Module 4 - Digestion & Elimination

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  1. MO: What are the big ideas regarding digestion?
    1. Digestion is a north to south process, starting with the brain.

    2. The big three organs of digestion from a nutritional standpoint are: Stomach, Pancreas and Gallbladder

    3. Digestion is fundamental to nutritional therapy. Every cell that makes up every tissue that makes up every organ depends on the body's Digestive System to provide the nutrients it needs to keep on functioning.
  2. MO: Describe how digestion is supposed to work -BRAIN.
    Digestion starts north with the brain (sight & smell of food trigger saliva production & ACh ANS tells stomach food is coming, start stretching out and start producing acid.  Brain also initiates release of insulin from pancreas.).
  3. MO: Describe how digestion is supposed to work - MOUTH.
    • Mouth is physical entry point for food and begins mechanical & chemical breakdown.
    • The teeth physically break down food into smaller parts (mastication).
    • The salivary glands secrete saliva to moisten the food and help with swallowing.
    • Saliva = 99.5% water + 0.5% solutes
    • One solute is the enzyme, salivary amylase, which begins the chemical breakdown of carbohydrates.
    • When you swallow, the bolus enters the esophagus for passage to the stomach. The cardiac sphincter at the bottom of the esophagus opens to allow the bolus to pass into the stomach.
  4. MO: Describe how digestion is supposed to work - STOMACH.
    • The stomach continues the mechanical & chemical breakdown of food.
    • Mechanically, it works like a front-loading washing machine, churning food this way and that.
    • Chemically, several things happen:
    • Gastric juice is secreted from millions of tiny gastric glands located in the mucosal lining of the stomach.
    • Gastric Juice consists of mucous, pepsinogen/pepsin & hydrochloric hcid (HCl)
    • HCl activates pepsinogen to become pepsin
    • HCl and pepsin begin breaking down proteins into peptides (smaller strings of amino acids)
    • HCl triggers gastrin to be released into the bloodstream.
    • The resulting mix of churned food and gastric juices is a paste called chyme (very acidic).
  5. MO: Describe how digestion is supposed to work - DUODENUM.
    • Chyme is released into the upper part of
    • small intestine (duodenum) through the pyloric sphincter.
    • The acidic pH (1.5- 3.0) of the chyme triggers the small intestine to secrete mucous.
    • At the same time the intestinal walls are secreting mucous, they are also secreting two hormones into the bloodstream: SecretinCholecystokinin (CCK)
    • Here, three accessory organs (liver, gallbladder & pancreas) come into play.
    • Secretin stimulates the pancreas to release bicarbonate and pancreatic juice.
    • CCK stimulates the gallbladder to release bile.
    • By the time chyme leaves the duodenum, it is almost totally digested:
    •  – Carbohydrates are broken down into glucose molecules by pancreatic amylase.
    • – Proteins are broken down into amino acids and polypeptides by pancreatic protease.
    • – Fats are broken down into fatty acids and glycerol molecules by pancreatic lipase.
    • Peristalsis moves these absorbable molecules into the jejunum.
  6. MO: Describe how digestion is supposed to work - SMALL INTESTINE.
    • Millions of villi and microvilli absorb the nutrient molecules into the bloodstream, where they are carried to the entire body:
    • Glucose, amino acids, and short-chain fatty acids are carried by the villi to the capillaries and into the liver.
    • Long-chain fatty acids require bile for proper absorption and end up in the lymphatic system.
  7. MO: Describe how digestion is supposed to work - LARGE INTESTINE.
    • The leftover chyme from the small intestine (indigestible fibers, bile, water,
    • sloughed off cells) gets passed on to the large intestine through the ileocecal valve.

    • The large intestine:
    • Recycles the water
    • Recycles the waste material, which nourishes the colon cells
    • Captures any lost nutrients that are still
    • available (with the help of the bowel flora) and converts the nutrients to Vitamins K/B1/B2/B12 and butyric acid.
    • Forms and expels feces.
  8. MO: Digestive Dysfunction - BRAIN.
    • As a culture, we are sympathetically stressed.
    • Need to be in a parasympathetic state to digest food.
    • Counsel clients to RELAX while they eat.
  9. MO: Digestive dysfunction - MOUTH.
    • If food is not properly chewed (~30 seconds):
    • The brain does not get the message to trigger the proper digestive processes for the foods you’re eating.
    • Food does not get broken down enough, placing a burden on the stomach.
    • The production of saliva is not adequately triggered.
    • Saliva is a complex mixture of electrolytes, hormones, and enzymes.
    • If the proper enzymes are not secreted, the breakdown of carbohydrates does not begin.
    • Salivary amylase begins the chemical breakdown of starches.
    • The pancreatic amylase cannot complete the breakdown of starch in the small intestine, leaving undigested starch entering the colon.
    • This feeds candida and general dysbiosis further down the digestive tract.
  10. MO: Digestive dysfunction - STOMACH.
    The stomach is all about acid; normal pH is 1.5 – 3.0.

