You’ve probably heard the expression, “you are what you eat.” but, what if you can’t digest the foods that you’re eating? Most people know that nutrition plays a role in health, however, navigating the abundance of nutritional information at our disposal can be overwhelming, to say the least. What’s more, there is no such thing as a one-size-fits-all approach when it comes to nutrition. When digestive function is compromised, even the healthiest of diets may not be enough to support healing and pain management.
What is nutrition therapy?
Nutrition therapy aims to optimize health by coaching clients to make changes to their diet and lifestyle. Certified nutrition therapy practitioners recognize bio-individuality and take a holistic approach to address health issues. Their role is not to diagnose or treat medical conditions, but rather, to assess body function and support the body in its healing process.
Here are five things that everyone should know about their digestive function:
1). You need adequate hydrochloric acid in the stomach.
You may be aware that protein intake is critical for healing, and this is because the human body is made of proteins. Proteins also play a key role in maintaining our blood volume, immune function, blood clotting and pH regulation. Dietary protein will be broken down into amino acids, which the body will then utilize to synthesize proteins to create muscle, tendons, bones, blood, organs, hair, skin, nails, hormones, enzymes, and DNA. However, in order for this to happen, the body must be able to appropriately digest and absorb proteins.
As with all digestion, food is mechanically broken down in the mouth. Food then enters the stomach, where protein digestion is initiated. The parietal cells of the stomach produce hydrochloric acid (HCl), which does two things: first, it denatures proteins (in other words, it changes the shape of the protein so that it has more surface area for enzymes to act on it) and second, it activates pepsinogen into pepsin. Pepsin is an enzyme that cleaves proteins into smaller portions, including polypeptides and some free amino acids. Therefore, inadequate HCl can impair the body’s ability to digest proteins. The stomach acid also serves as the body’s first line of defense against any ingested bacteria or viruses.
How do you know if you’re not digesting protein? Signs include a feeling of “heaviness” or a sense of delayed emptying in your stomach after consuming protein. Additionally, bad breath and foul-smelling gas can be an indicator that protein isn’t being properly digested. This happens because undigested protein putrefies in the GI tract and creates a putrid smell.
So, what can we do to promote protein digestion? The best first step is to ensure you’re not taking any antacids. Increasing your water intake between meals, but limiting water intake with meals can ensure that the stomach acid is not diluted. Furthermore, thorough chewing of food is critical to initiate the digestion process (salivary enzymes in the mouth can start to break food down chemically as it’s being digested mechanically through the chewing process). There are supplements that can be used to stimulate stomach acid, but they are not appropriate for everyone, so be sure to chat with a professional before using things like digestive enzymes, apple cider vinegar or betaine.
But what about acid reflux/heartburn? Well, the stimulus for closing the lower esophageal sphincter (LES) is HCl. This means that if you don’t have enough HCl, the LES will remain open and HCl can enter the esophagus and create heartburn. Long-term use of antacids can perpetuate hypochlorhydria (low stomach acid).
2). Gluten can contribute to inflammation.
There’s no question about it – gluten gets a bad rep, due to its purported inflammatory effect. Gluten is a group of proteins, mainly gliadin and glutenin. There are several theories about non-celiac gluten sensitivity and/or development of wheat allergies. But, literature has shown an inflammatory response to consumption of gliadin. Additionally, consumption of gluten leads to release of a hormone called zonulin, which breaks the tight junctions between the cells lining the gut. When the integrity of these tight junctions is compromised, undigested food particles and nutrients can pass directly into the blood, which initiates an immune response and subsequent inflammation, as well as development of food sensitivities.
When you’re already dealing with pain, it’s best to try to mitigate any extra inflammatory load to the system. One of the easiest ways to do this is to avoid consuming gluten in large quantities. A little gluten here and there is typically fine, particularly if you don’t have gluten sensitivity. But, if you’ve found yourself in a persistent flare-up, or if you’re rehabbing from an injury, you’d be well-served to try eliminating gluten from your diet and notice if your symptoms improve.
3). Sugar and stress go hand in hand.
