FEATURE STORY
From your stomach to your liver to your intestines, the major players keeping you alive finally have their say
By Eric Spitznagel
ILLUSTRATIONS BY SERGE SEIDLITZ
IT’S ALWAYS DISCONCERTING when a peer passes away. Yes, there’s the grieving. But it’s also natural to look at the untimely deaths of others for clues about our own health. What got them in the end? Were they seriously overweight, lifetime smokers? Were they mostly ... just like me?
So you can imagine my surprise upon learning that a guy I’d known since grade school had died from liver disease. I hadn’t paid much attention to my liver; because of my family history, my heart and brain have always been my biggest concerns. But what if I’ve been ignoring the wrong organs? How often do I consider my liver or, for that matter, my gallbladder, lungs, intestines or stomach?
Maybe my friend’s death was a canary in my personal health coal mine. I needed to take my other organs seriously. What could I do to extend their shelf life—and by extension, my own? I set out to have those difficult conversations. It was like the movie Fantastic Voyage but with a My Dinner With André vibe. Here’s what I learned.
YOUR LIVER
The Body’s Front Desk
Liver: Can I help you?
Me: Oh, sorry, I was just …
L: Hold it right there! Nobody gets backstage body access without going through me. Food, booze, medications, nobody. [Eyes me up and down.] OK, you seem mostly nontoxic.
You’re the gatekeeper here?
L: [Rolls eyes.] Yeah, I man the front desk while doing more than 500 different jobs. I remove toxins from your blood; I make bile to digest fat; I store sugar for energy; I turn extra glucose into glycogen; I make protein for blood plasma. But the brain gets all the glory. They put parts of Einstein’s brain in a museum. His liver? No. But I guarantee you, without his liver making glucose available to his brain, Einstein wouldn’t have known his E from his MC squared.
How can I help, other than cutting back on booze?
L: Well, try not to drink like you’re a Beat poet from the ’50s. But that cheese-steak isn’t doing me any favors either. For me to be healthy, you need to watch your weight and cholesterol. Ask your doctor about testing for hepatitis C even if you have no symptoms. Eat high-fiber foods like whole grains and fruits and veggies. Exercise.
OK. So basically, you don’t like anything fun.
L: Maybe if I got a day off. Listen, have that cheesesteak every once in a while, but maybe don’t make it a regular thing. Have a few cocktails during the week—just try not to have them all at once. Pretend your body is a high-end hotel and nobody gets upstairs without me checking their credentials. All I’m asking is, don’t invite all your rowdiest friends on the same night. I only have so many hands.
Technically you don’t have any hands.
L: Hey, you’re the one talking to an anthropomorphic internal organ.
How do we know if you’re overwhelmed? Is that what liver spots are about?
L: Nah, that’s a myth. Those spots are actually just skin blemishes caused by sun damage. Nothing to do with me! If you’re looking for symptoms of cirrhosis or fatty liver, look out for things like swollen legs and ankles, jaundice, abdominal pain, extreme fatigue, dark urine or musty breath.
Musty breath?
L: Yeah. If your oral hygiene is OK but your breath still smells like rotten eggs and garlic, I am not doing OK. And it won’t always be that obvious, especially at the start of liver disease. It’s not a bad idea to get a hepatic function test as part of your annual metabolic panel. Don’t wait till I start pounding on your rib cage in protest to see if there’s something wrong.
YOUR LUNGS
The Busiest Organs
Me: Hello. I wonder if I could—
Right lung: No time to talk. Very busy! We’re taking 17,000 breaths a day! Six million breaths a year! Hold on: A cough’s coming. [The room reverberates like it’s an earthquake.]
Yikes! Am I sick?
Left lung: No, it’s perfectly normal to cough occasionally throughout the day—unless you’re a smoker. Smoking is still the leading cause of preventable death in the U.S. And let’s not even get started on e-cigarettes. Plus, there are other threats—everything from air pollution to secondhand smoke to radon. Your best defense is a good offense.
Which means what?
RL: Breathe! Anything that fills us with oxygen is gonna help us keep healthy. Take a brisk walk. Sing along with the radio. Blow up a balloon. Or just laugh. Laughter gets rid of all the stale air so we can pull in more fresh oxygen. You wanna hear a joke? What do you call a lung thief? [Dramatic pause.] Breathtaking!