    • Factors such as stress, excess carbohydrate
    • consumption, nutrient deficiencies, allergies,
    • and excess alcohol consumption can inhibit HCl production.

    Approximately 90 percent of Americans produce too little HCl.

    • With too little HCl, our first line of defense against pathogenic microorganisms is gone:
    • - Yeast, prions, bacteria, viruses, parasites, etc… are actually little proteins.
    • - When the pH is correct in the stomach, pepsin digests these microorganisms… they become food.
    • - When the pH is not correct, an environment is created in which these organisms thrive and raise havoc in the GI tract.

    • With too little HCl the pyloric sphincter does not want to release chyme into the duodenum:
    • – If the chyme is too alkaline, chyme stays longer in the stomach and begins to degenerate.
    • • Proteins putrefy
    • • Carbohydrates ferment
    • • Fats become rancid
    • – Putrefaction, for example, produces organic acids that hurt the mucosal lining of the stomach, allowing microorganism such as H. pylori to exist.
  11. MO: Digestive dysfunction - STOMACH & H. PYLORI.
    • Most of us have some H. Pylori in our stomachs.
    • They tolerate acidic environment, but overgrow when acidity is reduced (i.e., pH goes up).
    • Overgrowth of H. Pylori can lead to stomach & duodenal ulcers and cancer.
    • Never EVER ever give HCl to someone who has ulcers.  Must do a gastric healing protocol first.
  12. MO: Digestive dysfunction - STOMACH & GERD.
    • GERD is Gastroesophageal Reflux Disease.
    • If there is not enough acid in the stomach, foods do not get broken down (carbs ferment, fats rancidify, proteins putrefy) and gasses form that put upward pressure on LES.
    • These maldigested foods cause a reflux, or backward flow, into the esophagus.
    • The esophagus is not made for the acidic foods (even at higher than normal pH) from the stomach, so it burns.
  13. MO: Digestive dysfunction - PANCREAS.
    • If the chyme pH is not correct, secretin is not excreted to trigger the release of pancreatic juice.
    • Sodium bicarbonate is not released to raise the pH of the chyme, and it burns the mucosal lining…this leads to duodenal ulcers.
    • Bad pH -> No Sodium Bicarbonate -> No Enzyme Action -> Incomplete Chemical Digestion -> Intestinal Problems
  14. MO: Digestive dysfunction - GALLBLADDER.
    • Dysfunction of the gallbladder is related to poor quality fats or low-fat diets vs. too little acid.
    • Fats are primarily digested by bile salts and pancreatic lipase in the duodenum.
    • Fat in the chyme stimulates the release of CCK, which stimulates the gallbladder to release bile.
    • Low fat diets fail to adequately stimulate the release of bile, causing the bile to get old/viscous.
    • Bad fat diets also cause the bile to become viscous.
    • The gallbladder tries to contract, but is unable to release the thick/viscous bile.
    • No bile release leads to no absorption of fats.
    • Undigested fats rancidify in colon, stress out liver and leave you fatty acid deficient.
  15. MO: Digestive dysfunction - UNDIGESTED FOODS & LEAKY GUT.
    • All inadequately digested foods impact the villi and microvilli of the small intestine.
    • The lining becomes leaky…selectivity as to what passes through the lining is lost (leaky gut syndrome).
    • This allows protein and fat molecules to pass through the gut between the cells without proper signaling to the immune system; this overwhelms the immune system.
    • What should have been a nourishing food is now one more assault on the immune system.
  16. MO: Digestive dysfunction - LARGE INTESTINE.
    • The large intestine deals with the leftover maldigested foods.
    • Maldigested foods can include parasites, microorganisms, and undigested fats.
    • As this maldigested debris tries to pass into the colon, the ileocecal valve can get clogged or jammed open.
    • Maldigested foods degenerate in the colon, causing dysbiosis and disrupting the healthy flora.
    • Without healthy flora, butyric acid (which nourishes the colon) is not produced, which weakens the cells of the colon.
    • Colon now subject to inflammation, diverticula, and loss of tone.
    • Leads to issues such as IBS, Crohn's, colitis, celiac disease.
    • Each has unique etiology, but all are exacerbated by this process.
  17. MO: Test points for Digestion Functional Evaluation - STOMACH/DUODENUM
    1.  Ridler's Reflex/HCl Point: 1 anatomical inch inferior and lateral to the Xiphoid process, on the medial margin/edge of left rib cage. Press medial to lateral M>L . One finger (or thumb) palpation.  DOES NOT LNT.

