5. DIGESTION Flashcards
This module covers: • Digestion and its influences on health and other body functions. • The different areas and organs of the digestive system, including their anatomy and functions. • How food is digested and how the different macronutrients are acted on by digestive juices. • The gut-brain connection and the microflora. • How digestion can be impaired and supported. • Digestion and energetics. • Naturopathic signs of poor digestive health.
1
Q
Explain the three functions of the digestive system
A
1. Digestion
* Mechanical digestion (i.e., chewing, peristalsis).
* Chemical digestion (gastric juices, pancreatic enzymes, bile and enterocyte enzymes).
2. Absorption
* Primarily in the small intestine.
* Absorption into the blood and lymph.
3. Excretion
Waste materials (including toxins acted on by the liver) are excreted via the intestines as faeces.
Elimination also occurs via the urine, skin and lungs.
2
Q
What is digestion?
A
The process of breaking down food by mechanical and chemical action (in the digestive tract) into substances that can be used by the body.
View as NP: See the digestive system as the one responsible for transforming the foods ingested into the crucial nutrients, that can nourish the cells and the tissues of the body.
3
Q
Give two examples of mechanical and chemical digestion
A
Mechanical: Chewing, peristalsis
Chemical: gastric juices, pancreatic enzymes, bile, enterocyte enzymes
4
Q
Where does absorption mainly occur?
A
- Primarily in small intestine (90%)
- Absorption into the blood (water soluble) and lymph (fat soluble)
poor digestion leads to poor absorption!
5
Q
Name four organs of elimination
A
- Intestines
- Bladder
- Skin
- Lungs
As a NP, optimize them!
6
Q
Name four accessory organs of the digestive system
A
- salivary glands
- pancreas
- liver
- gall bladder
- biliary tract
7
Q
Which enzyme is released by the salivary glands?
A
Salivary amylase
8
Q
What is the optimal pH for salivary amylase and what does it break down?
A
It has a pH of 6.8 and breaks down polysaccharides found in starchy foods, into smaller sugar units.
3D shape is important for the function
Saliva contains also IgA for defence.
9
Q
Suggest two things that help digestion in the mouth
A
- Chewing up to 20 times
- Avoid drinking during meals
“the stomach has no teeth”
10
Q
Give 4 examples of factors that can impair the functionality of salivary amylase
and lower the pH in the mouth
A
- Heavy metals (dental amalgams)
- refined sugars
- meat
- dairy
- chewing gum
- processed foods
- cigarettes
- alcohol
- chronic stress
Urin and saliva are outputs of the body for excess of acidity.
11
Q
What happens when food enters the stomach?
Food entering the stomach = bolus
A
The hormone gastrin is released and the enteric nerves are stimulated.
Both stimulate the peristalsis of the stomach (churning) –> release and formation of gastric juice with HCl (from the parietal cells) and the digestive enzymes (lipase and pepsinogen) from the chief cells.
NSAID: by inhibiting prostaglandin production, they reduce the mucus production , –> lining of stomach damaged by HCl.
12
Q
Name four anatomical parts of the body that form part of the digestive tract
A
- mounth
- pharynx
- oesophagus
- stomach
- small and large intestine
13
Q
What does gastric juice contain?
A
HCI and digestive enzymes (lipase and pepsinogen)
14
Q
Name the two enzymes released from the stomach wall and explain their functions
A
(from inactive pepsinogen ) Pepsin breaks down protein and Gastric lipase breaks down lipids
HCl transforms Pepsinogen in Pepsin.
15
Q
Name four substances absorbed in the stomach which go directly to the liver via the portal vein.
A
- Water
- alcohol
- iodine
- fluoride
16
Q
What’s the pH of HCI?
A
2-3
17
Q
Which mineral and which vitamin are required for the production of HCI? Name two food sources for each.
A
- Zinc (oysters / pumpkin seeds/fish, meat, eggs)
- Vitamin B6 (Walnuts / sunflower seeds/green veggies/avocado, fish)
18
Q
What are the actions performed by stomach acid
A
- Breaks down proteins and lipids into chyme
- The acid of the chyme further triggers peptide cholecystokinin (CCK), which activates the gallbladder and the pancreas to release pancreatic juice and bile into duodenum
- eliminates micro-organisms such as bacteria, viruses and fungi, protecting against infection.
NB: Iron and Calcium need stomach acid to be ionised
19
Q
Name four possible causes of low stomach acid
A
- Chronic stress
- chronic H. pylori
- autoimmune gastritis
- low Vit B6 and Zinc
- Ageing
- Medications such as PPI
20
Q
How does low stomach acid typically present?
A
- Bloating, belching and flatulence within 1-2 h after eating
- abdominal pain and fullness after eating, with foul-smelling stools or floating stools
- Nails are brittle, thin, easy breaking
- Get nauseous after supplementing
Test: first thing in the morning, 1/2 teaspoon of bicarbonate soda in a glass water , swallow: - if audible belching within 2-3 minutes, ok. If early and repetitive, excess ; if no belching within 3 min, low stomach acid.
21
Q
Detail three ways in which low stomach acid can impair digestion
A
- Poor protein digestion, leading to putrefaction and polyamines, implicated in colorectal cancer
- Undigested food allows bacteria to proliferate in the small intestine, causing SIBO
- Reduced gastric activity results in less intrinsic factor, compromising Vit B12 absorption.
22
Q
Name 5 ways of increasing stomach acid
A
- Apple cider vinegar in a little water before meals.
- Bitter herbs and foods taken 15-20 minutes before meals stimulate stomach acid release. (Herbs: Gentian, Barberry bark, Andrographis, Dandelion, Goldenseal. Foods: rocket, chicory, artichoke and watercress).
