THE SCIENCE OF EATING YOURSELF TO DEATH

O N APRIL 22, 1891, a fifty‑two‑year‑old carriage driver in the city of Stockholm swallowed the contents of a bottle of prescription opium pills. Mr. L., as he became known, was found by his landlord and taken to a hospital, where the staff got busy with the tools of overdose: a funnel, a length of tubing, and lukewarm water to flush out and dilute the drug. The technique is known today as pumping the stomach, but in the case report it was referred to as gastric rinsing. The term gives a deceptive air of daintiness to the proceedings, as though Mr. L.’s stomach were a camisole in need of a little freshening. Hardly. The patient was slumped in a chair, thinly attached to his wits, while the medics loaded his stomach, multiple times in fast succession. With each filling, the organ appeared to hold more, which should have been a clue. Mr. L. had sprung a leak.

If you define eating as the mechanical act of putting something in your mouth and swallowing it, you could say that Mr. L., in consuming the pills, had eaten himself to death. Generally that is the only way to do it, to eat oneself to death. Bursting a stomach by overfilling is a nearly impossible feat, owing to a series of protective reflexes. When the stomach stretches past a certain point–to accommodate a holiday dinner or chugged beer or the efforts of Swedish medical personnel–stretch receptors in the stomach wall cue the brain. The brain, in turn, issues a statement that you are full and it is time to stop. It will also, around the same time, undertake a transient lower esophageal sphincter relaxation, or TLESR, or burp. The sphincter at the top of the stomach briefly relaxes, venting gas and restoring a measure of safety and relief.

Sterner measures may be needed. “A lot of people, myself included from time to time, eat way the hell past that point,” says dyspepsia expert Mike Jones, a gastroenterologist and professor of medicine at Virginia Commonwealth University. “Maybe they’re stress‑eating. Or it’s just: ‘You know what, that’s some damn fine key lime pie.’” The caution signs grow more obvious: pain, nausea, and the final I‑warned‑you‑buster–regurgitation. A healthy stomach will up and empty itself well before it reaches the breaking point.

Unless for some reason it can’t. In the case of Mr. L., the opium had interfered. The patient had “shown strong urges to vomit,” wrote Algot Key‑Åberg in a case report published in a German medical journal after Mr. L.’s autopsy was completed, but he had been unable to manage it. Key‑Åberg was a professor of medicine at the local university and a very thorough man. I had hired a translator named Ingeborg to read Key‑Åberg’s paper aloud to me. The description of Mr. L.’s stomach and the ten parallel rupture wounds ran to two and a half pages. At some point Ingeborg looked up from the page. “So I guess the rinsing did not work out.”

Mr. L.’s was the first stomach in Key‑Åberg’s experience to have ruptured by overfilling. The case, he wrote, “stands on its own in the literature.” Medicine needed to know about this so that future rinsers and pumpers could be alerted to the danger. Was it the volume of water or the force of its flow that mattered more? “In order to gain more clarity,” Key‑Åberg continued, “I needed to experiment with the stomach of a cadaver.” Ingeborg made a small noise. “These experiments I conducted in large numbers.” For much of the spring, unclaimed Stockholm corpses, thirty in all, were delivered to Key‑Åberg’s lab and maneuvered into chairs in a “half‑seated position.” Here one longs for some of that Key‑Åberg zeal for detail. Was the position designed to mimic Mr. L.’s posture during the treatment, or did it simply reflect the difficulty of persuading a corpse to assume the upright profile of a dinner guest?

Key‑Åberg found that if the stomach’s emergency venting and emptying systems are out of commission–because the person is in a narcotic stupor, say, or dead–the organ will typically rupture at three to four liters, around a gallon. If you pour slowly, with less force, it may hold out for six or seven liters.

Very, very occasionally, the stomach of a live, fully conscious individual will give way. In 1929, Annals of Surgery published a review of cases of spontaneous rupture–stomachs that surrendered without forceful impact or underlying weakness. Here were fourteen people who managed, despite the body’s emergency ditching system, to eat themselves to death. The riskiest item in these people’s stomachs was often the last to go in: bicarbonate of soda (aka, baking soda, and the key ingredient in Alka‑Seltzer). Bicarbonate of soda brings relief two ways: by neutralizing stomach acid and by creating gas, which forces the TLESR. (Less often, the stomach‑inflating gas comes from actively fermenting food or drink. The Annals roundup includes a man killed by “much young beer full of yeast,” and two deaths by sauerkraut.)

More recently, a pair of Miami‑Dade County medical examiners reported the case of a thirty‑one‑year‑old bulimic psychologist found seminude and fully dead on her kitchen floor, her abdomen greatly distended by two‑plus gallons of poorly chewed hot dogs, broccoli, and breakfast cereal. The MEs found the body slumped against a cabinet, “surrounded by an abundance of various foodstuffs, broken soft drink bottles, a can opener and an empty grocery bag” and–“the coup de grace”–a partially empty box of baking soda, the poor man’s Alka‑Seltzer. In this case, the greatly ballooned stomach had not burst; rather, it killed her by shoving her diaphragm up into her lungs and asphyxiating her. The pair theorized that the gas could have forced one of the poorly chewed hotdogs up against the esophageal sphincter, at the top of the stomach, and held it there, preventing the woman from burping or vomiting.

