Trust your gut & follow your heart

Human organs may have their reasons

that reason knows nothing of…

by Geoff Olson

“That’s where the truth lies, right down here in the gut. Do you know you have more nerve endings in your gut than you have in your head? You can look it up. I know some of you are going to say, ‘I did look it up and that’s not true.’ That’s ‘cause you looked it up in a book. Next time, look it up in your gut. I did. My gut tells me that’s how our nervous system works.”

– Stephen Colbert, explaining how he and George W. Bush think alike, at the 2006 White House Press Dinner. (See end of article for link to Colbert’s roast.)

IN HIS BLACK-TIE routine about the human gut, Stephen Colbert cloaked a medical truth in the guise of comedy. The midsection really does house a secondary brain, scientists say, a discovery consistent with our personal perceptions of “butterflies” in the stomach and “gut feelings.”

Although the gut has only 100 million neurons, compared to an estimated 100 billion in the brain, that’s enough for some sophisticated programming and processing. It’s called the “enteric nervous system,” and it plays a major role in our feelings of well-being. This complex network of neurons sheathes the stomach, esophagus and small intestine. The same neurochemicals, neuropeptides and hormones that are found in the brain are found in the enteric nervous system, acting as a command and control centre for your entrails.

When an approaching job interview causes an attack of cramps, that’s the gut-brain at work. Through the tenuous connection of the vagus nerve, the brain sends signals to the gut, and vice versa. Under life-threatening or dangerous conditions, the brain will shut down the gut-brain entirely (there is no need to defecate or eat on the battlefield). Hence, the difficulty swallowing under fearful conditions.

In a 1996 article in the New York Times, Dr. Michael Gershon, professor of anatomy and cell biology at Columbia-Presbyterian Medical Center in New York, told of how the gut-brain and cranial brain act in concert, and sometimes create negative feedback loops. “Just as the brain can upset the gut, the gut can also upset the brain,” he said. “If you were chained to the toilet with cramps, you’d be upset, too.” Even the folk wisdom that indigestion causes nightmares may have some truth to it; patients with bowel problems show disrupted patterns of REM sleep.

Dr. Gershon gave an anecdotal example of the gut-brain’s surprising independence. A male nurse, an old sergeant, was doing rounds in a hospital treating paraplegic war veterans. With their lower spinal cords destroyed, the patients would get impacted. “The sergeant was anal compulsive,” Dr. Gershon told the New York Times. “At 10:00 AM every morning, the patients got enemas. Then the sergeant was rotated off the ward. His replacement decided to give enemas only after compactions occurred. But at 10 the next morning, everyone on the ward had a bowel movement at the same time, without enemas.” It appeared that the nurse had trained the men’s colons to evacuate at the appointed time.

Scientists don’t reject the notion that the enteric system may be capable of rudimentary learning and memory, like its more highly evolved counterpart upstairs. But the possibility that any other organ, other than the brain, might possibly demonstrate a similar capacity? In academe, this notion is more likely to produce tightened sphincters than research papers.

The gut may have a “mind” of its own, but the heart?

In April of 2008, the Daily Mail reported that 69-year-old Sonny Graham had committed suicide in Vidalia, Georgia, in exactly the same way as the man who had given him a new heart. In 1995, Graham was given less than six months to live when he received a call from the Medical University of South Carolina, telling him that a heart had just become available from 33-year-old Terry Cottle, who had taken his own life by shooting himself in the throat with a shotgun. After the operation, Graham contacted the organ donation agency, wanting to thank the man’s family for saving his life. He met with the donor’s wife, Cheryl, and the two fell in love. The wife of the donor became the wife of the recipient.

Thirteen years later, Cheryl Cottle was grieving all over again, after Graham committed suicide from a gunshot to the neck, repeating her first husband’s fate.

Graham’s story was part of an odd series of articles in the Daily Mail about heart transplant patients who claimed to have taken on the personality traits of their donors. In one tale, a middle-aged man developed a newfound love for classical music after a heart transplant. “It transpired that the 17-year-old donor had loved classical music and played the violin. He had died in a drive-by shooting, clutching a violin to his chest.”

Dr. Gary Schwartz claims he and his co-workers at the University of Arizona have documented dozens of cases of a similar kind. “It’s a targeted personality change,” he told the Daily Mail. “If this is the result of drugs, or stress, or coincidence, none of those would predict the specific patterns of information that would match the donor.”

The Daily Mail article on Sonny Graham’s suicide floated the idea of “cellular memory.” Nonsense, responded skeptics, who argued there is no hard-core scientific evidence for any such occult mechanism. They also claimed that Schwartz had not done properly controlled scientific studies to back his claims of personalities accompanying heart transplants, and was relying exclusively on anecdotal tales.

