Ingestible pills reveal gastric correlates of emotions
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eLife assessment
This important study used a novel method to relate gastric acidity to subjective ratings of emotions induced by video clips. The findings are solid but could be strengthened by additional analyses and/or visualization. The findings have broad implications for the field of emotion research and opens new avenues of research for understanding psychosomatic disorders.
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Abstract
Although it is generally held that gastrointestinal (GI) signals are related to emotions, direct evidence for such a link is currently lacking. One of the reasons why the internal milieu of the GI system is poorly investigated is because visceral organs are difficult to access and monitor. To directly measure the influence of endoluminal markers of GI activity on the emotional experience, we asked a group of healthy male participants to ingest a pill that measured pH, pressure, and temperature of their GI tract while they watched video clips that consistently induced disgust, fear, happiness, sadness, or a control neutral state. In addition to the objective physiological markers of GI activity, subjective ratings of perceived emotions and visceral (i.e. gastric, respiratory and cardiac) sensations were recorded, as well as changes in heart rate (HR), heart rate variability (HRV) and spontaneous eyes blinks as non-gastric behavioral and autonomic markers of the emotional experience. We found that when participants observed fearful and disgusting video clips, they reported to perceive not only cardiac and respiratory sensations but also gastric sensations, such as nausea. Moreover, we found that there was a clear relation between the physiology of the stomach and the perceived emotions. Specifically, when disgusting video clips were displayed, the more acidic the pH, the more participants reported feelings of disgust and fear; the less acidic the pH, the more they reported happiness. Complementing the results found in the deep gastric realm, we found that disgusting stimuli induced a significant increase in HRV compared to the neutral scenarios, and together with fearful video clips a decrease in HR. Our findings suggest that gastric signals contribute to unique emotional states and that ingestible pills may open new avenues for exploring the deep-body physiology of emotions.
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Author Response
Reviewer #1 (Public Review):
(1.1) The work by Porciello and colleagues provides scientific evidence that the acidic content of the stomach covaries with the experienced level of disgust and fear evoked by disgusting videos. The working of the inside of the gut during cognitive or emotional processes have remained elusive due to the invasiveness of the methods to study it. The major strength of the paper is the use of the non-invasive smart pill technology, which senses changes in Ph, pressure and temperature as it travels through the gut, allowing authors to investigate how different emotions induced with validated video clips modulate the state of the gut. The experimental paradigm used to evoke distinct emotions was also successful, as participants reported the expected emotions after each emotion block. While the …
Author Response
Reviewer #1 (Public Review):
(1.1) The work by Porciello and colleagues provides scientific evidence that the acidic content of the stomach covaries with the experienced level of disgust and fear evoked by disgusting videos. The working of the inside of the gut during cognitive or emotional processes have remained elusive due to the invasiveness of the methods to study it. The major strength of the paper is the use of the non-invasive smart pill technology, which senses changes in Ph, pressure and temperature as it travels through the gut, allowing authors to investigate how different emotions induced with validated video clips modulate the state of the gut. The experimental paradigm used to evoke distinct emotions was also successful, as participants reported the expected emotions after each emotion block. While the reported evidence is correlational in nature, I believe these results open up new avenues for studying brain-body interactions during emotions in cognitive neuroscience, and future causal manipulations will shed more insight on this phenomena. Indeed, this is the first study to provide evidence for a link between gastric acidity and emotional experience beyond single patient studies, and it has major implications for the advancement of our understanding of disorders with psycho-somatic influences, such as stress and it's influence of gastritis.
1.1 First of all, we want to thank Reviewer#1 for his cogent comments and for highlighting that our findings may inspire future research on brain-body interactions. We took into the highest consideration all the remarks and changed the manuscripts accordingly.
(1.2) As for the limitations, little insight is provided on the mechanisms, time scales, and inter-individual variability of the link between gastric Ph and emotional induction. Since this is a novel phenomena, it would be important to further validate and characterize this finding. On this line, one of the most well known influences of disgust on the gut is tachygastria, the acceleration of the gastric rhythm. It would be important to understand how acid secretion by disgusting film is related to tachygastria, but authors only examine the influence of disgusting film on the normogastric frequency range.
