ntc module 4 digestion and elimination...3 mixing/propulsion–moving the food through the gi tract...

NTC Module 4: Digestion and Elimination

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MODULE 4Digestion and Elimination

Copyright © 2016 Nutritional Therapy Association, Inc.

MODULE 4 OBJECTIVES

Copyright © 2016 Nutritional Therapy Association, Inc. 2

State the Big Ideas for Digestion1

Describe the way Digestion is supposed to work2

Explain at least 3 things that can go wrong in the Digestive System3

4 Define the 3 possible reactions a client can have to a nutritional protocol

5 Summarize the five step process for Coca’s Pulse Test


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Introduction to

Digestion


DIGESTION DEFINED

Digestion is the mechanical and chemical breakdown of food

The goal of digestion is to reduce food to molecules so small that the nutrients can be absorbed and used by the

cells



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DIGESTIVE SYSTEM


THE SIX DIGESTIVE FUNCTIONS


1 Ingestion – Intake of food

2 Secretion –Water, acid, buffers, enzymes

3 Mixing/Propulsion– Moving the food through the GI tractate and describe the test points for the Digestion Functional Evaluation

4 Digestion – Breakdown of food

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Absorption – Passage of nutrients into the blood and lymph

Defecation – Elimination of the “leftovers”


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THE BIG IDEAS


Digestion is a North to South process

2 The big three organs from a nutritional standpoint are:

• Stomach• Pancreas• Gallbladder

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THE BIG IDEAS (CONTINUED)


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.


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Digestion:Proper Function


DIGESTION STARTS NORTH


1. Digestion begins in the brainThe sight and smell of food triggers the salivary glands to begin producing saliva

2. The mouth is the physical gateway to the digestive system

Mechanical and chemical breakdown of the food begins


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IN THE MOUTH


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

DIGESTION CONTINUES SOUTH


When you swallow, bolusenters 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 3. The stomach continues

the mechanical breakdown of food, along with a number of chemical activities


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THE STOMACH


IN THE STOMACH


Bolus enters the stomach

Gastric juice is secreted from millions of tiny gastric glands located in the mucosal lining of the stomach

• Mucous• Pepsinogen/Pepsin • Hydrochloric Acid (HCl)

HCl and pepsinogen begin breaking down proteins into peptides (smaller strings of amino acids)

HCl triggers gastrin to be released into the bloodstream


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KEEP IN MIND

The stomach is all about ACIDDesigned for a normal pH of 1.5 – 3.0

HCl is excreted into the stomach at a pH of 0.8…that’s almost pure acid


Roles of Acid:

• Baths the stomach• Disinfects the stomach• Kills bacteria and parasites• Activates pepsin, so we can digest proteins• Stimulates gastrin• Breaks down proteins



Chyme

After the stomach churns the bolus and mixes it with gastric juice, the food breaks down even more into a paste called chyme (very acidic)

Chyme is released into the upper part of small intestine (duodenum) through the pyloric sphincter


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THE SMALL INTESTINE


Duodenum

ACCESSORY ORGANS


Right Lobe of Liver

Left Lobe of Liver

Cystic Duct

Gallbladder

Right Hepatic Duct

Left Hepatic Duct

Liver Pancreas

Common Hepatic Duct

DuodenumJejunum

Pancreatic Duct

Common Duct to Duodenum


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IN THE SMALL INTESTINE


4. Chyme enters the duodenum

The acidic pH (1.5‐3.0) of the chyme triggers the small intestine to secrete mucous

IN THE SMALL INTESTINE (CONTINUED)


The small intestine has a dual role as a digestive organ and a

gland

At the same time the intestinalwalls are secreting mucous, theyare also secreting two hormonesinto the bloodstream:

• Secretin• Cholecystokinin (CCK)


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MucousBile

Pancreatic JuiceBicarbonate

Secretin stimulates the pancreas to release bicarbonate and pancreatic juice, and CCK stimulates the gallbladder to release bile

Bile is necessary to emulsify and absorb fats

As part of the pancreatic juice, the pancreas first releases sodium bicarbonate to help raise the pH of the chyme to neutral (7.0)

Once the chyme pH reaches neutral, the enzyme portion of

the pancreatic juice is released to complete the chemical digestion of carbohydrates, proteins, and

fats

BILE FUNCTION


Digestible molecules Lymphatics Work throughout the body


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THE SMALL INTESTINE (CONTINUED)


By the time chyme leaves the duodenum, it is almost totally digested:

Carbohydrates are broken down into glucose molecules

Proteins are broken down into amino acids and polypeptides

Fats are broken down into fatty acids and glycerol molecules

Peristalsis moves these absorbable molecules into the jejunum



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


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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

IN THE LARGE INTESTINE


Transverse Colon

Descending Colon

Sigmoid Colon

Anal Canal

Lymph Nodes

Ileocecal Valve

Ascending Colon

Right Hepatic FlexureLeft Splenic Flexure

Appendix


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IN THE LARGE INTESTINE


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

NORTH TO SOUTH SUMMARY


1. Brain

2. Mouth

Salivary Glands

Food

Bolus

3. Stomach

Chyme

4. Small Intestine

Liver/Gallbladder

Pancreas

5. Large Intestine

Remains

Feces

Nutrients

Water/Vitamins


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Digestion:Dysfunction


DYSFUNCTION IS NORTH TO SOUTH


Just as proper digestion is a north to south process, so is dysfunction

When working with clients, begin north and work your way south


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DYSFUNCTION: BRAIN


• As a culture, we are sympathetically stressed

Need to be in a parasympathetic state

to digest food

• Council your clients to RELAX while they eat

DYSFUNCTION: MOUTH


If you don’t take thetime to properly chewyour food (~30 seconds):

The brain does not get the message to trigger the proper digestive processes for the foods you’re

eating

The brain does not get the message to trigger the proper digestive processes for the foods you’re

eating

The production of saliva is not triggered


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DYSFUNCTION: SALIVA

Saliva is a complex mixture of electrolytes, hormones, and enzymes


This feeds candida

creating general dysbiosis further down the digestive tract

The pancreatic enzyme amylase cannot complete the breakdown of starch in the small intestine

leaving undigested starch entering the colon

Salivary amylase begins the chemical breakdown of starches

If the proper enzymes are not secreted, the breakdown of carbohydrates does not begin

DYSFUNCTION: STOMACH


The stomach is all about acid

Normal pH is 1.5 – 3.0

Factors that can inhibit HCl production:

• Stress

• Excess carbohydrate consumption

• Nutrient deficiencies

• Allergies

• Excess alcohol consumption


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DYSFUNCTION: STOMACH (CONTINUED)

Approximately 90 percent of Americans produce too little HCl


Jonathon Wright, MD, came to this conclusion using Heidelberg Gastrotelemetry equipment to check the

stomach pH of thousands of patients

Dr. George Goodhart, Chiropractor, came to the same conclusion using kinesiological analysis and functional

assessment


So, what happens if you do not produce enough HCl?

1. 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


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So, is it the environment that causes the illness or the microorganism?


Louis PasteurBelieved it is the microorganism

Antoine BechampBelieved it is the terrain

We

We believe it is actually a combination of the two

‐If the microorganism is not present, you will not get sick

‐However, if the environment is optimal, even if you get the microorganism, it cannot survive



Helicobacter Pylori (H. pylori)

According to the Clinical Pearls on gastric cancer, H. pylori, and vitamin C:

“It is very important to get from this article that gastric atrophy and reduced hydrochloric acid secretion may be the initiating factors in Helicobacter pylori infection, along with reduced vitamin C secretion in the stomach, thereby increasing the risk of gastric cancer due to the lack of the ability of vitamin C to inhibit mutagenesis.”


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Helicobacter Pylori (continued)

“It is very interesting that the last thing one would consider regarding H. Pylori infection, since it is associated with ulcer, is a lack of stomach acid. The whole paradox of the use of a variety of antacids or anti‐gastric acid‐secreting agents in ulcers and the relationship to H. Pylori infection, which may be due in part to a lack of stomach acid, is confusing but might be explained in the following way. When vitamin C levels in the gastric area are lowered, that tissue is more susceptible to irritation by any amount of acid which is highly concentrated. Even the amount of acid secreted with gastric atrophy could be irritating. If this is the case, treating with antacid type medications may bring symptom relief in the short run but in the long run may increase the likelihood of recurrence. The treatment might be vitamin C supplementation, probiotics, and appropriate antibiotics or other medical therapies not only for the H. Pylori infection but for other pathogens as well. After the lining has healed, then hydrochloric acid replacement may be of value in keeping other irritating pathogens from growing.”


2. People experience Gastroesophageal Reflux Disease (GERD):


If there is not enough acid in the stomach, foods do not get broken down

These maldigested foods cause a reflux, or backward flow, into the esophagus

The esophagus is not made for the acidic foods from the stomach, so it burns

Carbohydrates Ferments Proteins PutrefyFats Rancidify


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THE BIG QUESTION

If the REAL problem is too little acid produced in the stomach, why do antacids

seem to relieve the symptoms?


THE LUCRATIVE ANSWER

Antacids, acid blockers, etc. raise the pH of chyme to neutral, so it doesn’t

burn the esophagus. However, now the chyme is much too alkaline for the

stomach.


What is this doing to the rest of the digestive

system?


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POOR MENTAL HEALTH PROGRESSION

In the words of the holistic medical doctor, Alan R. Gaby:


Big Mac & Fries(Bad Food)

Prilosec(Acid Blockers)

Prozac(Depression)


3. 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

‐ Carbohydrate Ferment‐Proteins Putrefy‐Fats Rancidify

Example: Putrefaction produces organic acids that hurt the mucosal lining of the stomach, allowing microorganism such as h‐pylori to

exist


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EXPERIMENT


• Make 1 extra portion at dinner:Meat, potatoes, veggies, salad, desert

• Throw it all in a blender

• Add ½ cup of water

• Spit in it

• Blend it all up

• Find some place warm to set it(~98.6 degrees)

• See how long it takes to get disgusting

This is what happens to the food in your stomach if you are not producing enough

HCl

DYSFUNCTION: PANCREAS


In proper function, chyme enters the duodenum and its acidic pH triggers the release of pancreatic juice

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


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DYSFUNCTION: PANCREAS (CONTINUED)


Bad pH

No Sodium Bicarbonate

No Enzyme Action

Incomplete Chemical Digestion

Intestinal Problems

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


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DYSFUNCTION: GALLBLADDER (CONTINUED)

Low fat diets do not trigger the release of bile‐Low fat diets do not stimulate the release of bile, causing the bile to get old/viscous

‐Bad fat diets cause the bile to become viscous


The gallbladder tries to contract, but is unable to release the viscous bile

No bile leads to no absorption of fats



Digestible molecules Lymphatics Work throughout the body

Normal Function


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Undigested globules Rancidify in Colon Stress out liver and leaves you fatty acid deficient

Dysfunction

UNDIGESTED PROTEINS


Undigested proteins (in fact all undigested foods) impact the villi and microvilli of the small intestine

What should have been a nourishing food is now one more assault on the immune system

The lining becomes leaky, selectivity as to what passes through the lining

is lost (leaky gut syndrome)

This allows proteins and fats to pass through the gut in inappropriate sizes, which overwhelms the

immune systemLeaky Gut


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DYSFUNCTION: LARGE INTESTINE


Ileocecal Valve

Once again, the large intestine deals with the leftovers from Digestion

In the case of dysfunction, this includes:

Maldigested foods full of parasites, microorganisms, and undigested fats

As this maldigested debris tries to pass into the colon, the ileocecal valve can get clogged or jammed open

DYSFUNCTION: LARGE INTESTINE (CONTINUED)


• The maldigested foods are degenerating in the colon, causing dysbiosis and disrupting the healthy flora

• Without the healthy flora, butyric acid is not produced, which weakens the cells of the colon


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DYSFUNCTION: LARGE INTESTINE (CONTINUED)


This leaves the colon subject to inflammation, diverticula, and loss of tone leading to issues such as:

• Irritable Bowel Syndrome • Crohn's Disease • Colitis • Celiac Disease

Each has its own unique etiology, but all are exacerbated by the process

DYSFUNCTION SUMMARY


1. Brain

2. Mouth

Salivary Glands

Food

Bolus

3. Stomach

Chyme

4. Small Intestine

Liver/Gallbladder

Pancreas

5. Large Intestine

Remains

Feces?

Nutrients?

Water/Vitamins?


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Digestion:Solutions


PRECAUTIONS

Supplements can be safely chewed and tasting/chewing supplements is

advised to increase efficacy


However, there are some exceptions:

• HCl supplements

• Oregano or other strong herbs

• Other acid containing products including Orth phosphoric acid and bile salts

• Any product with proteolytic enzymes


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SUPPLEMENTS

There are several companies that manufacture and/or distribute nutritional supplement lines that will

extend professional accounts to NTPs:


Biotics Research Apex Energetics

Metagenics Priority One

NutriWest Many Others

Note: that the generic ingredients are listed on the Functional Evaluation sheets and on the left side of the supplement charts

A Few Words on Dosing



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VITAMIN TOLERABLE UPPER LIMIT RANGES