Considering that thousands of heart transplants are performed daily across the world, and that there are significant mind/body responses to postoperative drugs, to say nothing of the trauma of the surgery itself, is it not reasonable to expect occasional coincidental connections between donors and recipients, behaviourally speaking?

In one case, Schwartz says a young patient had been very health conscious after her heart surgery, and one of the first things she did after leaving the hospital was to visit a fast food outlet, something she had previously avoided. She also became “aggressive and impetuous.” On his “Neurologica” blog, Steven Novella notes that all of the patient’s postoperative traits – aggression, impetuousness and hunger – were hardly a mystery. “Those happen to all be typical side effects of prednisone, an immunosuppressant drug that many transplant recipients require,” he explains.

The Daily Mail also excerpted passages from A Change of Heart, the 2007 memoir of Claire Sylvia. At the age of 47, Sylvia was dying from a disease called primary pulmonary hypertension. In 1988, she had a heart-lung transplant, then a radically new procedure in the US.

Sylvia was the first person in her state to have such an operation, she writes, and there was a lot of publicity. Two reporters came to the hospital to interview her, and one asked what she wanted to do more than anything else, after this miracle. “I’m dying for a beer right now,” she replied. She was mortified that she had given such a flippant answer, and also surprised. “I didn’t even like beer. But the craving I felt was specifically for the taste of beer.”

Sylvia found she’d developed a sudden fondness for certain foods she hadn’t liked before: Snickers bars, green peppers, Kentucky Fried Chicken takeaway. The changes in her behaviour gave her an alarming thought: what if her male donor’s heart started to affect her sexual preferences? Over time, she found she was still attracted to men, but she didn’t have the same desire to have a boyfriend. “I was freer and more independent than before – as if I had taken on a more masculine outlook,” she writes in her memoir.

Sylvia noted that even her walk became more manly. Her daughter asked her why she was lumbering around like a football player. “This new masculine energy wasn’t limited to my walk,” she explained. “I felt a new power that I associated with strength and vibrancy.”

Her postoperative condition reminded of being pregnant, when she experienced something she described as “foreign and beyond my control, yet terribly precious and vulnerable [as if] a second soul were sharing my body.”

All she knew of the donor was that he was an 18-year-old boy who had been killed in a motorcycle accident. Against the hospital’s advice, she decided to track down the donor family. She discovered that the young donor’s likes and dislikes were exactly in line with her personality changes.

There is no greater expression of western culture’s schizoid nature than how we think of the heart. To most scientists and doctors, the heart is nothing more than a glorified pump. William Har-vey’s 17th century discovery that the heart pumps blood through the body’s circulatory system is one of the touchstone moments of medical history.

Yet in many cultures throughout history, the heart has been considered the source of emotions, passion and wisdom. For example, the Chinese term “hsin” means the totality of our psychic functioning, and more specifically, the centre of that functioning, which is associated with the central point of the upper body, in the chest.

In Western tradition, the heart is repeatedly referred to as a thinking, feeling organ in its own right, summed up in philosopher Blaise Pascal’s line that the “heart has its reasons that reason knows nothing of.” The “heartache” of a lost loved one, or from unrequited love, is a universal human experience. For most of us, the heart’s joys and pains aren’t just vacuous greeting card sentiments, but an experiential reality.

In fact, the heart is a rather more remarkable organ than we give it credit for. There isn’t just neural traffic from the brain to the heart, but the other direction as well. J. A. Armour of the Centre de Recherche at the Hôpital du Sacré-Coeur de Montréal, has written on what he calls the heart’s “little brain,” a “nervous system intrinsic to it.”

“These studies provided the scientific basis to explain how and why the heart affects mental clarity, creativity and emotional balance,” writes Mohamed Omar Salem, assistant professor of Psychiatry and Behavioural Science at the United Arab Emirates University. He cites a 2002 paper in which scientists claim to have discovered a neural pathway and mechanism whereby the heart’s neural input could inhibit or facilitate the brain’s electrical activity. The heart appears to have its own “peculiar logic” that often departs from the direction of the autonomic nervous system, Salem observes.

The heart’s afferent nerves enter the brain at its base, and cascade up to the higher cognitive centres in the cortex, where they are able to influence perception, decision-making and other cognitive processing. The heart’s nerves also connect with the limbic system, the emotional centre of the brain.

