Your Digestive System

Someone asked me the other night which part of the intestines does food get digested first.  I said the small intestine.  The sequence is like this:  

First, the mouth: chewing and mixed by saliva.  After the mouth, food passes through the esophagus for a bit more digestion.  That's second. Third, the food reaches the stomach where it is chemically and muscularly destroyed by the stomach muscles and powerful hydrochloric acid.  From the stomach, you food transports to the small intestine, where the majority of your foods nutrients are absorbed.  The large intestines absorb water and render your food more suitable for waste.  There is some digestion in the large intestine as well.  Check out the photo:

This a pretty good description of your digestive system:

The primary functions of the small intestine are to break down food by means of chemicals and to absorb some of the food's nutrition through the intestine walls. Food enters the small intestine from the stomach and travels through the intestine by means of peristalsis. The first section of the small intestine, called the duodenum, receives digestive juices from the pancreas that aid in the breakdown of fats, proteins and carbohydrates. These digestive juices also help to neutralize acid that accompanies the food from the stomach. Bile from the gall bladder enters the duodenum to further aid in the breakdown of fatty substances. 

The walls of the small intestine contain small protruding components called microvilli, and these small structures help to increase the wall's absorption capabilities so that large amounts of nutrients may pass through the intestine walls into the blood stream. The remaining waste passes into the large intestine for later expulsion.  

Next is how to take care of it, the whole thing, as well as the different parts?  How does one avoid a leaky gut? Where does it usually occur?  

This you already knew:

The most acidic part of the human gastrointestinal tract is the stomach, which is generally around pH 1 to pH 3. The high acidity in the stomach fights bacteria that are ingested with food. As the distance increases from the stomach, the pH level gradually increases. The large intestine is pH 5.5 to pH 7.

Dr. Mary Ruwart on the FDA, Libertarian Party, Licensing, and More . . . .

Show comments start here.  Date on this show is two years old, April 20, 2014.

"When you use morally acceptable means, you get good results.  When you use aggression as your means to an end, you get aggressive [possibly violent] results."  Whether it's banking, small business, pollution, or foreign policy, case after case you get aggression if you use aggression.  Aggression boomerangs on the perpetrator. 

One of her favorites is the FDA.  These regulations 1962, in the wake of the Thalidomide tragedy, have left people to die waiting for life-saving drugs.  AIDS community tested and used blackmarket drugs.  By the time the FDA gave its approval to test on humans, every AIDS patient in the country who wanted her drugs said they'd already had them and had developed resistance to them.  Wow!!  So she had to wait for new diagnoses before she could actually do the tests.  Incredible.  FDA is tragically behind the curve.  Regulations that take choice away from the consumer actually harm the consumer.  F"DA is going to keep some effective drugs off the market, but it does its job to keep people safe, so maybe it's just a wash" asks Dr. Woods in the hypothetical.  Her answer?  "Well, actually, it's not a wash.

FDA regulation because we want to be protected from poisonous drugs, particularly from 1962 with the thalidomide tragedy, takes 5 to 15 years to get life-saving drugs to the market.  By the time AIDS drugs were marketed, they had to change the drug because people became . . . .

FDA drug policy is not a wash.  Problems with drugs are due to the fact that we don't have enough science to test them.  We're so different genetically.  With the foods we eat.  A small group reacts poorly to some drugs--even penicillin--can kill people because drugs have side effects.  Adding 10 years to development time increases the costs and time so much, that life-saving drugs aren't developed.  People can die from allergic reactions.  Development time does not give us protection at all.  New life-saving drugs aren't developed because it's too difficult to please the FDA.  She has a patent for liver disease.  But if you've got a patent or a drug to cure, she doesn't know how much to give.  By the time you get the drug to market, your patent has run out, it goes generic, and you can't recover your costs.  Long timeline increases costs so much that companies aren't willing to take a chance to design a cure. 

"What about licensing?" Tom asks.  Certification.  It gives people greater choice.  With licensing comes monopoly.  With certification you've got more choices.  Still can have bad players in the market, but certification at least gives you the opportunity to go elsewhere.  Whereas licensing only allows you to go to someone else within the same licensed system.  You get certification from certain professional groups where you have to meet certain requirements.  Beauty is that you always have a choice as a consumer.  Certification does signal testing.   Example: 

WHO ARE THESE PEOPLE?

