Summary of GUT by Giulia Enders: Preface and First Chapter


By Giulia Enders


The author was born by cesarean section and was not breastfed as an infant. The effect this had on the microbes in her gut left her increasingly susceptible to disease later in life.

While she had a few health issues as a child that hinted at the problem, the extent of the issue became clear when she was 17 and she developed a debilitating skin condition. In seeking a solution for it, she stumbled across an article linking skin conditions to antibiotic use. Once she stopped treating her issue as a dermatological problem and started treating it as an intestinal condition, her skin cleared up.

Today the links between the gut and the health of our whole body, including our brain, is a rapidly growing field of study. Still, though, most doctors learn very little about the intestinal system in school, despite the fact that it accounts for two-thirds of our immune system and produces more than twenty unique hormones.

Further, those engaged in this field of medical research often keep their findings to themselves, hidden in academic circles. The purpose of this book is to bring some of this information out into the open, to make it accessible to the average person so we can use this knowledge to improve our daily lives.


A human develops in the womb, roughly speaking, from three tubes. The first two become our cardiovascular and nervous systems. The third grows into our intestinal tube — the gut. The heart and the brain are held in high regard, but the gut, in most people’s eyes, just hangs around our bellies, letting off a little steam every now and then, and is good for little more than going to the bathroom. This book aims to correct that, and to shed light on the body’s most underrated organ.



The book begins by examining the final step of the digestive process, in which solid waste is excreted.

This process is a brilliant demonstration of the adaptations our bodies have made to our cultural needs, to ensure that we don’t release our waste at socially inappropriate times.

Consider, first, the set of two sphincters that control the final release. Most people are familiar with the outer sphincter, the one we can consciously direct, but there’s inner one, too, that we can’t. When the inner one judges the time is right for a release, it lets a small “taster” through. The sensor cells located between the two sphincters tell the brain whether this is just gas, or something more, and the brain then decides whether or not to open that outer sphincter.

The body has evolved a positional fail-safe, as well, to ensure our waste gets released only when it is invited to. In a standing or sitting position, there is a muscle that circles the gut like a lasso, creating a kink in the tube, and putting the brakes on any feces making its way down. This kink is only released, and the tube properly straightened, when we are in a squatting position—notably, the position humans have defecated in since time immemorial, up until the advent of indoor sanitation in the late eighteenth century.

The system can fail, of course. If the prompting of the inner sphincter is constantly overridden by the outer sphincter, or if damage occurs, such as during childbirth, communication between the two sphincters can break down, resulting in either constipation or incontinence.

And years of straining to push feces past that natural kink, while sitting on the toilet, can cause conditions such as diverticulitis, hemorrhoids, varicose veins, a stroke, or defecation syncope—fainting on the toilet. Many of these conditions are far less common, or even unheard of, in cultures that still practice squat-pooping.

But there are easy ways to prevent these outcomes. Don’t ignore your inner sphincter’s urges. If you do sustain damage to that area, there are medical procedures that can retrain your sphincters to communicate again. And there’s no need to throw out your toilet in favor of a hole in the ground—when sitting on a toilet, simply incline your body forward and raise your feet onto a footstool.

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