1.2 We are aware that at the moment our data are mainly descriptive and do not provide a clear picture of the causal mechanisms. However, to deal with this outstanding issue we added a new series of analysis.
Most of the data on gastric activity come from analysis of the normogastric band. However, information about the EGG tachygastric rhythm in humans is of potential great importance. To deal with the reviewer’s comment and considering the previously published literature, we re-examined the EGG data focusing on the tachygastric rhythm. The methodology remained consistent with the process described for normogastric peak extraction but this time, we extracted the peak in the tachygastric band, specifically 0.067 to 0.167 Hz (i.e., 4–10 cpm). The ANOVA performed over the tachygastric cycle revealed a significant main effect of the type of video clip (F(4, 112) = 2.907, p = 0.025, Eta2 (partial) = 0.09). However, the Bonferroni corrected post hoc tests did not show any significant difference between the different type of emotional video clips and the neutral condition. The sole significant comparison was observed between participants viewing happy and fearful video clips, indicating that participants’ tachygastric cycles were faster when exposed to happy rather than fearful video clips (p = 0.038). For a visual representation of the outcomes, please see Fig S6.
We revised the main text (Page 17, lines: 472-482) to include this analysis. The revised text now reads as follows:
“Finally, we explored whether normogastric and/or tachygastric cycle changed in response to specific emotional experience. After checking that normogastric and tachygastric peak frequencies were normally distributed (all ps > 0.05), we ran two separate ANOVAs on the individual peak frequencies in the normogastric and tachygastric range. Each analysis had the type of video clip as within-subjects factor. The ANOVA performed on the normogastric rhythm was not significant (F(4, 44) = 1.037, p = 0.399) suggesting that the gastric rhythm did not change while participants observed the different emotional video clips. In contrast, the ANOVA performed on the tachygastric rhythm did show a significant main effect (F(4, 112) = 2.907, p = 0.025, Eta2 (partial) = 0.09). However, the only comparison that survived the Bonferroni correction was the one between happy and fearful video clips, namely participants’ tachygastric cycle was faster when they observed happy vs fearful video clips (p = 0.038) see Fig. S6 for a graphical representation of the results.”
To deal with the Reviewer’s comment, we also correlated the average pH value with the corresponding frequency of the tachygastric cycle recorded in the disgusting, happy and the fearful video clips, namely the emotions associated to changes in pH. The only significant correlation was the one found during the disgusting video clips (r= 0.435; p= 0.023, all the other rs ≤ 0.351, all the other ps ≥ 0.073). Differently from what we expected, we found a positive correlation suggesting that when participants were exposed to disgusting video clips the less acidic was the pH the higher was the frequency of the tachygastric cycle. Instead, we know from our pill data that disgusting video clips are associated to more acid values, and from literature (not replicated by us) to a faster gastric rhythm. Since we did not find strong support in the EGG analysis suggesting a relationship between the gastric rhythm and the emotional experience, we believe that additional evidence will help to clarify the relationship between pH and gastric rhythm.
(1.3) Additionally, only one channel of the electrogastrogram (EGG) was used to measure the gastric rhythm, and no information is provided on the quality of the recordings. With only one channel of EGG, it is often impossible to identify the gastric rhythm as the position of the stomach varies from person to person, yielding inaccurate estimates of the frequency of the gastric rhythm.
1.3 We agree with Reviewer 1 on this point. We acknowledge the potential limitation associated with one-channel EGG recording in our study. To deal with this remark, in a separate (ongoing) study (N# participants= 25) we recorded the electrogastrogram following the methodology outlined by Wolpert et al., 2020 published on Psychophysiology. Thus, in order to study the EGG in association to the emotional experience, we used a bipolar 4-channels montage while participants observed the same emotional video clips used in our current study (see picture below for the montage set-up).
Author response image 1 shows the 4-channels EGG bipolar recording montage reproducing the one proposed by Wolpert et al., 2020.
Author response image 1.
Then, we extracted the gastric cycle in both the normogastric and the tachygastric bands.
