1 00:00:01,000 --> 00:00:07,000 The Science Museum in London is being prepared for a most peculiar event. 2 00:00:08,000 --> 00:00:16,000 Here live in front of hundreds of people an alien world is about to be explored. 3 00:00:16,989 --> 00:00:18,990 Mosley: Oh, God. 4 00:00:19,058 --> 00:00:21,259 Keep going. Keep going. 5 00:00:21,327 --> 00:00:24,829 Mosley, voice-over: It will be scrutinized... 6 00:00:24,897 --> 00:00:26,798 And probed. 7 00:00:28,200 --> 00:00:28,933 Oh! Oh! Oh! 8 00:00:30,536 --> 00:00:32,671 Mosley, voice-over: Our guts... 9 00:00:32,738 --> 00:00:36,007 a mysterious place 10 00:00:36,075 --> 00:00:38,977 of writhing tubes, 11 00:00:39,045 --> 00:00:41,579 corrosive acid, 12 00:00:41,647 --> 00:00:44,516 pulsating muscles. 13 00:00:44,583 --> 00:00:46,051 Mm... 14 00:00:46,118 --> 00:00:48,753 Mosley, voice-over: Their dirty work, normally invisible, 15 00:00:48,821 --> 00:00:53,525 is about to be laid bare in all its gruesome detail... 16 00:00:56,696 --> 00:00:58,496 And the Guinea pig for this... 17 00:00:58,564 --> 00:01:00,131 Ha ha ha! 18 00:01:00,199 --> 00:01:03,868 Well, that'll be me. 19 00:01:03,936 --> 00:01:05,970 During my medical training and more recently 20 00:01:06,038 --> 00:01:08,073 as a television presenter, I have taken part 21 00:01:08,140 --> 00:01:11,276 in some pretty bizarre and painful experiments, 22 00:01:11,343 --> 00:01:12,977 but nothing quite like this. 23 00:01:23,522 --> 00:01:25,442 Announcer: This program was made possible in part 24 00:01:25,458 --> 00:01:27,592 by contributions to your PBS station 25 00:01:27,660 --> 00:01:29,294 from viewers like you. 26 00:01:29,361 --> 00:01:30,829 Thank you. 27 00:01:37,503 --> 00:01:41,806 Mosley, voice-over: There's a new attraction at the science museum today. 28 00:01:41,874 --> 00:01:47,946 For one day only, my intestines are going on display. 29 00:01:48,013 --> 00:01:51,582 I want to do this because I'm curious. 30 00:01:51,650 --> 00:01:54,585 The digestive system is something we all have 31 00:01:54,653 --> 00:01:57,021 but know so little about. 32 00:01:57,089 --> 00:02:02,260 My guide is gut expert Dr Mark McAlindon. 33 00:02:02,328 --> 00:02:03,594 Hi, Mark. Hi, Michael. 34 00:02:03,662 --> 00:02:05,496 Nice to meet you. And you. 35 00:02:05,564 --> 00:02:06,631 This is a very theatrical setting, isn't it? 36 00:02:06,699 --> 00:02:07,799 It is. 37 00:02:07,866 --> 00:02:09,267 It's not a conventional medical environment, 38 00:02:09,335 --> 00:02:10,401 but there we go. 39 00:02:10,469 --> 00:02:11,536 I think we're gonna have some fun today. 40 00:02:11,603 --> 00:02:12,503 I think so, too. Right. 41 00:02:12,571 --> 00:02:14,439 So what happens next? 42 00:02:14,506 --> 00:02:16,074 Ok. So first of all, stick this one in. 43 00:02:16,141 --> 00:02:18,343 Ok. Ooh, cold. 44 00:02:18,410 --> 00:02:20,251 Mosley, voice-over: Mark is going to monitor me 45 00:02:20,312 --> 00:02:23,314 as I eat a typical day's food, 46 00:02:23,382 --> 00:02:27,819 and we'll all watch what happens as it goes on its merry way. 47 00:02:30,823 --> 00:02:33,858 These lucky visitors will see parts of me 48 00:02:33,926 --> 00:02:36,527 that have never been seen before. 49 00:02:36,595 --> 00:02:38,029 That's up. Ask you to put that over your head. 50 00:02:38,097 --> 00:02:39,163 Sure. 51 00:02:42,968 --> 00:02:45,903 Mosley, voice-over: We're using the very latest technology... 52 00:02:45,971 --> 00:02:50,875 a miniature camera inside a pill. 53 00:02:50,943 --> 00:02:55,046 It will, hopefully, travel through me 54 00:02:55,114 --> 00:02:59,684 and transmit live pictures from the depths of my guts... 55 00:03:02,721 --> 00:03:08,326 And as it goes, I'm gonna take part in a number of tests. 56 00:03:08,394 --> 00:03:10,428 It's a leap into the unknown. 57 00:03:10,496 --> 00:03:13,464 We'll be trying things today that few have tried before. 58 00:03:13,532 --> 00:03:14,766 McAlindon: Lie down. 59 00:03:14,833 --> 00:03:16,667 We'll just do your pulse and blood pressure. 60 00:03:16,735 --> 00:03:20,204 Ooh, elegant chaise lounge here. 61 00:03:20,272 --> 00:03:23,441 There is one, which is just as well. 62 00:03:23,509 --> 00:03:25,710 It means you're as fit as a fiddle, fit to go. 63 00:03:25,778 --> 00:03:27,879 Marvelous, fit to swallow pills. 64 00:03:30,883 --> 00:03:35,553 Mosley, voice-over: Once swallowed, I'll have no control of the camera. 65 00:03:35,621 --> 00:03:40,191 The murky world of my intestines is a law unto itself, 66 00:03:40,259 --> 00:03:42,326 and how long it will take the camera 67 00:03:42,394 --> 00:03:46,297 to work its way through is anybody's guess. 68 00:03:46,365 --> 00:03:48,800 16 hours. A few days. 69 00:03:48,867 --> 00:03:50,401 One day. Two days. 70 00:03:50,469 --> 00:03:52,203 Two hours. 71 00:03:55,974 --> 00:03:59,343 Mosley, voice-over: Food can take up to 3 days 72 00:03:59,411 --> 00:04:01,712 to travel through the gut, but last night, 73 00:04:01,780 --> 00:04:05,416 I drank 4 liters of laxative to clear the way. 74 00:04:05,484 --> 00:04:07,351 So I'm expecting my camera 75 00:04:07,419 --> 00:04:09,954 to travel rather more quickly than that. 76 00:04:10,022 --> 00:04:11,089 Ok, Michael. 77 00:04:11,156 --> 00:04:14,125 Well, I'll give you the pill camera, 78 00:04:14,193 --> 00:04:17,662 and if you'd like to take it out of its holder, 79 00:04:17,729 --> 00:04:19,063 if I can actually manage that... 80 00:04:19,131 --> 00:04:20,364 right. Ok. 81 00:04:27,706 --> 00:04:30,675 Mosley, voice-over: This pill houses a mini film crew, 82 00:04:30,742 --> 00:04:33,945 complete with lights and camera. 83 00:04:34,012 --> 00:04:37,148 It wl take pictures 3 times a second 84 00:04:37,216 --> 00:04:40,852 and transmit them to screens here in the science museum 85 00:04:40,919 --> 00:04:42,653 via sensors on my body. 86 00:04:47,092 --> 00:04:49,994 So, Michael, ready when you are. Ok. 87 00:04:50,062 --> 00:04:51,796 You pop that into your mouth, 88 00:04:51,864 --> 00:04:53,698 a few gentle sips of water. 89 00:04:58,036 --> 00:04:59,003 [Gulp] 90 00:04:59,071 --> 00:05:01,105 Uh! That's in. 91 00:05:01,173 --> 00:05:02,940 Has it gone? It's gone. 92 00:05:03,008 --> 00:05:04,909 It's gone on its long journey. 93 00:05:04,977 --> 00:05:06,978 I can't get it back. It's too late. 94 00:05:18,123 --> 00:05:22,426 Mosley, voice-over: My first feeling is one of relief. 95 00:05:22,494 --> 00:05:24,962 The camera is clearly working as it slides 96 00:05:25,030 --> 00:05:29,000 down the back of my throat and heads towards my stomach. 97 00:05:31,937 --> 00:05:35,173 Ha ha ha! It's very funny. 98 00:05:35,240 --> 00:05:36,974 Ha ha ha! 99 00:05:47,319 --> 00:05:49,554 Mosley, voice-over: Propelling the camera down 100 00:05:49,621 --> 00:05:54,392 are powerful muscles that line my gullet, or esophagus. 101 00:05:54,459 --> 00:05:56,994 McAlindon: Anytime you swallow food, 102 00:05:57,062 --> 00:05:59,130 the esophagus will be able to tell 103 00:05:59,198 --> 00:06:01,032 that there's a force on its wall, 104 00:06:01,099 --> 00:06:03,901 and that initiates the process of contraction 105 00:06:03,969 --> 00:06:07,605 of the muscles to try and push it further down. 106 00:06:07,673 --> 00:06:10,374 Mosley, voice-over: It's really quite magical. 107 00:06:10,442 --> 00:06:11,803 McAlindon: So this black hole here, 108 00:06:11,810 --> 00:06:15,112 soon you'll see the capsule passing into the stomach. 109 00:06:15,180 --> 00:06:18,416 Here it goes. Ooh, there it goes. 110 00:06:25,524 --> 00:06:27,225 Mosley, voice-over: Down here, 111 00:06:27,292 --> 00:06:30,761 it's a cavernous, alien landscape, 112 00:06:30,829 --> 00:06:36,267 and you can see some white blobs of porridge I ate for breakfast, 113 00:06:36,335 --> 00:06:38,970 but what's really striking is, 114 00:06:39,037 --> 00:06:43,608 there is so much pulsing and throbbing movement going on. 115 00:06:43,675 --> 00:06:45,876 It's something we're normally completely unaware of, 116 00:06:45,944 --> 00:06:48,179 but it's happening all the time 117 00:06:48,247 --> 00:06:50,915 and throughout our digestive system. 118 00:06:52,818 --> 00:06:55,653 Our guts are a tireless machine, 119 00:06:55,721 --> 00:06:58,623 and I spent a morning in the run up to this exhibition 120 00:06:58,690 --> 00:07:01,092 having some scans to find out 121 00:07:01,159 --> 00:07:04,462 just how the different parts work together. 122 00:07:10,802 --> 00:07:15,172 I've seen my heart beating, my brain buzzing, 123 00:07:15,240 --> 00:07:19,043 but I've never seen my guts in action. 124 00:07:19,111 --> 00:07:22,913 Well, lucky me, today I get that chance. 125 00:07:24,916 --> 00:07:27,184 Mosley, voice-over: Here at University College Hospital, 126 00:07:27,252 --> 00:07:30,621 Radiologist Stuart Taylor and his team 127 00:07:30,689 --> 00:07:33,391 are using a stop-motion technique 128 00:07:33,458 --> 00:07:36,527 to capture the unconscious movement involved 129 00:07:36,595 --> 00:07:40,631 in a journey through our guts. 130 00:07:40,699 --> 00:07:42,466 To get the best possible images, 131 00:07:42,534 --> 00:07:46,037 I'm knocking back a rather disgusting drink. 