- Zinc (meat, Fish, eggs, Rice, Pumpkin seeds) and Vit B6 (Organ meat, Poultry, Tuna, Salmon, Chickpeas)-rich foods.
- Avoid over-eating and ensure meals are relaxed (eat mindfully). Avoid processed foods.
- A diet rich in fruit & vegetables.
- Eat fermented vegetables (e.g. sauerkraut).
- Himalayan and sea salt provide the chloride for HCl (and cayenne pepper).
Bitters are colding foods. Gentian: not in ulcers; berberine in barverry dark good for SIBO; apple cider vinegar with the mother (unfiltered and unpasteurised) Warm foods acting on the gastric juices: ginger, cardamome, fennel.
23
Q
What is CCK and what triggers its release?
A
CCK (Cholecystokinin) is a hormone released from the duodenal wall, triggering the release of pancreatic juice and bile.
Its release is triggered by the initial presence of the acidic chyme in the duodenum, meaning that low stomach acid can ultimately significantly impair digestion.
24
Q
What is the pH of chyme and how is it neutralised?
A
Chyme has a pH of about 2. It is usually acted upon quickly by bicarbonate, which is secreted by the pancreas and liver. This neutralises chyme and creates a pH of about 6.5 in the duodenum.
Chyme is formed in the stomach
25
90% of nutrient absorption takes place in the small intestine.
Name the three regions of the small intestine and what characteristically happens in each.
1. **Duodenum** (30cm) – most digestion occurs here, aided by the influx of pancreatic juices and bile. Some vitamins and minerals are absorbed, too.
2. **Jejunum** (2.5m) – most absorption occurs here, i.e. sugars, fatty acids, amino acids, vitamins.
3. **Ileum** (3.5m) – vitamin B12 is absorbed.
26
Which structures in the small intestine creates a vast surface area to aid digestion?
Villi and microvilli
27
‘Brush border enzymes’ are attached to the small intestinal lining and break double-chained carbohydrates and proteins, allowing them to be absorbed. Name four and state their specific functions.
* **Maltase, Sucrase & Lactase:** *Breaks down sugars into glucose, fructose, galactose, etc.*
* **Dipeptidase:** *Breaks down proteins into amino acids.*
28
# Complete:
------------- and ----- ---- enter the blood capillaries of the small intestine to be sent to the liver.
Carbohydrates
amino acids
29
# Complete:
----- ----- including fat-soluble vitamins are digested in the small intestine and enter --------- -----------.
Fatty acids
lymphatic capillaries
30
What is the key exocrine function of the pancreas?
The key exocrine function of the pancreas is to produce enzymes that digest carbohydrates, proteins and fats. These enzymes are secreted into the small intestine.
31
How much pancreatic juice is produced daily?
1.2-1.5L
32
Name three pancreatic enzymes and what they digest.
* Pancreatic Amylase: carbohydrate-digesting.
* Pancreatic Lipase: fat-digesting.
* Proteases (trypsin, chymotrypsin): protein-digesting.
## Footnote
Summary of digestive enzymes slide 22
33
What can result from poor pancreatic enzyme production?
Foods ferment in the intestines, resulting in symptoms such as bloating, flatulence and abdominal pain about 1 hour after eating. The lack of digestion can also lead to weight loss.
## Footnote
Same symptoms as candida overgrowth. So how to differentiate ? with a Comprehensive Digestive Stool Analysis (CDSA)
34
What are the consequences of over-eating?
* When eating often and too much, digestive enzymes are used up.
* Not all food can then be digested, resulting in malnutrition and bodily dysfunctions.
* Organs such as the pancreas and stomach are placed under stress.
* Energy is directed away from healing & repair, increasing the risk of disease.
35
Name three ways that can help to support the digestive system
– Do not eat more than 3 meals a day.
– Avoid over-eating and snacking between meals.
– Don’t drink with meals.
## Footnote
Nutritious diet : 10% of energy expenditure to digest it; 50% necessary when dense forms of proteins (meat, soya and junk food) are eaten.
36
Explain Bernard Jensen's findings
* Bernard Jensen found that undigested materials are stored in the mucus-secreting lining of the intestines, impairing the absorption and delivery of nutrients to body tissues.
* This would create an optimal environment for parasites and candida to flourish, as well as under-nourishing body tissues and organs.
## Footnote
Support detox is key to aid the body's elimination. Intermittent fasting to minimise the digestive system load is also important. Jensen recommended also vegetable broths.
37
What did Jensen suggest to support the digestive system?
* Detoxification
* intermittent fasting
* vegetable broths
38
What is the function of the gallbladder?
Storage and release of bile which is produced by the liver.
39
What are the main components of bile?
Bile consists mostly of water, as
well as bile salts , cholesterol and bilirubin.
## Footnote
Bilirubin gives the colours to the stool, it's a waste product from haem (haemoglobin)
40
**Describe the function of bile in relation to:**
1. Fat Emulsification
2. Detoxified liver products
3. Peristalsis
4. Cholesterol
1. Bile breaks lipids into smaller molecules, increasing the surface area for digestion by pancreatic lipase.
2. The liver excretes detoxified harmful materials into bile to be excreted.
3. Bile stimulates intestinal peristalsis.
4. Bile contains excess cholesterol that the body wishes to excrete.
## Footnote
A poor bile flow means an impaired capacity to eliminate waste of the liver into the digestive system (bowel) and all th abilities cited above impaired...
41
What is carried by the pancreatic duct?
Pancreatic enzymes and bile
42
What is the result of poor bile flow?
Poor bile flow negatively affects fat digestion and the body’s ability to eliminate toxins via the bowel.
