter the patient's intestine from either end: via enemas or orally, through a tube. "These patients are at the ends of their ropes," says Gewirtz. "They're willing to try something that isn't very pleasant."
So: Bad gut bacteria stay bad when Subway workers don't wash their hands after doing you-know-what. Good gut bacteria stay good even after they exit one body in feces and are more or less fed to another.
Anneli Rufus is the author of several books, most recently The Scavenger's Manifesto (Tarcher Press, 2009).