132 00:07:46,104 --> 00:07:48,539 Taylor: So this liquid has got a special sugar in 133 00:07:48,607 --> 00:07:50,074 which isn't absorbed by your body 134 00:07:50,142 --> 00:07:51,876 so when we do the scanner, we'll be able to see 135 00:07:51,943 --> 00:07:53,344 the inside of the bowel very well 136 00:07:53,412 --> 00:07:55,146 and how the bowel works and moves. 137 00:07:55,213 --> 00:07:56,747 It's an acquired taste, isn't it? It is. 138 00:07:56,815 --> 00:07:58,049 Probably not something you'd choose 139 00:07:58,116 --> 00:07:59,917 to drink every day, but hopefully not too bad. 140 00:08:08,327 --> 00:08:12,963 Michael, I am going to start a few brief pulse scans now, ok? 141 00:08:17,469 --> 00:08:20,438 Breathe in and hold your breath. 142 00:08:22,674 --> 00:08:24,875 Mosley, voice-over: As I hold my breath, 143 00:08:24,943 --> 00:08:27,878 the team takes a series of high-speed images. 144 00:08:27,946 --> 00:08:29,980 This is the last scan. 145 00:08:30,048 --> 00:08:32,183 Mosley, voice-over: These will be stitched together 146 00:08:32,250 --> 00:08:36,320 to form a 20-second film of my guts in action. 147 00:08:36,388 --> 00:08:37,788 Technician: All finished. Well done. 148 00:08:41,426 --> 00:08:44,228 Mosley, voice-over: This technique is normally used 149 00:08:44,296 --> 00:08:48,699 to diagnose disorders affecting movement in the gut. 150 00:08:48,767 --> 00:08:51,102 That's absolutely fascinating. 151 00:08:51,169 --> 00:08:53,838 What surprises me is just how much movement there is in here. 152 00:08:53,905 --> 00:08:55,506 You know, it really is a dance. 153 00:08:57,576 --> 00:09:01,245 Mosley, voice-over: I was lying completely still in the scanner, 154 00:09:01,313 --> 00:09:05,516 but this slice through my guts shows they were anything but. 155 00:09:09,821 --> 00:09:13,157 Any food passing through my digestive system 156 00:09:13,225 --> 00:09:16,761 takes the same route through this pulsating, 157 00:09:16,828 --> 00:09:20,531 writhing, continuous tube... 158 00:09:20,599 --> 00:09:24,902 down my gullet and into my stomach, 159 00:09:24,970 --> 00:09:28,339 then into my small intestine, or small bowel. 160 00:09:30,542 --> 00:09:33,177 Next stop, it's the large intestine, 161 00:09:33,245 --> 00:09:35,513 otherwise known as the colon... 162 00:09:38,183 --> 00:09:40,818 And then it's out the other end. 163 00:09:44,689 --> 00:09:48,492 It's this constant movement throughout our guts 164 00:09:48,560 --> 00:09:51,362 that enables our bodies to transform food 165 00:09:51,430 --> 00:09:54,398 into the nutrients that keep us alive. 166 00:10:00,972 --> 00:10:03,874 Back here at the science museum, 167 00:10:03,942 --> 00:10:06,410 the camera has traveled down my gullet 168 00:10:06,478 --> 00:10:09,113 and into my stomach, 169 00:10:09,181 --> 00:10:11,415 where it's transmitting live pictures 170 00:10:11,483 --> 00:10:14,585 to an enthralled audience. 171 00:10:17,189 --> 00:10:19,056 Now it's time for some food 172 00:10:19,124 --> 00:10:21,892 to start its journey through my guts, 173 00:10:21,960 --> 00:10:26,730 and Mark has got something else to view it with. 174 00:10:26,798 --> 00:10:28,699 The pill camera is still down in my stomach. 175 00:10:28,767 --> 00:10:30,501 We're about to stick another camera in 176 00:10:30,569 --> 00:10:32,937 which is slightly intimidating-looking. 177 00:10:33,004 --> 00:10:35,039 It's got a nice tip there, 178 00:10:35,106 --> 00:10:36,907 and it's gonna go down through my nose. 179 00:10:36,975 --> 00:10:37,908 It should be fairly unpleasant, 180 00:10:37,976 --> 00:10:39,410 and when it's down there, 181 00:10:39,478 --> 00:10:41,198 we'll get a much better look at the stomach, 182 00:10:41,246 --> 00:10:43,314 and then I get to eat a little bit 183 00:10:43,381 --> 00:10:45,516 so we can sort of see more of the stomach action. 184 00:10:45,584 --> 00:10:47,952 So this is gonna be a little bit uncomfortable, isn't it? 185 00:10:48,019 --> 00:10:50,020 A little bit. 186 00:11:02,467 --> 00:11:05,202 Mosley: Oh, God, brings tears to your eyes. 187 00:11:05,270 --> 00:11:07,137 Ooh, that is uncomfortable. 188 00:11:07,205 --> 00:11:09,039 There we go. There we go. Oh, dear. 189 00:11:12,777 --> 00:11:14,912 Mosley, voice-over: Although this camera will only go 190 00:11:14,980 --> 00:11:18,082 as far as my stomach, it is steerable 191 00:11:18,149 --> 00:11:21,418 and should give higher-resolution pictures. 192 00:11:26,057 --> 00:11:28,826 Oh, that was so uncomfortable. 193 00:11:30,896 --> 00:11:32,429 McAlindon: And there we are into the stomach, 194 00:11:32,497 --> 00:11:35,032 and there's some porridge from earlier. Ha! 195 00:11:35,100 --> 00:11:38,302 You ok, Michael? Yes. 196 00:11:38,370 --> 00:11:40,971 I know it's not the perfect position to be dining, 197 00:11:41,039 --> 00:11:44,108 but would you like to try a little bit of something? 198 00:11:44,175 --> 00:11:48,112 How about if we go for something with color? 199 00:11:48,179 --> 00:11:49,547 Ok. Something red? 200 00:11:49,614 --> 00:11:52,049 That sounds good, a few bits. 201 00:11:53,418 --> 00:11:55,853 A few bits of yellow. Yep. 202 00:11:57,856 --> 00:12:01,292 So we should see it passing by in a minute. 203 00:12:01,359 --> 00:12:03,861 Ah, there we go. 204 00:12:03,929 --> 00:12:06,797 Yeah. Something green went past. 205 00:12:08,500 --> 00:12:10,935 Mosley, voice-over: You can see the way the food 206 00:12:11,002 --> 00:12:15,739 is being churned up by muscles in my stomach wall. 207 00:12:15,807 --> 00:12:18,609 As well as this mashing action, my stomach is also releasing 208 00:12:18,677 --> 00:12:21,612 gastric juices and began doing so 209 00:12:21,680 --> 00:12:23,480 long before I started eating. 210 00:12:24,916 --> 00:12:28,218 Gastric juices are released at the sight, smell, 211 00:12:28,286 --> 00:12:31,155 or even thought of food, 212 00:12:31,222 --> 00:12:33,157 and the powerful chemicals they contain 213 00:12:33,224 --> 00:12:35,593 will help turn these lumps of food 214 00:12:35,660 --> 00:12:39,730 into a creamy mush known as chyme. 215 00:12:39,798 --> 00:12:40,965 Oh, nice. 216 00:12:46,338 --> 00:12:49,239 But I don't think I can bear having this camera 217 00:12:49,307 --> 00:12:51,842 down here any longer. 218 00:12:51,910 --> 00:12:53,611 Coming back. 219 00:12:54,980 --> 00:12:58,282 Oh, that's horrible. 220 00:12:58,350 --> 00:12:59,550 Out your nose. 221 00:12:59,618 --> 00:13:02,853 Oh, horrible, horrible, horrible, horrible. 222 00:13:02,921 --> 00:13:06,357 Oh, God! Bloody hell, that was horrible. 223 00:13:06,424 --> 00:13:13,631 Ach! Ah... Ohh! 224 00:13:13,698 --> 00:13:15,432 Agh... 225 00:13:15,500 --> 00:13:18,369 Mosley, voice-over: To see my food sloshing around 226 00:13:18,436 --> 00:13:22,239 in my gastric juices was a novel experience, 227 00:13:22,307 --> 00:13:25,976 but it wasn't a camera that gave us the first insights 228 00:13:26,044 --> 00:13:28,812 into the workings of the stomach. 229 00:13:28,880 --> 00:13:32,249 It was actually a gunshot wound that revolutionized 230 00:13:32,317 --> 00:13:35,252 our understanding of human digestion. 231 00:13:35,320 --> 00:13:37,388 [Bell tolls] 232 00:13:37,455 --> 00:13:40,691 [Car horn honks] 233 00:13:40,759 --> 00:13:44,294 Our story starts in June 1822 234 00:13:44,362 --> 00:13:47,865 when a young man is accidentally shot in the chest. 235 00:13:47,932 --> 00:13:48,932 [Gunshot] 236 00:13:53,772 --> 00:13:58,442 The victim was Canadian boatman Alexis St. Martin, 237 00:13:58,510 --> 00:14:01,111 working on the shores of lake Michigan. 238 00:14:01,179 --> 00:14:05,149 The blast ripped through his ribs, his lungs, 239 00:14:05,216 --> 00:14:07,584 and the front wall of his stomach. 240 00:14:10,355 --> 00:14:15,259 Mosley, voice-over: First on the scene was young army doctor William Beaumont. 241 00:14:15,326 --> 00:14:16,927 He dressed the wound 242 00:14:16,995 --> 00:14:19,863 but really didn't expect his patient to live... 243 00:14:24,469 --> 00:14:28,305 But survive he did, and I've come to meet 244 00:14:28,373 --> 00:14:31,241 medical historian Lindsey Fitzharris 245 00:14:31,309 --> 00:14:34,445 to find out how this unfortunate accident 246 00:14:34,512 --> 00:14:39,416 went on to lay the foundations of modern gastroenterology. 247 00:14:39,484 --> 00:14:41,318 Hi. Hi, Lindsey. 248 00:14:41,386 --> 00:14:44,388 So, this is an actual diagram of the original wound, 249 00:14:44,456 --> 00:14:46,056 and you can see the outline of it. 250 00:14:46,124 --> 00:14:47,458 It was really big. 251 00:14:47,525 --> 00:14:49,593 When St. Martin was shot, it was about the size 252 00:14:49,661 --> 00:14:52,563 of a man's palm, essentially. 253 00:14:52,630 --> 00:14:53,731 Wow, that big. 254 00:14:53,798 --> 00:14:55,065 Very big. Yes. 255 00:14:55,133 --> 00:14:56,667 It was on the left side of the chest, 256 00:14:56,735 --> 00:14:58,168 right about there. 257 00:14:58,236 --> 00:14:59,903 We tend to think of the stomach being low, 258 00:14:59,971 --> 00:15:01,371 but it's actually much higher up, 259 00:15:01,439 --> 00:15:02,940 right below the diaphragm. 