After checking that data were normally distributed (Kolmogorov-Smirnov ds > 0.10; ps> .20), in the case of the gastric cycle extracted in the normogastric band, we ran a repeated measures ANOVA with the type of video clip as the only within-subjects factor measured on the 5 levels (i.e. the five types of video clip: Disgusting, Fearful, Happy, Neutral, and Sad). The ANOVA shows that the gastric cycle recorded during the different video clips did not differ (F (4,96) = 0.39; p= 0.81), see the plot on Author response image 2.
Author response image 2.
Gastric cycle (normogastric band) recorded via multiple-channels electrogastrogram (EGG) during the emotional experience. The plot shows the gastric cycle extracted in the normogastric band while participants were observing the five categories of the video clips (i.e. those inducing disgust, fear, happiness, sadness and, as control, a neutral state).
We also extracted the gastric cycle in the tachygastric band, the distribution of the data was not normal in one condition (Kolmogorov-Smirnov ds > 0.27; p < 0.05), therefore we ran a Friedman ANOVA to compare the gastric cycle during the different emotional experiences. The Friedman ANOVA was not statistically significant (χ2 (4) = 2.88; p = 0.58), suggesting that, similarly to the gastric cycle extracted in the normogastric band, also the one extracted in the tachygastric band was not clearly associated to the investigated emotional states, see Author response image 3.
Author response image 3.
Gastric cycle (tachygastric band) recorded via multiple-channels electrogastrogram (EGG) during the emotional experience. The plot above shows the gastric cycle extracted in the tachygastric band while participants were observing the five categories of the video clips (i.e. those inducing disgust, fear, happiness, sadness and as control a neutral state).
Results from this control study seem to suggest that the non-significant effect of the gastric cycle was probably not due to the fact that we use a one-channel egg montage, at least for what concerns the gastric cycle extracted from the normogastric band.
For what concerns the tachygastric frequency associated to the emotional experience these results from a multi-channel EGG recording seem to go in the same direction of the normogastric one, namely no frequency of the gastric cycles recorded during the emotional video clips was different from the control condition.
The only significant difference that we found in our 1-channel EGG study was the one between the happy and the fearful video clips (see Fig. S6 contained in the supplementary materials and above). Specifically, we found that happy video clips were associated to higher gastric frequency compared to the fearful ones. However, we did not replicate these findings in our multi-channels EGG study.
Although suggestive, this evidence is not conclusive. Indeed, we are aware that a final word on the results of our multi-channel study can be said only when a larger sample is obtained.
(1.4) Finally, I believe that the results do not show evidence in favor of the discrete nature of emotions theory as they claim in the discussion. Authors chose to use stimuli inducing discrete emotions, and only asked subjective reports of these same discrete emotions, so these results shed no light on whether emotions are represented discretely vs continuously in the brain.
We revised the discussion in order to better describe our results and toned down the interpretation that the present findings directly support the discrete nature of emotions, as suggested by this Reviewer.
Now page 21&22 lines 622-631 reads as follow:
“Overall, and in line with theoretical and empirical evidence (Damasio, 1999; Harrison et al., 2010; James, 1994, Lettieri et al., 2019; Stephens et al., 2010), our findings may suggest that specific patterns of subjective, behavioural, and physiological measures are linked to unique emotional states...We acknowledge that our results, although novel, are restricted to a sample of male participants, and more importantly they need to be replicated. We also acknowledge that future studies should better investigate the mechanisms underlying the role of the pH in the emergence of specific emotion. For instance, pharmacologically manipulating stomach pH during emotional induction, not only for basic emotions but also for exploring complex emotions such as moral disgust (Rozin et al., 2009), would enable researchers to generalize these findings and examine the directionality of this relationship.”
