Transcript The Digestive System

Systems Synergy
• Digestive system
provides the raw
materials for the body
to both function and
repair itself.
• All systems are
influenced by the
digestive system.
• 90% of the bodies
serotonin is
produced in the gut.
• 70% of the body's
immune system
Digestive System Overview
• Enteric Nervous System : Is a
complex system that has as
many neurons as the spinal
cord.
•
Often referred to as the second
brain.
• Parasympathetic nervous
system has many neural
connections to the ENS.
•It stimulates digestive
activities via the vagus nerve.
•Encourages blood flow to
the gut and activates
associated digestive organs.
•What state of mind is best
for digestion?
Microscopic Anatomy of the Small Intestine
Digestion is a very energy intensive process.
Under stress blood is shunted away from the
digestive organs resulting in a reduced
ability to create ATP.
Less nutrition can be absorbed under stress.
Nutrients
• Ingested chemicals used for growth, repair or
maintenance.
• Macronutrients consumed in large amounts
– proteins, fats and carbohydrates
• Micronutrients needed in small amounts
– Vitamins, minerals, phytonutrients, etc.
• Essential nutrients can not be synthesized
– minerals, vitamins, 8 amino acids and fatty acids must
be consumed in the diet every day.
Vitamins
• Body synthesizes some vitamins from precursors
– niacin, vitamin A and D
– vitamin K, pantothenic acid, biotin, folic acid
• produced by intestinal bacteria
• Water-soluble vitamins (C, B)
– absorbed with water in small intestine; not stored
• Fat-soluble vitamins (A, D, E, K)
– absorbed with dietary lipids; stored
Functions of Minerals
• Calcium and phosphorus
– bones and teeth
• Phosphorus
– phospholipids, ATP, CP, buffers, nucleic acids
• Calcium, iron, magnesium and manganese
– cofactors for enzymes
• Iron - essential for hemoglobin and myoglobin
• Chlorine - component of stomach acid (HCl)
• Mineral salts
– electrolytes; govern function of nerve and muscle cells;
regulate distribution of body water
Protein
• 12-15% of body mass
– mostly in skeletal muscles
• Functions
– muscle contraction, cell membranes , collagen, bones, keratin,
antibodies, myoglobin, enzymes, neurotransmitters, plasma
proteins needed for blood osmolarity and viscosity.
• Protein requirements vary.
– ADA:(.8g /kg)
– ACSM: Power athletes: 1.6-1.7g /kg Endurance athletes: 1.2-1.4g /kg
– On average the body can only utilize between 20- 30 grams per meal.
Protein Sources
• Nutritional value depends on proportions of amino acids
– 8 essential amino acids can not be synthesized
• Complete proteins (dietary)
– supply all amino acids in right amount needed to
synthesize protein
• Animal proteins (meat, eggs and dairy)
– Closely match human proteins in amino acid composition
– Protein with every meal will reduce the glycemic load of
the meal which will stabilize blood insulin levels.
Carbohydrates
• Carbohydrates found in 3 places in body
– 450 grams total
• Muscle (325 grams)
• Liver glycogen (90-100 grams)
• Blood glucose(4-5 grams)
• Carbohydrate serves as fuel exclusively
– neurons and RBCs depend on glucose
• Blood glucose carefully regulated by insulin and glucagon
• Not all carbohydrates are created equal!!!
– Highly processed refined sugars and flours
• Deplete the body of many micronutrients
– Dietary fiber are nutrient rich and provide many health benefits.
Dietary Fiber
• Fibrous carbohydrates that are indigestible because we don’t produce the
specific enzyme.
• Fiber is important to diet (RDA is 25-45 g/day)
• Water- soluble fiber
– Found in fruits, potatoes, oatmeal, beans
– Bind bile salts which  blood cholesterol, BGLs and LDL levels
– Act as prebiotics :feed the probiotics.(good bacteria and yeast)
– Role in immune system activation and modulate inflammation.
– Dysbiosis : to many of the bad bacteria. Associated with obesity and disease
• Water-insoluble fiber
– Found in wheat, bran, and pears.
– absorbs water in intestines, softens stool, gives it bulk, speeds transit
time
Why Water
• Thermoregulation
• Its needed for enzymatic
reactions within the body.
• Both anabolism and
catabolism
• Needed to maintain proper
electrolyte balance
• Neuronal function and
maintaining blood
pressure
• Needed to maintain proper
connective tissue
• Tensile vs compressive
forces
Structural Elements of Connective Tissue
Nutritional Exercise Recommendations
• Carbohydrates Requirements
• Daily requirements: 6-10g CHO/kg BW depending on intensity
of work out.
• Pre-work out snack:
• Post exercise :1.5 g CHO/kg of CHO within 2 hours (maximize
glycogen storage)
– 4:1 CHO to PRO
• Water requirements
– Pre workout: 500 ml (about 17 ounces) of fluid 2 hours before
exercise.