260 00:15:03,007 --> 00:15:04,441 When he was shot, 261 00:15:04,509 --> 00:15:06,110 parts of his undigested breakfast 262 00:15:06,177 --> 00:15:07,878 began pouring out along with bits 263 00:15:07,946 --> 00:15:10,080 and pieces of his torn stomach, 264 00:15:10,148 --> 00:15:11,648 but Beaumont is called to the scene, 265 00:15:11,716 --> 00:15:13,250 and over a course of a year, 266 00:15:13,318 --> 00:15:15,786 he's able to nurse Alexis back to health, 267 00:15:15,854 --> 00:15:17,888 and what happens to this giant hole 268 00:15:17,956 --> 00:15:20,257 is that it shrinks, and it forms 269 00:15:20,325 --> 00:15:22,926 this 2.5-centimeter-diameter fistula. 270 00:15:22,994 --> 00:15:24,695 Right. So you've got the original whole 271 00:15:24,763 --> 00:15:27,064 the size of my palm, and it's shrunk right down, 272 00:15:27,132 --> 00:15:28,332 yes. But it's still open. 273 00:15:28,399 --> 00:15:30,768 It's still open, and through that fistula, 274 00:15:30,835 --> 00:15:33,337 he can see directly into the stomach. 275 00:15:33,404 --> 00:15:35,472 It was an incredible opportunity for Beaumont 276 00:15:35,540 --> 00:15:37,775 to study the living digestive system 277 00:15:37,842 --> 00:15:39,810 in a way that no other surgeon or physician 278 00:15:39,878 --> 00:15:41,578 had been able to do until that point. 279 00:15:45,517 --> 00:15:49,086 Mosley, voice-over: Beaumont certainly made the most of this opportunity. 280 00:15:51,089 --> 00:15:55,526 Once his patient had recovered, he employed him as a handyman 281 00:15:55,593 --> 00:15:59,997 and studied his stomach for the next 10 years. 282 00:16:01,800 --> 00:16:05,969 Fitzharris: He subjects St. Martin to a series of experiments, 283 00:16:06,037 --> 00:16:08,405 and he takes little bags like this, 284 00:16:08,473 --> 00:16:11,275 and he wraps pieces of food in these bags... 285 00:16:11,342 --> 00:16:13,510 cabbage, meat, all kinds of things... 286 00:16:13,578 --> 00:16:15,879 and he sticks it directly into that fistula. 287 00:16:15,947 --> 00:16:17,214 Right. Very nice. 288 00:16:17,282 --> 00:16:18,949 So he just pops it into this convenient hole there... 289 00:16:19,017 --> 00:16:20,350 Pops it into the stomach, yes. 290 00:16:20,418 --> 00:16:21,885 Leaves it there to brew for a while 291 00:16:21,953 --> 00:16:23,153 exactly. Yes. Sort of like a cup of tea, 292 00:16:23,221 --> 00:16:25,956 and then brings it out and inspects it. 293 00:16:26,024 --> 00:16:28,992 He was very interested in how different condions 294 00:16:29,060 --> 00:16:31,161 affected the digestive system, 295 00:16:31,229 --> 00:16:32,663 for instance, if it was cloudy, 296 00:16:32,730 --> 00:16:34,765 if it was sunny, if it was cold. 297 00:16:37,035 --> 00:16:40,938 Mosley, voice-over: As well as putting things into St. Martin's stomach, 298 00:16:41,005 --> 00:16:43,640 Beaumont also sucked out the juices 299 00:16:43,708 --> 00:16:45,576 that were produced there... 300 00:16:49,547 --> 00:16:54,685 And it was these previously inaccessible bodily fluids 301 00:16:54,752 --> 00:16:57,721 that were to turn popular beliefs about digestion 302 00:16:57,789 --> 00:16:59,656 on their head. 303 00:16:59,724 --> 00:17:01,825 Mosley: Did he know what that juice was? 304 00:17:01,893 --> 00:17:04,394 He didn't at first, but he had it analyzed, 305 00:17:04,462 --> 00:17:06,196 and they discovered that... of course, 306 00:17:06,264 --> 00:17:07,598 what we know today... that a lot of it 307 00:17:07,665 --> 00:17:10,601 is hydrochloric acid, which is highly corrosive. 308 00:17:10,668 --> 00:17:12,836 Mosley, voice-over: As well as acid, 309 00:17:12,904 --> 00:17:15,839 the juices contained digestive enzymes, 310 00:17:15,907 --> 00:17:18,475 and Beaumont discovered he could break down food 311 00:17:18,543 --> 00:17:22,946 outside the body simply by mixing it with this juice. 312 00:17:23,014 --> 00:17:25,415 Until then, it was widely believed 313 00:17:25,483 --> 00:17:28,185 that digestion was purely mechanical, 314 00:17:28,253 --> 00:17:31,088 but Beaumont showed that the gastric juices 315 00:17:31,155 --> 00:17:35,192 also had a vital role to play. 316 00:17:35,260 --> 00:17:36,793 And this was a big revelation, presumably. 317 00:17:36,861 --> 00:17:38,629 Oh, it was a huge paradigm shift. 318 00:17:38,696 --> 00:17:41,832 I mean, you're going from the mechanical view to the chemical view, 319 00:17:41,900 --> 00:17:44,968 and he was criticized for it back home in America. 320 00:17:45,036 --> 00:17:46,837 He really achieves his fame afterwards 321 00:17:46,905 --> 00:17:48,238 and today, of course, he is known 322 00:17:48,306 --> 00:17:50,507 as the father of gastric physiology. 323 00:17:50,575 --> 00:17:51,708 This is a wonderful, wonderful story, isn't it, 324 00:17:51,776 --> 00:17:53,010 I mean, just an extraordinary story. 325 00:17:53,077 --> 00:17:54,711 It's an extraordinary story and one 326 00:17:54,779 --> 00:17:57,180 that really changed the way we understand the body today. 327 00:17:57,248 --> 00:18:00,651 Mosley, voice-over: I'm going to test the powers of my digestive system 328 00:18:00,718 --> 00:18:03,720 by feeding it a substantial meal 329 00:18:03,788 --> 00:18:06,723 that will really fill my stomach. 330 00:18:06,791 --> 00:18:09,159 Mosley: Ok. Bring on the food. 331 00:18:09,227 --> 00:18:11,895 Hooray! 332 00:18:11,963 --> 00:18:14,097 I have been waiting a long time for this. 333 00:18:14,165 --> 00:18:15,599 Thank you. 334 00:18:15,667 --> 00:18:18,635 So this is the first green thing I've seen for about 3 days. 335 00:18:20,772 --> 00:18:22,105 Mm... 336 00:18:22,173 --> 00:18:24,508 Mosley, voice-over: As the food reaches my stomach, 337 00:18:24,575 --> 00:18:27,878 powerful gastric juices are released. 338 00:18:27,946 --> 00:18:30,948 These juices contain hydrochloric acid 339 00:18:31,015 --> 00:18:33,517 and digestive enzymes... 340 00:18:33,584 --> 00:18:34,952 [Gulp] 341 00:18:35,019 --> 00:18:36,320 Ahh! 342 00:18:37,989 --> 00:18:40,657 Mosley, voice-over: And over the next few hours, 343 00:18:40,725 --> 00:18:43,560 they transform my food. 344 00:18:48,466 --> 00:18:50,434 Mosley: So this is my stomach having eaten, 345 00:18:50,501 --> 00:18:51,868 and the picture is very different 346 00:18:51,936 --> 00:18:53,537 to when it was empty, isn't it? 347 00:18:53,604 --> 00:18:54,771 McAlindon: Yes. 348 00:18:54,839 --> 00:18:57,374 It shows what a fantastic job the stomach can do. 349 00:18:57,442 --> 00:18:59,309 It's really done a blenderizer job here. 350 00:18:59,377 --> 00:19:01,078 I think I saw something 351 00:19:01,145 --> 00:19:02,746 which was probably the beetroot going past, 352 00:19:02,814 --> 00:19:04,481 as well, that sort of red thing. 353 00:19:04,549 --> 00:19:05,782 Oh, there's a great, big leaf, isn't it? 354 00:19:05,850 --> 00:19:06,950 There's a leaf there, so... 355 00:19:07,018 --> 00:19:07,918 and it looks like a bit of beetroot over there 356 00:19:07,986 --> 00:19:09,486 on the top, a bit of pinky stuff. 357 00:19:09,554 --> 00:19:10,887 A bit pinky there. Yeah. 358 00:19:10,955 --> 00:19:13,357 Yes. The leaves will be a lot of fibrous material 359 00:19:13,424 --> 00:19:15,225 which is much more difficult to digest. 360 00:19:15,293 --> 00:19:17,661 So that might stay that way for a little bit longer, 361 00:19:17,729 --> 00:19:19,997 whereas the white bits are probably the chips. 362 00:19:20,064 --> 00:19:22,399 So they are now dissolving in the gastric acid. 363 00:19:22,467 --> 00:19:24,901 So that's more of a mash of stuff. 364 00:19:24,969 --> 00:19:27,304 What happened to the steak, then? 365 00:19:27,372 --> 00:19:30,841 It's interesting that we don't see lumps of meat. 366 00:19:30,908 --> 00:19:32,642 You would think that that would be the case, 367 00:19:32,710 --> 00:19:34,911 but the meat will be broken down 368 00:19:34,979 --> 00:19:37,514 into fibrous material by the action of chewing 369 00:19:37,582 --> 00:19:40,417 and then will be acted on by gastric enzymes 370 00:19:40,485 --> 00:19:42,519 and the gastric acid to such an extent 371 00:19:42,587 --> 00:19:45,088 that you can't actually recognize the meat in the stomach. 372 00:19:45,156 --> 00:19:47,124 You can recognize the plant material 373 00:19:47,191 --> 00:19:49,760 and some of the carbohydrate, the starchy material, 374 00:19:49,827 --> 00:19:51,762 but no lumps of meat there. 375 00:19:54,432 --> 00:19:57,601 Mosley, voice-over: With a big meal of steak and chips inside me, 376 00:19:57,668 --> 00:20:02,305 my stomach has expanded, but by how much? 377 00:20:02,373 --> 00:20:03,707 This big. 378 00:20:03,775 --> 00:20:05,242 No. That's too big. 379 00:20:05,309 --> 00:20:07,110 My fist. Small rugby ball. 380 00:20:07,178 --> 00:20:08,578 Medium-sized melon. 381 00:20:08,646 --> 00:20:11,648 I reckon a good... I think two liters. 382 00:20:16,454 --> 00:20:18,722 Mosley, voice-over: She's right. 383 00:20:18,790 --> 00:20:21,358 The average human stomach can expand 384 00:20:21,426 --> 00:20:24,461 from the size of a small apple when it's empty 385 00:20:24,529 --> 00:20:27,397 to about two liters when full. 386 00:20:27,465 --> 00:20:31,902 That's a fortyfold increase, 387 00:20:31,969 --> 00:20:35,806 and it's now clear that this expandable bag of muscle 388 00:20:35,873 --> 00:20:38,275 has more subtle and powerful ways 389 00:20:38,342 --> 00:20:40,977 to influence how and when we eat 390 00:20:41,045 --> 00:20:43,480 than was ever previously imagined. 