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In the past month's series on nutrition, I explained how the manner in which we eat can affect us as much as our food choices can. We looked at the vital roles that cooking and chewing play in digestion, and the importance of eating slowly and not too much. And I described the digestive tract from the mouth to the stomach. I think it’s important that everyone understands at least the basics of how their organs work, so let's look at the rest of the digestive tract this time.
Although we may have teeth and reality TV, we’re more like worms than we like to think. We’re all just a bunch of cylinders, with a tube of the outside world running through us. Worms put dirt in theirs, we put marshmallows in ours.
After the mouth, esophagus, and stomach, food enters the small intestine, which is about 23 feet long. It's where most nutrient absorption takes place, and all the value of good nutrition hinges on good absorption. At the beginning of the small intestine, a bunch of gastric juice is injected from the pancreas and gallbladder, which neutralizes the acidic food coming from the stomach, and makes the nutrients more absorbable. The pancreas produces a blend of digestive enzymes that break down the different components of food - fat, carbohydrates, and protein. The gallbladder squirts out bile (which is produced in the liver) to make fats absorbable.
The lining of the small intestine is composed of many folds, covered with tiny hair-like protrusions called villi (which are further covered with tinier hairs called microvilli). These greatly increase the surface area of the small intestine to maximize nutrient absorption. Some inflammatory conditions, such as celiac disease (gluten intolerance) and bacterial overgrowth of the small intestine (SIBO) can damage this membrane, leading to malnutrition.
The small intestine is followed by the much shorter but wider large intestine (most of which is called the colon). Food spends a very long time in the large intestine, where water and some remaining nutrients are absorbed, and stool is compacted and waits to be liberated. Finally, the stuff we can’t digest, along with waste products from throughout the body, leaves the rectum as stool. About 60 percent of its dry weight is bacteria.
Where does it come from? Riding along with us in our intestines are about 100 trillion microorganism passengers. There are about 500 different kinds, most of which are bacteria. They’re known as our “gut flora,” and they do all sorts of useful things for us, such as helping us digest things, protecting us from harmful microbes, synthesizing some vitamins, stimulating growth of intestinal cells, and assisting the immune system. We acquire these microscopic pals by eating food that’s contaminated with them or deliberately cultured with them (like yogurt and sauerkraut), and by taking them in supplements known as probiotics.
So, as we’ve seen, our environment (what we select from it based on taste) literally passes through us. We make the outside world into ourselves. It’s a practice worth taking seriously. Besides the healthy eating practices I discussed previously, some of the main factors in good absorption are having enough gastric juice, having healthy gastric membranes, having a strong and healthy population of gut flora, and having a relaxed nervous system.
Cultivating a relaxed nervous system has many additional benefits, so spend time in nature, eat in a calm environment, get massages, meditate, do whatever works for you to become peaceful. As for gastric juice, insufficient enzyme secretion is pretty common. Consider a good digestive enzyme complex, taken at the beginning of a meal. I’ve had at least a hundred patients who have overcome longstanding digestive problems just by supplementing for a while with digestive enzymes. Some people who have trouble digesting fat do well to take a product that also contains ox bile. Finally, promote healthy gut flora by eating live, fermented/cultured foods on a regular basis, and occasionally taking a course of probiotics (especially after using antibiotics).
If you’re interested in learning more about the big picture of eating and nutrition, check out the four week course I developed for The Dragontree, called How to Eat.
Be well,
Dr. Peter Borten
[post_title] => Basic Vehicle Maintenance, Part Three: Know Your Insides
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IF WE’RE NOT SUPPOSED TO EAT ANIMALS, HOW COME THEY’RE MADE OUT OF MEAT?
I saw that line on a bumper sticker when I was about 16, shortly after becoming a vegetarian. I laughed heartily at it; it was a good reminder not to take myself too seriously.
I stopped eating meat mostly because I just didn’t like it. But in the early 1990s I encountered John Robbins’s Diet for a New America, and my reasons for not eating flesh became more numerous. If you aren’t familiar with him, Robbins is the vegan son of the cofounder of the Baskin-Robbins ice cream empire, and he left the ice cream business in part because of his opposition to the mistreatment of cows and his emerging belief that humans shouldn’t consume animal products. In Diet for a New America he explores the ethics of factory farms, the environmental impacts of animal production, and the health effects of consuming dairy and meat. It made sense to me and I felt empowered in my position.
But when I began grad school in Chinese Medicine some years later, my Asian professors were perplexed by the high rate of vegetarianism among the students. They asked us, “Why wouldn’t you eat meat if you can afford it?” To them, vegetarianism was an involuntary choice necessitated by poverty. They pointed to our sharp canine teeth and the place of meat in the history of human diets. They weren’t familiar with any of the issues or fads around meat eating and vegetarianism; they only cared about what’s best for human health. So I decided to set aside my biases and earnestly seek the truth.
When I began my clinical internship, I met numerous vegetarian patients – and even more vegans – who were weak and had insufficient immune function. Their pulses, which should have felt something like a jumping piece of spaghetti at the wrist, were often more like a faintly twitching thread. Often, they were under the impression that not eating meat in itself would make them healthy – even if they never gave much thought to what they did eat instead.