• ACSM/ADA rec: 16-24 oz per pound weight loss
– Intense exercise lasting longer than 1 hour, it is recommended
that electrolytes and carbohydrates be added to prevent
dehydration, hyponatremia and delay fatigue.
– Carbohydrates and electrolytes will improve rehydration!
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2009
(*BMI 30, or about 30 lbs. overweight )
1999
1990
2009
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
A picture is worth a 1000 words
1900’s
2014
Contributors of Recent Obesity Epidemic
• Sedentary life style
– Technology, scary world, comfortable couches!
• Increased stress levels :
– Increased cortisol leads to increased insulin
resistance
– increase deposition of visceral fat.
• Increased consumption of both total caloric
intake and nutrient depleted processed foods.
• Super Size me please!
CHEESECAKE
25 Years Ago
Today
260 calories
3 ounces
640 calories
7 ounces
Calorie Difference: 380 calories
What Role Does Governmental Policies Play
Government Subsidized Foods
• Many key ingredients found in processed foods are
government subsidized. The major players are corn,
soy beans, cotton and wheat .
– Examples include HFCS, xantham gum, maltodextrin,
Sucrose, Fructose, citrus cloud emulsion, gluten,
hydrolyzed soybean extract, soy lecithin, flours many
more!
– Corn, soybeans and wheat are all genetically modified
unless labeled organic.
– Corn is feed to chicken, cows and even fish now.
– Concentrated Animal Feeding Operation(CAFO)
– Corn feed cows developed resistant bacterial strains E-cole
0157:H7
– Long food labels are a marker for highly processed food!
What Not To Eat!
• Avoid trans fats!!!
– Toxic to the coronary cardiovascular system.
• Processed meats such as hot dogs, sandwich meats and pepperoni.
– Grain fed animals given with hormones, antibiotics and pesticides.
– Sodium nitrate which provides the bright red color is a known
carcinogen.
• Sugar correlates with hypertension, diabetes, CAD, obesity, renal
disease and fatty liver disease.
• Soda is a concentrated form of sugar particularly high fructose corn
syrup.
– Associated with an increase in osteoporosis, tooth decay and obesity.
Carbs Rules!
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Limit products with added sugar/fructose (HFCS).
Limit flour of any type.
Limit breads unless they are 100% whole wheat.
Limit fruit juice. (eat your calories)
Unrefined Carbs naturally have fiber. Eat whole grains,
fruit and vegetables)
• At least 4 grams per serving
• No added sugar!
CLASSIC FOOD PYRAMID
Standard American Food Pyramid
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Omnivores' Dilemma by Michael Pollen
Watch Food Inc.
Let Food Be Thy Medicine Hippocrates
Phytonutrients : Polyphenols: a class of phytonutrients that
has anti-inflammatory, antibacterial, anti-mutagenic,
antioxidant effects, inhibit platelet aggregation, strengthen
vessel walls and influence gene expression.
– Coffee, Dark Chocolate, blueberries, extra virgin olive oil,
citrus fruits and walnuts
• Bioflavonoids: colored pigmented citrus fruits , nuts,
legumes, seeds and vegetables.
• Sulforaphanes and indoles are phytonutrients found in
cruciferous vegetables and sulfur compounds such as garlic.
These provide protection from a variety of cancers such as
breast and bladder cancer.
•
Carotenoids
•
Pigments produced by the plants that are responsible for
the red, orange and yellow colors.
• There are over 600 types including beta-carotene, betacrytoxanthin, lutein, zeaxanthin ,astaxanthin and lycopene.
– Peppers, carrots, sweet potatoes, tomatoes, oranges ,
spinach and salmon.
– Protection from diseases of the skin ,eyes, prostate,
cervix, lung and digestive tract.
– Best absorbed with a little fat such as olive oil
– Bioavailability increased with cooking.
Plants Defense is Our Best Defense!
• Many of the bright colors, textures, tastes and
shapes are part of the plants immune system.
• Plants have a cell wall which don’t produce
cholesterol.
• Much of their benefits are found in their skin.
• Phytonutrients and antioxidants are produced by
plants in response to stress from their environment.
– These include sunlight, being eaten by bugs and
even the cutting of their leaves.
The Science of Fresh
• 6H2O + 6CO2 + 36 ATP  C6H12O6 + 6O2 + 36 ADP +36 P
• Once a plant is harvested it continues to respire using its glucose
maintaining cellular functions including phytonutrient and
antioxidant production.
• Once glucose reserves become exhausted plant cellular functions
cease.
• The cold water lowers their temperature, which slows the aging
process. It also increases the internal moisture of the greens, which
keeps them crisp longer.
• Storing methods vary
– micro perforated plastic bags vs. countertop.
Conventional vs. Organic
• Studies examining nutritional profiles are conflicting.
• Stanford University Study: showed no nutritional difference?
– 30% increase in pesticide residue, conventionally raised chicken and
corn were treated with more hormone, antibiotics and harbor more
resistant bacteria.
– Long-term environmental concerns were not even taken into
consideration.