391 00:20:43,548 --> 00:20:45,782 Mm. 392 00:20:45,850 --> 00:20:50,120 Mosley, voice-over: Father of 4 Bob Lakhanpal rarely feels full, 393 00:20:50,188 --> 00:20:52,055 no matter what he eats. 394 00:20:52,123 --> 00:20:53,290 Shall I make you one? 395 00:20:53,357 --> 00:20:55,826 No. I don't want salad. 396 00:20:57,095 --> 00:20:59,162 Lakhanpal, voice-over: About 9:00, 10:00, 397 00:20:59,230 --> 00:21:00,764 I have my first breakfast... 398 00:21:00,832 --> 00:21:04,301 couple of toasts, a bowl of corn flakes. 399 00:21:07,305 --> 00:21:10,273 Lunchtime is normally a couple of chapatis 400 00:21:10,341 --> 00:21:12,609 with some chicken or vegetable. 401 00:21:14,846 --> 00:21:17,380 After my lunch if I'm feeling more hungry, 402 00:21:17,448 --> 00:21:21,852 I just get a bowl of corn flakes or weetabix. 403 00:21:21,919 --> 00:21:26,089 In the evening, I get some chips, a burger, 404 00:21:26,157 --> 00:21:28,692 and later on, a chapati. 405 00:21:30,862 --> 00:21:33,396 If I'm feeling a bit peckish, 406 00:21:33,464 --> 00:21:35,732 I buy a big crisp bag 407 00:21:35,800 --> 00:21:38,001 and just munch away. 408 00:21:38,069 --> 00:21:41,705 I just can't get full. 409 00:21:41,772 --> 00:21:43,773 I want to eat everything. Ha ha ha! 410 00:21:46,010 --> 00:21:50,080 Mosley, voice-over: Bob is almost 20 stone, 411 00:21:50,148 --> 00:21:54,651 and being so overweight has had serious consequences. 412 00:21:54,719 --> 00:21:58,655 6 years ago, he had a major health scare. 413 00:21:58,723 --> 00:22:00,257 Lakhanpal, voice-over: I was at home. 414 00:22:00,324 --> 00:22:02,626 I was lying down, and next minute, 415 00:22:02,693 --> 00:22:05,629 I'm getting pain in my jaw and in my arm. 416 00:22:05,696 --> 00:22:07,764 So I thought, "something's wrong. 417 00:22:07,832 --> 00:22:09,966 Let me just drive to the hospital." 418 00:22:10,034 --> 00:22:13,870 So I drove there, and they said, "you're having a heart attack." 419 00:22:13,938 --> 00:22:17,274 I was about 28 at the time, 420 00:22:17,341 --> 00:22:20,510 young, I mean, getting a heart attack. 421 00:22:20,578 --> 00:22:23,747 I was just devastated. Yeah. 422 00:22:23,814 --> 00:22:27,317 Mosley, voice-over: Bob tried going on a diet 423 00:22:27,385 --> 00:22:29,986 but couldn't lose enough weight. 424 00:22:30,054 --> 00:22:37,527 He and his doctors have decided to take more drastic action. 425 00:22:37,595 --> 00:22:41,932 Bob is about to have a gastric bypass operation. 426 00:22:41,999 --> 00:22:46,603 The size of his stomach will be radically reduced. 427 00:22:46,671 --> 00:22:52,342 His doctors expect the operation to have a dramatic effect on his appetite. 428 00:22:54,579 --> 00:22:57,881 For Bob and his family, it's the best hope 429 00:22:57,949 --> 00:23:02,852 of bringing about the health changes that he desperately needs. 430 00:23:02,920 --> 00:23:03,954 Does he come in? 431 00:23:04,021 --> 00:23:05,488 Yeah. Ok. 432 00:23:05,556 --> 00:23:07,991 Take 3 slow deep breaths. At the end of the third one, 433 00:23:08,059 --> 00:23:11,361 things will be much better, drifting gently off to sleep. 434 00:23:11,429 --> 00:23:12,796 Good. 435 00:23:18,836 --> 00:23:23,306 Mosley, voice-over: I'm here at Charing Cross Hospital to watch Bob's surgery. 436 00:23:27,478 --> 00:23:33,917 His surgeon is leading bariatric consultant, Mr Ahmed Ahmed. 437 00:23:33,985 --> 00:23:37,487 All right, John, are we ready to start? 438 00:23:37,555 --> 00:23:43,627 He will operate on Bob using the latest techniques in keyhole surgery. 439 00:23:43,694 --> 00:23:46,896 Ahmed: I've gone through the skin, and the yellow stuff there is fat. 440 00:23:46,964 --> 00:23:53,003 We go through the fat and then through the abdominal wall muscle there. 441 00:23:53,070 --> 00:23:55,171 First quick peek inside, we're gonna see 442 00:23:55,239 --> 00:23:58,675 that all the yellow stuff here you see is fat. 443 00:23:58,743 --> 00:24:00,710 Mosley, voice-over: The first stage of the operation 444 00:24:00,778 --> 00:24:03,980 is to shrink the size of the stomach. 445 00:24:04,048 --> 00:24:08,485 Ahmed: That little pale pink organ coming up and that's your stomach right there. 446 00:24:08,552 --> 00:24:11,855 Mosley: And you're essentially going to reduce the size of that, are you? 447 00:24:11,922 --> 00:24:13,390 Yes, absolutely. 448 00:24:13,457 --> 00:24:14,858 By what sort of amount? 449 00:24:14,925 --> 00:24:16,893 We'll probably make it about 1/10th of its normal size. 450 00:24:16,961 --> 00:24:18,695 10% of what it is at the moment. 451 00:24:18,763 --> 00:24:20,230 Wow, that's quite radical, isn't it? 452 00:24:20,298 --> 00:24:23,600 Yes. The total volume is going to be about 20 mils, 453 00:24:23,668 --> 00:24:26,102 which is about 3 or 4 tablespoons. 454 00:24:26,170 --> 00:24:28,872 So, 90% of the stomach will just be kind of left there inactive, will it? 455 00:24:28,939 --> 00:24:30,373 Exactly. 456 00:24:30,441 --> 00:24:32,142 It's still going to have its blood supply 457 00:24:32,209 --> 00:24:38,415 and it's still gonna make gastric juices but it'll never see food again. 458 00:24:38,482 --> 00:24:40,417 Mosley, voice-over: And surprisingly enough, 459 00:24:40,484 --> 00:24:44,354 it's not just Bob's stomach they are affecting. 460 00:24:44,422 --> 00:24:48,358 Now, you might think that just by reducing the size of the stomach 461 00:24:48,426 --> 00:24:51,194 that's how it's going to sort out Bob's problems, 462 00:24:51,262 --> 00:24:53,196 because smaller stomach, you eat less. 463 00:24:53,264 --> 00:24:54,964 It's sort of straightforward. 464 00:24:55,032 --> 00:24:59,302 But actually the mechanism by which it works is completely different, 465 00:24:59,370 --> 00:25:01,971 and it's only relatively recently that they've discovered 466 00:25:02,039 --> 00:25:06,976 why doing gastric bypass is so effective. 467 00:25:07,044 --> 00:25:11,181 Ahmed: The modern thinking actually is that by making a smaller stomach, 468 00:25:11,248 --> 00:25:15,318 you're actually inducing the changes in various chemical messengers, 469 00:25:15,386 --> 00:25:19,055 which in turn affect hunger levels and fullness levels, 470 00:25:19,123 --> 00:25:20,357 which in turn cause the weight loss. 471 00:25:20,424 --> 00:25:22,425 Mmm. 472 00:25:22,493 --> 00:25:26,529 Mosley, voice-over: So, as well as reducing the size of Bob's stomach, 473 00:25:26,597 --> 00:25:32,802 the point of the operation is to change the levels of certain gut hormones. 474 00:25:32,870 --> 00:25:37,440 These chemical messengers are released by the gut in response to food 475 00:25:37,508 --> 00:25:41,311 and tell the brain when to eat or stop eating. 476 00:25:41,379 --> 00:25:45,448 One of the hormones, ghrelin, makes you feel hungry. 477 00:25:45,516 --> 00:25:48,318 We think that ghrelin is actually being produced 478 00:25:48,386 --> 00:25:51,421 from this part of the stomach up here. Right. 479 00:25:51,489 --> 00:25:53,556 This is called the fundus of the stomach, 480 00:25:53,624 --> 00:25:57,293 and this is where all the cells that produce ghrelin are sort of based. 481 00:25:57,361 --> 00:25:59,529 What we think we're doing is we're actually separating 482 00:25:59,597 --> 00:26:02,399 that part of the stomach completely from ever seeing food. 483 00:26:02,466 --> 00:26:06,770 So the food will never touch those cells that make the ghrelin. 484 00:26:09,940 --> 00:26:11,941 Mosley, voice-over: Once they're isolated, 485 00:26:12,009 --> 00:26:14,778 the ghrelin cells no longer function normally. 486 00:26:17,748 --> 00:26:22,852 Hormone production will be reduced and Bob should feel less hungry. 487 00:26:22,920 --> 00:26:24,821 Extraordinary, isn't it, 488 00:26:24,889 --> 00:26:28,691 that little area of the stomach could be responsible for 489 00:26:28,759 --> 00:26:30,293 how hungry you feel? 490 00:26:33,063 --> 00:26:35,231 Mosley, voice-over: The next stage of the operation 491 00:26:35,299 --> 00:26:40,703 is to re-attach Bob's smaller stomach back to his intestine. 492 00:26:40,771 --> 00:26:43,473 Ok, let go. Thanks. 493 00:26:43,541 --> 00:26:47,477 From now on, it will be right next to the part of his intestine 494 00:26:47,545 --> 00:26:52,415 that produces the gut hormone, pyy, that makes him feel full. 495 00:26:52,483 --> 00:26:54,951 Mosley: How long does food normally take to get there? 496 00:26:55,019 --> 00:26:57,420 At this point, about 20 or 30 minutes, I would imagine. 497 00:26:57,488 --> 00:27:00,056 Right. So instead of taking, say, 20 minutes 498 00:27:00,124 --> 00:27:02,659 for your brain to get the message, "you're full, stop eating", 499 00:27:02,726 --> 00:27:04,194 it might take, what, 5 minutes? 500 00:27:04,261 --> 00:27:05,762 Yeah, around 5 minutes. 501 00:27:22,079 --> 00:27:25,114 Mosley, voice-over: Mr. Ahmed believes the operation 502 00:27:25,182 --> 00:27:28,985 will have an immediate impact on Bob's appetite. 