43
What can be used to stimulate the release of pancreatic juice and bile?
Bitters
(such as gentian, dandelion, milk thistle, golden seal, artichoke leaves)
44
What is the production and release of bile and pancreatic juice dependent on?
Sufficient water consumption
## Footnote
but also for the release, dependent on the acidic drive of the chyme and CCK (Choleocytokinin).
45
How many liters of blood does the liver filter per minute?
1.4L
46
What substances are stored by the liver?
Carbohydrates (in form of glycogen), fats, iron, Vit A, D, E, K and B12
47
Name two functions of the liver other than storage.
* Detoxification and deactivation of hormones;
* creates bile,
* produces albumin;
* produces heat for the body
## Footnote
TIREDNESS will be a key symptom, if the liver can not do its functions.
48
What can impair liver detoxification?
- Lack of nutrients,
- trans fats,
- heavy metals,
- alcohol,
- caffeine
- and pesticides
49
Outline Phase I Liver Detoxification
* Volatile toxins are converted into smaller substances that are water soluble (important to excrete them).
* CYP450 enzymes create an active binding site on the toxin / hormone so that it can be conjugated (in phase II).
* On completion of phase I, toxins are oxidised and free radicals are formed. These must be neutralised by anti-oxidants (Vit A, C and E) to protect against oxidative damage.
## Footnote
Needed in P.I: Milk thistle, glutathione, anti-ox, B vit and flavonoids.
50
Outline Phase II Liver Detoxification
Conjugation phase:
* Reactive toxins are made safe and excretable by conjugation with a chemical group.
* The bound toxins are then pumped into the blood or bile for excretion mostly via the kidneys or bowels, but also sweat and exhalation.
* The key antioxidant for neutralising free radicals
in the liver is glutathione, which is a tripeptide formed from cysteine, glycine and glutamine.
*Nutrients including sulphur (e.g., garlic and onions), magnesium, B vitamins are required for phase II. Whilst herbs such as dandelion, milk thistle and liquorice root support liver detoxification.
## Footnote
Hg (teeth?) is a pb: it deposits in the liver
Selenium (found in Brasil Nuts) crucial for prod of glutathione peroxidase.
51
Which nutrients are required for Phase ll liver detoxification?
* Sulphur (garlic and onions),
* magnesium
* and B vitamins
## Footnote
Add garlic only at the end of the cooking and gepressed for having allicin
52
Which herbs support liver detoxification?
* Dandelion,
* pepper
* shallots
* ginger
* milk thistle
* and liquorice root
53
Which tripeptide is the key antioxidant for neutralising free radicals in the liver? Which three amino acids is it formed from?
* Glutathione
* Formed from cysteine, glycine and glutamate
54
Where does the final stages of digestion and absorption occur?
Large intestine
| Water as well as some minerals and vitamins are absorbed.
## Footnote
Mucus (from goblet cells) lubricates the lining of large intestine, but no digestive enzymes are released there.
55
Describe the four regions of the large intestine
1. **Caecum** – attached to appendix (twisted tube about 8cm long, almost entirely formed of immune tissue in its wall (macrophages, lymphocytes) which acts as a key reservoir for beneficial gut bacteria.
2. **Colon** – ascending, transverse, descending regions.
3. **Rectum** – pushes stool into anal canal.
4. **Anal canal** – contains an involuntary internal anal sphincter and voluntary external anal sphincter.
## Footnote
Appendix: breeding ground for the microflora, heps with development of good bacteria, a lot of GALT around, area for immune defense and regulation of microflora.
56
Where are nutrients absorbed?
The most absorption occurs in the small intestine , especially in the jejunum.
## Footnote
It is also the part affected by coeliac . Csqces : malabsorption with coeliac and if they eat gluten.
57
What is absorbed in the STOMACH?
* Water,
* Ethyl alcohol (only stomach)
* Copper (Stomach and Duodenum)
* Iodide (only stomach)
* Fluoride (only stomach)
* Molybdenum (stomach and jejunum)
| pH 1-3
58
What is absorbed in the DUODENUM?
* Vit A,D,E,K
* Biotin B7
* Folate B9
* Niacin B3
* Riboflavin B2
* Thiamin B1
* Calcium
* Copper ( only stomach and duodenum)
* Iron
* Magnesium
* Phosphorus
* Selenium (only dudodenum)
| pH goes from 1-3 with the chyme till 6-8 when the bicarbonate has done i
59
What is absorbed in the JEJUNUM?
everything, except : copper, selenium, vitamin B12 and others found exclusively in Stomach, in Ileum or large intestine.
| pH: 5-7
60
What is absorbed in the ILEUM?
* vitamin C
* vit B9 (folate)
* vit B12 (only ileum)
* vit D
* vit K
* Magnesium
* bile salts and acids
| pH 5-7
61
What is absorbed in the LARGE INTESTINE?
* Sodium
* chloride
* potassium
* vit K2
* Biotin B7
* Short fatty chain acids
| pH 5-7
62
Where is GALT found and what does it contain?
Gut associated Lymphoid Tissue is found in GIT wall and houses leukocytes (macrophages and lymphocytes).
63
What is the function of the leukocytes in the GALT?
Identification of microbes through close interaction with bacterial surface antigens (identity markers)
64
Providing immune defence, what is secreted into the GIT mucosa and is reduced during periods of stress?
Secretory IgA
## Footnote
s. notes done page 36bis of slides.
65
What are the functions of the microflora?
* **Final stages of nutrient extraction** through microbial fermentation
* **Fermentation of carbohydrates** (creating methane & hydrogen), if in excess, it's due to poor digestion
* **Fermentation of amino acids** (creates hydrogen sulphide). If gas in excess with strong odour, it's a sign of poor digestion
* **Synthesis of vitamins** such as Biotin and K2.