    2.  Chapman Stomach/Duodenum:  6th  intercostal space on left rib cage, mid mammary line (almost always under the bra band on women). One finger palpation, A>P.  DOES LNT.
  18. MO: Test points for Digestion Functional Evaluation - PANCREAS.
    Ridler’s Reflex/Enzyme Point:  1 anatomical inch inferior and lateral to the xiphoid process, on the medial margin/edge of right rib cage. Press medial to lateral  M>L. One finger (or thumb) palpation.  DOES NOT LNT.
  19. MO: Test points for Digestion Functional Evaluation - GALLBLADDER.
    1.  Chapman Gallbladder:  6th Intercostal Space on right, mid-mammary line (almost always under bra band on women).  Palpate anterior -> posterior. DOES LNT.

    • 2. Murphy’s Sign: Liver/Gallbladder - Acute
    • Position client with knees bent; place finger tips 1.5-2” away from curvature of ribs on right side.  Ask client to take deep breath in and when they exhale palpate A>P. Ask the client to take one more breath and on the exhale gently change the direction of your palpation more deeply, Inferior to Superior I>S and under the rib cage. With your hand still under the ribcage, ask them to inhale one last time. This allows the diaphragm to push the gallbladder into your fingertips. Be sure to watch client’s face and stop the palpation at any point when they feel discomfort or you cannot fairly easily go further. Rate either tenderness and/or tension.  DOES NOT LNT.

    3.  Right thumb web:  Indication of chronic gallbladder congestion.  Feel the right thumb web on the edge of the skin web and the muscle RIGHT next to the bone at the base of the thumb; to locate pinch the muscle and then slide off and back onto the web until client indicates tenderness or you feel nodulation, much like a BB.  DOES NOT LNT.
  20. MO: Test points for Digestion Functional Evaluation - SMALL INTESTINE.
    • 1. Bennett’s Reflexes: Small Intestine.  Draw imaginary circle 2-3 anatomical inches around the umbilicus and divide into 4 quadrants.  FIRST PALPATION: palpate with the flat of your fingers gently in all 4 quadrants; you are feeling for resistance or congestion.  SECOND PALPATION: change to a deeper palpation,  A>P, & imagine you are separating the tissue as you work deeper.
    • Have the client indicate tenderness for each quadrant.  DOES LNT.

    • 2.  Chapman Small Intestine: 8th, 9th & 10th Intercostal Spaces on both sides of rib cage.  
    • Work from the back and draw your hands around the sides letting your fingers fall into the spaces between the tips of the ribs; if the client is ticklish, hold the client’s hands and have them do the palpation on themselves.  DOES LNT.
  21. MO: Test points for Digestion Functional Evaluation - LARGE INTESTINE.
    1.  Ileocecal Valve:  Palpate 1/2 the distance between the right ASIS and the umbilicus. Palpate A>P  feeling for tenderness. Use a slight  circular motion (clockwise) to help move the tissue as you probe deeper.  DOES LNT.

    2.  Large Intestine/Colon Palpation:  With the edge of your fingers palpate deeply feeling for resistance/congestion or until the client feels tenderness in the surrounding lymphatic tissues. Start just inside the ASIS, right side, palpate side to side and concurrently A>P  across the colon, upward to the rib cage (ascending colon), then across the abdomen, palpating in an upward and downward motion (transverse colon), and then down the left side, side to side motion (descending colon). On the exam form the points are indicated A-B and B-C (A being the ASIS on the right, B the midpoint of the abdomen and C the ASIS on the left) Record any tenderness in corresponding areas.  DOES LNT.

    3.  Chapman Colon/Iliotibial Bands:  The iliotibial band runs down the exterior of the leg from the hip (greater trocanter) to the knee in the same place as the stripe on a band uniform. This mirrors the Large Intestine palpation. If you dissected the colon in the middle of the abdomen and drew the ends down the iliotibial band, the palpations for tenderness on the iliotibial band would likely mirror the tender points on the colon and should validate your findings for the Colon. If only the iliotibial band is tender at the mid-point, this is likely an indicator of prostate/uterus weakness, not a colon indicator.  DOES LNT.
  22. MO: Describe how to prioritize Digestion test points used in LNT process.
    • The strategy for selecting test points and supplements to LNT should be based on the BIG IDEA that digestion is a north-to-south process.
    • I.e., even though the small intestine may be the only “hot” point, the cause may be an enzyme deficiency and not an intestinal deficiency. In other words, start “north.”
  23. MO: Define three possible reactions a client can have to a nutritional protocol.
    • 1. Digestive Reaction
    • – Looks like a digestive problem
    • – Examples: diarrhea, cramping, heartburn, constipation
    • – Action: support digestive process

    • 2. Sensitivity/Allergic Reaction
    • – Looks like sensitivity or allergy symptoms
    • – Examples: Rashes, congestion, etc.
    • – Action: stop treatment and try something else

    • 3. Healing Reaction (Herxheimer)
    • – Mimics symptoms client is working to overcome
    • – Examples: flu-like symptoms if you’re working on immune function or nausea if you're working on gallbladder
    • – Action: if moderate maybe work through it, if severe make sure they call you right away, stop protocol for a few days and then restart w/ lower dosages.

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Module 4 - Digestion & Elimination
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