Giulia Enders: How to keep our guts healthy

In what seems a different life, I worked for a software company in Darmstadt, Germany. If translated literally, Darmstadt means “Intestine Town”; an apt description. The fact that intestine does seem to fit for a description of a miserable town highlights that we don’t think very highly of our internal workings. Whilst it is fine to talk about the mouth and the throat, the further down you go, the more squeamish or embarrassing the conversation seems to become.

Giulia Enders is a remarkable woman: she wrote “Darm mit Charme” having not even finished her PhD at the age of 24. Her enthusiasm for the gut and, more generally, for investigating why things do what they do and what research is available to support the evidence is infectious (in a good way). This comes across immediately. In her few years in academia, she has gained an amazing understanding of the intestines from how food is perceived by the eyes as it enters the mouth to how it is dealt with by our very helpful microorganisms and what is excreted.

She first became a bit of an online sensation when a video of her presentation at the Science Slam in Berlin was posted on YouTube. It talks about the intestines and going to the toilet but with plenty of humour. Whilst it also contains some useful pointers, it is in a way a shame that her fantastic knowledge and enthusiasm has been whittled down to toilet humour. Nevertheless, this humour is a common thread running through the book: if you are going to talk about bums and anuses and farts then you can’t really ignore the associated toilet humour so you might as well roll with it.

Enders covers everything from burping and vomiting to the consistency of poo. However, whilst there are many interesting anecdotes (lie on your left side if you feel you need to burp), the main body of text is regarding the gut flora, the mircobiota that resides in our intestines. Whilst the mircobiota (the community of living organisms sharing our gut with us) only represents 1-3% of our mass, there are 10 times more microbial cells than human cells and it is still startling to many that we are not the only inhabitants of our bodies. There are good and bad microorganisms living at every stage of the gut (as well as pretty much everywhere else on us). Some of the good ones help us to digest complex compounds that our cells cannot absorb, in effect eating our food and providing us with the waste. The bad ones are often tolerated and kept in check rather than attacked, presumably because the energy cost would be too great.

The majority of bacteria are in the large intestine (near the end) whilst in the small intestine we manage the digestion process largely on our own. The opposite is true of cows and other ruminants; they keep most bacteria at the beginning of the digestive system and largely allow the bacteria to do their digesting for them. When the bacteria die, they pass through the intestines and are digested, providing the largest source of protein for the cow. Rodents, on the other hand, keep their bacteria at the end of their intestines and eat their own faeces, as it is a good source of protein in the form of dead bacteria.

Each person’s microbiota is unique. We start in the womb with a clean slate that is then greatly influenced by how we are delivered and how we are fed as babies. By around the age of three, our microbiota has largely stabilised but will continue to change and evolve based on the tactile experiences we have, the choices of food we make and the environment in which we live. This is more the case than ever as we travel more and as food and microbes become global travellers. In one rather odd piece of research in the US, the flora of belly buttons was examined and found to contain bacteria that had previously only ever been found in the seas off Japan.

It is remarkable how new a field of study this is. It only gained serious research attention in the early 1990s and there is still plenty to learn. Enders shares some of the theories with us in a balanced way as if we are part of a research committee. There are, for example, three theories trying to understand what influence our microbiota has on our propensity for obesity. Further theories consider the relationship between us and specific types of microbe. The resounding conclusion that the book comes to is that it is far too early in the research to make any sweeping claims. It is likely that there are multiple causes and bacteria that impact a given symptom and the complexity is just starting to be unravelled. So, if any pharmaceutical company claims to have developed the ‘cure’ for obesity or Alzheimer’s by having identified the bacteria that are causing it or the friendly bacteria that are preventing it, you can only be sure that they are not telling the whole truth.

The final section of the book looks at cleanliness, antibiotics, probiotics and prebiotics. These are words all well covered in the press but mostly misunderstood. One’s stance on cleanliness should neither be to allow your children to endlessly roll in dog-poo-infested mud or to keep them in an airtight, sterilised greenhouse but a sensible balance in between. Most bacteria that we come across are harmless and some are useful so to ban all contact with them is a disadvantage.

Sensible tips she gives are to wash fruit and vegetables; whilst the cleanliness around meat production is tightly regulated, the same is not true of fruit and vegetables that are often fertilised with animal manure that may contain harmful bacteria. Washing them, only with water, dilutes the number of bacteria to proportions manageable by your body.

Enders is not really anti anything but speaks more as a guiding voice to advise when to use one tool and when another. Antibiotics are useful with persistent bacterial infections but are overkill for a common cold (and utterly useless when the cold-like symptoms are from a viral infection).

They can strip both good and bad bacteria from your gut and leave you in a worse position than before. If there is a large population of ‘bad’ bacteria, some may survive an onslaught of antibiotics and those will be the toughest strain, more resistant to future courses of antibiotics.