LL: I’m sorry, we need to get back to work. [Whispers to right lung.] We’ll discuss this later.
YOUR GALLBLADDER
The Fat Fixer
Me: Excuse me.
Gallbladder: [Without looking up.] Liver is upstairs. Intestines are the next floor down.
No, I want to talk to you.
G: Me? Really? Wow. I’m not used to getting much attention. Most people don’t even remember I exist until it’s the holidays, and they’ve eaten too much of Grandma’s buttery mashed potatoes, and their upper right abdomen starts throbbing and they end up at the ER.
Does that happen a lot?
G: Every Thanksgiving and Christmas like clockwork. They eat their body weight in saturated fats and refined carbohydrates and think, I’m sure one of my vital organs will break down all this fat.
Isn’t that your job?
G: Technically, yeah. And I can mostly handle whatever you throw at me. But sometimes things start to build up—mostly cholesterol—and my bile acid can’t handle it all, and it solidifies into a gallstone. One of them lodges in my duct, and things back up like New York during a garbage strike.
It sounds like we wouldn’t be able to eat fatty foods without you.
G: Well … I am an important part of this process, but I don’t know if I’d call myself indispensable. About 300,000 people in the U.S. get their gallbladder removed every year. The bile just goes straight from the liver to the small intestine.
Hmm.
G: Hey, don’t even think about it. Did you know people with pancreatic cancer are six times more likely to have had gallstone disease the year before their diagnosis? Plus, I’m a fun guy. I love wine! Two glasses per day can reduce my chances of getting gallstones. Same with coffee: Drinking more than 6 cups a day is associated with a 23 percent lower risk. You want some coffee now?
No, thank you, I—
G: How about some healthy fat, like nuts or olives? At least 10 grams of fat per meal helps me empty the bile.
Sounds great. [Slowly backing away.] I’ll be in touch!
YOUR KIDNEYS & BLADDER
This Way Out
Kidneys: You can’t be serious. It’s happening again?
Bladder: I’m not sure why you think badgering me about it will help.
Me: Is everything OK?
K: Mr. Bladder over here is being shy all of a sudden.
B: Hey, shy bladder syndrome is a real thing. And it’s not my fault. I don’t have anxiety—the brain does.
How unhealthy is it really to hold in your pee? It can’t be that bad.
K: Maybe not in the short term. But holding in your pee for too long can overstretch and weaken the bladder or lead to a urinary tract infection or even something really serious, like causing us to swell and possibly get infected, and then all that bacteria can leak into the bloodstream.
It could be worse, though, right? You could have leakage. Isn’t that a normal part of aging?
K: Peeing your pants? You think everyone over 50 is peeing their pants?
No, I just meant—
B: Incontinence is common. A quarter to a third of people in the U.S. have at least a little bladder incontinence. But there are things you can do that may help control or at least minimize it. Get your prostate checked, do pelvic-floor exercises, lose weight and quit smoking, and look into possible causes like diabetes and urinary tract infection.
K: When we’ve got a problem, you’ll know about it. We had kidney stones a few years ago, and the brain thought we were gonna die.
Kidney stones are mostly made of calcium, right?
K: Yeah, but that doesn’t mean avoid eating foods high in calcium. My stones can be caused by a number of factors, including eating too much salt and animal protein, particularly lots of red meat. Also, stress can be a contributing factor.
Anything else I can—
K and B: Drink more water!
That’s it?
B: Yes. Please. Women should consume at least 11.5 glasses [92 ounces] of water and other fluids per day, and men should gulp down around 15.5 glasses [124 ounces]—although you can get a lot of that fluid from fruits and vegetables as well as drinks.
What if drinking a lot makes me pee at night?
K: If you’re peeing more than once a night, that’s called nocturia. It’s caused by anything from an enlarged prostate to hormone changes and sleep disorders, and in some cases could even be a sign of heart failure. If you cut down on nighttime drinks but keep waking up with the urge to pee, you should absolutely tell your doctor.
B: Speaking of peeing … fellas, I’ve got great news. The levee’s about to break!
YOUR STOMACH
The Blender in Your Belly
Me: Hi there. Would you be willing to answer a few questions?
Stomach: It’s about time! You would not believe the rumors going around about me. Ulcers are caused by spicy foods! Don’t swim for at least half an hour after eating or you’ll get stomach cramps and drown!
