Second Brain: A Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestine


Dr. Michael Gershon has devoted his career to understanding the human bowel (the stomach, esophagus, small intestine, and colon). His thirty years of research have led to an extraordinary rediscovery: nerve cells in the gut that act as a brain. This "second brain" can control our gut all by itself. Our two brains — the one in our head and the one in our bowel — must cooperate. If they do not, then there is chaos in the gut and misery in the head — everything from "butterflies" to cramps, from diarrhea to ...

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Dr. Michael Gershon has devoted his career to understanding the human bowel (the stomach, esophagus, small intestine, and colon). His thirty years of research have led to an extraordinary rediscovery: nerve cells in the gut that act as a brain. This "second brain" can control our gut all by itself. Our two brains — the one in our head and the one in our bowel — must cooperate. If they do not, then there is chaos in the gut and misery in the head — everything from "butterflies" to cramps, from diarrhea to constipation. Dr. Gershon's work has led to radical new understandings about a wide range of gastrointestinal problems including gastroenteritis, nervous stomach, and irritable bowel syndrome. The Second Brain represents a quantum leap in medical knowledge and is already benefiting patients whose symptoms were previously dismissed as neurotic or "it's all in your head."

"Thirty years of research have led this author to the rediscovery of nerve cells in the gut, which act as a second brain, leading to a radical new understanding about a wide range of gastrointestinal problems."

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Editorial Reviews

New York Times Book Review
Persuasive, impassioned... hopeful news [for those] suffering from functional bowel disease.
Kirkus Reviews
The nature of a so-called second brain in the gut is revealed in exquisite detail by a neurogastroenterologist who has spent some 30 years researching the subject. Gershon, professor of anatomy and cell biology at New York's Columbia-Presbyterian Medical Center, is enthralled by the sophistication of the enteric nervous system. He calls this system, which operates the bowel, a second brain, pointing out that it contains all the classes of neurotransmitters found in the brain. For nonbiologists entering his world, a whole new vocabulary with terms like neural crest, 5-HT1P receptor, and functional ligand must be acquired. While the terminology can be daunting and the exhaustive details sometimes overwhelming, Gershon has wisely included lots of clear line drawings to help the novice understand the nervous system and the complexities of the digestive system that it runs. Happily, he also tells his story in human terms, paying homage to those whose discoveries enabled his own, good-humoredly sharing the exhilaration of jousting with colleagues over his theories, and generously describing the skills and inventiveness of researchers in his own laboratory and those of other neurobiologists. As this research sheds light on how the "brain in the belly" controls the behavior of the bowel, progress can be expected in the prevention, treatment, and control of gastrointestinal disease. When patients present with gastrointestinal problems for which doctors can find no specific cause, too often they are dismissed as neurotic complainers. That answers may be found in the enteric nervous system offers new hope for the 20 percent of Americans diagnosed with functional bowel disorders. An authoritativework that makes abundantly clear the value of basic research; unfortunately, it's encumbered with an intimidating amount of technical detail that may discourage interested readers.
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Product Details

  • ISBN-13: 9780060930721
  • Publisher: HarperCollins Publishers
  • Publication date: 11/28/1999
  • Edition description: 1 HARPER
  • Edition number: 1
  • Pages: 336
  • Sales rank: 169,200
  • Product dimensions: 5.31 (w) x 8.00 (h) x 0.75 (d)

Meet the Author

Michael D. Gershon M.D., is chairman of the Department of Anatomy and Cell Biology at Columbia University's College of Physicians and Surgeons at the Columbia-Presbyterian Medical Center in New York City.

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Read an Excerpt

Chapter One

The Discovery Of The Second Brain

Those Of Us Who deal in science, even the most enlightened of us have a strong and objectionable tendency to hubris. Hubris for scientists comes from an inadequate knowledge and appreciation of the past. Discoveries are thus made and claimed that are really rediscoveries -- not new advances at all, but history lessons.

Neurogastroenterology: A Rediscovery
Brings Hope for the Future

Not long ago, the New York Times ran an article about the second brain in its science section. David Wingate, a gastroenterologist with an academic practice in London, was cited as a source for a comment that identified me as the father of the new field of neurogastroenterology. I admit to being the father only of three children. Clearly, David did not insult me by attributing to me the fatherhood of a field. In fact, I would love to be able to just send him a note saying something nice, like "David, you've noticed." Unfortunately for my ego, however, I know better.

I have made discoveries in my scientific career, but the basic principles on which my work is based are about to celebrate their one hundredth anniversary. That bit of information is very good for putting down my own particular brand of hubris. I am not really disappointed, because

I have to conceded priority to people who came before me. Rediscovery is every bit as good as discovery, if what is rediscovered is important and was forgotten. It is better still when the rediscovered information has the capacity to improve the fives of those aroundus.

Neurogastroenterology began when the first investigators determined that there really is a second brain in the bowel. The seminal discovery that established its existence was the demonstration that the gut contains nerve cells that can "go it alone"; that is, they can operate the organ without instructions from the brain or spinal cord. Those of us who qualify as neurogastroenterological fathers in David Wingate's estimation are really children. None of us discovered the existence of the second brain. That discovery had passed, however, like the Roman Empire, into oblivion. What I have done, with a great deal of help from colleagues around the world, is to find it again and return it to scientific consciousness. To me, that accomplishment, which will soon provide relief to millions of people suffering from the misbehavior of an ill-tempered bowel, is sufficient. Dayenu.

Ecclesiastes Was Right: There Really Is Nothing New Under the Sun

Neurogastroenterology really started with Bayliss and Starling, two investigators whose work in nineteenth-century England established them as immortals in the Pantheon of Physiology. I love to envision what life must have been like in the laboratories of England at the turn of the century. It was a time when notorious fogs descended on London and mixed with the smoke of thousands of coal stoves to clog lungs and blot out the view. This was the time of Jack the Ripper, David Copperfield, and Ebenezer Scrooge. I had experienced an update of an English laboratory in 1965-1966, when I was a postdoctoral fellow at Oxford. One needs to read Dickens to appreciate the conditions under which English scientists work.

Winters in England are not usually very cold. Certainly, New York is colder than Oxford or London. The trouble with England is that there is very little difference in most of the country between the indoor and the outdoor temperatures. I worked at my laboratory bench with my scarf on, and I wore gloves with the fingertips cut off so that I could feel what I touched. The benches tended to be high, and we sat on backless wooden stools. Since these laboratories were the result of half a century of progress, the working conditions faced by Bayliss and Starling must have been almost penal. Whatever their laboratories were like, the accomplishments of Bayliss and Starling were quite startling. In fact, until Margaret Thatcher became prime minister and suffocated British science, the physlological laboratories of England were a match for those of any other nation.

The Law of the Intestine

Bayliss and Starling worked with dogs. They isolated a loop of intestine in anesthetized animals and studied the effects of stimulating the bowel from within its internal cavity, thereby mimicking the effects that normal intestinal contents might exert on the wall of the gut. In their critical experiments, Bayliss and Starling increased the pressure within the loop of bowel. The gut responded with a stereotyped behavior that, in its reproducibility, caught their attention. Whenever its internal pressure was raised sufficiently, the bowel would exhibit muscular movements that had the effect of propelling the contents of the intestine in a startlingly oneway direction. The propulsive movements consisted of a coordinated descending wave of oral contraction and anal relaxation that forced the intestinal contents relentlessly and inevitably in an anal direction.

Bayliss and Starling called this response of the gut to increased internal pressure "the law of the intestine." Bayliss and Starling were very much into "laws." Their physiological legacy includes a "law of the heart" and a "law of the circulation" as well as the "law of the intestine." They probably used the word "law," which now seems quaint, to imply that they had discovered an everlasting principle that governs the behavior of a biological system. Perhaps it was the contemporaneous notoriety of the case of Jarndyce versus Jarndyce in Dickens's great book Bleak House that focused their terminology in such a legal direction. In any case, the "law of the intestine," despite its catchiness as a phrase, failed to persist. Not that Bayliss and Starling were wrong. In fact, their work has stood up wen over time and is easily reproduced. The "law of the intestine" that Bayliss and Starling formulated still describes the behavior of the bowel, but the name of the activity has changed.

The Second Brain. Copyright © by Michael Gershon. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.
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Table of Contents

Acknowledgments ix
Preface xi
Part I The Early Breakthroughs 1
Chapter 1 The Discovery of the Second Brain 2
Chapter 2 The Autonomic Nervous System and the Story of Chemical Neurotransmission 8
Chapter 3 The Turning Point 37
Chapter 4 The Workshop 57
Part II The Travelogue 81
Chapter 5 Beyond the Teeth: The Domain Stalked by Heartburn and Ulcer 82
Chapter 6 Onward and Downward 113
Chapter 7 "It Ain't Over 'Til It's Over" 145
Chapter 8 A Bad Bowel 176
Part III The Origin of the Second Brain and Its Disorders 189
Chapter 9 The Enteric Nervous System Now 190
Chapter 10 Immigrants and the Lower East Colon 236
Chapter 11 Location, Location, Location 275
Chapter 12 The State of the Bowel 306
Endnote: Animals in Biomedical Research 312
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  • Anonymous

    Posted April 9, 2005

    A thought-provoking book

    I thought it was an interesting premise that the gut was a 'second brain gone south'. I would add too that the author responded to a question I emailed him and thanked me for reading his book. A courtesy that you don't always receive these days.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted April 18, 2001

    Second brain is link to first brain disorders

    I am a neurological development consultant who has read this book thoroughly and concur with the findings from a developmental point of view. I found this book a must read for anyone who has a developmentally challenged child or adult. In working with brain disorders and brain injuries, I always look to the bowel in the course of the examination because, 'if the bowel ain't happy, the brain ain't either!' There is so much more that is not in this book about the bowel that affects the brain that it would take several volumes of books to elaborate on what is already known today. If you or a loved one suffer from psychological ailments, brain disorders, IBS, or even just common irregularities of the bowel,reading this book is an appropriate start to gain an understanding of basic biological processes of the bowel.

    1 out of 1 people found this review helpful.

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