In my practice, ethics and preferences began to take a back seat to biological necessity. When these patients began to eat meat – often because I advised them to experiment with it – nearly all of them felt stronger and healthier. I even met some people who thrived on meat, whose bodies seemed to crave meat over anything else and whose only intolerances were to certain plant-based foods. Eventually I started eating a little meat now and then. (I can’t say I noticed much difference in my health from doing so, but I was already eating plenty of animal protein in the form of eggs and yogurt.)
Coincidentally, meat was making a big comeback. When I first moved to Portland, it had a large selection of vegetarian restaurants. Fifteen years later, many of these had been replaced with restaurants that were unapologetically meat-based with barely a flesh-free dish on the menu. Elk burgers, pork bellies, and lard were so hot. With the advent of Paleo diets, people were flocking back to meat as if it they’d been deprived their whole lives.
Meanwhile, I became a father, I became more connected to the earth, I realized I had never really forgotten all those points that Robbins made 30 years ago, and I found it increasingly difficult to be willfully ignorant of the impacts of my choices of consumption. One of those impacts is that meat production – in the prevailing manner and scale – is devastating to the planet.
Thus, I found myself in the middle of the complex intersection of nutrition, industry, environment, ethics, and politics – and I’ve never again had an easy answer to the question of whether people should or shouldn’t eat meat.
We’ll look more closely at the pros and cons of meat consumption next week. I’d love to hear about your experience with – or without – meat in the comments below.
Be well,
Dr. Peter Borten
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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.
Be well,
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.
[post_title] => The Difference Between Stomachs and Balloons
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In the past month's series on nutrition, I explained how the manner in which we eat can affect us as much as our food choices can. We looked at the vital roles that cooking and chewing play in digestion, and the importance of eating slowly and not too much. And I described the digestive tract from the mouth to the stomach. I think it’s important that everyone understands at least the basics of how their organs work, so let's look at the rest of the digestive tract this time.
Although we may have teeth and reality TV, we’re more like worms than we like to think. We’re all just a bunch of cylinders, with a tube of the outside world running through us. Worms put dirt in theirs, we put marshmallows in ours.
After the mouth, esophagus, and stomach, food enters the small intestine, which is about 23 feet long. It's where most nutrient absorption takes place, and all the value of good nutrition hinges on good absorption. At the beginning of the small intestine, a bunch of gastric juice is injected from the pancreas and gallbladder, which neutralizes the acidic food coming from the stomach, and makes the nutrients more absorbable. The pancreas produces a blend of digestive enzymes that break down the different components of food - fat, carbohydrates, and protein. The gallbladder squirts out bile (which is produced in the liver) to make fats absorbable.
The lining of the small intestine is composed of many folds, covered with tiny hair-like protrusions called villi (which are further covered with tinier hairs called microvilli). These greatly increase the surface area of the small intestine to maximize nutrient absorption. Some inflammatory conditions, such as celiac disease (gluten intolerance) and bacterial overgrowth of the small intestine (SIBO) can damage this membrane, leading to malnutrition.
The small intestine is followed by the much shorter but wider large intestine (most of which is called the colon). Food spends a very long time in the large intestine, where water and some remaining nutrients are absorbed, and stool is compacted and waits to be liberated. Finally, the stuff we can’t digest, along with waste products from throughout the body, leaves the rectum as stool. About 60 percent of its dry weight is bacteria.
Where does it come from? Riding along with us in our intestines are about 100 trillion microorganism passengers. There are about 500 different kinds, most of which are bacteria. They’re known as our “gut flora,” and they do all sorts of useful things for us, such as helping us digest things, protecting us from harmful microbes, synthesizing some vitamins, stimulating growth of intestinal cells, and assisting the immune system. We acquire these microscopic pals by eating food that’s contaminated with them or deliberately cultured with them (like yogurt and sauerkraut), and by taking them in supplements known as probiotics.
So, as we’ve seen, our environment (what we select from it based on taste) literally passes through us. We make the outside world into ourselves. It’s a practice worth taking seriously. Besides the healthy eating practices I discussed previously, some of the main factors in good absorption are having enough gastric juice, having healthy gastric membranes, having a strong and healthy population of gut flora, and having a relaxed nervous system.
Cultivating a relaxed nervous system has many additional benefits, so spend time in nature, eat in a calm environment, get massages, meditate, do whatever works for you to become peaceful. As for gastric juice, insufficient enzyme secretion is pretty common. Consider a good digestive enzyme complex, taken at the beginning of a meal. I’ve had at least a hundred patients who have overcome longstanding digestive problems just by supplementing for a while with digestive enzymes. Some people who have trouble digesting fat do well to take a product that also contains ox bile. Finally, promote healthy gut flora by eating live, fermented/cultured foods on a regular basis, and occasionally taking a course of probiotics (especially after using antibiotics).
If you’re interested in learning more about the big picture of eating and nutrition, check out the four week course I developed for The Dragontree, called How to Eat.
Be well,
Dr. Peter Borten
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