Wait, none of that’s true?
S: Not even close! The swimming thing was a myth that goes at least as far back as the Boy Scouts handbook in 1908. As for ulcers, they’re usually caused by a kind of bacteria. Stay away from contaminated foods and dirty water, and we should be fine. And nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen and naproxen aren’t great for me if you pop them like breath mints. But it’s not like you’re giving me cancer or something.
Is stomach cancer even a thing anymore?
S: Well, it’s a thing. But it’s not the scary thing it was about a century ago. In the 1930s, it was the leading cause of death from cancer. But that was before everyone had refrigerators, when cured meats high in nitrites were a part of everybody’s diet. Now people are eating more fresh fruits and vegetables, which is a good thing for all of us organs, but especially me.
Can you die from overeating, like that exploding guy in the Monty Python movie?
S: OK, first of all, it’s a movie. Explode, no. But rupture? Maybe, but it’s very, very rare. Even in competitive eaters.
So what’s going on with those guys? Joey Chestnut holds the world record for eating 76 hot dogs and buns in 10 minutes in 2021. How is that even possible?
S: We stomachs are remarkably elastic. You tell us we can’t do something, we do it anyway. And Joey Chestnut’s stomach—he may not have even hit the stomach ceiling yet.
Which is what?
S: Competitive eaters could theoretically eat up to 84 hot dogs in under 10 minutes before they reach their capacity, according to one study.
Doesn’t all the sodium in hot dogs cause bloating?
S: Not exactly. Bloating is caused by too much gas in your gastrointestinal tract, or a condition like gastroparesis, where I’m too slow to empty. There are lots of reasons.
So, diet doesn’t matter?
S: Oh, diet matters quite a bit. Just make smarter choices. Avoid processed foods like white bread, cookies, cake, candy—a high-fiber diet makes a big difference.
And fiber feeds the gut microbiome, right?
S: Could be. I don’t know. You’d have to ask the intestines.
Wait, isn’t the stomach where the gut microbiome is?
S: No. Be honest: You don’t know what the gut microbiome is.
No clue. But it’s got “gut” in the name, so I just assumed it had something to do with you.
S: Talk to the intestines. Ask them about … [lowers voice, looks side to side] gluten. Word on the street is, they can’t handle it.
YOUR INTESTINES
The Evacuation Team
Small intestine: Is that what your stomach said?
Me: Yeah. Is that not—
SI: If you have celiac disease, then absolutely stay away from gluten. But an estimated quarter of Americans are on gluten-free diets, and only a fraction of them actually need to be. We have trillions of microbes down here. I can handle a little gluten.
Trillions?
Large intestine: Oh yeah! Bacteria, viruses, fungi, you name it. Everything you eat contributes to your gut microbiome.
SI: And those microbes influence your blood sugar levels and may help regulate cholesterol
LI: It’s all so important, I just get ... I get so overwhelmed.
Is he OK?
SI: The big lug just gets a little emotional. Nobody thinks of us when they’re talking about emotions. But researchers in the Netherlands found 13 types of bacteria in us linked to depression. Some microbes produce serotonin and dopamine, which regulate moods and emotions. So the next time you feel sad, don’t reach for the stuff you call “comfort food.”
LI: If a friend was sad, would you punch them in the face? That’s what it’s like when you eat ultra-processed food like chips, cookies or those bright orange crunchy things.
I get you. So, what is actual comfort food?
LI: Eat a variety of plants. Any whole grains like those found in whole wheat bread or oatmeal are considered plants. Fruits, vegetables, nuts, even spices fall into the plant category.
What about probiotic supplements?
LI: A probiotic supplement needs to make it through the stomach, which has more acid than a jam band festival. A better bet: fermented foods like sauerkraut, kefir, yogurt and miso. Or prebiotics like bananas, asparagus, apples and most root vegetables, all of which have types of fiber that the microbiome loves.
SI: Or try meditating. Researchers studied the stools of Tibetan monks and found that the monks’ microbiota were enriched with bacteria linked to a decreased risk of anxiety, depression and heart disease.
OK, I should let you guys get back to work.
LI: I’m gonna miss you.
SI: Will you please just eat a vegetable so this poor guy can get his emotions in check?
Eric Spitznagel is the executive editor of The Arrow, AARP’s newsletter for Gen X men. He has written for Men’s Health and other magazines.