503 00:27:29,053 --> 00:27:31,688 Ahmed: Patients who normally eat 3 or 4 meals throughout a day 504 00:27:31,755 --> 00:27:35,525 eat maybe just 1 or 2 meals after surgery, and when they do eat, 505 00:27:35,593 --> 00:27:39,529 they eat really small portions through, you know, side plates 506 00:27:39,597 --> 00:27:42,398 or children's portions because they just don't feel like eating 507 00:27:42,466 --> 00:27:45,368 the same amounts as they were before, and they're happy. 508 00:27:45,436 --> 00:27:48,371 It's not like something that's imposed on them. 509 00:27:48,439 --> 00:27:50,874 They actually are very satisfied. 510 00:27:50,941 --> 00:27:53,309 [Doctors talking indistinctly] 511 00:27:53,377 --> 00:27:56,138 Mosley, voice-over: What I find really astonishing about this operation 512 00:27:56,146 --> 00:28:01,584 is that the effects are so profound and widespread because, in essence, 513 00:28:01,652 --> 00:28:03,753 what he is doing is he's just sort of making the stomach smaller 514 00:28:03,821 --> 00:28:07,857 and connecting the bits and yet the effect on Bob will be enormous. 515 00:28:07,925 --> 00:28:11,961 We think that the brain rules our decision-making process, 516 00:28:12,029 --> 00:28:16,566 but its pretty clear from this that our stomach has a very, very profound effect 517 00:28:16,634 --> 00:28:18,768 on how we behave. 518 00:28:29,146 --> 00:28:31,247 Mosley, voice-over: 6 weeks after surgery, 519 00:28:31,315 --> 00:28:34,617 Bob is certainly slimmer than he once was. 520 00:28:36,186 --> 00:28:41,124 Bob: Since operation, I have lost 3 stones. I was 20 stones. 521 00:28:41,191 --> 00:28:45,628 Yeah, I've been losing weight and all my clothes are all loose. 522 00:28:47,865 --> 00:28:53,736 Mosley, voice-over: Crucially, Bob's urge to eat lots of fatty foods has gone. 523 00:28:53,804 --> 00:28:56,573 Bob: I had a bite of a burger. I couldn't swallow it. 524 00:28:56,640 --> 00:28:59,742 So I'm keeping to my diet. 525 00:28:59,810 --> 00:29:02,879 I only drink a cup of soup and I'm full. 526 00:29:02,947 --> 00:29:05,148 I'm happy with that and I can stick with that. 527 00:29:05,215 --> 00:29:06,583 Boy: Dad! 528 00:29:09,553 --> 00:29:11,254 It's just great. 529 00:29:11,322 --> 00:29:15,592 Family's happy. I'm happy. Can't wait to lose more weight. 530 00:29:20,464 --> 00:29:25,735 Mosley, voice-over: The camera has now been traveling inside me for over 4 hours. 531 00:29:25,803 --> 00:29:31,207 It's made its way through the acidic and forbidding world of my stomach 532 00:29:31,275 --> 00:29:34,711 and embarked on the longest part of its journey. 533 00:29:34,778 --> 00:29:38,147 The small intestine or small bowel. 534 00:29:43,787 --> 00:29:47,724 Over the next few hours, as it travels along this tube, 535 00:29:47,791 --> 00:29:50,760 my steak and chips will be broken down, 536 00:29:50,828 --> 00:29:57,233 absorbed and transformed into the energy needed to run my body. 537 00:29:57,301 --> 00:30:01,804 As for me, I'm taking it easy. 538 00:30:01,872 --> 00:30:06,209 Ooh, it's amazing how contented you feel after a nice big meal, 539 00:30:06,276 --> 00:30:08,645 also how tired and slothful. 540 00:30:17,388 --> 00:30:20,757 And I suppose it's no surprise. I'm tired. 541 00:30:20,824 --> 00:30:24,661 There's a frenzy of digestion going on inside me. 542 00:30:27,898 --> 00:30:32,869 As I snooze, the tight folds on the wall of the small intestine 543 00:30:32,936 --> 00:30:37,674 are mixing and churning my mushed-up food in a corkscrew motion. 544 00:30:40,477 --> 00:30:44,681 Digestive enzymes from the pancreas and gall bladder flood the area. 545 00:30:47,618 --> 00:30:50,820 These enzymes induce chemical reactions, 546 00:30:50,888 --> 00:30:56,693 which break the food down into nutrients that my body can readily absorb. 547 00:30:59,463 --> 00:31:04,634 The walls of my small intestine look a bit like a Fluffy towel... 548 00:31:06,804 --> 00:31:10,640 And they are there to aid absorption. 549 00:31:12,309 --> 00:31:15,278 So on the folds here, on the folds of the small bowel, 550 00:31:15,345 --> 00:31:18,548 you can see the finger-like projections of the small bowel lining, 551 00:31:18,615 --> 00:31:20,283 which are called villi. 552 00:31:20,350 --> 00:31:24,287 What they do is to increase the surface area of the small bowel hugely. 553 00:31:24,354 --> 00:31:26,289 What sort of surface area are you talking about? 554 00:31:26,356 --> 00:31:30,827 About a tennis court size if you strip it all out. So it's really huge. 555 00:31:30,894 --> 00:31:33,663 There's a huge amount of work that goes on in there. 556 00:31:36,867 --> 00:31:41,804 Mosley, voice-over: And all this work requires a healthy blood supply. 557 00:31:41,872 --> 00:31:45,408 As I'm lying here digesting my steak and chips, 558 00:31:45,476 --> 00:31:50,213 1/3 of my body's blood is being diverted away from my extremities 559 00:31:50,280 --> 00:31:53,282 and towards the action in my guts. 560 00:31:53,350 --> 00:31:55,685 There's certainly active noises down there. 561 00:31:57,588 --> 00:32:03,226 And as this blood rushes through the vessels in the wall of my small intestine, 562 00:32:03,293 --> 00:32:05,728 it's picking up digested nutrients 563 00:32:05,796 --> 00:32:08,631 and transporting them all over my body. 564 00:32:14,304 --> 00:32:19,075 But this could take another 3 or 4 hours, 565 00:32:19,143 --> 00:32:24,647 so there's time for me to get more hands-on with another digestive system. 566 00:32:29,553 --> 00:32:31,788 Ooh, yes. Here we go. Looks great, isn't it? 567 00:32:31,855 --> 00:32:35,725 Mosley, voice-over: Surgeon and gut specialist James Kinross 568 00:32:35,793 --> 00:32:37,760 has brought along the intestine of an animal 569 00:32:37,828 --> 00:32:40,763 that was destined for the food chain. 570 00:32:40,831 --> 00:32:43,232 So, what we have here... this is a pig 571 00:32:43,300 --> 00:32:46,502 from mouth down to the anus at this end here. 572 00:32:46,570 --> 00:32:48,404 Right. So, this is... 573 00:32:48,472 --> 00:32:51,908 Mosley, voice-over: Although we don't look much like pigs on the outside, 574 00:32:51,975 --> 00:32:54,777 their intestines are remarkably similar to ours. 575 00:32:54,845 --> 00:32:58,815 And what you can see is that the gastrointestinal tract 576 00:32:58,882 --> 00:33:01,317 is basically a tube, and it runs literally from your mouth 577 00:33:01,385 --> 00:33:02,785 all the way down to your bottom. 578 00:33:02,853 --> 00:33:05,721 So, what you have is the esophagus at the top end. 579 00:33:05,789 --> 00:33:10,259 We can actually trace all of this bowel the whole way down. 580 00:33:10,327 --> 00:33:14,764 Mosley, voice-over: The walls of the small intestine feel surprisingly delicate, 581 00:33:14,832 --> 00:33:18,768 and they are threaded with tiny capillaries. 582 00:33:18,836 --> 00:33:21,704 And what you'll see is there's a layer of connective tissue. 583 00:33:21,772 --> 00:33:23,339 Oh, yes. 584 00:33:23,407 --> 00:33:25,741 So the bowel has this connective tissue which takes the blood supply. 585 00:33:25,809 --> 00:33:27,710 And you can see the blood supply here. 586 00:33:27,778 --> 00:33:29,278 So when you absorb a meal, 587 00:33:29,346 --> 00:33:31,247 obviously, the nutrition that you take out of it 588 00:33:31,315 --> 00:33:32,748 has to get into the blood supply. 589 00:33:32,816 --> 00:33:34,250 Yes, that's what's happening to me at the moment. 590 00:33:34,318 --> 00:33:36,352 So, let's see how long this is. 591 00:33:36,420 --> 00:33:39,722 Mosley, voice-over: The human small intestine is roughly 4 meters, 592 00:33:39,790 --> 00:33:41,224 the length of this table. 593 00:33:41,291 --> 00:33:42,758 Ok? All right. 594 00:33:42,826 --> 00:33:44,260 A pig's is much longer. 595 00:33:44,328 --> 00:33:47,263 Return journey. Keep going and keep going. 596 00:33:47,331 --> 00:33:51,734 Our intestines absorb about 7 liters of food, fluid, 597 00:33:51,802 --> 00:33:55,872 and gut secretions every day. 598 00:33:55,939 --> 00:33:59,275 But perhaps the most extraordinary thing about the intestine 599 00:33:59,343 --> 00:34:01,744 is that buried deep inside its tissue 600 00:34:01,812 --> 00:34:04,614 is a very thin layer of brain. 601 00:34:11,788 --> 00:34:13,723 When you think about your brain, 602 00:34:13,790 --> 00:34:16,225 normally you think about the thing up there in your skull, 603 00:34:16,293 --> 00:34:20,296 but you actually have a second brain deep down in the gut. 604 00:34:20,364 --> 00:34:24,734 It's made up of cells like neurons, which you also find in your main brain, 605 00:34:24,801 --> 00:34:27,737 and, in fact, there are over 100 million of them... 606 00:34:27,804 --> 00:34:31,641 as many as you would find in the brain of a cat. 607 00:34:35,879 --> 00:34:38,814 Mosley, voice-over: The neurons are spread out in a thin mesh 608 00:34:38,882 --> 00:34:42,652 that extends all the way from the throat to the rectum. 609 00:34:46,323 --> 00:34:51,761 This brain in our gut orchestrates our digestion. 610 00:34:51,828 --> 00:34:55,865 It's also involved in gut pain. 611 00:34:55,933 --> 00:35:03,272 And surprisingly enough, the way we respond to pain seems to be linked to our personality type. 612 00:35:06,877 --> 00:35:12,248 I've got a personality test here which I've got to fill in which could be dangerously revealing. 