I don't ask that question with any endearing tones.  Far from it.  I can certainly respect professionals who represent their field and profession well.  Anybody in uniform, ah, I get nervous.  People in white coats or blue scrubs, ah, they make me not a little nervous.  Maybe the profession has changed.  Maybe it's been filled with more thoughtful, ethical people.  Maybe.  . . . maybe not.  Maybe those new to the profession are under strict enforcement to a narrative that serves the patient last.  Maybe.  Maybe people need to learn more about doctors in general and more about their specific doctor in particular.  Doctors are not in the business of healing.  What!!

Nope.  Sorry to disappoint you.  "But I thought that . . . ."  Yeah, we all did.  But the study of medicine is different than the study of nursing.  In fact, some of the advanced degrees in nursing probably offer more in terms of healing than a doctor can.  That's not to slam doctors.  They certainly are studied and trained in their field.  But what exactly is a doctor trained for?  What is his focus or training?  

So I thought it would not hurt to know what your doctor's designation is.  I was just assigned a new doctor, part of a medical group that has at least 10 different doctors.  More actually.  And I am not sure that all of them are doctors.  While a few are MD's, I have already seen physicians or practitioners (how broad of a term can that be!!!) that come with the designation PA-C and FNP-C.  So what are these?

A PA-C is a Certified Physician's Assistant. 

An FNP-C stands for Certified Family Nurse Practioner.

A PN is Nurse Practioner. According to Wikipedia, the typical curriculum for a Nurse Practioner

. . . includes courses in epidemiology; health promotion; advanced pathophysiology; physical assessment and diagnostic reasoning; advanced pharmacology; laboratory/radiography diagnostics; statistics and research methods; health policy; role development and leadership; acute and chronic disease management (e.g., adults, children, women's health, geriatrics, etc.); and clinical rotations, which varies depending on the program and population focus.

There is also ANP, Advanced Nurse Practioner. 

An MD is a licensed doctor. 

A BSN is a Bachelor's of Science in Nursing.

An ADN is an Associate's Degree in Nursing. 

An MSN is a Master's of Science in Nursing. 

People who have a master’s degree in nursing have several career options. Some of those options include: teaching and becoming a nurse practitioner, nurse anesthetist or clinical nurse specialist.  A nurse practitioner is someone who is trained to perform many of the tasks that doctors perform. Nurse anesthetists have received training in administering anesthetics. They usually work under the direction of an anesthesiologist. A clinical nurse specialist is a nurse who specializes in a certain area, such as pediatrics or cardiac care.

A friend writes that the difference between a nurse and doctor is the degree of knowledge and training.  And he reminds me that there is a world of difference between the study of medicine, which doctors study, and the study of nursing, which nurses study.  Whereas nurses are in the practice of executing a doctor's instructions toward the best or optimal results for a patient along medicinal lines, given his medical history, age, and retrieving one's health along a plan mapped out by the doctor, the doctor's main task is akin to a quarterback calling the plays.  He writes 

Degree of knowledge and training.  I would not expect an NP or PA to do surgery or long-term drug therapy.  But I would be very comfortable with either of those doing follow-up care on that surgery or follow that drug therapy. In short, it is a way for insurance companies to pay less for medical services to have non-MD's to do day-to-day medical issues.

What's not clear to me are all of the different nursing and medical designations.

An MD stands for Doctor of Medicine.  What does that mean?  First, it means that he has a Ph.D. in medicine.  Does that qualify him as a healer?  I have my doubts.

This might be of some use to folks:

Profession Comparison Chart (updated September 2015)

Programs vary and the following represents averages for each vocation.

