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Gut Check

Food, Design, and a Reimagining of Public Health

Joe Schlaud

Design is, at its core, a dialogue. It’s the application of ideas — some large, some very small — to questions that remain open. It’s an attempt to define and direct not a static moment, but an ongoing and evolving dynamic. And when it comes to design issues requiring more urgency, there are few more momentous than that of where our food comes from.

At the most essential level, the goal of a food production and distribution system is to ensure that everyone in a defined area has access to food, and it’s to be assumed that this food is both safe for consumption and nutritionally wholesome. But assumptions are dangerous, especially when the scale of that area becomes, say, the United States: a nation spanning nearly 3.8 million square miles with a current population of roughly 325 million. Is the way we currently produce and distribute our food the only possible way it could be done?

Broadly speaking, our current food-distribution design dates roughly to the 1950s, and the inauguration of the Interstate Highway System. Coincidentally, the ‘50s also saw the triumph of centrally processed, frozen and prepared foods over the local farm-to-table model that characterized our history up to this point. “Triumph” is a deliberate choice of words; the post-War era represented an apex of mechanistic, “rational” and systems-based design and thought — a response to the chaos and uncertainty of the Depression, the ensuing global war, and the threat of an ascendant ideological adversary in the Soviet Union.

And let’s give it its due: The American Model, including its massive increases in agricultural productivity and the defining abundance of cheap, alluring foodstuffs, was on its face a stunning success: rising prosperity and quality of life for the majority of Americans — for the sake of brevity, let’s not examine that claim too closely, shall we? — and a beacon of freedom, whatever that might exactly mean, recognized across the globe.

But there’s that nagging assumption again; that bit about safety and wholesomeness. Most (but not all) of us are fed each day, but “feeding every mouth” may have tipped from being the mandate to being the disease itself. Spare a glance at the “typical” American city, and you’ll see deep dysfunction on multiple levels: societal, medical, and political, for a start. In the short term, continuing to do what we currently do is easier than changing it, and there is powerful pressure from the commercial interests invested in the current arrangement.

But imagine for a moment the design of a food production system built not around the conveniences of centralized slaughter, interstate shipping, and cheap fuel (not to mention its agrarian analog, phosphate-based fertilizers), but around a more intuitive goal: nourishing the bodies that actually consume that food.

On the level of systems design, it’s merely an inversion: swapping the top-down, centralized approach, patterned in part after our own brain and nervous system, for one based on the actual locus of our consumption, our gut. That’s the beauty of design; with a twist of the hand, the pyramid becomes the nabla — the Greek inverted triangle — as apt a symbol for digestion as one could devise. What amount of effort would revising this design actually require, and more to the point, how much longer can we afford not to revise it?


We stand at so many frontiers at this peculiarly fractured moment. Many Americans feel the country is at a tipping point, but we don’t know towards where. Progressivism and conservatism are deadlocked, each one’s prospectus anathema to the other. There is no clear consensus on which way we as a nation will go, and this moment of tension is quite literally — judging from the refresh rate of our handheld news feeds — driving many of us mad. Frontiers are usually defined as being outside the body, an external goal somewhere on the horizon. But if we as a nation are unable to agree on what our external goal should be, what would happen if we were to turn our attention inward, to a figurative (and literal) frontier: the gut.

This is not an exercise in navel-gazing (though that portal is ironically close to the mark). The “gut frontier” (aka the intestinal epithelium) is, to quote the National Center for Biotechnology Information:

…a single-cell layer that constitutes the largest and most-important barrier against the external environment. It acts as a selectively permeable barrier permitting the absorption of nutrients…while maintaining an effective defense against toxins.

What is the source of these nutrients, and of these potential toxins, as well? Food, of course. We’re not typically comfortable making the association between food and pathogens, but from a design standpoint — as in, how do we design a food-production system that reduces or eliminates the possibility of contamination and mass illness — it’s an essential and unavoidable truth. The potential for mishandling or tainting foods, particularly animal proteins, is difficult to eliminate; when the source of that protein is massive, centralized slaughterhouses and processing plants, the repercussions take on a truly terrifyingly scale.

This doesn’t even begin to examine the plague of empty calories; it’s little exaggeration to describe much of what we eat as “zombie foods,” similacrum of recognizable ingredients and dishes “enhanced” or replaced entirely by replicants brimming with salt, sugar (high-fructose corn syrup, actually), and fat.

Viewed in this light, our relationship with food takes on a new and central significance, both on a personal and a societal level. It’s not merely what nourishes and entertains us, but potentially an almost imperceptible (but readily quantifiable) IV drip straight into our cores. What exactly is in that IV drip? Aside from the obvious, violent — and typically, thankfully brief — outbreaks of foodborne illness, could it be changing the way we think and feel, and thus contributing to our national malaise? What if the road to consensus were not on the external horizon, but inside each one of us?

The Gut

The word “gut” has a funny — guttural? — abruptness to it, a holdover from its roots in the terse Old English (essentially our modern definition: “bowel”) though its Middle Dutch and Proto-German cognates expand this to include “channel” or “drain,” both charmingly blunt characterizations of its role, but hardly an explication of its potential significance as more than a sloshy nutrient-absorbing production line.

The notion of the gut as something more — the very font of our emotions — came later; it’s a Medieval notion, nowadays more readily lumped in with the Greeks’ belief in bodily humors, or Victorians trust in the shape of the cranium as a predictor of moral character. These ideas were more or less discarded with the rise of pathogen-based medicine, in the 19th century, and the modern hospital as we would recognize it in the early 20th century.

And with good reason. Researchers such as Dr. Alexander Fleming, the discoverer of antibiotics, were vastly expanding our understanding of the body and our ability to direct — if not entirely control — its processes, a directive based less on supposition than on observed cause and effect. And what a boon this was! My own father was twice given up for dead before the age of ten, both times due to infections that would easily have been treatable by common antibiotics, had they yet been available.

But in imagining that we could control our bodies, we bought in to — some would say vastly oversubscribed to — a notion that every process was ultimately definable and therefore manageable. If my father nearly died for want of penicillin, within a few decades children such as myself were regularly being dosed for simple, non-threatening infections, minor abrasions, even acne.

More ominously — and largely invisibly — antibiotics weren’t relegated to just the human realm; by 1950, researchers had concluded that adding antibiotics to livestock feed increased their rate of growth, an outcome entirely distinct from their intended application. Exactly how much antibiotic is given to livestock is a contentious issue, though according to a 2009 FDA report, 80 percent of the antibiotics taken in this country go to animals, not humans. As Dr. Fleming himself warned in his Nobel acceptance lecture in 1945:

The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.

As a result of this and other antibiotically liberal practices, we increasingly live in a world populated by drug-resistant microbes. A 2010 report implicates Invasive Methicillin-resistant Staphylococcus aureus in some 19,000 deaths per year, more than the annual United States deaths from AIDS.

The Birthplace of Emotion

In discarding the notion of humors and adopting a more evidential approach to medicine, we tend to assign one-to-one correlations: the liver cleanses the blood; the gallbladder helps us digest fat; the appendix … well actually, no one knows what that does. So it’s no great leap to suppose that emotions — perhaps the least predictable of our functions — is the province of a single organ: the brain. Sure, it’s incredibly complex, but eventually we’ll understand it completely, once we take enough CAT scans.

Of course, this seems not only natural but self-evident. Where else would emotion — that vast subset of “thought” — come from but the brain? Thus far, most research has proceeded according to this supposition — even allowing for the 50-year heyday of Freudian theory, by and large the medical establishment’s understanding of the brain has been along biochemical lines of inquiry.

But what if there were more to the story? What if, rather than that clean, appealing one-to-one correlation — the lungs pumping oxygen into our bloodstream, the brain pumping emotions into our consciousness — our forebears were actually onto something when they posited the notion of the gut as the font of our emotional health? And most troublingly, what if one of the principal methods we now use to manage and guide our physical experience — all those prophylactic doses of antibiotics — was doing our emotional experience untold harm in the process?


In the olden days (well, at least a couple of years ago) it was common to hear the inspirational phrase: “Mind over matter,” sometimes expressed as “mind over body.” Increasingly, though, it appears that at least in some regards, the body is the mind.

Hippocrates, the Greek “Father of Medicine,” famously proclaimed “all diseases begin in the gut,” and he applied this dictum to his theory of humorism, stating in On the Nature of Man:

The Human body contains blood, phlegm, yellow bile, and black bile. These are the things that make up its constitution and cause its pains and health. Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with others.

This theory formed the basis of Western medicine for nearly 2,000 years. As far as medical practices went, treatments were typically designed to draw off excesses of unwanted humors; they took the form of emetics, bloodlettings, colonics, and other counterbalancing approaches. (Note to self: Be thankful you were not alive during any previous period in history, ever.)

In the second half of the 19th century, clinicians such as Rudolf Virchow pioneered the sciences of pathology — the recognition that diseases had specific causation — and social medicine, the study of societal and economic conditions as they impacted human health. It might be noted that Virchow was himself ardently anti-Evolution, and castigated his assistant Ernst Haekel — still celebrated for the precision and beauty of his geometric nature illustrations — for his advocacy of Darwinism.

If humorism was (rightfully) superseded by this new approach, some faint echoes of its approach lingered. If our feelings were the province of the brain, why did certain intestinal disorders and events — what we would out of habit tend to describe as physical events — inspire highly specific emotional outcomes?