* **Supports intestinal barrier:** Bacteria produce short-chain fatty acids from fibre they ingest, that is then used by enterocytes. Protective against leaky gut.
* **Pathogen protection:** Out-competes for attachment to the intestinal epithelium and nutrients (e.g. against candida).
* **GALT:** Crucial for effective functioning of the immune system.
* **Appetite-regulating** proteins are produced by bacteria (satiety) .
* **Mood Regulation:** The microflora can synthesise neurotransmitters (Bach Therapy by Edward Bach). Connection gut-brain through microflora.
66
Name five things that can damage the intestinal barrier, possibly causing 'leaky gut'?
* **Poor nutrition**: hydrogenated & trans-fats, refined sugars (inflammation +++), processed foods / junk foods, refined wheat or gluten.
* **Heavy metals** (e.g. mercury, lead, aluminium), pesticides, herbicides and cleaning toxins, etc.
* **Drugs**: Corticosteroids, NSAIDs, antibiotics, vaccinations (s. note).
* Excessive **stress**.
* **Dysbiosis and candida overgrowth**. When candida is growing, its filaments pull the cells apart
* **Alcohol and smoking**.
* **Radiation and chemotherapy**, as every 5-7 days the intestinal epithelium replaces itself.
* Early **weaning** (<6 months).
* **Zonulin**: marker for gut permeability, discovered in 2000. It disassembles the transmembrane proteins.
## Footnote
s. side effects of drugs in Case Taking File Excel Table
67
As well as poor nutrition, name two things that could negatively alter the colonies of bacteria in the large intestine, causing them to become pathogenic?
* Chronic stress
* Diabetes
* Medications (e.g. antibiotics, antacids)
* Lack of digestive secretions (e.g. stomach acid, bile)
68
How could 'leaky gut' be implicated in an inflammatory condition?
Bacterial toxins can cross the intestinal wall if the barrier has been impaired. This can create a systemic inflammatory response.
69
Describe the term 'dysbiosis'
‘Dysbiosis’ is an imbalance in the colonies of the bowel flora, leading to a disruption in health.
## Footnote
is having an overgrowth of pathogenic strains of bacteria
70
What can indicate poor digestion as a result of bacterial action?
Excess flatulence with strong odour
71
Which vitamins are synthesised by the microflora?
Biotin and vitamin K2
72
Explain how the microflora supports the intestinal barrier
The enterocytes use short-chain fatty acids produced by bacteria, which helps maintain the tight junctions.
73
What happens when the GI mucosal membrane surface is damaged?
Tight junctions become “leaky", allowing undigested proteins to enter circulation.
74
What happens when cell membranes of gut bacteria abnormally enter the blood?
Excessive immune response, potentially leading to allergies and autoimmunity
75
Name four possible causes of "leaky gut"
* Poor nutrition
* heavy metals
* drugs
* excessive stress
* dysbiosis and candida overgrowth
* alcohol
* smoking
* radiation / chemotherapy
* early weaning
76
Which pathologies could be associated with dysbiosis or appear as consequences of dysbiosis?
* Vitamin, mineral, amino acid insufficiencies.
* Malabsorption of carbohydrates and fats.
* Inflammatory Bowel Diseases (e.g. Crohn’s)
* Colorectal cancer.
* Alzheimer’s and Parkinson’s.
* Autoimmunity
*Allergies and intolerances.
* Obesity and mood disorders.
77
Name the effects of eating junk food
* Gut dysbiosis --> inflammation, reduced immune function, “leaky gut”.
* “Spikes” in blood glucose --> excess insulin production, increased risk of T2D, Obesity, PCOS, Acne.
* Increased blood pressure & cardiovascular disease (atherosclerosis).
* Deficiencies in vital vitamins and minerals.
* Addictive eating behaviour, mood swings.
78
Who developed the 'Germ Theory of Disease' and what does it propose?
Louis Pasteur (1822 – 1895) developed the ‘Germ Theory of Disease’, which holds microbes such as bacteria responsible for disease. He said “germs cause disease” and proposed that disease occurs from outside of the body.
79
What is the 'Terrain Theory' and who developed it?
Antoine Béchamp (1816 – 1908) developed the Terrain Theory, which holds that it is not the microbes, but the internal environment that is responsible for disease.
He said that “germs were ‘opportunistic’ in nature & lived with us symbiotically”.
To prevent illness, he advocated not to ‘kill’ germs but to promote health (i.e. through diet, exercise etc.)
80
What is the Migration Motor Complex and its role?
A distinct pattern of electromechanical activity in the smooth muscle between the stomach and distal ileum during the periods between meals.
It sweeps residual undigested material through the digestive tube.
81
How does the MMC operate and how can it be supported?
Opening the pyloric sphincter and increasing gastric, biliary and pancreatic secretions. The secretions aid in the cleansing and also in preventing SIBO.
Avoid over-eating/ leaving longer gaps between meals/ chew better / intermittent fasting/ optimise sleep/pro-kinectics before meals / diaphragmatic breathing exercises/stress management.
| pro-kinetics: ginger, artichoke, haritaki, gotu kola.
## Footnote
Nervines: ashwagandha
82
What are the two key elements for the elimination of waste from the body?
Water and fibre
(optimised with aloe vera, psyllium husk, linseeds)
## Footnote
Constipation: flaxseeds grounded , prune juice (together for the night in the fridge), Mg Citrate, no refined sugars, drink aloe juice
83
What is known as the "brain of the gut"? Describe it.
The enteric nervous system.
It consists of two nerve plexuses - myenteric and submucosal plexus.
84
What regulates the enteric nervous system?