Category	Medical Assistant	Nurse (RN, BSN)	Nurse Practitioner	Physician Assistant	Physician (Family Practice)
Prerequisite Education	None	None	Bachelor Degree in Nursing & clinical hours	Bachelor Degree & clinical hours for most	Bachelor Degree
Learning Model	-	Medical-Nursing	Medical-Nursing	Medical-Physician	Medical-Physician
Time in Classroom	134 hrs	Varies greatly by program.	500 hrs	1000 hrs	2 years
Time in Clinic	160 hrs	Varies greatly by program.	500-700 hrs	2000 hrs	2 years
Total Post High School Education	1-2 years	2-4 years	6-8 years	4-6 years	8 years
Residency	None	None	None	Optional 1-2 years depends on specialty	3-8 years
Degree or Certification Awarded	Certificate or Associate Degree	Associate or Bachelor Degree	Master's Degree Planned Transition to Doctorate by 2015	Physician Assistant Certified (PA-C) Most also award Master's Degree. Some now pursuing PHD	Doctor of Medicine (M.D.) Doctor of Osteopathy (D.O.)
Recertification	60 education points or exam every 5 years	1000 hours practicing in area of certification  specialty OR exam every 5 years	1000 professional practice hours AND ~15 CE credits/year OR exam every 5 years	100 education hours every 2 years Exam every 10 years	MD: 50 education hours every year & ABMS certification recommended DO: 120 education hours every 3 years & ABMS certification recommended.
Base Salary U.S. National Average 2010	$29,708	$66,220	$97,990	$97,280	$185,151
Duties Performed
Independent Practitioner			18 states allow NPs to practice independently		X
Complicated or High Risk Cases			VARIES	ASSIST	X
Perform Surgery			ASSIST	ASSIST	X
Deliver Babies			X	VARIES BY STATE	X
Write Prescriptions			X	X	X
Prescribe controlled substances			VARIES BY STATE	VARIES BY STATE II-V in MOST states	X
Conduct Physical Exams		ASSIST	X	X	X
Diagnose			X	X	X
Treat Illness		X	X	X	X
Order & interpret tests		ASSIST	X	X	X
Patient counseling		X	X	X	X

HCL "[optimizes] the immune system gut flora"

This is important . . . , but always, always take these claims with your most judicious caveat.  The article begins thus, 

We all know that eating a healthy, balanced, natural diet is a cornerstone of perfect health, but what if all of that nutritious food is not being processed efficiently? 

It opens with a statement that we've all just accepted as a prevailing truth because that point has been droned into our heads for decades, a statement that, in my opinion, tends to benefit the vitamin supplement industry.  Important to eat a "healthy, balanced, natural diet," yes, but what does that even look like?  I mean who can dispute such a fact?  And then that statement of fact ends ominously with a worrisome question, ". . . but what if all of that nutritious food is not being processed efficiently?" For one, at least in America, food is cheap.  Even for people who can afford to eat better than the average American, they still consume junk--fast food, snack food, sweets, etc., in other words, junk.  So the article opens on a dubious premise.  It then proceeds to answer its own question,

Betaine hydrochloride, derived from beets, is a supplement for helping food to be fully dissolved and processed in the stomach for optimum nutritional benefits.

". . . derived from beets"!!  Wow!  It must be okay then.  And I am sure it is.  It's just that the author is looking for some kind of authority, and since beets is a natural food grown in the earth, who can question the nutritious value of beets?  I love beets.  Have eaten them raw and pickled in a syrupy sauce, the way they used to be sold for years.  My mom loved beets.  A supplement derived from beets?  Even safer, right?  Maybe.  I am not disputing the benefits of Betaine Hydrochloride.  It think it is beneficial for folks with gastro-intestinal problems.  I have tried Betaine Hydrochloried, and I noticed several benefits.  However, I am not convinced that one should try as much as they like or for as long as they like.  Short-term in small amounts might be judiciously advised.  

The stomach processes food both mechanically and chemically by breaking it down with hydrochloric acid into its basic constituents, which are then forwarded to the digestive system and blood for nutritional distribution

That's a good point.  It's good to imagine how the muscles of your stomach and its lining are mechanically employed to break food down. And chemically, of course.  But this article poses concerns that stem from digestive inefficiency by the stomach muscles and its chemical, hydrochloric acid.   

If food is not processed effectively by the stomach, it is as if the body is being starved of a healthy diet with the same potential health consequences due to an inefficient or sub-optimal immune system. All disease arises from either low immunity, abnormal immunity or auto-immunity, including cancer, the immune system as a whole being ultimately dependent on gut flora of the stomach and digestive tract.