Reviewer #2 (Public Review):
To measure the role of gastric state in emotion, the authors used an ingestible smart pill to measure pH, pressure, and temperature in the gastrointestinal tract (stomach, small bowel, large bowel) while participants watched videos that induced disgust, fear, happiness, sadness, or a control (neutral). The study has a number of strengths, including the novelty of the measurement (very few studies have ever measured these gut properties during emotion processing) and the apparent robustness of their main finding (that during disgusting video clips, participants who experienced more feelings of disgust (and to a lesser degree which might not survive more stringent multiple comparison correction, fear) had more acidic stomach measurements, while participants who experienced more happiness during the disgusting video clips had a less acidic (more basic) stomach pH. Although the study is correlational (which all discussion should carefully reflect) and is restricted to a moderately-sized, homogenous sample, the results support their general conclusion that stomach pH is related to emotion experience during disgust induction. There may be additional analyses to conduct in order for the authors to claim this effect is specific to the stomach. Nevertheless, this work is likely to have a large impact on the field, which currently tends to rely on noninvasive measures of gastric activity such as electrogastrography (which the authors also collect for comparison); the authors' minimally-invasive approach yields new and useful measurements of gastric state. These new measures could have relevance beyond emotion processing in understanding the role of gut pH (and perhaps temperature and pressure) in cognitive processes (e.g. interoception) as well as mental and physical health.
We are very grateful to Reviewer#2 for skilfully managing the paper and highlighting its strengths, particularly the innovative measurement approach and the potential implications these findings might offer for future research into the impact of gastric signals on emotional experiences and potentially on many other higher-order cognitive functions. Additionally, we would like to thank her for the highly valuable feedback. We have incorporated all the comments into the revised manuscript, aiming to enhance its quality.
Reviewer #3 (Public Review):
This study used novel ingestible pills to measure pH and other gastric signals, and related these measures to self-report ratings of emotions induced by video clips. The main finding was that when participants viewed videos of disgust, there was an association between gastric pH and feelings of disgust and fear, and (in the opposite direction) happiness. These findings may be the first to relate objective measures of gastric physiology to emotional experience. The methods open up many new questions that can be addressed by future studies and are thus likely to have an impact on the field.
We thank very much also Reviewer#3 for the accurate reading of our manuscript; for highlighting the strengths of our study; and for providing valuable feedback. Below, a point-by-point response to all the comments raised by this Reviewer. We have incorporated their comments, and we hope they are satisfied by the new version of the manuscript.
(3.1) My main concern is with the reliability of the results. The study associates many measures (pH, temperature, pressure, EGG) in stomach, small bowel, and large bowel with multiple emotion ratings. This amounts to many statistical tests. Only one of these measures (pH in the stomach) shows a significant effect. Furthermore, the key findings, as displayed in Figure 4 do not look particularly convincing. Perhaps this is a display issue, but the relations between stomach pH and Vas ratings of disgust, fear, and happiness were not apparent from the scatter plot and may be influenced by outliers (e.g., happiness).
3.1 We thank Reviewer#3 for raising this issue which was also raised by Reviewer#1 and #2, se replies above. As reported above we worked on the data analysis in order to provide more evidence supporting our claim, i.e. that pH plays a role in the emotional experience of disgust, happiness and fear. We modified Figure 4 (now 5) as also requested by Reviewer 1 and 2, and we now hope that it is clearer. We included a new analysis, in which we used all the datapoints recorded from the ingestible device and we performed a mixed models analysis with pH as dependent variable, type of video clips and number of datapoints (‘Time’) as fixed factors, and the by-subject intercepts as random effects. This analysis not only supported the results of the original one but provided evidence for a causal role of the emotional induction on the pH of the stomach. Results of this analysis are described in point 1.7 in the response to Reviewer#1 and results of the new analysis and the revised version of the main figure can be found in track change in the manuscript (Page 15&16, lines: 408-439) in the main text and copied and pasted below.
“To explore how the emotional induction could modulate the pH of the stomach and how the length of the exposure to that specific emotional induction could also play a role in modulating pH variations, we ran an additional model, Model 2. This model included all the pH datapoints registered using the Smartpill as dependent variable, the type of video clip and the number of the datapoints (“Time”) as fixed effects, and the by-subject intercepts as random effects (see Supplementary information for a detailed description of the model). Model 2 had a marginal R2 = 0.014 and a conditional R2 = 0.79. Visual inspection of the plots did reveal some small deviations from homoscedasticity, visual inspection of the residuals did not show important deviations from normality. As for collinearity (tested by means of vif function of car package), all independent variables had a GVIF^(1/(2*Df)))^2 < 10.
Type III analysis of variance of Model 2 showed a statistically significant main effect of the Time (F = 20.237, p < 0.001, Eta2 < 0.01) suggesting that independently from the type of video clip observed, the stomach pH significantly decreased as a function of the time of exposure to the induction. A significant main effect of the type of video clip was also found (F = 22.242, p < 0.001, Eta2 = 0.01) suggesting that pH of the stomach changes when participants experienced different types of emotions. In particular, post hoc analysis revealed that pH was more acidic when participants observed disgusting compared to fearful (t= -11.417; p < 0.001), happy (t= -15.510; p < 0.001) and neutral (t= -3.598; p = 0.003) video clips.
Also, pH was more acidic when participants observed fearful compared to happy (t= -4.064; p < 0.001), and less acidic compared to neutral (t= 7.835; p < 0.001) and sad scenarios (t= 9.743; p < 0.001). Finally, pH was less acidic when participants observed happy compared to neutral (t= 11.923; p < 0.001). and sad videoclips (t= 13.806; p < 0.001), see Fig.6, left panel. Interestingly, also the double interaction Time X Type of video clip was significant (F = 3.250, p = 0.0113, Eta2 < 0.01) suggesting that the time of the exposure to the induction differentially influenced the pH of the stomach depending on to the type of the observed video clip. Simple slope analysis showed that while pH did not change over time when observing disgusting (t= -1.2691; p = 0.2045) and happy (t= 0.4466; p = 0.6552) clips, it did significantly decrease over time when observing fearful (t= -4.4212; p < 0.001), sad (t= -2.0487; p = 0.0405) and neutral video clips (t= -2.7956; p = 0.0052), see Fig.6, right panel."
We believe that the new evidence reported provides support of our claims and we hope that the reviewer agrees with us. However, as we also mentioned in the paper, we are aware that replications are needed and we are already working on this.
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eLife assessment
This important study used a novel method to relate gastric acidity to subjective ratings of emotions induced by video clips. The findings are solid but could be strengthened by additional analyses and/or visualization. The findings have broad implications for the field of emotion research and opens new avenues of research for understanding psychosomatic disorders.
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Reviewer #1 (Public Review):
The work by Porciello and colleagues provides scientific evidence that the acidic content of the stomach covaries with the experienced level of disgust and fear evoked by disgusting videos. The working of the inside of the gut during cognitive or emotional processes have remained elusive due to the invasiveness of the methods to study it. The major strength of the paper is the use of the non-invasive smart pill technology, which senses changes in Ph, pressure and temperature as it travels through the gut, allowing authors to investigate how different emotions induced with validated video clips modulate the state of the gut. The experimental paradigm used to evoke distinct emotions was also successful, as participants reported the expected emotions after each emotion block. While the reported evidence is …
Reviewer #1 (Public Review):
The work by Porciello and colleagues provides scientific evidence that the acidic content of the stomach covaries with the experienced level of disgust and fear evoked by disgusting videos. The working of the inside of the gut during cognitive or emotional processes have remained elusive due to the invasiveness of the methods to study it. The major strength of the paper is the use of the non-invasive smart pill technology, which senses changes in Ph, pressure and temperature as it travels through the gut, allowing authors to investigate how different emotions induced with validated video clips modulate the state of the gut. The experimental paradigm used to evoke distinct emotions was also successful, as participants reported the expected emotions after each emotion block. While the reported evidence is correlational in nature, I believe these results open up new avenues for studying brain-body interactions during emotions in cognitive neuroscience, and future causal manipulations will shed more insight on this phenomena. Indeed, this is the first study to provide evidence for a link between gastric acidity and emotional experience beyond single patient studies, and it has major implications for the advancement of our understanding of disorders with psycho-somatic influences, such as stress and it's influence of gastritis.
