Jeremy Woodward - The Gastro-Archeologist: Revealing the Mysteries of the Intestine and its Diseases

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I have worked as a gastroenterologista doctor specialising in gutsover the last 25 years. During this time, I have witnessed dramatic advances in our understanding of diseases and our ability to treat them. At the same time, I have seen how there is a growing desire amongst non-specialists to understand how our bodies work. Thanks to the Internet and the popular science press, not only have terms such as DNA and protein become familiar to those without a scientific background, but also the general concepts behind them. Over these years, the nature of my job has also changed. A doctor is appropriately no longer an authoritarian figure, expecting the patient to dutifully take their medicine with little in the way of explanation, but is now primarily an educator.

At the time of writing, the only treatment available for coeliac disease is the lifelong and absolute avoidance of eating glutenthere is no other medicine for it. In order for patients to accept such a change in their lifestyle, my prescription therefore has to be the imparting of sufficient knowledge to understand not only how but why to follow such a diet. For 2 hours every month over the last 8 years, a dietitian and I have done exactly that in an informal group setting with patients newly diagnosed with coeliac disease. The benefits of this approach have been frankly extraordinary (and have saved substantial healthcare resources) simply by empowering patients to look after themselves. The overview of coeliac disease that I provide in these sessions is necessarily very superficial. However, I often get asked interesting and challenging questions that lead me to realise that quite a few people wish to understand the condition in more depth.

Working as I do in Cambridge I actually have quite a few molecular biologists as patients, but how does one begin to describe to those people without any prior knowledge of biology the complexities of intestinal immunology? It is a subject that popular science authors have assiduously avoided and is notoriously challenging to teach even to medical students. However, a few hilarious sessions at local Coeliac UK patient groups and one occasion with catering managers showed me that it is not altogether impossiblealbeit with the use of oven gloves, scrunched up paper balls attached to a length of string and audience members participating in role play! This is where this book startedbut as with all such projects it took on a life of its own and I found myself describing the history of the gut and the immune system in order to explain coeliac disease before embracing other conditions such as food allergies and Crohns disease as well.

This book is not intended as a textbook, as I have avoided any jargon unless absolutely necessary. Neither is it really popular scienceit covers far too much ground for that. I hope that it will be accessible in most part to people with relatively little biological knowledge, but will equally entertain those who also have some or even a lot of science behind them as it may present well-known concepts in an unusual or interesting way. To the experts reading this book, I apologise in advance for the degree to which I have simplified complex processes. However, the view is often clearer when free of intricate details. Just as a long-distance path can be completed very enjoyably in stages and each part may differ in its appeal, so one should not feel bad about not completing the journey in this book to its conclusion. The history of the gut and the workings of the immune system make for perfectly interesting stories in their own right, but I have kept them together in order to provide the complete story (so far) behind the diseases. Many unknowns remain for us to uncover in these conditions as I point out along the way but I have made every effort to make sure that the stories I relate here are as accurate and up to date as possible.

There are so many people who have contributed to the telling of this story (often without knowing that they have) that I simply cannot acknowledge them all here, but my gratitude to them is none the less for that. I list those without whom I would probably never have started, or finished.

Jane, my extraordinary, amazing wife, has supported me, fed me and generally looked after me whilst I was helplessly in the zone ignoring everything and everyone around me for hours on end whilst staring at this laptop screen. I cannot begin to express my gratitude for this indulgence. Or indeed for the life that we share with our five fabulous children, Josh, Toby, James, Jack and Tom.

My parents, the kindest and most generous folk that I know, undoubtedly shaped this book through me. My father, John, instilled in me my captivation and enthusiasm for life in all its forms and my mother, Annes revulsion of snakes, moths and butterflies, might have had something to do with my fascination for those lifeforms in particular! My first publication at the age of 14 (in Camping and Caravanning Worldmuch to the hilarity of my academic colleagues) was written with my father on the reptiles of the UK, with photographs taken by him. Memories of developing and printing black and white photographs in the attic of our home in Sidcup remain as a magical experience.

Bob Allan was my gastroenterologist mentor in Birmingham, and I owe him a huge debt of gratitude for passing on his love of the subject, as well as to John Owen, Eric Jenkinson and Graham Anderson in the thymic biology laboratory, for opening up the amazing vistas of immunology research.