Age (yr)Niacin

(mg/day)Vitamin B6

(mg/day)Folate

(mcg/day)Choline (mg/day)

Vitamin C

(mg/day)Vitamin A (mcg/day)

Vitamin D (mcg/day)

Vitamin E (mg/day)

Infants0‐0.5 ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ 600 25‐‐‐‐‐.05‐1 ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ 600 25‐‐‐‐‐Children1‐3 10 30 300 1000 400 600 50 2004‐8 15 40 400 1000 650 900 50 3009‐13 20 60 600 2000 1200 1700 50 600Adolescents14‐18 30 80 800 3000 1800 2800 50 800Adults19‐70 35 100 1000 3500 2000 3000 50 1000>70 35 100 1000 3500 2000 3000 50 1000Pregnancy≤18 30 80 800 3000 1800 2800 50 80019‐50 35 100 1000 3500 2000 3000 50 1000Lactation≤18 30 80 800 3000 1800 2800 50 80019‐50 35 100 1000 3500 2000 3000 50 1000

Reference: http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/ULs%20for%20Vitamins%20and%20Elements.pdf

MINERAL TOLERABLE UPPER LIMIT RANGES


Age (yr)Sodium (mg/day)

Chloride (mg/day)

Calcium (mg/day)

Phosphorus(mg/day)

Magnesium (mg/day)

Iron (mg/day)

Infants0‐0.5 ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ 40.05‐1 ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ 40Children1‐3 1500 2300 2500 3000 65 404‐8 1900 2900 2500 3000 110 409‐13 2200 3400 2500 4000 350 40Adolescents14‐18 2300 3600 2500 4000 350 45Adults19‐70 2300 3600 2500 4000 350 45>70 2300 3600 2500 3000 350 45Pregnancy≤18 2300 3600 2500 3500 350 4519‐50 2300 3600 2500 3500 350 45Lactation≤18 2300 3600 2500 4000 350 4519‐50 2300 3600 2500 4000 350 45

Reference: http://www.cengage.com/nutrition/discipline_content/tables/0‐534‐558986‐7_C.pdf


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ADULT DOSING GUIDELINES


The recommended dosing on the bottle is a conservative dose for general maintenance

Therapeutic dosing needs to be higher; you have to start out aggressive enough to make a change

without overwhelming the client

As a very general guideline:

Start the client off using 1 – 3 tablets/capsules taken two or three times a day

For larger people, start at the top of that range

For smaller people, start at the bottom of that range

DOSING GUIDELINES FOR CHILDREN


Dosing Guidelines for Children

For breast‐fed infants give a full dose to the mother

Infants less than 1 year old (not breast‐fed)

give 1/4 to 1/10 of the adult dose on a pacifier or crushed in formula

Children 1 to 5 years old recommend 1/3 of the adult dose

Children 6 to 12 years old recommend 1/2 the adult dose

Children over 12 recommend the adult dose


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PREGNANCY


High doses of any specific nutrient may be contraindicated during pregnancy.

Be particularly careful not to exceed the tolerable upper limits of vitamins and minerals during

pregnancy.

Use the following with caution:

Vitamin A ‐ over 3,000 mcg/day or 10,000 IUVitamin C ‐ Over 1 gram/dayVitamin B6 ‐ Over 25 mg/dayBotanicals/Herbs – Unless specifically recommendedPhosphorus – Without appropriate calcium and magnesium

(except for short periods of less than one week)

OTHER CONTRAINDICATIONS


High doses of vitamins may be contraindicated in liver and kidney disease and with some types of

chemotherapy

Advise your client to consult with their pharmacist and/or medical doctor for contraindications


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Coca’s Pulse Test

ALLERGIC SYMPTOMS: DR. COCA



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THE COCA PULSE TEST


Coca’s Pulse Test is a simple, yet extremely effective way to identify foods to which a client may be allergic, intolerant, or sensitive. Quite simply, stress will cause the pulse to increase. Foods to which you are intolerant are stressful and will reveal themselves by speeding up your pulse.

THE DIET/PULSE RECORD



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RULES FOR COCA’S PULSE TEST


Rule 1: Because accuracy is important, you must always take your pulse for one full minute. Do not do 15 seconds and multiply by 4.

Rule 2: If your pulse‐count when standing is at least 6 points greater than your pulse‐count when sitting, this is a positive indication of a food or environmental sensitivity (Sanchez‐Cuenca).

Rule 3: If at least 14 pulse‐counts are taken each day and if your daily maximal pulse‐rate is constant (within one or two beats) for three days in succession, this indicates all “food sensitivities” were avoided on those days.