613 00:35:12,316 --> 00:35:15,851 It says "a number of characteristics here may or may not apply to you," 614 00:35:15,919 --> 00:35:20,289 and I've got to score between 1 and 5 for each of these particular characteristics 615 00:35:20,357 --> 00:35:25,194 where 1 means disagree strongly and 5 means agree strongly. 616 00:35:25,262 --> 00:35:28,898 So, first up, "is talkative?" 617 00:35:28,966 --> 00:35:32,802 I think I do like talking. I'll give myself a 4. 618 00:35:32,869 --> 00:35:34,270 Agree a little. 619 00:35:34,338 --> 00:35:36,739 "Tends to find fault with others." Nope. 620 00:35:36,807 --> 00:35:38,774 2 on that. 621 00:35:38,842 --> 00:35:42,645 Mosley, voice-over: This test is designed to analyze the broad traits 622 00:35:42,713 --> 00:35:46,015 that make up the human personality. 623 00:35:46,083 --> 00:35:50,019 "Is original." I'm gonna give myself a 5 on that one. 624 00:35:50,087 --> 00:35:54,156 Of these traits, two have been strongly linked to the gut... 625 00:35:54,224 --> 00:35:58,661 being extrovert and being neurotic. 626 00:35:58,729 --> 00:36:02,398 Extroverts tend to be the life and soul of the party, 627 00:36:02,466 --> 00:36:09,372 whereas neurotics are quieter, more anxious, and often put a negative spin on events. 628 00:36:09,439 --> 00:36:11,507 Nope. No, I don't like quarreling. 629 00:36:11,575 --> 00:36:16,445 "Can be tense." Yes, I can be tense... sometimes, sometimes not. 630 00:36:16,513 --> 00:36:21,217 Most people are predominantly one or the other. 631 00:36:21,284 --> 00:36:25,955 I think I'll give myself a 4 on that, 3, 5, 1, 4. 632 00:36:26,023 --> 00:36:29,725 Not overly. So, ok, that's complete. 633 00:36:29,793 --> 00:36:32,928 I'm going to send it off for analysis. 634 00:36:32,996 --> 00:36:35,131 Be interesting to see what they make of it. 635 00:36:39,436 --> 00:36:43,239 Mosley, voice-over: My test will be analyzed at the Wingate Institute in London 636 00:36:43,306 --> 00:36:47,743 by gastroenterologist Dr Adam Farmer. 637 00:36:47,811 --> 00:36:49,612 So what we're trying to do in this study 638 00:36:49,679 --> 00:36:54,016 is to relate personality to pain responses 639 00:36:54,084 --> 00:36:57,653 and then to try and link the two together. 640 00:37:01,825 --> 00:37:04,293 Mosley, voice-over: Adam reckons that my personality 641 00:37:04,361 --> 00:37:11,200 will influence the way the neurons in my gut respond to pain he's about to inflict. 642 00:37:11,268 --> 00:37:12,668 You just rest your arm there. 643 00:37:12,736 --> 00:37:14,603 Just so you're nice and comfortable. 644 00:37:16,273 --> 00:37:18,174 Mosley, voice-over: These findings are important 645 00:37:18,241 --> 00:37:24,747 because they could change the way doctors treat chronic gut pain. 646 00:37:24,815 --> 00:37:30,619 The test involves once again sticking a tube down my nose and into my gullet. 647 00:37:32,322 --> 00:37:35,724 So, once it's down and sat in your gullet round about there, 648 00:37:35,792 --> 00:37:39,195 then we'll inflate the balloon to cause pain. 649 00:37:39,262 --> 00:37:42,731 Oh, God. 650 00:37:42,799 --> 00:37:45,101 Ok, here we go. So slight tickling 651 00:37:45,168 --> 00:37:46,836 at the back of your nose now. 652 00:37:46,903 --> 00:37:50,739 Mosley, voice-over: Adam has found that the guts of extroverts and neurotics 653 00:37:50,807 --> 00:37:53,242 respond to pain in very different ways. 654 00:37:53,310 --> 00:37:55,711 Well, done. So, the tube is down. 655 00:37:55,779 --> 00:37:57,179 You're quite safe now. 656 00:37:57,247 --> 00:37:58,848 [Coughs] 657 00:37:58,915 --> 00:38:02,651 Mosley, voice-over: I may be safe, but I fear the worst is yet to come. 658 00:38:02,719 --> 00:38:04,220 [Coughing] 659 00:38:04,287 --> 00:38:08,290 We're going to give you a series of 7 painful stimuli. 660 00:38:08,358 --> 00:38:11,660 I'm going to inflate the balloon up to your pain tolerance level. 661 00:38:11,728 --> 00:38:13,195 What, really, I mean by that 662 00:38:13,263 --> 00:38:15,664 is to the point where you can't tolerate any more, 663 00:38:15,732 --> 00:38:17,266 where you've had enough. 664 00:38:17,334 --> 00:38:18,767 You ready? I'm ready if you're ready. 665 00:38:18,835 --> 00:38:21,670 I'm just about ready. Begin. Ok. 666 00:38:21,738 --> 00:38:23,606 Ooh, yeah. 667 00:38:25,242 --> 00:38:26,709 Ok. 668 00:38:26,776 --> 00:38:31,714 I'm putting this at 7 to 8. Absolute pain about an 8. 669 00:38:31,781 --> 00:38:34,250 Ugh! Bloody horrible. 670 00:38:34,317 --> 00:38:37,219 Mosley, voice-over: To see how my body responds to pain, 671 00:38:37,287 --> 00:38:40,756 Adam monitors my heart rate and blood pressure. 672 00:38:40,824 --> 00:38:46,629 I'm expecting them both to rise because that's what the text books say. 673 00:38:48,265 --> 00:38:49,632 So the pain is coming now. 674 00:38:53,770 --> 00:38:55,237 Yeoow! 675 00:38:55,305 --> 00:38:58,641 Yeah. I am keen for you to remove this thing now. 676 00:39:01,278 --> 00:39:03,712 See the results. 677 00:39:03,780 --> 00:39:07,249 Mosley, voice-over: If Adam is right, my pain response 678 00:39:07,317 --> 00:39:10,719 will be determined by my personality type. 679 00:39:10,787 --> 00:39:15,224 Your psychological results were extremely interesting. 680 00:39:15,292 --> 00:39:18,761 In terms of what do you feel your personality traits are, 681 00:39:18,828 --> 00:39:20,262 it's often a good suggestion. 682 00:39:20,330 --> 00:39:24,934 Yeah. I think I'm probably inclined towards the neurotic. 683 00:39:25,001 --> 00:39:27,403 People when they meet me they assume I'm more extrovert, 684 00:39:27,470 --> 00:39:30,806 but actually I suspect I'm a neurotic posing as an extrovert. 685 00:39:30,874 --> 00:39:37,313 Absolutely they were very much the results from your personality questionnaires 686 00:39:37,380 --> 00:39:42,184 that out of a possible 100 on the neuroticism scale, you scored 75. 687 00:39:42,252 --> 00:39:43,819 Ok! 688 00:39:43,887 --> 00:39:45,721 Mosley, voice-over: And as a neurotic, 689 00:39:45,789 --> 00:39:48,190 the changes in my heart rate and blood pressure 690 00:39:48,258 --> 00:39:50,726 were exactly what Adam expected. 691 00:39:50,794 --> 00:39:55,764 So we can see that in response to the balloon, 692 00:39:55,832 --> 00:40:00,803 you actually dropped your blood pressure and slowed your heart rate down 693 00:40:00,870 --> 00:40:03,239 for a transient couple of seconds. 694 00:40:03,306 --> 00:40:06,642 I find that really, really surprising, I must admit, 695 00:40:06,710 --> 00:40:10,312 because I would absolutely have expected them to go up. 696 00:40:10,380 --> 00:40:14,250 I've always been taught pain, basically, your heart rate goes up, 697 00:40:14,317 --> 00:40:16,785 your blood pressure goes up, your body doesn't like it. 698 00:40:16,853 --> 00:40:20,756 Mosley, voice-over: It seems, however, that when neurotics are hurt, 699 00:40:20,824 --> 00:40:24,526 the vagus nerve, a nerve that connects your brain to your gut, 700 00:40:24,594 --> 00:40:26,962 becomes more active. 701 00:40:27,030 --> 00:40:30,432 This causes heart rate and blood pressure to drop, 702 00:40:30,500 --> 00:40:36,772 which in turn is believed to have a calming effect, reducing the amount of pain that's felt. 703 00:40:36,840 --> 00:40:38,320 And you don't find that in extroverts? 704 00:40:38,375 --> 00:40:42,578 No, extroverts tend to have the more classic heart rate goes up, 705 00:40:42,646 --> 00:40:44,847 blood pressure goes up. 706 00:40:44,914 --> 00:40:49,285 Mosley, voice-over: For Adam, the results mean that neurotics and extroverts 707 00:40:49,352 --> 00:40:53,789 could be treated for gut pain in very different ways. 708 00:40:53,857 --> 00:40:56,825 For instance, those who have high neuroticism scores, 709 00:40:56,893 --> 00:41:01,463 we would use psychological techniques such as cognitive behavioral therapy 710 00:41:01,531 --> 00:41:03,866 whereas the more extrovert ones, 711 00:41:03,933 --> 00:41:07,770 we may well use pharmaceutical or drug therapy in these patients. 712 00:41:07,837 --> 00:41:11,740 Brilliant, I have to say. I rarely go in for an experiment of some form 713 00:41:11,808 --> 00:41:14,777 where I'm genuinely surprised at the end, but I was 714 00:41:14,844 --> 00:41:17,279 genuinely, genuinely, surprised by this one. 715 00:41:17,347 --> 00:41:20,716 Great, well you were an excellent subject and you did extremely well. 716 00:41:20,784 --> 00:41:22,217 Thank you. 717 00:41:22,285 --> 00:41:23,652 Oh, yeah! 718 00:41:27,857 --> 00:41:31,760 Mosley, voice-over: It's been almost 9 hours since I swallowed the camera 719 00:41:31,828 --> 00:41:35,731 and began life as a museum exhibit. 720 00:41:35,799 --> 00:41:41,770 During that time the camera has traveled over 5 meters through my guts, 721 00:41:41,838 --> 00:41:45,274 but from now things will really slow down 722 00:41:45,342 --> 00:41:49,178 and move along at an even more leisurely pace. 723 00:41:52,882 --> 00:41:59,688 We're at the outer reaches of this alien world... the large intestine or colon. 724 00:42:03,660 --> 00:42:06,128 You can see that the lining of the colon 725 00:42:06,196 --> 00:42:08,630 is very much flatter and whiter than the small bowel. 