It would seem that we have underrated our gut in terms of how it affects us but also in terms of its complexity. There are countless organisms living in various stages of our gut and which determine not only what we can and cannot eat but also, possibly, influence our moods and overall sense of wellbeing. It is a deceptively easy read that does not reflect the complexity of the subject matter. Don’t be fooled by the amusing sketches provided by Enders’s sister, this is serious stuff and only the tip of the iceberg. Research will continue and I hope to find further Enders books keeping an amusing tab on the developments.


Happiness by Design - Paul Dolan

Self-help sections of bookshops are probably my least frequented. Perhaps I don’t like the idea of admitting that I need help or don’t want to be seen to need help or perhaps I just don’t believe that big issues can be solved by reading a book that filters the issue into 7 (or 10 or 20…) bullet points. Thankfully, there was no one looking when I made a purchase on Amazon for Paul Dolan’s exceptional book, Happiness by Design.

Dolan’s background is in economics rather than psychology (he is now a professor of behavioural science at the London School of Economics) which brings a refreshing perspective to what we regard as happiness, how we quantify it and how we can nudge the balance between being happy and not.

The first thing he addresses is the definition of happiness. Instinctively, this should be something easy to grasp as we can list endless ‘things’ that make us happy. However, when we drill down a little deeper, we realise that the happiness derived from owning an expensive car is different from the happiness we feel at completing a marathon. Indeed the happiness from owning an expensive car may well be different to the happiness experienced driving that same car. Dolan has spotted something that, as with all clever ideas,, once revealed, is blindingly obvious; there is a happiness that derives from pleasure and there is a very different type of happiness that stems from purpose.

The pleasure-purpose principle needs to be considered over time. This is a really important way of considering the different forms of happiness: things with purpose may not give you the immediate, ecstatic feeling that those with pleasure at the core do but, over time, there can be a deep sense of happiness and contentment in achieving something. Conversely, spending an entire weekend watching the back catalogue of Game of Thrones might be pleasurable but I bet you have a sense, once the weekend is over, that you could have derived more purpose from those hours.

What makes this book very much worth reading is that we don’t always make the right choice for our overall, long-term happiness. Like eating a piece of cake might give us immediate pleasure, by constantly following that perfectly legitimate urge we may end up, a few years and a few kilogrammes down the line, considerably less happy. Dolan sees that much of our happiness decision making is managed by the unconscious and based on hard-wired impulses from millions of years of evolution that don’t necessarily fit with our modern environment. Take the example of the cake: for millions of years, sugar has been a rarity that for most was only found in honey. We are therefore naturally inclined to seize every opportunity to stock up on a rare commodity. Except it is no longer rare.

If we add purpose into the mix, we realise that there can be a longer-term strategy at play here by trying to add perspective to our decision-making. I will eat a banana rather than that slice of cake because I realise that my body will thank me for it over time. That decision is one of purpose that can provide satisfaction.
I think the struggle with anything written about something so deep an emotion such as happiness is that the changes required in order to benefit from reading the book can seem insurmountable. Nevertheless, Dolan provides sensible mini-steps to get you started on a road to increased happiness. These might be as simple as keeping a diary for a week of what you do and working out how much of it you enjoy and how much of it can be avoided or re-packaged. If you don’t enjoy something you tend to procrastinate. That means that you take even longer to do it meanwhile losing out on the time you could be having more fun. He cites countless studies that help to point the way: generally doing things with friends and family help to increase happiness (that is true even for commuting). Doing something philanthropic helps increase a sense of purpose. So, while doing the housework, get on Skype and speak to a friend you have been meaning to call; car pool to work; donate some time to mentor someone or volunteer a few hours a week of your time.

There is a finite time available to you and so in many ways there is a finite amount of happiness that can be enjoyed in your lifetime. From Dolan’s economist perspective, happiness can be regarded as a resource that, if not maximised, is being utilised inefficiently. There is no such thing as saving up happiness for later; enduring a job you hate because of the potential happiness it might bring makes no sense.

He touches on mindfulness highlighting that, while it has its benefits, is self-selecting and requires quite a lot of effort. He does concede, however, that it does have its benefits; if you give yourself time to think, you may make more sensible decisions by considering a long-term perspective as well as that you really, really want to eat cake right now! He also recognises that if every endeavour to increase your happiness was totally at odds with your old life, it is likely to fail. Instead, make small changes to environment and gradually get into a ‘habit loop’ where there is a cue to remind your brain, a routine that you brain can easily follow and a reward that makes you want to repeat the process. This could be as simple as a note on the back of your front door reminding you to take the stairs, the routine of taking the stairs and the reward of feeling a little out of breath but a bit more alert.

The book is written in a light-hearted way but rest assured it contains some heavy topics that you may need to re-read. I am not going to be spending any more time in self-help sections of bookshops as a result of having read Happiness by Design but I may check out the “customers also bought” section of Amazon, discretely.

Happiness By Design by Paul Dolan