By way of underscoring the impressive pressure produced by the chemical reaction of sodium bicarbonate and acid, I direct you to any of the myriad websites devoted to Alka‑Seltzer rockets. Or, less playfully, the works of P. Murdfield, who, in 1926, ruptured the stomachs of fresh cadavers by pouring in a half gallon of weak hydrochloric acid and then adding a little sodium bicarbonate.

A safer road to relief is to drink a few sips of something carbonated. Or to swallow some air. People who swallow air chronically–aerophagia is the clinical term–are known among gastroenter‑ologists, or one of them anyway, as “belchers.” “You see a lot of belchers,” says Mike Jones. “They do this hard swallow, where they’re gulping air. It’s like this nervous tic. Probably two‑thirds of them are totally unaware that they’re doing it. You watch them do it right in front of you, and they’re going, ‘Doc, I’m belching, and I can’t understand it.’”

In addition to the social side effects, chronic belching splashes the esophagus with an excess of gastric acid, which sloshes out of the stomach along with the gas. If this happens too much or too often, the acid burns the esophagus. Now you have another reason to visit Dr. Jones: heartburn. How much acid exposure is “too much”? More than about an hour a day, according to research by David Metz, the University of Pennsylvania gastroenterologist we met in the previous chapter. That’s the cumulative time each day that the normal esophagus is exposed to gastric acid. (People with gastric reflux spend far more time bathing their pipes in acid; in their case the sphincter may be leaky.)

One of the surgical treatments for chronic gastric reflux, called fundoplication, occasionally creates problems with belching. Now you really, really need to keep away from the bicarbonate of soda. “I know a case, this was fifteen years ago, where the man ate a huge meal and then took an inordinate amount of Alka‑Seltzer.” Jones made an exploding sound into the telephone.[64]“It was like that Monty Python sketch, the Wafer‑Thin Mint, where the guy is gorging himself and finally he goes, ‘I’ll just have this one wafer‑thin mint….’”

I F A WOMAN’S abdomen is stretched so far that her belly button is inside out, it is usually safe to assume she is pregnant. The woman wheeled into the emergency room of the Royal Liverpool Hospital at 4 A.M. on an unspecified date in 1984 was an exception. She turned out to be carrying a meal. As dinners go, this was triplets: two pounds of kidneys, one and a third pounds of liver, a half pound of steak, two eggs, a pound of cheese, a half pound of mushrooms, two pounds of carrots, a head of cauliflower, two large slices of bread, ten peaches, four pears, two apples, four bananas, two pounds each of plums and grapes, and two glasses of milk. Nineteen pounds of food. Though her stomach eventually ruptured and she died of sepsis, the organ heroically held out for several hours. Likewise, recall the other bulimic–the model with the badly chewed hotdogs and broccoli. She died of asphyxia; the stomach never actually ruptured.

Clearly some stomachs hold more than a gallon.

The only human to have come close to the poundage record set by the Liverpudlian is Takeru Kobayashi, who consumed eighteen pounds of cow brains in an eating competition. Kobayashi had a fifteen‑minute time limit. Presumably he’d have bested, or worsted, or wursted, nineteen pounds had the timer not gone off. Most food records are not measured in pounds, so it is hard to know how many others have come close. Ben Monson, for instance, consumed sixty‑five Mexican flautas. Who knows what the freightage was on that. I never before noted the similarity between flautas and flatus , but I bet Ben Monson has.

Bulimic models and professional eaters are career bingers. They challenge the body’s limits on a regular basis. Here is my question: Is the ability to eat to extremes a matter of practice, or are some stomachs–and I’m not saying anything here about my husband Ed–naturally more compliant?

In 2006, medical science took a look. David Metz observed the stomachs of a competitive eater–Tim Janus, then ranked number 3 on the circuit, under the name Eater X–and a six‑foot‑two, 210‑pound control subject, while the men spent twelve minutes eating as many hotdogs as they could. A side of high‑density barium enabled Metz to follow the wieners’ progress via fluoroscope. Metz had a theory I hadn’t considered: that prodigious eaters were people with faster‑than‑normal gastric emptying times. In other words, their stomachs might be making more room by quickly dumping food out the back door into the small intestine. The opposite turned out to be true. After two hours, Eater X’s stomach had emptied only a fourth of what he’d eaten, whereas the control eater’s stomach, more in keeping with a typical stomach, had cleared out three‑fourths.