726 00:42:10,834 --> 00:42:16,705 You can see the little blood vessels running though very, very clearly in the colon. 727 00:42:16,773 --> 00:42:19,141 Very weird, isn't it? 728 00:42:22,812 --> 00:42:24,780 It's a big organ, so you can often see a big hole, 729 00:42:24,848 --> 00:42:29,151 whereas a small bowel is very long but very small in diameter. 730 00:42:36,760 --> 00:42:40,662 Mosley, voice-over: Through the flatter, wider surfaces of the colon, 731 00:42:40,730 --> 00:42:45,300 water is being drawn out from what remains of my food. 732 00:42:45,368 --> 00:42:49,238 You have some slightly more, uh, formed material in there. 733 00:42:49,305 --> 00:42:50,739 Ha ha ha! 734 00:42:52,976 --> 00:42:58,680 That's Mark's polite way of saying that what we're looking at is feces. 735 00:43:02,352 --> 00:43:04,720 But it's not just leftover food. 736 00:43:04,788 --> 00:43:09,124 1/3 of the weight of my feces is actually bacteria. 737 00:43:11,828 --> 00:43:16,865 There are trillions of them, and they form their own mini-ecosystem. 738 00:43:16,933 --> 00:43:22,371 They feed on the food that my small intestine wasn't able to digest, 739 00:43:22,439 --> 00:43:28,310 helpfully breaking it down into nutrients and also making vitamins. 740 00:43:28,378 --> 00:43:31,447 From their dark, dank home in the colon, 741 00:43:31,514 --> 00:43:36,652 these bacteria play a critical role in keeping us healthy. 742 00:43:41,324 --> 00:43:44,793 Most of us don't want to think too hard about feces, 743 00:43:44,861 --> 00:43:47,896 but I'm off to meet a scientist who is absolutely fascinated by it, 744 00:43:47,964 --> 00:43:51,767 and she claims that you can learn an awful lot about somebody 745 00:43:51,835 --> 00:43:54,636 simply by examining their excrement. 746 00:43:54,704 --> 00:43:56,872 Well, I've sent her a sample of my own 747 00:43:56,940 --> 00:44:01,677 and I'm off now to discover just what she has learnt about me. 748 00:44:08,918 --> 00:44:13,722 Mosley, voice-over: Microbiologist Dr Gemma Walton spends her professional life 749 00:44:13,790 --> 00:44:19,228 investigating the different bacteria that colonize our guts. 750 00:44:19,295 --> 00:44:22,231 It's important work, but her research 751 00:44:22,298 --> 00:44:26,768 does give her laboratory a very distinctive odor. 752 00:44:26,836 --> 00:44:30,873 Ooh, God! [Coughing] 753 00:44:30,940 --> 00:44:33,709 Uhh! That is... Hello, Gemma. 754 00:44:33,776 --> 00:44:35,244 Hi. Nice to meet you. 755 00:44:35,311 --> 00:44:36,745 I'm not sure I should shake hands. 756 00:44:36,813 --> 00:44:39,715 That is a truly revolting smell. 757 00:44:39,782 --> 00:44:41,216 It's a lovely lab smell. 758 00:44:41,284 --> 00:44:43,252 It's not a lab smell. 759 00:44:43,319 --> 00:44:48,290 It's the worst bathroom sort of pooey smell. 760 00:44:48,358 --> 00:44:50,359 Mosley, voice-over: Inside these flasks, 761 00:44:50,426 --> 00:44:55,297 Gemma has re-created the conditions found in the human colon. 762 00:44:55,365 --> 00:45:00,903 She uses this to study some of the huge variety of bacteria that live there. 763 00:45:00,970 --> 00:45:07,676 Each of us has our own unique mix of different strains, and Gemma has been looking at mine. 764 00:45:07,744 --> 00:45:10,212 First up, lactobacillus. 765 00:45:10,280 --> 00:45:13,715 So lactobacillus is a big group of bacteria 766 00:45:13,783 --> 00:45:17,252 associated with some quite beneficial effects. 767 00:45:17,320 --> 00:45:19,788 Mosley, voice-over: As well as helping break down food, 768 00:45:19,856 --> 00:45:25,694 lactobacillus excrete acid which fights off other, more harmful bacteria. 769 00:45:25,762 --> 00:45:27,729 So these are good guys? 770 00:45:27,797 --> 00:45:32,267 So, yes, these are your own good guys. 771 00:45:32,335 --> 00:45:37,773 But she's also found some species that don't sound so friendly. 772 00:45:37,840 --> 00:45:39,808 If you have a look at that plate there for me, Michael, 773 00:45:39,876 --> 00:45:42,744 do you see some pink colonies on there? Yes. 774 00:45:42,812 --> 00:45:45,714 Now, those pink colonies are likely to be E. coli. 775 00:45:45,782 --> 00:45:47,249 Right. 776 00:45:47,317 --> 00:45:50,352 E. coli I think of as food poisoning, 777 00:45:50,420 --> 00:45:52,254 infections of the urinary tract. 778 00:45:52,322 --> 00:45:55,791 Well, E. coli are often associated with those events. 779 00:45:55,858 --> 00:45:58,760 However, there are many, many different strains of E. coli, 780 00:45:58,828 --> 00:46:01,863 so it's not necessarily something negative. 781 00:46:01,931 --> 00:46:06,201 In fact, I would be more surprised if I couldn't find any within your sample. 782 00:46:06,269 --> 00:46:09,671 So they're a perfectly normal part of the gut balance. 783 00:46:09,739 --> 00:46:11,807 Ok. 784 00:46:11,874 --> 00:46:14,209 Mosley, voice-over: Gemma reckons I have over a thousand 785 00:46:14,277 --> 00:46:17,713 different strains of bacteria in my feces. 786 00:46:17,780 --> 00:46:21,350 And fortunately I have a healthy mix, 787 00:46:21,417 --> 00:46:27,222 but that balance can become upset, leading to diarrhea and irritable bowels. 788 00:46:27,290 --> 00:46:30,759 If that happens, the good guys may need help. 789 00:46:30,827 --> 00:46:35,731 So there's two ways that you can do that, it's the pre-biotic way. 790 00:46:35,798 --> 00:46:38,233 So the pre-biotic is the food that you eat 791 00:46:38,301 --> 00:46:40,869 that then is a food for your bacteria. 792 00:46:40,937 --> 00:46:45,273 So that can help increase numbers of your beneficial bacteria. 793 00:46:45,341 --> 00:46:48,744 The other way is you can top up the good bacteria 794 00:46:48,811 --> 00:46:50,746 by consuming pro-biotic products 795 00:46:50,813 --> 00:46:53,782 that actually have their own live bacteria in, 796 00:46:53,850 --> 00:46:57,252 and you're introducing them into your gut by consuming them. 797 00:46:57,320 --> 00:47:00,656 Mosley, voice-over: In some cases that's not enough. 798 00:47:02,659 --> 00:47:04,092 [Whirring] 799 00:47:06,729 --> 00:47:09,731 Another lab and more feces, 800 00:47:09,799 --> 00:47:13,669 this time St Mark's hospital in London. 801 00:47:13,736 --> 00:47:15,704 Yes. 802 00:47:15,772 --> 00:47:18,573 Gastroenterologist Dr Ailsa Hart 803 00:47:18,641 --> 00:47:21,710 is working with colleagues from Imperial College 804 00:47:21,778 --> 00:47:26,248 on novel approaches to rebalancing gut bacteria, 805 00:47:26,315 --> 00:47:32,621 the most drastic of which involves performing a fecal transplant. 806 00:47:37,860 --> 00:47:40,729 Hello there. Hello. Michael. Hello. 807 00:47:40,797 --> 00:47:42,364 So, what's happening in here? 808 00:47:42,432 --> 00:47:44,266 Well, we're just in the process of preparing a sample 809 00:47:44,333 --> 00:47:47,769 for a fecal transplant that we're doing as part of a research trial here. 810 00:47:47,837 --> 00:47:51,773 Mosley, voice-over: In this pilot study, feces from a healthy donor 811 00:47:51,841 --> 00:47:58,780 are transplanted into the guts of patients suffering from a condition called pouchitis. 812 00:47:58,848 --> 00:48:01,783 Pouchitis is a form of inflammatory bowel disease, 813 00:48:01,851 --> 00:48:05,220 and normally that's treated very simply with antibiotics, 814 00:48:05,288 --> 00:48:07,122 but in a small group of patients 815 00:48:07,190 --> 00:48:09,124 when the antibiotics haven't worked, 816 00:48:09,192 --> 00:48:11,693 the next line of therapy becomes a little bit trickier, 817 00:48:11,761 --> 00:48:13,228 and it's in that group of patients 818 00:48:13,296 --> 00:48:15,597 that we're going to try this particular technique. 819 00:48:18,301 --> 00:48:22,704 Mosley, voice-over: They are hoping to replace the unhealthy mix of bacteria 820 00:48:22,772 --> 00:48:27,709 in the patient's guts with a healthy mix of someone else's. 821 00:48:27,777 --> 00:48:31,179 First, the donor feces are blended with salt-water... 822 00:48:31,247 --> 00:48:34,683 [Whirring] 823 00:48:34,751 --> 00:48:36,618 And then filtered. 824 00:48:38,888 --> 00:48:41,690 It sounds, I must admit, slightly revolting. 825 00:48:41,758 --> 00:48:43,225 Ha ha ha! 826 00:48:43,292 --> 00:48:45,360 It does sound revolting. It sounds disgusting. 827 00:48:45,428 --> 00:48:50,232 But this is for a group of patients who have had a lot of therapies beforehand, 828 00:48:50,299 --> 00:48:52,801 troubled by lots of diarrhea, awful incontinence, 829 00:48:52,869 --> 00:48:55,771 and really dreadful quality of life, actually. 830 00:48:55,838 --> 00:49:00,742 Mosley, voice-over: The next stage is to put the fecal solution into the patient. 831 00:49:00,810 --> 00:49:02,677 Hart: We take the nasogastric tube. 832 00:49:02,745 --> 00:49:04,679 Down it goes? Down the nose presumably? 833 00:49:04,747 --> 00:49:06,715 Down the nose into the patient's stomach, 834 00:49:06,783 --> 00:49:09,184 and then it's simply the syringe goes onto there and you put it down 835 00:49:09,252 --> 00:49:10,685 into the patient's stomach. 836 00:49:10,753 --> 00:49:12,187 And it just goes straight to the stomach? 837 00:49:12,255 --> 00:49:13,735 And it goes straight into the stomach. 