The autonomic nervous system
85
What does the myenteric plexus govern?
GIT peristalsis
86
What does the submucosal plexus control?
Release of digestive secretions such as gastric juice and digestive enzymes
87
How does the parasympathetic system influence the enteric nervous system?
Increases muscular activity as well as glandular secretions in the GIT
88
How does the sympathetic nervous system influence the enteric nervous system?
Decreases muscular activity and decreases glandular secretions
89
What does the Vagus Nerve connect and where it is located?
When is Vagus Nerve activity suppressed?
Connects brain and gut and extended from the head through the thorax and diaphragm to digestive organs.
During chronic stress
| vagus nerve= 10th cranial nerve
## Footnote
Activity of vagus is enhanced with diaphragmatic breathing. Stool that floats = poor fat digestion.
90
Which plexuses does the vagus nerve stimulate?
Myenteric and submucosal plexus.
91
What connection do the brain and gut have?
Develop from the same part of human embryonic tissue and share many nerve endings and neuro transmitters.
Nearly every chemical that controls the brain has been identified in the GIT.
92
What neurotransmitter plays a role in peristalsis, secretion and sensation?
Serotonin
93
What percentage of serotonin is produced in the GIT?
95%
| Tryptophan precursor + Zn Mg Vit Bs needed to produce serotonin.
## Footnote
Association with mood. This could explain a possible link between poor gut health and depression, migraines,..
94
Which dietary habits compromise digestion?
* Swallowing w/o chewing properly
* Eating junk food and refined sugars
* Excessive protein & soya
* Drinking whilst eating
* Overeating and snacking
* Drinking coffee
* Chronic stress
* Nutritional deficiency
## Footnote
When clients drink coffee, always asking when do they do that?
95
What is mindful eating?
Whilst eating notice your thoughts, feelings and sensations
| Mindful about how and what you eat.
96
Coaching for mindful eating
* Do you think about WHY you eat? (which emotions are triggering your eating?)
* Do you eat only when you are hungry?
* or is it out of BOREDOM?
* What are your thoughts, feelings and sensations? before and after
* And also how full are you?
* Is WHAT you are eating HEALTHY?
* How does it look, smell and taste and feel?
* how was the food processed, stored?
* was it grown organically?
97
What are the implications of poor digestion and absorption?
Less nutrient absorption, fermentation of undigested food, increased toxaemia, and the retention of undigested materials
| toxaemia: toxins in blood -
polyamines created --> colorectal cancer
98
* What molecule is dietary vitamin B12 bound to?
* On the presence of which substances is this dependent?
* R-Protein, released by the salivary glands in the saliva (it prevents the B12 from being destroyed by the gastric acid)
* it is dependent on the presence of pepsin and stomach acid.
99
What are pancreatic proteases?
Protein digesting enzymes
## Footnote
they digest the R-protein and hence release B12.
100
Where is vitamin B12 - intrinsic factor complex (IF-B12) absorbed?
## Footnote
IF is produced in the stomach by the parietal cells.
The terminal ileum
## Footnote
poor gastric and pancreatic function or damage to the ileum impair B12 absorption
101
When a patient is vit B12 deficient, where could it come from?
* Diet
* saliva (R protein)
* parietal cells (IF)
* gastric acidity
* pancreatic enzymes
* ileum
102
What is produced in the liver from dietary fats and is needed to synthesise vitamin D?
Cholesterol
103
What element is a co-factor for the conversion of vitamin D in the liver and kidneys?
Magnesium
## Footnote
Alcohol and drugs impair this process.
104
How to increase vit D in the body?
* 10-20 min of daily sun exposure
* eat D3 rich foods (oily fish) or
* eat D2 rich plant based food such as shiitake mushrooms
* avoid alcohol, coffee, drugs and refined sugars
## Footnote
when sun at the highest and shadow of the body shorter than the height
105
Outline the functions of Vitamin D3 in the digestive tract
* Vitamin D3 acts on the digestive sytem to increase the intestinal absorbtion of calcium and phosphorus.
* Vitamin D maintains calcium balance in the body, in conjunction with Vitamin K2, which controls utilisation of calcium (depositing it in bones) by stimulating osteocalcin.
* vit K2 is produced in microflora
* 70-80% of ingested calcium is absorbed in the ileum.
* Vitamin D helps regulate bacterial species in the intestines.
## Footnote
Deficiency in vit D --> imbalance of the intestinal flora, IBD, link with auto-immune diseases.
106
What is needed for the absorption of vitamin D?
Healthy fats
107
Name four anti-oxidants absorbed from foods that protect cells against free radicals / oxidative damage.
| Link between healthy digestive system and cellular health
* Beta-carotene
* Vitamin C
* Vitamin E
* Quercitin
A body that is poorly detoxifying and eliminating wastes can increase the toxic burden on cells, disrupting the cellular functions.
DNA can be damaged leading to mutations
## Footnote
important for neutralisation of free radicals, and for detoxification.
108
Which organ neutralises a large number of free radicals through detoxification?
The liver
109
Where are the amino acids and minerals absorbed which are required for collagen synthesis?
| Link between healthy digestive system and bone health
The small intestine
110
How could dysbiosis lead to osteoporosis?
| Link between healthy digestive system and bone health
* The small intestine is responsible for the absorption of key minerals and amino acids required to build the collagen (protein) matrix of bone.
* The intestinal microflora also produce vitamin K2, which causes calcium deposition in bones.
* Dysbiosis disturbs this balance, resulting in osteoporosis.
## Footnote
If an osteoporotic patient comes to the praxis, think K2 and weight-bearing exercises.
111
Which nutrients are required to support muscle health?
| Link between healthy digestive system and muscle health
* **Calcium** - for muscle contraction.