Okay, some important facts here that can be extrapolated from the sales pitch.  It's true that "the immune system as a whole [is] dependent on gut flora of the stomach and digestive tract."  Which only blows me away when I think how hospitals when they admit patients will flood a patient's body without question or a single regard for their condition with antibiotics that absolutely destroy gut flora, thereby weakening the patient and priming them for doctor-prescribed medicine while they are laid up, getting weaker and sicker in the hospital.  The pharmaceutical industry has for the most part been the agency that has promoted doctors and built their respectable reputation.  But be careful with that; they don't always deserve your unexamined respect.  These guys have peddled antibiotics to people with virus infections, and yet they never offer a sound, logical explanation for prescribing such an irrational remedy.

The article was doing just fine until it reaches into its bag of industry-standard scaremongering, 

Research has shown that, after the age of 21 years, the concentration of hydrochloric acid in the stomach begins to fall progressively with age, a condition known as "hypochlorhydria."

Oh, so now we have a new condition, one that I have never heard of. One, your body has amazing compensatory, feedback mechanisms to keep you alive despite horrible assaults and insults to your biology.  To cite the age of 21, a time when most people are just developing and coming into their own, as the age when people are in decline is absurd.  I had a doctor tell me once, following a short-term bout of declining energy, that I was at that age when things begin to fail.  I stood there with a fixed stare like I was listening to some sorcerer standing in front of an inscrutable sphinx. For men, and I would also say for women, your 40s are some of your best years, but this article contradicts my observation,

By the time people reach the age of 40 or 50, stomach hydrochloric acid concentration is much lower and attributable to age-related immune and auto-immune conditions, including diabetes, cancer and obesity--particularly abdominal fat--hence the so-called "middle age spread." Use of betaine hydrochloride has frequently been credited with flattening the stomach for this reason.

Now that is miraculous.  Using Betaine Hydrochloride can get rid of belly fat.  Actually, it can.  I lost 5 pounds while using the stuff for about ten days.  I just can't say with any certainty that it was a healthy weight loss. Can't say either that it wasn't.  My blood tests came back clean.  Except that I need to drink more water.  I am getting enough protein; didn't think there was a problem with that, but it was nice to hear from the doctor that my blood was good.  He said "You're like Brad Pitt."  I laughed.

The article does note that acid reflux is caused by lactic acid, not hydrochloric acid rising from your stomach up into your esophagus:

Acid reflux is caused by lactic acid, a warning sign for too low of a concentration of hydrochloric acid, causing incomplete digestion of food. Acid reflux needs to be treated by increasing hydrochloric acid, not antacids which will neutralize hydrochloric acid, making reflux worse as well as other health consequences.

That has the ring of truth to it.  

Low hydrochloric acid is a potential cause of cancer and other immune and auto-immune conditions.

Everyone, without exception, has cancer genes, "oncogenes," circulating around the body. These cancer genes are normally kept in check by a healthy immune system, but in the case of cancer, the immune system can no longer suppress the cancer genes, which can then get out of control and multiply. The immune system responds by forming a tumor to contain the malignant cancer cells.

Chemotherapy may suppress cancer cells temporarily but also destroys the immune system, exposing the patient to a very wide range of additional diseases as well as additional types of cancer through immune-suppressed cancer gene expression.

If the "Th1" immune system is compromised or disabled, the "Th2" component of the immune system attempts to take over. Th2, not being equipped to function as Th1, perceives genuine body tissues as foreign invaders, attacking them as it would a bacterium or virus. Th1 suppression is also a root cause of auto-immune diseases such as allergies, celiac disease and arthritis.

How Betaine HCl supplementation can bring valuable health benefits:

Betaine hydrochloride (betaine HCl) increases the concentration of hydrochloric acid in the stomach relative to how much is taken before meals. This enables the stomach to much more completely dissolve and process foods right down to base nutrients, as well as produce methyl groups, an important element in preventing cancer and other diseases.

Taking betaine HCl before meals helps the stomach make optimum use of all dietary nutrients, also optimizing the immune system gut flora, without which, even with a healthy diet, many diseases including cancer can arise and propagate.

Low hydrochloric acid is related to other serious ailments.  See here.

Vaxxed

This is no mystery to me.  You might enjoy Jon Rappaport's comments after viewing the documentary's trailer here: