ON 22 APRIL 1891, a 52-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. Today we might call it stomach pumping, 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鈥檚 stomach were a camisole in need of a little freshening. Hardly. Mr L was slumped in a chair, thinly attached to his wits, while the medics loaded his stomach, many 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.
He is one of a few who have died this way. Overfilling a stomach to bursting point is a near-impossible feat, owing to a series of protective reflexes. When the stomach balloons past a certain point, whether 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 transient lower oesophageal sphincter relaxation, 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. 鈥淎 lot of people, myself included from time to time, eat way the hell past that point,鈥� says Mike Jones, a gastroenterologist at Virginia Commonwealth University in Richmond. 鈥淢aybe they鈥檙e stress-eating. Or it鈥檚 just: 鈥榊ou know what, that鈥檚 some damn fine key lime pie鈥�.鈥� The warning signs grow ever more obvious: pain, nausea and the final I-warned-you-buster regurgitation. A healthy stomach will up and empty itself well before it reaches breaking point.
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Unless for some reason it can鈥檛. In the case of Mr L, the opium was the problem. The patient had 鈥渟hown strong urges to vomit鈥�, but had been unable to manage it, wrote Algot Key-Aberg in a case report published in a German medical journal after he had completed Mr L鈥檚 autopsy. Key-Aberg was a professor of medicine at the local university and a very thorough man. I had hired a translator named Ingeborg to read Key-Aberg鈥檚 paper aloud to me. The description of Mr L鈥檚 stomach and the 10 parallel rupture wounds ran to two-and-a half pages. At some point Ingeborg looked up from the page. 鈥淪o I guess the rinsing did not work out.鈥�
Mr L鈥檚 was the first stomach in Key-Aberg鈥檚 experience that had ruptured when overfull. Medicine needed to know about this, so that future rinsers and pumpers would be alert to the danger. Was it the volume of water or the force of its flow that mattered more? 鈥淚n order to gain more clarity,鈥� Key-Aberg continued, 鈥淚 needed to experiment with the stomach of a cadaver.鈥� Ingeborg made a small noise. 鈥淭hese experiments I conducted in large numbers.鈥� For much of the spring, unclaimed Stockholm corpses, 30 in all, were delivered to Key-Aberg鈥檚 lab and manoeuvred into chairs in a 鈥渉alf-seated position鈥�.
Key-Aberg found that if the stomach鈥檚 emergency venting and emptying systems were out of commission because the person was in a narcotic stupor, say, or dead, the organ would typically rupture after 3 or 4 litres. If you pour slowly, with less force, it may hold out for 6 or 7.
Very, very occasionally, the stomach of a live, fully conscious individual will give way. In 1929, Annals of Surgery published , when stomachs surrendered without forceful impact or underlying weakness. Here were 14 people who managed, despite the body鈥檚 emergency ditching system, to eat themselves to death. The riskiest item in these people鈥檚 stomachs was often the last to go in: sodium bicarbonate (also known as baking soda, and the key ingredient in Alka-Seltzer). Sodium bicarbonate brings relief two ways: it neutralises stomach acid and it creates gas, which prompts the burp.
More recently, a pair of Miami-Dade County medical examiners reported the case of a 31-year-old psychologist with bulimia found semi-nude and dead on her kitchen floor. Her abdomen was greatly distended by 9-plus litres of poorly chewed hot dogs, broccoli and breakfast cereal. The medical examiners found the body slumped against a cabinet, 鈥渟urrounded by an abundance of various foodstuffs, broken soft drink bottles, a can opener and an empty grocery bag鈥�. The 鈥渢he coup de grace鈥� was a partially empty box of baking soda. In this case, the greatly ballooned stomach had not burst; rather, it had shoved her diaphragm up into her lungs and asphyxiated her. The pair theorised that the gas could have forced one of the poorly chewed hotdogs up against the oesophageal sphincter at the top of the stomach and held it there, preventing the woman from burping or vomiting.
Should you doubt the impressive pressure produced by sodium bicarbonate reacting with acid, I direct you to any of the . Or, less playfully, the works of P. Murdfield, who in 1926 ruptured the stomachs of fresh cadavers by filling them with a couple of litres of weak hydrochloric acid and dropping in some sodium bicarbonate.