We all know that excess sugar isn’t great for our health, neither is stress. But, what you may not know is that the hormones released in response to sugar intake and a stressor are very interrelated.
The endocrine system is quite complex, but all that you need to know for the sake of this discussion is that the adrenal glands are located on top of the kidneys, and they produce glucocorticoids (including cortisol), which function to raise blood sugar levels and mobilize energy stores so that your body can have a source of fuel to deal with the stressor in front of you (i.e. you need energy to fight or flee!). Insulin is produced by the pancreas, and it serves to lower blood sugar by stimulating cells to uptake glucose from the blood.
You now know that stress (and subsequent cortisol release) raises blood sugar levels by metabolizing stored glucose, but cortisol keeps blood sugar high by suppressing insulin activity. So, if you are experiencing chronically high stress levels, chances are you’re going to have a hard time regulating your blood sugar. With inadequate insulin, blood sugar levels will remain high, and the pancreas will struggle to keep up with insulin production. When this goes on long-term people can develop problems with insulin signaling, may experience poor energy levels or weight gain, and could develop hormone imbalance and cardiovascular disease.
Therefore, it is imperative to develop adequate stress management practices in order to prevent chronic cortisol release. It’s also important to avoid refined sugars and processed carbohydrates (both of which lead to insulin spikes) when dealing with poorly-managed stress.
4). Optimizing liver function is key to hormone balance.
The liver plays a huge role in digestion – it helps with metabolism of fats, carbohydrates and protein; it also functions in blood sugar regulation with its ability to store glycogen and synthesize glucose from proteins and triglycerides. But, it’s also responsible for removing all toxins (including alcohol, pharmaceutical drugs, environmental toxins, as well as metabolic byproducts and hormones) from the body.
Liver detoxification involves two phases. During phase 1, both endotoxins (e.g. metabolic byproducts, hormones and toxins from bacteria) and exotoxins (e.g. pharmaceuticals, alcohol, and environmental toxins) are converted into an intermediate form by a set of enzymes called Cytochrome P450. These intermediary compounds can often be more harmful than the origin toxin, so it’s important that phase 2 is working well; this process also creates reactive oxygen species (also known as free radicals), which must be neutralized by antioxidants in order to prevent cellular damage. During phase 2, the liver breaks down intermediary compounds and binds them to protein molecules for elimination during a process called conjugation. Compounds bound to bile are eliminated in the stool, while other compounds are bound to serum proteins, which are then sent to the kidney and are ultimately excreted in the urine. Phase 2 conjugation may become “sluggish” if the toxic load is too large. In other words, the liver may fail to eliminate hormone metabolites that can subsequently be reabsorbed into the body, thereby creating hormone imbalances that can perpetuate conditions like PCOS and endometriosis.
So, how do we support our livers with our diet? Eating plenty of cruciferous vegetables is key. Incorporate sulfur-rich foods (including eggs, garlic and onion), which help to excrete heavy metals. A diet rich in whole, antioxidant-rich foods (e.g. berries, beets and dark, leafy greens) will help to mitigate any potential oxidative damage created during phase 1 detoxification. Adequate water intake is also important to support liver function; starting the day with 8-10 ounces of warm water with fresh lemon juice is a great strategy to support liver function.
We can also support our liver function by limiting our exposure to common toxins. Obviously, limiting alcohol intake is one of the first steps to decrease the liver’s load. When choosing produce, it’s important to choose organic when buying produce on the “dirty dozen” list (includes: strawberries, spinach, kale, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery and potatoes), as these foods are more likely to be contaminated with pesticides. When consuming animal products (e.g. chicken, beef, eggs and dairy), be sure to choose organic in order to avoid unnecessary exposure to hormones or antibiotics. Furthermore, GMO’s (especially soy) should be avoided, as they can disrupt endocrine (hormone) function. Environmental toxin exposures can be reduced by using a water filter, avoiding plastics when possible, eliminating industrial household cleaners (especially those containing ammonia, chlorine and Perchloroethylene or PERC), and choosing natural beauty products/fragrance.
5). Regular bowel movements are an indicator of digestive health.