* **Magnesium** - for muscle relaxation.
* **Iron** -to help deliver oxygen to the muscle.
* **Sodium & potassium** - for nerve stimulation of muscles.
* **Amino Acids** - for muscle growth and maintenance.
112
How does poor digestive health negatively impact muscles and vice versa?
| Link between healthy digestive system and muscle health
- Poor digestive health results in poor delivery of essential nutrients, leading to muscle weakness, aching, cramping, fatigue and pain.
- Muscle health is also crucial in supporting digestive health: Diaphragmatic movements provide a visceral massage on the abdominal digestive organs and stimulate the release of serotonin, promoting digestion and hence nutrient absorption.
113
To which molecule in red blood cells is almost all oxygen bound?
| Link between healthy digestive system and cardiovascular health
haemoglobin
114
Which foods are known as 'blood builders' and why?
| Link between healthy digestive system and cardiovascular health
Due to chemical similarities with haemoglobin, Chlorophyll-rich foods (green leafy vegetables, chlorella, spirulina, etc.) can be used as ‘blood-builders’ as they nourish the blood.
## Footnote
Chlorophyll and haemoglobin have the same structure, the only difference is the heart: RBC have an IRON heart while the chlorophyll have an MAGNESIUM heart.
115
How is digestive health linked with cardiovascular and mitochondrial health?
| Link between healthy digestive system and cardiovascular health
## Footnote
Thnk Iron
- Good digestive health is crucial to support the effective absorption of iron. Stomach acid is particularly important for this process, whilst the presence of vitamin C also aids absorption in the small intestine into the blood.
- Oxygen transport (using the key mineral ‘iron’), is crucial for cells to produce energy aerobically.
116
Which vitamin aids the absorption of iron ?
| Link between healthy digestive system and cardiovascular health
Vitamin C
117
What is the strict range of pH that must be maintained in the blood and what can challenge this?
| Link between healthy digestive system and cardiovascular health
* The blood must maintain a strict range of pH between 7.35 and 7.45 to keep the body alive.
* This is challenged by excess acidity, toxins, poor nutrition (refined sugars), chronic stress and limited movement / exercise.
## Footnote
The acidic burden is balanced by alkalising minerals.
Should the mineral supply via food fall short, minerals are taken from storage sites such as bones, muscles, gums and arteries.
This can lead to osteoporosis, cellulite, cramps and receeding gums.
118
Which hormones are released from the GIT epithelial cells and what do they stimulate?
| Link between digestive health and endocrine health
* **CCK** - stimulates pancreatic juice and bile flow & stimulates sense of satiety (fullness)
* **Gastrin** - stimulates gastric activity
* **Ghrelin** - stimulates hunger from the stomach.
119
What hormone is released in response to the ingestion of carbohydrates?
| Link between digestive health and endocrine health
Insulin
| Prepare for the absorption and storage of sugars.
120
Which nutrients, reliant on good digestive health for absorption, are needed to produce thyroid hormones?
| Link between digestive health and endocrine health
iodine, tyrosine, selenium and zinc
121
Which nutrients must we be able to digest and absorb to enable nervous system electrical activity?
| Link between digestive health and nervous system health
Sodium (Na+), Potassium (K+), Chloride (Cl-) and Calcium (Ca2+) ions.
122
Which vitamin is important for Ca2+ absorption?
| Link between digestive health and nervous system health
Calcitriol (vitamin D)
123
How does the digestive system impact on the neurotransmitter 'dopamine'?
| Link between digestive health and nervous system health
The digestive system is responsible for absorbing substances required to manufacture neurotransmitters. Dopamine requires: Tyrosine, Fe, B1, B3 and B6
Tyrosine : chicken, turkey, fish, peanuts, almonds, avocados, bananas, pumpkin seeds, and sesame seeds
Iron: (Red Meat, liver, Edamame Beans, Spinach, Pumpkin seeds, Lentils)
B1: (Pork, Fish, Beans, lentils, Green peas, cauliflower, oranges, potatoes, asparagus, and kale )
B3: (Red meat: beef, beef liver, pork, Poultry, Fish.
Brown rice, Nuts, seeds, Legumes, Bananas Avocado and Mushroom)
B6: (Beef liver, Tuna, Salmon, Poultry, Chickpeas, Raw Bananas, Avocados)
124
Why is the absorption of Vitamin B12 crucial for the nervous system?
| Link between digestive health and nervous system health
- Vitamin B12 myelinates neurons – increasing their speed of conduction.
- Poor digestive health results in less mineral and B12 absorption, impairing nerve activity which potentially results in symptoms such as in tingling, numbness, loss of balance and pain.
125
What are three areas of consideration when aiming to create a healthy 'terrain' where cancer cannot take hold
* **Dietary and lifestyle factors** affect the environment that we bathe our genes in.
* **Good nutrition, as well as a healthy digestive system** and lifestyle nourishes the body on a cellular level.
* **Well functioning detoxification and elimination pathways** are important to support this healthy terrain, by preventing the accumulation of toxins in body tissues.
126
# Complete:
‘Genes load the ____ and the environment pulls the ____’
gun
trigger
127
What kind of terrain do cancer cells thrive in?
1. **An acidic environment:** Red meats, processed foods, dairy, refined sugars, table salt and smoked foods create acidity in body tissues.
2. **An anaerobic environment:** “Lacking oxygen”. Consider stress, poor breathing mechanics
(upper rib breathing), poor nutrition, lack of exercise.
3. **A glucose-rich terrain:** Refined sugars fuel cancer cells. Malignant cells are dependent on glucose for their own metabolism.
128
# TRUE OR FALSE:
90-95% of cancers are attributed to genetics.