In fact, the heart’s independent nervous system is the very thing that allows it to survive surgical transplants. “Normally, the heart communicates with the brain via nerve fibres running through the vagus nerve and the spinal column. In a heart transplant, these nerve connections do not reconnect for an extended period of time; in the meantime, the transplanted heart is able to function in its new host only through the capacity of its intact, intrinsic nervous system,” writes Salem.

The heart also releases noradrenaline and dopamine neurotransmitters, once thought exclusively limited to the central nervous system. It is also a hormonal gland, producing a hormone called atrial natriuretic factor. ANF affects the blood vessels, the kidneys, the adrenal glands and a large number of regulatory regions in the brain.

Scientists have also discovered that the heart secretes oxytocin, the “love” or bonding hormone. According to Salem, “In addition to its functions in childbirth and lactation, recent evidence indicates that this hormone is also involved in cognition, tolerance, adaptation, complex sexual and maternal behaviour, learning social cues and the establishment of enduring pair bonds. Concentrations of oxytocin in the heart were found to be as high as those found in the brain.”

And last, but not least, the heart is responsible for the body’s most powerful electromagnetic field. It can be detected by instruments several feet away from the body. The heart glows – not just metaphorically, but in a measurable, scientific sense.

We’re obviously talking about a far more sophisticated device than a mere pump. It’s a complex, self-regulating system with its own neural network that communicates with, and influences, the brain through chemical signals and neural pathways, just as the enteric nervous system does.

Mainstream scientific opinion draws the line at spooky, postoperative personality transfers, however. In 1992, a group of Austrian doctors published a retrospective inquiry on 47 heart transplant patients in a paper entitled “Does changing the heart mean changing personality?” The patients, all of whom had undergone transplants over a two-year period in Vienna, were asked for an interview, to determine if they felt they experienced a change in personality since their operations.

The respondents fell into three distinct groups. Seventy-nine percent stated that their personality had not changed at all postoperatively. As noted in the paper, “In this group, patients showed massive defence and denial reactions, mainly by rapidly changing the subject or making the question ridiculous.”

“Fifteen percent stated that their personality had indeed changed, but not because of the donor organ, but due to the life-threatening event.”

Only six percent – three patients – reported a distinct change of personality due to their new hearts. “These incorporation fantasies forced them to change feelings and reactions and accept those of the donor. Verbatim statements of these heart transplant recipients show that there seem to be severe problems regarding graft incorporation, which are based on the age-old idea of the heart as a centre that houses feelings and forms the personality,” the paper reported.

In other words, the doctors interpreted the three patients’ reports from a psychiatric perspective, taking them to be a confused mix of folklore and anxiety. The patients had been duped by the “age-old idea of the heart as a centre that houses feelings and forms the personality,” resulting in their “incorporation fantasies.” The Austrian doctors had dragged the ghost of Freud into their scientific reasoning to disavow the ancient idea of the heart as a source of feeling and to position the three patients’ postoperative perceptions as delusional ideation.

Yet is it so incredible to hypothesize that memory might inhere in the heart’s workings? That might be a bit of stretch for anyone who still clings to the idea of the heart as a glorified pump. But the elastic tension of science is really tested with the notion that some human character traits might not be entirely brain-based, and that they may even be passed along with transplanted tissue.

After a series of bizarre dreams about her young donor, heart-lung transplant recipient Claire Sylvia managed to track down his family. During a visit with the parents, she says she confirmed that all of her newfound character traits – her taste for particular foods and beverages and sense of independence – were identical to those of her teenage donor.

During her visit, Sylvia sat with the donor’s parents, who gave her a framed photo of their son to look at. “In this photo, he looked about 14. He was dressed in formal clothes, standing beside a priest. But even with the glasses, I could see the sparkle in his eyes.

“June (the mother) started to say something about Tim when she suddenly choked up. Now the tears flowed. I felt a bond between us like nothing I had ever known. But I couldn’t quite comprehend this: me holding Tim’s picture in my hands and his heart in my chest.

“I paused to take a breath and Tim’s lungs filled with air. Except that they were my lungs now,” Sylvia writes.

If the gut-brains of disabled veterans can demonstrate memory and learning, can the “little brains” of healthy people’s hearts also demonstrate similar capabilities? And if desires and feelings are inscribed in the cryptic language of neuropeptides and synapses, could these desires and feelings be reexpressed in another body, via a transplanted organ?

You can’t say the scientific jury is still out on this claimed phenomenon – the jurors have yet to be called. Claire Sylvia’s strange story may be entirely the result of chance, a confirmation bias or a folie à deux between her and the donor family. But there is probably enough in her story, and those of other heart transplant patients, to make a case worth pursuing in the court of science.

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