Bowel function is far too complex for the sake of this discussion. However, it’s important to understand that bowel movements are largely dependent upon the movement of the large intestine and our fiber content. It’s also worth noting that a meal is typically in our GI tract for approximately 24 hours! If you want to test your meal transit time, try eating corn or beets and see how long it takes for the byproducts to end up in your stool.
The large intestine (including the ascending, transverse and descending colon) propels food forward toward the rectum with peristaltic waves, haustral churning and mass peristalsis. These movements are reflexive in nature. In other words, the pressure of food in the stomach leads to movement down the line in the large intestine. Therefore, eating a meal should stimulate a bowel movement and evacuation of an earlier meal, which means it is normal to have 3 bowel movements per day! However, many of us have lost this intrinsic peristaltic reflex. Blame prolonged sitting, snacking (rather than eating large meals), or stress. History of abdominal surgeries and subsequent scar tissue, as well as muscle tension or guarding through the abdomen can also inhibit the inherent movement of our large intestine.
It’s probably no surprise to hear that adequate fiber intake is imperative for healthy bowel movements. A key role of fiber is to facilitate elimination of toxins; bile bound to liver byproducts then binds to fiber and is excreted in the stool.
Quite simply, fiber is the structural parts of plants (e.g. stems, roots, leaves, skins). Fiber differs from starches because the bonds between their sugars cannot be broken down by digestive enzymes. This is why fiber helps digestion – it remains intact until it reaches the colon, where it is broken down by bacteria. There are two main categories of fiber: soluble and insoluble fiber.
As its name implies, soluble fiber can dissolve in water and forms a viscous, gel-like product. It is fermentable and is easily digested by the bacteria in the colon. It is found in barley, oats, legumes and fruits. Soluble fiber binds with bile in the intestine, which helps the body to excrete broken-down hormones. It slows transit time through the upper GI tract and helps to lower blood glucose levels by slowing down glucose absorption from the small intestine. It also increases the water intake of stool, thereby acting as a stool softener.
Insoluble fiber does not dissolve in water, therefore, it does not form gels. It is found in whole grains, seeds, nuts, vegetables (cabbage and Brussel sprouts, in particular) and legumes. Other food component sources include psyllium and cellulose. It can increase the bulk of stool and can improve bowel movements by acting as a “broom” to “sweep” the lining of the colon.
Unfortunately, many people suffer from irregular bowel movements. Ultimately, your bowel function is an indicator of your digestive health. If you’re experiencing recurrent diarrhea, constipation or distress with bowel movements, be sure to address these symptoms with a medical provider, as you may be experiencing food sensitivities or bacterial imbalance.
We can promote healthy, regular bowel movements with diet. If you’re having “sticky” stools that lack form, try to incorporate more insoluble fiber. On the other hand, if your stool is hard, you likely need more water and/or soluble fiber. If you’re someone that doesn’t have regular bowel movements, you may benefit from elimination of snacking and focusing on eating 3-4 larger meals, in an attempt to restore your reflexive peristalsis. It’s also worth addressing any structural restrictions in your abdomen (e.g. scar tissue and/or muscle guarding) with your physical therapist, as this will facilitate the motility of your large intestine.
- Biesiekierski, J. R. (2017) What is gluten?. Journal of Gastroenterology and Hepatology, 32: 78– 81.
- Fasano, A. (2012). Intestinal Permeability and Its Regulation by Zonulin: Diagnostic and Therapeutic Implications Clinical Gastroenterology and Hepatology, 10(10): 1096-1100.
- Wilcox G. Insulin and insulin resistance. Clin Biochem Rev. 2005;26(2):19-39.
- Genes SG. Role of the liver in hormone metabolism and in the regulation of their content in the blood. Arkh Patol. 1977;39(6):74-80.
About the Author
Amy is a Doctor of Physical Therapy at the Capitol Hill location. She also works as a Certified Nutrition Therapy Practitioner and Restorative Wellness Practitioner. You can learn more about her health and wellness business at dramyosborne.com or schedule a physical therapy session with her at provider.kareo.com/Amanda-osborne at her provider profile.