**False**
*90-95% of cancers are attributed to the environment and lifestyle.*
129
List five environment and lifestyle risk factors for cancer.
- Chronic inflammation (i.e. a disease / lifestyle-induced).
- Radiation (e.g. medical, microwaves, phones).
- Compromised detoxification and elimination pathways (e.g. liver dysfunction).
- Chronic stress and obesity.
- Smoking and alcohol.
- Medications e.g. antibiotics, immunosuppressants.
- Heavy metals (e.g. aluminium, mercury, lead).
- Cosmetics (e.g. parabens).
130
List five dietary risk factors for cancer.
* Low fruit/vegetable intake (a low antioxidant diet).
* Red meats - mostly non-grass-fed/non-organic, with a higher risk if charcoal cooked/smoked & at high temperatures).
* Burnt starchy food - produces ‘acrylamides’.
* Low fibre - high in phytochemicals, fibre clears toxins & hormones such as oestrogen through the bowel.
* N-nitroso compounds - e.g. cured meats.
* Refined sugars - feed and promote growth of cancer cells (and increase acidity). Especially concentrated fructose, e.g.
pasteurised fruit juices, High Fructose Corn Syrup (HFCS), etc.
* Dairy (especially cow’s) - pro-inflammatory & contain IGFs
(insulin-like growth factors) that promote tumour growth.
* Table salt, pesticides, artificial sweeteners.
131
* What is Energetics?
* What happens when there is blockage of insuffiency in the vital force?
| Energetics
## Footnote
Vital force=Qi (TCM) Prana(Ayurveda), healing power of nature (western naturopathy)
* Relates to flow of energy in the human body
* Illness and pathology.
132
In Western energetics the digestive system is described as?
| Energetics
* Fire, hot
* this governs the digestive enzymes and bile flow
* the liver (anger, livid, fiery)
* all active muscular heat generating tissues
* clearing out impurities
133
Give 5 foods and herbs that are energetically hot, and what is their function?
| Energetics
* Ginger,
* garlic,
* rosemary,
* thyme,
* and cayenne warm up a cold condition, such as weak digestion
134
What is inflammation associated with?
| Energetics
**Excess heat**
may benefit from cooling foods / herbs such as:
* fruits, e.g., melon, mango, grapes,
* sea vegetables, green leafy vegetables, cucumber, celery and goldenseal.
* However, there are some exceptions such as ginger, which is warming yet anti-inflammatory.
135
* Constipation is considered which type of energy?
* What could help?
| Energetics
* Dry.
* It would benefit from moist mucilaginous herbs, like marshmallow root and aloe vera
136
* Diarrhoea is considered which type of energy?
* What could help?
| Energetics
* Moist.
* It would benefit from drying foods such as whole grains, nuts, seeds and pulses
137
What is known as 'Agni' in Ayurveda?
| Energetics
Digestive fire, which is the power to digest, transform and absorb nutrients from food.
## Footnote
Its highest is in the morning, importance of nutritious first meal of the day.
138
When Agni is weak due to energetic imbalance (excess cold or heat) or bad eating habits, what does this cause and increase in?
| Ayurveda
Ama = toxins which are caused by excess hot or cold, bad eating habits which can cause food to remain undigested.
139
How can you reduce Ama?
| Ayurveda
* Increase consumption of spices and herbs, such as coriander, fennel, cumin, cardamom, and fenugreek.
* Fresh ginger root tea,
* Leaving 3 hours between last meal and bed.
* Eating slowly , chewing well,
* leaving gaps of 4-6 hours between meals,
* not eating if not hungry,
* Adequate exercise
* Avoiding ice cold drinks (only room temp or above)
* Not working/reading whilst eating
* Not eating when stressed.
140
What does TCM stand for?
| TCM
Traditional Chinese Medicine
141
According to TCM, what is the function of the spleen?
| TCM
It is a functional (rather than physical) organ that encompasses all aspects of the digestion and absorption of food.
| Spleen in TCM is not related to Spleen in the Western medecine
142
Symptoms of diarrhoea, bloating after eating, food intolerances, and indigestion are all signs of?
| TCM
Weak digestion called
Spleen Qi deficiency.
## Footnote
Use warming Spleen Qi Tonics such as ginger, cardamom, fennel and citrus (orange) peel.
143
What is the function of the stomach?
| TCM
To 'rot and ripen'. The stomach completes the process of rotting meats and ripening fruits, vegetables and grains.
Note: Chyme is created in the process that will then go into the duodenum thus trigger CCK for further digestion.
| pourrir et mûrir
## Footnote
Concept of stomach fire = notion of stomach acid.
144
What is 'stomach fire' within TCM closely linked to?
| TCM
Stomach acid (in the Western notion).
145
What is the TCM point of view of the stomach?
| TCM
It plays a crucial role in immunity as it provides fluids to the mucous membranes and for sweat.
146
What foods will a spleen friendly diet include?
| TCM
* Warm wet breakfasts, such as porridge and congees which hydrate.
* Wet cooking methods
* Well-cooked whole grains, naturally sweet vegetables (cooked or steamed, or as soups and stews)
* Warming herbs and spices such as ginger, cinnamon, cumin, caraway seeds, thyme, bay leaves, mustard seeds, celery seeds and cardamom, all nourish the digestive system.
* Avoid drinking liquid with meals
* Avoid energetically cold meals (fibre-rich raw foods and smoothies).
* Avoid dampening foods such as gluten, dairy and refined sugar, as they draw on the energy too much and we can not digest other foods.
## Footnote
In case of excessive fire, cool it down. Otherwise, the above recommendations apply.