As for the limitations, little insight is provided on the mechanisms, time scales, and inter-individual variability of the link between gastric Ph and emotional induction. Since this is a novel phenomena, it would be important to further validate and characterize this finding. On this line, one of the most well known influences of disgust on the gut is tachygastria, the acceleration of the gastric rhythm. It would be important to understand how acid secretion by disgusting film is related to tachygastria, but authors only examine the influence of disgusting film on the normogastric frequency range. Additionally, only one channel of the electrogastrogram (EGG) was used to measure the gastric rhythm, and no information is provided on the quality of the recordings. With only one channel of EGG, it is often impossible to identify the gastric rhythm as the position of the stomach varies from person to person, yielding inaccurate estimates of the frequency of the gastric rhythm. Finally, I believe that the results do not show evidence in favor of the discrete nature of emotions theory as they claim in the discussion. Authors chose to use stimuli inducing discrete emotions, and only asked subjective reports of these same discrete emotions, so these results shed no light on whether emotions are represented discretely vs continuously in the brain.
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Reviewer #2 (Public Review):
To measure the role of gastric state in emotion, the authors used an ingestible smart pill to measure pH, pressure, and temperature in the gastrointestinal tract (stomach, small bowel, large bowel) while participants watched videos that induced disgust, fear, happiness, sadness, or a control (neutral). The study has a number of strengths, including the novelty of the measurement (very few studies have ever measured these gut properties during emotion processing) and the apparent robustness of their main finding (that during disgusting video clips, participants who experienced more feelings of disgust (and to a lesser degree which might not survive more stringent multiple comparison correction, fear) had more acidic stomach measurements, while participants who experienced more happiness during the disgusting …
Reviewer #2 (Public Review):
To measure the role of gastric state in emotion, the authors used an ingestible smart pill to measure pH, pressure, and temperature in the gastrointestinal tract (stomach, small bowel, large bowel) while participants watched videos that induced disgust, fear, happiness, sadness, or a control (neutral). The study has a number of strengths, including the novelty of the measurement (very few studies have ever measured these gut properties during emotion processing) and the apparent robustness of their main finding (that during disgusting video clips, participants who experienced more feelings of disgust (and to a lesser degree which might not survive more stringent multiple comparison correction, fear) had more acidic stomach measurements, while participants who experienced more happiness during the disgusting video clips had a less acidic (more basic) stomach pH. Although the study is correlational (which all discussion should carefully reflect) and is restricted to a moderately-sized, homogenous sample, the results support their general conclusion that stomach pH is related to emotion experience during disgust induction. There may be additional analyses to conduct in order for the authors to claim this effect is specific to the stomach. Nevertheless, this work is likely to have a large impact on the field, which currently tends to rely on noninvasive measures of gastric activity such as electrogastrography (which the authors also collect for comparison); the authors' minimally-invasive approach yields new and useful measurements of gastric state. These new measures could have relevance beyond emotion processing in understanding the role of gut pH (and perhaps temperature and pressure) in cognitive processes (e.g. interoception) as well as mental and physical health.
-
Reviewer #3 (Public Review):
This study used novel ingestible pills to measure pH and other gastric signals, and related these measures to self-report ratings of emotions induced by video clips. The main finding was that when participants viewed videos of disgust, there was an association between gastric pH and feelings of disgust and fear, and (in the opposite direction) happiness. These findings may be the first to relate objective measures of gastric physiology to emotional experience. The methods open up many new questions that can be addressed by future studies and are thus likely to have an impact on the field.
My main concern is with the reliability of the results. The study associates many measures (pH, temperature, pressure, EGG) in stomach, small bowel, and large bowel with multiple emotion ratings. This amounts to many …
Reviewer #3 (Public Review):
This study used novel ingestible pills to measure pH and other gastric signals, and related these measures to self-report ratings of emotions induced by video clips. The main finding was that when participants viewed videos of disgust, there was an association between gastric pH and feelings of disgust and fear, and (in the opposite direction) happiness. These findings may be the first to relate objective measures of gastric physiology to emotional experience. The methods open up many new questions that can be addressed by future studies and are thus likely to have an impact on the field.
My main concern is with the reliability of the results. The study associates many measures (pH, temperature, pressure, EGG) in stomach, small bowel, and large bowel with multiple emotion ratings. This amounts to many statistical tests. Only one of these measures (pH in the stomach) shows a significant effect. Furthermore, the key findings, as displayed in Figure 4 do not look particularly convincing. Perhaps this is a display issue, but the relations between stomach pH and Vas ratings of disgust, fear, and happiness were not apparent from the scatter plot and may be influenced by outliers (e.g., happiness).
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