Rule 4: If your daily maximal pulse‐rate varies more than two beats (example: 72, then 78, then 76, then 71), you are certainly reactive provided there is no infection.

Rule 5: If the ingestion of a frequently eaten food causes an acceleration of your pulse of at least 6 beats, that food can be considered “reactive” for you and should be removed from the diet.

Rule 6: If you are sensitive to things in the environment, there is most likely a major food allergy that needs to be addressed.

Rule 7: If your minimum pulse‐rate does not regularly occur “before rising” after a night’s rest, this is usually an indication of sensitivity to dust, dust mites, or something in the sleeping environment (perfume, mattress, pillow, etc.)

LINGUAL‐NEURO TESTING


Start here

Lateral Hornof the spine

Hypothalamus Area


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LINGUAL‐NEURO TESTING (CONTINUED)

Lingual‐Neuro Testing (LNT) enables you to determine whether a particular nutritional supplement is “right” for your client


LNT PROCESS


1 Do not touch the supplements with your own hand

2 For capsules, it’s better to open & pour a little on the tongue

3

‐Do not put the capsule back in the test kit

Have a large glass of water ready

4 Have a small cup available for the supplements the client discards

5 In most cases, you want the client to hold the supplement in their mouth for 15 seconds


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THE LNT COCA’S PULSE TEST


THE SANCHEZ‐CUENCA TEST


A TEST TO DETERMINE GENERAL ALLERGIC TENSION

Have the client do the 3‐Day Pulse Journal, if the client shows signs of allergic tension during the

Sanchez‐Cuenca Test:

─ If pulse goes up more than 6 points, it is a positive indication of allergic tension. The more it goes up, the more significant the problem.

─ If pulse goes down, this is a sign of switching (the nervous system acting backwards). Some people go from sympathetic to parasympathetic instead of the other way around.

Rules for Sanchez‐Cuenca Test

• Sit down• Take a full one‐minute pulse• Stand up• Wait 15 – 30 seconds• Take a full one‐minute pulse• Compare the results:


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Protocols

PROTOCOLS FOR DIGESTION


In an ideal situation, you want to be able to perform the Functional Evaluation and LNT

process to determine the supplement program for your client

In cases where that is not possible, you have two “backup” methods:

1. a. Have the client complete the NAQ. b. Run the Symptom Burden Report (which we will learn in Part II of this course) c. Follow the Client Schedule program

2. Use the Nutritional Protocols located on NTTConnect in Reference section


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NUTRITIONAL PROTOCOLS


The Nutritional Protocols contain the following information:

• Related Conditions

• Physiologic Considerations

• Predisposing Factors

• Clinical Considerations

• Recommendations (including dietary)

• Primary Supplemental Support

• Secondary Supplemental Support

PROTOCOL LIST


• Acid Indigestion

• Appetite Excess

• Appetite Reduction

• Biliary Insufficiency

• Celiac

• Colitis

• Constipation

• Crohn’s Disease

• Diverticulitis

• Dry Mouth

• Dysbiosis

• Flatulence

• Gastritis

• Gum Disease

• Halitosis

• Ileitis

• Irritable Bowel Syndrome


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Possible Reactions to Nutritional

Therapy

POSSIBLE REACTIONS


Let your client know they may experience a reaction when beginning

any new protocol:

Possible Reactions to Nutritional Therapy

Digestive Reaction Looks like a digestive problem

Examples: diarrhea, cramping, heartburn, constipation

Sensitivity and/or Allergic Reaction These look like sensitivity or allergy symptoms

Examples: rashes, congestion, etc.

Healing Reaction Looks like the symptoms you are trying to fix

Examples: flu‐like symptoms if you’re working on immune function or nausea if you are working on gallbladder


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HANDLING REACTIONS


Handling Reactions to Nutritional Therapy

For Digestive Reaction Support their digestion

Sensitivity and/or Allergic Reaction Find an alternate therapy

Healing ReactionMild/Moderate Symptoms: give the client the option to cut back dose or work through it

Severe Symptoms: recommend the client call you

MODULE 4 SUMMARY


State the Big Ideas for Digestion1

Describe the way Digestion is supposed to work2

Explain at least 3 things that can go wrong in the Digestive System3

4 Define the 3 possible reactions a client can have to a nutritional protocol

5 Summarize the five step process for Coca’s Pulse Test

ntc module 4 digestion and elimination...3 mixing/propulsion–moving the food through the gi tract...

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