147
What is a sign for spleen Qi deficiency?
| TCM
Sugar cravings
148
What western medical conditions would relate to the 'damp and heat' associated with spleen Qi deficiency?
| TCM
Overgrowth of candida, weight gain, diabetes mellitus, hypertension and cardiovascular diseases.
149
What times of the day are linked to which organ?
| TCM clock
5am -7am: Large intestine (drink warm water, avoid caffeine).
7am - 9am: Stomach (breakfast most important meal of the day, warming and hydrating)
11am-1pm: Heart (lunch balanced, not overfilling. Do not overeat).
3pm -5pm: Bladder (drink warm liquids)
5pm-7pm: Kidneys (dinner fresh and light and nourishing)
150
What does the pulse represent in relation to determining constitution?
| TCM pulse
Rapid = heat
Slow = cold
Weak = Qi deficiency
Wiry = Qi stagnation
151
Name the 4 distinct areas of the tongue and the organs they are related to.
| TCM tongue
* Root/ Back = kindeys, bladder, intestines and reproductive organs
* Centre = central abdomen, stomach and spleen,
* Sides = gall bladder, liver
* Tip and front = chest, heart and lungs
152
Outline tongue diagnosis by shape and colour
| TCM tongue
* Tongue shaped, pale red or pink = Normal.
* Swollen tongue, pale in colour = Qi / yang deficiency
* Thin tongue, flat, red in colour = blood deficiency, B9 /B12 deficiency
* Teeth marks on edge = weak digestion or malabsorption of nutrients in small intestine
* Raised, upturned edge = high stress, liver issues
* Blue / purple = cold / poor circulation.
153
What do the following tongue coatings mean:
a) Thin white
b) Brown
c) Greasy yellow
d) Greasy white
e) No coating
| TCM tongue
a) Thin white coating = normal
b) Brown = chronic excess heat
c) Greasy yellow = damp heat
d) Greasy white = damp cold
e) No coating = Yin deficiency
154
In tongue analysis, what presentation would indicate the following?
1. Spleen Qi deficiency
2. Candida, SIBO or IBS
3. Stomach ulcers or IBD
| TCM tongue
1. A pale swollen tongue with teeth marks
2. Grey thick coating at centre, and root OR yellow thick coating in the centre and root.
3. Brown centre and root.
155
What do cracks and red spots on the tongue indicate?
| TCM tongue
Damage to stomach lining, heat and inflammation.
156
Using nail analysis, link the following observations to the deficiencies:
1. Spoon shaped nails.
2. Pale nails
3. Brittle easily split nails
4. White spots in nails
5. Vertical lines/ridges
6. Horizontal lines / ridges
1. Severe iron or zinc deficiency
2. Anaemia
3. Mineral deficency / low stomach acid
4. Zinc and or Vitamin A deficiency
5. Malabsorbtion of nutrients such as B, C, minerals and EFA's
6. Sign of strong illness or infection
157
Using facial diagnosis, link the following observations to the body dysfunctions:
1. Grey skin
2. Yellow skin/ jaundice
3. Butterfly rash around nose
4. Corrugated cardboard lines across the forehead
5. Vertical creases between eyebrows
6. Dry red forehead
| TCM facial
1. Constipation
2. Liver, or gall bladder / or biliary disease
3. Possibly rosacea linked to H pylori ( stomach) vitamin B3 deficiency
4. Large intestine toxicity has been present
5. Liver dysfunction
6. Possible bladder dysfunction.
158
In facial mapping -
1. What does acne round the chin area indicate?
2. Rash over the cheeks and nose?
3. Recurrent forehead acne or rashes can indicate?
| TCM facial
1. Hormonal imbalance
2. Stomach dysfunction
3. Bladder or intestinal problem, suggest possible detoxification needed.
159
# Eye analysis:
The following observations would indicate what imbalance?
1. Clear and bright
2. Yellow/jaundiced
3. Red / blood shot
4. Swollen
5. Dry
6. Floaters in vision
1. Normal/healthy
2. Liver, gall bladder or bilary disease
3. Issues with sleep = liver disharmony
4. Liver dysfynction
5. Possibly allergies, EFA deficiency or chronic stress
6. Blood deficiency , possible link to liver.
160
Hair - the following observations would indicate what issue?
1. Dry hair
2. Oily hair
3. Excessive hair loss
4. Dry itchy scalp
5. Dandruff
6. Greying
1. Excess heat or stress, possibly hypothyroidism
2. Excess body acidity and trans fats
3. Nutrient deficiencies such as B vitamins like biotin, zinc, iron, and protein
4. Lack of EFAs
5. Liver problems , excess heat
6. Nutrient deficiencies such as B5, zinc or copper. As a result of extreme stress
161
What are the teeth numbers and their associated organs?
**Upper Jaw -**
Right 1 & Left 16 heart and small intestine
R2&3, L15 &16 stomach, thyroid, and pancreas
R4&5, L12 & 13 Lung and colon
R6 & L11 Liver and gallbladder
R7 & 8, L9 & 10 Kidney, bladder , prostate and uterus
**Lower Jaw -**
Right 32 & Left 17, heart and small intestine.
R31 & 30, L18 &19 Stomach, thyroid and pancreas.
R29 & 28, L20 & 21 Lung + colon
R 27 & L22 Liver and gallbladder
R26 & 25, 24, 23 Kidney, prostate, bladder and uterus.
162
What do headaches in the daytime or evening relate to?
Day time = Qi / Yang deficiency.
Evening = Blood / Yin deficiency
163
What does the location of headaches at the Temples, Vertex and Forehead indicate?
Temples = liver, gall bladder
Vertex = liver
Forehead = stomach
164
What is fatigue an indication of?
Qi deficiency