838 00:49:16,325 --> 00:49:19,694 Mosley, voice-over: Dr Hart is looking for signs that this radical approach 839 00:49:19,762 --> 00:49:21,663 will improve her patients' symptoms. 840 00:49:21,731 --> 00:49:23,698 Ooh, very nice. 841 00:49:23,766 --> 00:49:25,200 So, by giving this transplant 842 00:49:25,268 --> 00:49:27,169 are we able to alter the bacteria 843 00:49:27,236 --> 00:49:28,737 in the guts of these patients? 844 00:49:28,805 --> 00:49:32,207 And of course is it having a clinical benefit in them as well? 845 00:49:32,275 --> 00:49:34,242 Mosley, voice-over: It's early days, 846 00:49:34,310 --> 00:49:39,214 and so far only a handful of patients have taken part in the study. 847 00:49:39,282 --> 00:49:42,717 Hart: It's the most densely populated ecosystem on earth, 848 00:49:42,785 --> 00:49:45,754 so to try and understand it is a very tall order. 849 00:49:45,822 --> 00:49:48,723 To try and modulate it, you know, you do ask the question, 850 00:49:48,791 --> 00:49:51,693 are we as human beings clever enough to do this? 851 00:49:51,761 --> 00:49:53,128 [Whirring] 852 00:49:54,764 --> 00:49:56,731 [Horn honking] 853 00:49:56,799 --> 00:49:58,733 Mosley, voice-over: Back at the Science Museum, 854 00:49:58,801 --> 00:50:03,238 my food has been digested and absorbed. 855 00:50:03,306 --> 00:50:07,309 What's left has been chewed over by my gut bacteria 856 00:50:07,376 --> 00:50:11,379 and is now nearing the end of its journey, 857 00:50:11,447 --> 00:50:17,752 but feces are not the only thing that the bacteria in your gut produce. 858 00:50:17,820 --> 00:50:20,755 Flatulence. All of us produce gas. 859 00:50:20,823 --> 00:50:25,760 I guess the question is how much do we produce. Any guesses? 860 00:50:25,828 --> 00:50:28,230 I would say about 7 times a day? 861 00:50:28,297 --> 00:50:30,365 Ooh, 12 to 15? 862 00:50:30,433 --> 00:50:32,267 I haven't farted so far today. Ha ha ha ha! 863 00:50:32,335 --> 00:50:33,735 You farted on the way here in the coach. 864 00:50:33,803 --> 00:50:35,303 No, I didn't. 865 00:50:35,371 --> 00:50:36,738 5 times a day? No. 866 00:50:36,806 --> 00:50:38,440 No, it's a lot more. 867 00:50:38,507 --> 00:50:41,676 It could be ones you don't even notice. You know, involuntary. 868 00:50:45,882 --> 00:50:50,785 Mosley, voice-over: In fact, we're letting out an average of 12 to 15 every day, 869 00:50:50,853 --> 00:50:54,289 typically releasing about two liters of gas. 870 00:50:54,357 --> 00:50:56,825 I was looking to see what he had going on. 871 00:50:56,893 --> 00:51:00,795 Fortunately, according to Gemma, not all of them are smelly. 872 00:51:00,863 --> 00:51:04,833 Well, there's two types of flatulence. 873 00:51:04,901 --> 00:51:10,772 Some people have a very odorous flatulence, and some people less so. 874 00:51:10,840 --> 00:51:13,742 Mosley, voice-over: If you have particularly unpleasant flatulence, 875 00:51:13,809 --> 00:51:18,246 blame the mix of bacteria in your colon. 876 00:51:18,314 --> 00:51:22,183 Some produce pungent hydrogen sulfide gas, 877 00:51:22,251 --> 00:51:25,954 others the less odorous but more flammable methane. 878 00:51:26,022 --> 00:51:29,758 And just as diet can affect the balance of good and bad bacteria, 879 00:51:29,825 --> 00:51:33,728 so it can alter the balance of sulfur to methane producers. 880 00:51:33,796 --> 00:51:35,530 By changing your diet, 881 00:51:35,598 --> 00:51:39,467 you might actually increase the amounts of hydrogen sulfide produced 882 00:51:39,535 --> 00:51:42,304 if you were eating quite a sulfate-rich diet. 883 00:51:42,371 --> 00:51:46,775 Which are the foods that actually produce the worst flatus? 884 00:51:46,842 --> 00:51:50,745 It would be things like beer and wine and breads. 885 00:51:50,813 --> 00:51:52,314 Right. 886 00:51:52,381 --> 00:51:53,782 And vegetables. Vegetables. 887 00:51:53,849 --> 00:51:55,650 Is this is a reason not to eat vegetables? 888 00:51:55,718 --> 00:51:57,385 No, not at all. 889 00:51:57,453 --> 00:51:59,754 Flatus is actually a really, really healthy side effect 890 00:51:59,822 --> 00:52:01,856 of eating fiber in the diet, 891 00:52:01,924 --> 00:52:03,725 so it's something you really want to be doing. 892 00:52:03,759 --> 00:52:05,126 Ha ha ha! 893 00:52:10,333 --> 00:52:12,233 Right, I thought I'd share with you, 894 00:52:12,301 --> 00:52:14,235 this is the essence, if you like, 895 00:52:14,303 --> 00:52:16,137 of really, really horrible flatulence. 896 00:52:18,975 --> 00:52:20,875 It's a sulfide group, 897 00:52:20,943 --> 00:52:22,711 and I thought that you would just be keen to have a little sniff. 898 00:52:22,778 --> 00:52:24,279 [People groaning] 899 00:52:24,347 --> 00:52:26,748 No, thanks. That's fine. 900 00:52:26,816 --> 00:52:30,218 Does anyone recognize the smell? 901 00:52:30,286 --> 00:52:31,720 These are sulfides. 902 00:52:31,787 --> 00:52:33,655 No, not for you? 903 00:52:36,826 --> 00:52:38,660 That's really, really revolting, isn't it? 904 00:52:43,099 --> 00:52:46,401 Mosley, voice-over: Maybe it was the smell that put them off, 905 00:52:46,469 --> 00:52:51,339 but it's late and the science museum is about to close. 906 00:52:51,407 --> 00:52:53,775 The day has certainly been eventful, 907 00:52:53,843 --> 00:52:59,381 and this alien world in my guts is a bit more familiar now. 908 00:52:59,448 --> 00:53:02,817 There's still quite a lot of gunge around there isn't there? 909 00:53:02,885 --> 00:53:07,188 Mosley, voice-over: Time for one more peek at what's going on inside me, 910 00:53:07,256 --> 00:53:11,760 and there's one last question on my mind. 911 00:53:11,827 --> 00:53:15,730 When's the camera going to come out? 912 00:53:15,798 --> 00:53:19,734 I know it will work its way out of my system, 913 00:53:19,802 --> 00:53:22,804 and that could happen sooner rather than later. 914 00:53:22,872 --> 00:53:25,240 I think I need to go urgently to the loo. 915 00:53:25,307 --> 00:53:26,708 I will be back. 916 00:53:26,776 --> 00:53:28,643 I'll see you shortly. 917 00:53:32,314 --> 00:53:35,650 That's good. It might come out yet. 918 00:53:42,291 --> 00:53:44,726 Uhh... 919 00:53:44,794 --> 00:53:46,728 Mmm! 920 00:53:46,796 --> 00:53:48,797 Mmm! 921 00:53:48,864 --> 00:53:53,034 Mosley, voice-over: Over the last 12 hours as I've digested my food, 922 00:53:53,102 --> 00:53:57,739 my guts have been under intense scrutiny. 923 00:53:57,807 --> 00:54:00,275 They've been poked and prodded 924 00:54:00,342 --> 00:54:04,212 in more ways than I could have possibly imagined. 925 00:54:04,280 --> 00:54:06,347 Oh, God. Brings tears your eyes. 926 00:54:06,415 --> 00:54:07,615 Yeahh! 927 00:54:10,853 --> 00:54:13,721 Along the way, I've discovered 928 00:54:13,789 --> 00:54:17,358 that what goes on inside this mess of tubing 929 00:54:17,426 --> 00:54:20,695 not only profoundly affects our health and well-being 930 00:54:20,763 --> 00:54:22,630 but our behavior, too. 931 00:54:30,806 --> 00:54:33,775 My experience as a museum exhibit 932 00:54:33,843 --> 00:54:39,747 has left me with a huge respect for my guts and its inhabitants. 933 00:54:39,815 --> 00:54:43,751 They are working together with an intelligence and complexity 934 00:54:43,819 --> 00:54:47,655 that we're only just beginning to understand. 935 00:54:51,327 --> 00:54:57,332 And as for the camera, it did eventually find its way out, 936 00:54:57,399 --> 00:55:04,038 but that's one part of this process that I'm going to keep private. 937 00:55:05,541 --> 00:55:07,509 Announcer: One man. 938 00:55:07,576 --> 00:55:09,511 One harley. 939 00:55:09,578 --> 00:55:11,012 Peter Sagal: We are ready to go. 940 00:55:11,080 --> 00:55:14,082 Announcer: One surprising look at the land of the free. 941 00:55:14,150 --> 00:55:16,151 Peter Sagal: I'm Peter Sagal, and I am taking a journey across 942 00:55:16,218 --> 00:55:18,586 the country to find out how the constitution works in the 943 00:55:18,654 --> 00:55:20,555 twenty-first century. 944 00:55:20,623 --> 00:55:21,823 I am so tweeting this. 945 00:55:21,891 --> 00:55:23,771 Woman: Cracks are showing in the bill of rights, 946 00:55:23,792 --> 00:55:25,393 and technology is putting them there. 947 00:55:25,461 --> 00:55:30,632 Announcer: Constitution USA with Peter Sagal, only on PBS. 948 00:55:33,002 --> 00:55:33,835 It's ok to be smart. 949 00:55:33,002 --> 00:55:34,869 Idea channel's a YouTube show 950 00:55:34,871 --> 00:55:35,803 about Internet and pop culture, 951 00:55:35,805 --> 00:55:36,571 philosophy and the arts. 952 00:55:36,573 --> 00:55:37,272 We ask crazy questions 953 00:55:37,274 --> 00:55:38,006 where viewers weigh in 954 00:55:38,008 --> 00:55:38,840 and we have a conversation. 955 00:55:38,842 --> 00:55:39,574 Do you have an opinion? 956 00:55:39,576 --> 00:55:40,441 Let us know in the comments. 957 00:55:40,443 --> 00:55:41,109 Oh, wait, this is TV. 958 00:55:41,111 --> 00:55:43,011 I'm not used to that. 959 00:55:51,687 --> 00:55:59,687 Announcer: For more Michael Mosley, visit pbs.org. 960 00:56:14,009 --> 00:56:15,929 Announcer: This program was made possible in part 961 00:56:15,945 --> 00:56:18,079 by contributions to your pbs station 962 00:56:18,147 --> 00:56:19,781 from viewers like you. 963 00:56:19,848 --> 00:56:20,581 Thank you.