This month’s theme is nutrition, and I started the series by explaining that, while we have greatly improved humans’ odds of surviving childhood, we haven’t made as much progress in prolonging the lives of older people. Old people tend to die of conditions that are long in the making, and there aren’t many ways to intervene in these processes near the end of life. The biggest value in life extension comes from adopting good habits earlier, such as healthy eating, exercise, and a spiritual or meditative practice.
Last week I compared the body to a car, and asserted that fuel quality isn’t everything. We always hear about what we should and shouldn’t eat, but how our fuel is introduced to the body is as important to our health as the fuel itself. (You can read part one and part two.) Previously, we looked at food preparation and the vital role of the mouth; now let’s travel a bit further down the rabbit hole. (Note: the gastrointestinal tract is not an actual rabbit hole; we do not condone swallowing live rabbits.)
Food goes in your mouth, travels down a tube called the esophagus, and pushes through a ring of muscle known as the lower esophageal sphincter (or LES) to enter your stomach. The LES is vital for keeping the top of your stomach closed, so food doesn’t back up and stomach acid doesn’t burn the lining of your esophagus. When you overfill your stomach, at least four bad things happen – it stretches the stomach, it promotes weight gain, it compromises digestion, and it puts lots of back pressure on the LES.
A stretched stomach is a feature of every overweight person. Fullness of the stomach is not a healthy way to gauge when to stop eating. If you routinely fill your stomach to capacity, it will inevitably expand, and you’ll need to eat more to get that full feeling. There’s a perceptible difference between enough and full, and enough is usually much less than full. Okinawans, known for their longevity, have a cultural practice of eating to just 80% of capacity. At 80% full, you will not be hungry, although you may convince yourself that you are, being used to that full stomach feeling. Undereating promotes longer life.
If the stomach is packed, it’s like an overly full washing machine. The clothes don’t circulate – they just get damp and wrinkly. Likewise, we don’t digest our best when the stomach is filled to capacity. A history of overeating tends to deplete the stomach, which can result in insufficient acid secretion. We need lots of acid to digest food (especially protein, minerals, and vitamin B12), to stimulate emptying of the stomach, to quickly dismantle potential allergens, and to kill bacteria and viruses that may have entered the GI tract. Low stomach acid is very common among older adults. I usually give patients hydrochloric acid in a form called betaine hydrochloride, though I’ve encountered many who have gotten good results from using apple cider vinegar in capsules or taken in some water.
If we frequently cram the stomach, the LES tends to become less competent at staying tightly closed. Especially when combined with shallow breathing, low stomach acid, sitting a lot, frequently wearing a tight belt or seat belt, and having a big belly, the result is acid reflux – AKA heartburn or gastroesophageal reflux disease (GERD). I don’t know if you’ve noticed, but a lot more people get acid reflux than in the past. When I began my practice, I didn’t encounter it that much. Now it seems every other patient is on an acid blocking drug. One reason is that portion sizes have increased and mealtimes have gotten shorter and less relaxed, so we eat both more and faster.
Sometimes a person with a history of acid reflux will develop pre-cancerous changes in their esophagus known as Barrett’s Esophagus, and in these cases, an acid blocker might be prudent (though I still recommend fixing the cause of the reflux). For everyone else, they are a bad idea except for occasional use. Over time, all of the functions of stomach acid I mentioned above can be expected to become compromised – nutrient absorption, killing of pathogens, breaking down allergens, etc. We’re already starting to see unusually high rates of uncommon infections in people on these drugs. There are lots of better and more natural approaches for relief, such as d-limonene, which comes from orange peel oil, and soothes and protects the esophagus. But the best thing you can do is to eat less food, do it slowly, prepare it as I explained in the last article, and chew thoroughly. It will not only improve your health, it will also bring you back to specialness that is the ritual of nourishing yourself.
Dr. Peter Borten
P.S. After years of teaching people about nutrition, I recently decided to create an online video-based nutrition course called How to Eat. If you’re interested in learning more about nutrition, including both Eastern and Western points of view, I encourage you to check it out. My goal is to have participants gain a lifelong, intuitive understanding of how to feed themselves, and to learn how to eat for optimal energy and weight. You can check it out here.