We don’t yet know the mechanism of this correlation, but we know it’s real. A 2017 study published in Psychosomatic Medicine supports the concept of gut-brain interactions, suggesting that the presence (or lack) of specific molecules in the gut biome not only affect emotional response, but the physical structure of the brain as well (a fascinating chicken-and-egg question, but that’s for another day).

My own interest in the intersection of gut and mood comes from personal, if robustly unscientific, experience. Checking myself into the hospital following mysterious pains in (where else?) my gut, I resurfaced from the depths of general anesthesia to a reality starkly different from the one I had departed mere hours before. Rather than feeling elated that I had correctly self-diagnosed a case of acute appendicitis, I was instead plunged into the blackest of depressions, one which no amount of rationalization could rectify.

Surgery itself, and the heavy (and, puzzlingly little-understood) cloak of anesthesia bring their own trauma and disruption to our consciousness, but it’s my gut feeling (pardon the expression) that it was the blow to my intestinal biome delivered by full-body paralysis that had such a disastrous effect on my emotions. It will likely be many years before a “gut map,” akin to that of the human genome, is complete, but preliminary studies — for instance one demonstrating different levels of specific gut bacteria correlating to people with and without autism — support this hunch.

The Gut of the Land: As inside, so outside

The notion of incremental alterations to the gut (by antibiotics and nutritionally void foods), or even the short, sharp shock (as manifest in the trauma of surgery) can be applied to nature as well. Although the cycle of cause and effect is typically far longer, it’s no less vital and no less apt. In a fascinating DWP Main Stage talk, Anya Fernald — the CEO of sustainable meat producer Belcampo — made a passing comment about the “parallel ecosystem” of the land (i.e. a parallel to our gut biome): the flora and microbiomes being killed by the phosphates in fertilizer and the antibiotics fed to livestock.

The reference was buried in a discussion of the economics and promise of the sustainable meat industry, but it struck with the force of cold, hard truth. The notion that the landscape too had been hijacked and poisoned — and that the mechanism and outcome of this perversion were identical to that of our own gut — was the closing of a giant mental circuit.

For those accustomed to viewing our world in holistic, interdependent — dare we say, “spiritual” — terms, it’s increasingly clear that as we sup on the food grown on these abused pastures, we become that land, and we become the food grown on that land, which we eat in ever-more-unconscious ways and amounts. Can we truly know what damage this steady and relentless diet has been wreaking?

Of course, some of its effects are tragically and visibly apparent: a nation in which slightly more than two-thirds of adults are overweight or obese; an epidemic of diabetes and other diseases of plenty; vast and growing inequity in lifespan between those with access to high-quality food and those without.

But linger in the spiritual realm a moment longer. What if that diet of empty calories and needless drugs is in fact the cause of our current political predicament as well? Has a dependence on empty calories (or cheap, drug-riddled protein) brought us to a place in which our social and political choices speak to, and reflect, the same lack of content and vision — the ballots cast as a cosmic “fuck it all,” “can’t be worse than the last guy,” “anyone but him or her” — we experience in our own bodies?

The Illusion of Borders

The gut is a border, and a highly effective one at that, at least compared to its human-made likenesses (see: Great Wall of China, Berlin Wall, etc.). But the gut can only stand so much; feed it an empty diet — or douse it in needless antibiotics — and it descends into disorder: depression, obesity, heart and liver disease, cancer, to name just a few.

Put another way, the gut isn’t an impermeable shield; it’s a fallacy to imagine we can sustain ourselves with toxic food and then believe that we are safe from harm, and can emerge physically and emotionally whole. Likewise, we can’t cordon ourselves off into separate-but-unequal ecosystems, drawing invisible lines in the dirt and constructing fortresses of empty media, ethically bankrupt leaders, and nakedly partisan political solutions and hope to emerge as healthy, whole beings.

What shape does a new design for responsible living, for true consensus-building take? I’m not going to presume to leave you with an answer, but I humbly suggest that in focusing on borders and that great, external frontier — perhaps the most enduring, yet most fraught symbol of this country — we may be looking in the wrong place.

Similarly, a system of food production and distribution that fails to fully account for the health and safety of its end users — the humans who actually consume that food — is, ultimately, doomed to entropy and failure. Just as our unfolding understanding of our own gut upends assumptions about our emotional health, a new, more-localized design of the means by which we access food could disrupt longstanding fallacies about the way this process must occur. Dietetically unsound, processed foods are now the hallmark of America’s caloric intake, but it was not always so, nor does it need remain so.

As the current models of discourse falter so alarmingly, perhaps a new paradigm — built not on the chemical interventions of science and its supposed domination of nature, but on the simplicity and beauty of our own intestinal ecosystem — can unite us, the land, and the animals we raise on that land in a new and truly sustainable communion.