Somewhere into the seventh dog, the control eater reported to Metz that he would be sick if he ate another bite. His stomach, on the fluoroscope, was barely distended beyond its starting size. Eater X, by contrast, effortlessly consumed thirty‑six hotdogs, taking them down in pairs. His stomach, on the fluoroscope, became “a massively distended, food‑filled sac occupying most of the upper abdomen.” He claimed to feel no pain or nausea. He didn’t even feel full.

But the question remains: Are prodigious eaters born with a naturally compliant stomach, or do they alter the organ over years of incremental stretching–the digestive version of the tribal lip plate? Is the lack of discomfort there from the start, or does it come from habitually overriding the brain’s signals? The implication, for the rest of us, being that the more you overeat, the more you overeat.

By happenstance, a friend of mine is acquainted with Erik Denmark–aka Erik the Red, ranked number 7 nationally–and offered to put us in touch. (The two had met on the set of dLifeTV, a show about living with diabetes. That a diabetic man holds the record for fry‑bread consumption is yet one more mystery of professional eating.) I asked Denmark, Is the successful glutton born or built? Both, it seems. Denmark recalled visits to McDonald’s as a child, where he would finish, by himself, the twenty‑piece family box of Chicken McNuggets. But Metz had the impression, based on conversations with Eater X, that nature trumped nurture. “It’s a structural thing,” he told me. “At rest their stomachs are not much bigger, but their ability to receptively relax is unbelievable. The stomach just expands and expands and expands.”

Though Denmark agrees with Metz that genes matter–as he puts it, “very few people could eat sixty hotdogs no matter how hard they worked at it”–he considers the inherently stretchy stomach merely the foundation, the starting point, for a career that requires daily practice and training. “I think,” he told me, “that it has more to do with how much you’re willing to push your body past the point that you would ever want to go.” Despite his natural assets, Erik the Red did not hit the ground running. At his first competition, he put away just under three pounds to the winner’s six pounds. (In relating the story, Denmark does not bother to mention what the food had been. It doesn’t seem to matter. Flavor fatigue sets in after three to five minutes; beyond that point everything is more or less equally revolting.)[65]

I asked Denmark why the body’s safety mechanisms, specifically regurgitation, don’t kick in. In fact, they do. “This is going to sound gross,” he said, “but you just, you know, like, swallow it down and keep eating.” Major‑league eating judges define regurgitation as the point at which food comes out, not up. “It’s like a speed bump that you just go over. It’s mental.” Yes.

All competitive eaters follow a conditioning regimen. The cheapest and least fattening training material is water. Denmark can water‑load about two gallons at a sitting. When he began his career, he could barely get through one. As a point of reference–and warning–recall that one gallon was the point at which Key‑Åberg’s cadavers’ stomachs began to rupture. Part of this training is psychological. In addition to stretching the stomach, water‑loading gets the competitor accustomed to the feeling of being grotesquely full.

David Metz has a theory, yet untested, that water‑loading could be used as a therapy for dyspeptics–people whose stomachs hurt after a meal, though they appear to be healthy. A 2007 study showed that dyspeptic patients report feeling full after drinking significantly less water, as compared with a control group of healthy, nondyspeptic volunteers. Could these people take a cue from professional eaters and gradually train themselves–by conditioning their stomachs–to comfortably hold more? “I think it would be a worthwhile project,” Metz says.

Additional support for the incremental stretching theory comes from the other end of the eating spectrum–the starvation end. A surgeon‑commander by the name of Markowski noted in a 1947 British Medical Journal paper that the stomachs of the World War II prisoners he treated were stretched from the large volumes of low‑quality food they needed to eat to get enough calories and nutrients to survive. He surmised that the chronic stretching might weaken the organ, and that this explained why the men’s stomachs sometimes ruptured after relatively small meals. Though if this were true, you’d expect to see stomach ruptures in major‑league eaters, and you don’t. I would have assumed that the prisoners’ stomachs had shrunk, and that that was why they ruptured. I asked Metz about this. He dismissed the notion that people’s stomachs shrink if they skip meals or cut way back on how much they consume. He says that when people say they feel full more quickly after eating less, it is because their tolerance for food is diminished; the feedback loops that are stimulated for hormone and enzyme production don’t work as well.

Here is what surprises me: people with capacious stomachs are no more likely to be obese. A study in the journal Obesity Surgery reported no significant differences in the size of the stomachs of morbidly obese people as compared with non‑obese control subjects. It is hormones and metabolism, calories consumed and calories burned, that determine one’s weight, not holding capacity. Erik the Red insists he does not–outside of competitions–overeat, even though he never feels full. He points out that however much willpower it takes to stop eating when you’re full, it takes far more to keep going (and going).

The biggest surprise of all is that the medical literature does not contain a single case report of stomach rupture among competitive eaters. Which brings us full circle to Mr. L. and my original point. By and large, it’s not how much you eat that kills you, it’s what you eat–especially, as we’re about to see, when what you are eating is ten dozen latex bundles of cocaine.

11. Up Theirs