Fit to burst
If a woman鈥檚 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, UK, at 4 am on an unspecified date in 1984 was the exception. She turned out to be carrying a meal. As dinners go, this was triplets: a kilogram of kidneys, a kilo of liver and steak, two eggs, a half kilo of cheese, a quarter kilo of mushrooms, a kilo of carrots, a head of cauliflower, two large slices of bread, 10 peaches, four pears, two apples, four bananas, a kilo each of plums and grapes and two glasses of milk. Nearly 9 kilos of food. Although her stomach eventually ruptured and she died of sepsis, the organ held out heroically for several hours. Clearly some stomachs can hold more than 4 litres.
The only human to have come close to the record set by the Liverpudlian is Takeru Kobayashi who consumed just over 8 kilos of cow brains in an eating competition. Kobayashi had a 15-minute time limit; presumably he鈥檇 have bested, or worsted, or wursted, more had the timer not gone off. Most food records are not measured by weight, so it is hard to know how many others have came close.
Models with bulimia and professional eaters are career bingers. They challenge their body鈥檚 limits on a regular basis. Here is my question: is the ability to eat to extremes a matter of practice, or are some stomachs just naturally more compliant?
In 2006, medical science took a look. Gastroenterologist David Metz at the University of Pennsylvania in Philadelphia of a competitive eater 鈥� Tim Janus, then ranked number 3 on the circuit, under the name Eater X 鈥� and a normal eater, while the men spent 12 minutes eating as many hotdogs as they could manage. A side order of high-density barium enabled Metz to follow the wieners鈥� progress via fluoroscope. Metz had a theory that prodigious eaters had faster-than-normal gastric emptying times. In other words, their stomachs might be making room for more by quickly dumping food out the back door into the small intestine. The opposite turned out to be true. After two hours, Eater X鈥檚 stomach had emptied only a quarter of what he鈥檇 eaten, whereas the other eater鈥檚 stomach, more in keeping with a typical stomach, had cleared out 75 per cent.
Somewhere into the seventh dog, the normal 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 36 hotdogs, downing then in pairs. His stomach, on the fluoroscope, became 鈥渁 massively distended, food-filled sac occupying most of the upper abdomen鈥�. He claimed to feel no pain or nausea. He didn鈥檛 even feel full.
Extreme eating
But the question remains: are prodigious eaters born with a naturally compliant stomach, or do they alter the organ over years of incremental stretching 鈥� 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鈥檚 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 competitive eater 鈥� aka Erik the Red, ranked seventh in the US 鈥� and offered to put us in touch. I asked Denmark: is the successful glutton born or made? Both, it seems. Denmark recalled visits to McDonald鈥檚 as a child where he would finish, by himself, the 20-piece family box of chicken McNuggets. But Metz formed the impression, based on conversations with Eater X, that nature trumped nurture. 鈥淚t鈥檚 a structural thing,鈥� he told me. 鈥淎t rest their stomachs are not much bigger, but their ability to receptively relax is unbelievable. The stomach just expands and expands and expands.鈥�
Although Denmark agrees with Metz that genes matter, as he puts it, 鈥渧ery few people could eat 60 hotdogs no matter how hard they worked at it鈥�. He considers the inherently stretchy stomach as merely the foundation, the starting point, for a career that requires daily practice and training. 鈥淚 think,鈥� he told me, 鈥渢hat it has more to do with how much you鈥檙e willing to push your body past the point that you would ever want to go.鈥� Despite his natural assets, Erik the Red did not hit the ground running. At his first competition, he put away 1.3 kilos to the winner鈥檚 2.7 kilos. I asked Denmark why the body鈥檚 safety mechanisms, specifically regurgitation, don鈥檛 kick in. In fact, they do. 鈥淭his is going to sound gross,鈥� he said, 鈥渂ut you just, you know, like, swallow it down and keep eating. 鈥� Eating judges define regurgitation as the point at which food comes out, not up. 鈥淚t鈥檚 like a speed bump that you just go over. It鈥檚 mental.鈥� Yes.
鈥淎 stretchy stomach is the starting point for a career that requires daily training鈥�
All competitive eaters follow a conditioning programme. The cheapest and least fattening training material is water. Denmark can water-load about 9 litres at a sitting; when he began his career, he could barely get through 4. As a point of reference 鈥� and warning 鈥� recall that 4 litres was the point at which the stomachs of Key-Aberg鈥檚 cadavers 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. Because as Erik the Red points out, however much willpower it takes to stop eating when you鈥檙e full, it takes far more to keep going (and going).
Read more: 鈥�Secrets of the body鈥�
This article appeared in print under the headline 鈥淓ats, throws up and leaves鈥�
