The Small Intestines

Our trip through the digestive system continues:

The action now moves into the small intestines.  Since digestion is a north to south process whatever happened in the stomach will impact the small intestines.  Did we digest our food or did it ferment?  Are we taking antacids for acid reflux?

As the food or “chyme” as it is now technically called moves into the small intestines the stomach sends a signal to the pancreas informing it of the amount of carbohydrate, fat, and protein coming its way.  The pancreas then prepares the required enzymes.  Not to overstate the obvious, but the more work the stomach has done, the less the pancreas and the small intestines will have to do. 

As you remember, the pH environment of the stomach is supposed to be acidic.  However, the pancreatic enzymes only work in an alkaline environment.  Secretions from the pancreas and bile from the gall bladder alkalinize the small intestine.  The pH of small intestine should be 8.3. Without sufficient bile, the small intestines do not reach this pH. 

Normally, food stays in the small intestine for 3-10 hours.  During that time approximately seven liters of enzymes are produced – amylase, protease, and lipase. Ninety five percent of all digestion and absorption occurs in the small intestines.  If the pH is not correct this will be compromised and transit time may be shorter (diarrhea) or longer (constipation).  During this process 5.5 liters of the fluid is reabsorbed.

When working properly the digested molecules from the food we ate will be absorbed into the blood stream in the small intestines.  Once in the blood it will fuel the body.  The undigested material is passed on to the large intestine – our next stop. 

What happens when food is not adequately digested and absorbed in the small intestines?  There are two scenarios.  First, food particles not digested well enough to pass across the gut wall pass down the alimentary canal, where they putrefy and form toxins that will be absorbed into the blood.  Undigested carbohydrates feed the “bad” bacteria that we will meet later in the large intestines.

Or, the food particles are digested well enough to pass through the gut wall and into the blood, but are not reduced to particles small enough to be utilized by the body.  This causes the intestinal mucosa to become inflamed which makes it more permeable. These are typically proteins.  If you look at the major food sensitivities, intolerances, allergies, or whatever you want to call them, they are generally related to proteins: gluten from grains; casein from dairy, soy, and eggs.

What else contributes to an inflamed mucosal barrier?  Studies show three major factors: therapy with prostaglandin inhibitors (NSAIDs, steroids, prednisone, and cortisone); antacids that decrease the acidity of the stomach, limiting the ability to digest proteins which leads to particles that get into blood leading to immune system reaction; and antibiotics that disrupt the normal balance of bacterial micro flora in the gut as well as the mouth, skin, and vagina leading to an overgrowth of bad bacteria and yeasts.  NSAIDs are non steroidal anti-inflammatory drugs including ibuprofen, aspirin, and naproxen.

As poor digestion (dysbiosis) becomes your “normal” your intestinal permeability continues to increase and is then referred to as “leaky gut syndrome.”  Healthy intestinal lining only allows properly digested foods to pass through into the bloodstream and be assimilated.  It also keeps out bacteria and other foreign substances. 

If the gut leaks these “things” get into the body a wide variety of symptoms and health problems are associated, including: abdominal pain, gas, indigestion, bloating, constipation, diarrhea, asthma, chronic joint pain, chronic muscle pain, confusion, fuzzy thinking, poor memory, mood swings, nervousness, aggressive behavior, anxiety, poor exercise tolerance, poor immunity, recurrent vaginal infections, skin rashes,  bed wetting, recurrent bladder infections, fevers of unknown origin, shortness of breath, primary biliary cirrhosis, and general fatigue and malaise.

The Importance of Hydrochloric Acid

Here’s a quick three question true or false quiz for you:

          1. The cause of gastric/acid reflux is too much stomach acid.

          2. When we are stressed, we produce extra stomach acid.
3. Antacids stop acid reflux.

What are your answers?  If you are like most Americans you probably answered true to all three.  Over the course of our lifetime you have most likely heard endless advertisements telling you so.  Well, sorry. These are all false! They are common misconceptions. 

Acid indigestion is a misdiagnosed and misunderstood condition.  Here’s two important points you need to understand.  First, acid reflux or GERD does not necessarily mean that there is too much stomach acid or HCl, which is a common belief.  The actual truth is that many people diagnosed with acid reflux (too much stomach acid) actually produce too little.  

Second, there are other acids in the stomach besides HCl.  These are the true acids of acid reflux.  So where do they come from?  Food enters the upper part of stomach where it can sit for up to an hour waiting for the body to produce enough acidity to activate its enzymes for protein digestion.

In a young, healthy person it takes approximately 45 minutes for the stomach to reach the pH that releases pepsin.  During this time the salivary enzymes continue to work.  If we ate some raw foods we would also have those enzymes assisting in digestion.  However, if we eat mostly cooked food and overeat it, something else is happening - it is decaying rather than being digested.  Decaying food produces organic acids of putrefaction and fermentation – these are the acids of indigestion. 

In addition, people who suffer from indigestion are often stressed, and eat in a rush, on the run, or while upset.  We have been told stress makes our stomach pump out too much acid, causing heartburn and ulcers.  But here’s the truth about stress and digestion. 

The actual fact is that stress engages the sympathetic nervous system.  This suppresses digestion, and thus HCl production.  Think about it.  Our sympathetic response is also called “fight or flight.” Back in the good old days if you saw a tiger (that would be a stress) you would want to run as fast as possible to get away.  The alternative of fighting it would be a losing proposition.  If you are running from a tiger your body is not worried about digestion.  The same thing occurs when we eat while stressed.  The body does not worry about making enzymes so the food sits longer in the stomach. 

Producing insufficient HCl is called hypochloridria.  A sympathetic nervous system response is one factor.  There are others.  As we age we make less HCl.  In fact, by age 65 we make about 15% of the HCl we produced at age 25.  Ever notice how more of the elderly seem to have acid reflux and other digestive issues?

Other causes include excessive use of antacids, a salt-free diet, chronic illness, and an increased metabolic demand (such as sports).  Hydrochloric acid is made from hydrogen and chloride.  Salt, better known as sodium chloride, is a source of chloride.  Zinc is a key mineral required in the body’s process of making HCl.  Chronic illness can deplete zinc.  It is also rather ironic that zinc requires an acidic environment in the stomach to be absorbed.  This requires HCl.  So, HCl requires zinc and zinc requires HCl.  An increased metabolic demand also burns up the minerals needed to make HCl.

How do you know if you are hypochloridric?  Symptoms include: burping, bloating, bad breath, indigestion.  Gas is the first sign that food is not digesting – it is rotting.  As I said before fats go rancid, proteins putrefy, and carbohydrates ferment producing the “organic acids” of acid reflux.

At the root of acid reflux is poor diet - The Standard American Diet (or appropriately abbreviated as SAD).  This is a diet high in processed foods, carbohydrates, starches and sugars, heavy in meat and particularly processed meat, and low in fiber.  Don’t get me wrong, there is nothing wrong with meat, it is just the quantity with respect to other foods and the overall quality that most Americans eat that is problematic.  At the same time the diet is low in nutritious foods such as vegetables and healthy meats.  Poor digestion occurs from the combination of poor food quality and lack of good bacteria and sufficient enzymes.

Other triggers for acid reflux include: tight fitting clothes, lying down too soon after eating, eating large meals, and specific foods that irritate (such as tomatoes, citrus fruit, dairy, meat, alcohol, coffee, high-fat foods, fried foods, spicy foods, onions, and chocolate).

While acid stopping medications and antacids can make the resulting symptoms better in the short term, but make the original problem worse!  Here’s why. We are essentially turning off digestion at the stomach and attempting to resume it in the small intestines.  

We know this is not a good idea!  As we learned we need an acidic stomach to digest proteins and specific key nutrients (calcium, iron, zinc, and Vitamin B12).  Without these we can become malnourished and lacking key nutrients.  This can lead to protein deficiency problems, B12 deficiencies, nail problems, iron anemia, allergies, and osteoporosis. 

As mentioned earlier HCl kills bacteria and parasites.  Without it, we are more susceptible to them.  They too are linked to a wide variety of illnesses.   Rotting food also contributes to degeneration of the gastric mucosa, increasing the likelihood of a gastric ulcer.  

And perhaps most important - digestion is a north to south process.  If we get behind in the stomach this places extra burden on the downstream organs.

Bernard Rosen, PhD is a Nutrition Consultant and Educator. He works with individuals, groups, and at corporations to create individualized nutrition and wellness programs. He has offices in Thiensville and Glendale, WI. To learn more or to schedule an appointment, e-mail at bernie@brwellness.com, call (262) 389-9907 or go to www.brwellness.com.

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The Stomach

The Stomach

Now that we've made it through the esophagus and into the stomach, the next two blogs will focus on it.  This first article talks about what is supposed to happen in the stomach and the second article discusses the importance of hydrochloric acid and much of the misinformation on that subject.

The stomach is where some serious digestion is supposed to start.  As mentioned it can hold one liter (four cups) comfortably.  It will stretch to hold more, but may struggle to process all of it properly.  The stomach makes hydrochloric acid (HCl) to facilitate the digestion process.  As the stomach stretches to accommodate food, this signals the body to make HCl.  The stomach concentrates the acid to lower its pH below 3.0, ideally getting down to 1.0 to 2.0.  

To protect itself from HCl the stomach makes mucus for its lining.  And here’s a critical point.  HCl does not digest food; it only serves to get the stomach acidic.  Once the stomach is acidic pepsinogen is released.  This makes pepsin which begins protein digestion.  

The stomach also makes what is called intrinsic factor to digest Vitamin B12 and lipase to digest fats.  Also note there is no carbohydrate digestion in the stomach.  If the stomach is not acidic enough pepsinogen will not make pepsin and lipase will not be released.  This means digestion is not occurring!

The acidic nature (and thus HCl production) of the stomach is critical for several other reasons.  Of prime importance is to purify our foods.  HCl will de-activate plant, animal and synthetic hormones and antibiotics from animals.  

Stomach acid kills bacteria and viruses so they cannot get to other parts of our body.  The bacteria H. Pylori turns off the stomach’s ability to make HCl.  It has been recognized as the root cause of stomach ulcers.  This bacteria eats away the stomach’s lining.  Without HCl the body cannot kill the bacteria without additional support. 

HCl is necessary for protein, B12, iron, and calcium absorption.  Protein is the structural basis for our body - our muscles, ligaments, tendons, organs, glands, nails, hair, vital fluids (blood, hormones, neurotransmitters), and enzymes are all protein based.  It builds and repairs all these tissues and cells. 

 

Vitamin B12 is important for many functions.  It is a cofactor for two important enzymes.  One used for the metabolism of methionine, an essential amino acid.  The other aids the production of energy from proteins and fats.  Overall Vitamin B12 supports the nervous system, promotes the maturation of red blood cells (hence the tie to anemia when deficient in B12), and supports bone and joint health.

Iron is critical for the health of our blood.  One-third of our 100 trillion cells are red blood cells!  Iron aids in hemoglobin production, which is critical in the transportation of oxygen around the body.  Oxygen fuels the body and hemoglobin helps get it around!  Iron also supports enzyme formation and function and is part of the enzyme system that produces DNA - the blueprint of the body - so it is critical in growth, reproduction, healing, and immune function.  

Iron is tricky as too little can cause anemia—but too much can lead to atherosclerosis and other cardiovascular problems. Unlike other minerals, excess iron is not excreted from the body. Instead, it’s stored in the tissues, accelerating iron overload indefinitely. 

Calcium is one of the most talked about minerals and for good reason.  It supports strong bone structure, teeth, and muscle tissue, aids in blood clotting function, supports cardiovascular and nerve functions, and helps in normal functioning of many enzymes.   I repeat, without HCl we cannot effectively absorb calcium.  So, if you are taking both antacids and calcium supplements what do you think is happening (or not happening)?

If all is going well, the stomach has begun the process of breaking down the proteins and fats and some key vitamins and minerals are being absorbed.  Next stop is the small intestines.  But before we get there, we’ll explore how digestion can be compromised in the stomach, which of course has significant impact as we continue down the north to south path.

The Esophagus

The Esophagus

We return to our north to south tour of the digestive system.  Next stop after the mouth is the esophagus.  Actually the esophagus is more like a transit point. We do not want anything to stop there!  The esophagus is the passageway from the mouth to the stomach. 

It has upper and lower valves.   The upper valve insures that food goes into the esophagus and not the trachea (which is used for moving the air we breathe into our lungs).  The lower esophageal valve prevents food from coming back up.  This valve can become incompetent and not stay completely shut.  When this occurs you may experience “acid reflux” – the “back up” of “stomach acid.”  

Several factors contribute to the lower esophageal valve becoming incompetent including a nervous system reaction, hormonal control, and pressure from the stomach.  Eating too much food (filling the stomach beyond a reasonable capacity) can press the valve back up.  The capacity of the average stomach is just one liter (approximately four cups).  

Nicotine, caffeine, sugar, and alcohol have also been shown to make the lower valve incompetent. Once the valve has become incompetent you become more susceptible to experiencing acid reflux on a regular basis.  We will discuss acid reflux in much more detail later.