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 gastroenterologists, 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.* “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. . . .’”
IF 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.