The Appendix Is Not Useless: Darwin's Error and the Gut Bacteria Safe House
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The Appendix Is Not Useless: Darwin's Error and the Gut Bacteria Safe House

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode!

Charles Darwin called the human appendix a shrunken, useless leftover, and medicine largely agreed for over a century. This episode maps the organ, a worm shaped tube about nine millimeters long anchored near McBurney's point, and explains why its position varies: it sits behind the cecum in about 67 percent of people in Ghana, appears on the left side in situs inversus, and is missing entirely in roughly one in 100,000 abdominal surgeries. It also explains how appendicitis develops, why the pain starts near the belly button before moving to the lower right, and what rebound tenderness signals.

The turn came around 2007, when William Parker and Randy Bollinger at Duke proposed the appendix as a safe house for gut bacteria that can repopulate the intestines after illness or antibiotics. A 2012 study found people without an appendix were twice as likely to have C. diff return. Surgeons also reuse a healthy appendix in the Mitrofanoff procedure to drain the bladder through the belly button. A 2013 study found the appendix evolved independently 32 to 38 times across mammals and was rarely lost.

  • How gut associated lymphoid tissue in the appendix helps train the immune system
  • Why a blocked appendix swells, cuts off its own blood supply, and can rupture into peritonitis
  • Antibiotics as an option in some uncomplicated cases instead of surgery
  • Darwin's herbivore theory based on the huge cecum of the koala
  • Studies from 2021 and 2023 linking the appendix to longevity and milder diarrhea in primates

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