• Conventionally grown food may have lower levels of the
protective antioxidants.
– Plants that are sprayed with pesticides, fungicides and
antibiotics don’t need to produce as much of their own
inherent protective defenses.
• Produce might look better cosmetically.
Environmental Working Group’s Dirty Dozen
http://www.foodnews.org/executive.php
12 most contaminated
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Peaches
Apples
Sweet Bell Peppers
Celery
Nectarines
Strawberries
Cherries
Pears
Grapes (Imported)
Spinach
Lettuce
Potatoes
(consider frozen)
15 Least contaminated with pesticides
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Onions
Avocado
Sweet Corn (Frozen)
Pineapples
Mango
Asparagus
Sweet Peas (Frozen)
Kiwi Fruit
Bananas
Cabbage
Broccoli
Papaya
grapefruit
Sweet potato
Honeydew
Food Labels
• Is it really low fat?
– 1% milk = 18% and 2% =36%fat calories
• Whole milk is more then 50 % fat calories
– Meat 75% lean has 225 calories which 14 grams come from fat
which equals 126 total fat calories = 57% fat by calories
– 93% ground lean = 45% fat calories
• because labeled by weight not % calories
The diet and conditions your meal lived in is important!
• The food industry can make up the serving size.
– 5 calories or less = non caloric.
– ½ gram of fat or less = none fat. Watch the potions size!
– Lite means ½ the amount of fat as the original.
• Usually sugar is substituted.
Food Labels
• Organic means 95% organic products
– Look for the USDA Organic food label
• Made with organic must be 70%
• Free range: in a chicken coup that the door must stay
open 5 minutes a day.
• Pastured means cage is on the grass.
•
Know your farmer!
• Whole Grain= only has to be a little more then ½ to
say it on the label.
– Made with whole grain may almost have none.
• Look for 100%
• Serving size 2 pieces
• Total calories 71
• Fat 3.5 grams
• Carbohydrates 6 grams
– Sugar 2
– Fiber 2
Chocolate health benefits include:
• Anti-inflammatory- polyphenolic compounds.
• Polyphenol making it bitter reduce oxidative damage of
arteries and inhibit platelet aggregation.
• Choose raw dark chocolate 70% or higher
• Protein 2 grams
• 70 % dark chocolate,
organic (almonds,
cashews, blueberries),
organic granola, organic
cocoa nibs, cinnamon,
and lots of love ;)
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Hidden Food Dangers
• Acrylamides: Linked to neurological problems and cancer form between sugars and
aminos in high heating. browning/ roasted or toasting of carbohydrates. ie french
fries and breakfast cereal.
• (BPA ) Bisphenol A : Chemical that makes up bottles and lining in cans.
• Linked to obesity, heart disease, neurological development, cancers of the
breast and prostate.
• Mimics estrogen. Acidic foods in cans can leach more out.
• BVO: Brominated vegetable oil: flame retardant used as emulsifier in many drinks.
• Linked to neurological problems such as memory loss. Possible endocrine disrupter
especially the thyroid!
• Nitrites: added as a preservative can increase stomach, colon and bladder cancer
through to production of nitrosamines.
• Polycyclic aromatic hydrocarbons: Form in many processed smoked meats during
the curing process.
• Heterocyclic amines (HCAs) form when meats are charred at high temperatures.
• Don’t smoke healthy oil! Know your smoke point!
Treat The Whole Person
• Sugar in moderation if coupled with fiber.
– Natural whole fruit and vegetables all provide you with many other
protective phytonutrients.
– Don’t eat carbohydrates alone.
• Eat healthy proteins and fats
• Control Insulin!
• Stress will naturally make you crave sugar!
– Stress hormones (catecholamines and cortisol) all increase BGL’s
resulting in greater visceral fat production.
• Exercise : Builds muscle which improves metabolic status
– Prevents disease and improves longevity.
– Lowers glycogen levels: less of it being converted to fat.
– Stimulates SNS which increases metabolism, mitochondrial function and
sense of well being.
Final Thoughts
• Michael Pollan Food Rules
– Eat food, not to much, mostly plants (especially leaves)!
– Don’t need anything your grandmother would not
recognize as food.
– Don’t eat food that make health claims.
– Don’t eat anything that has more than 5 ingredients.
– Don’t eat food that has ingredients that are
unpronounceable.
• Don’t know what’s wrong consider an elimination diet.
• Drink filtered water (minimize consumption of bottled water)
– Great Pacific Garbage Patch!
• Buy organic when possible especially foods that are most
contaminated.(Referred to EWG Dirty Dozen)
• Carbon Footprint and biodiversity
Questions?
New York State Views on Nutritional
Patient Education.
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Nutritional guidance is included in the curricula of accredited physical therapy
programs. Because many conditions are affected by diet and nutrition, the PT should be
aware of the association, and may provide guidance in conjunction with treatment. It is
appropriate, for instance, to talk to diabetic patients about the consumption of sugar
and the connection that diet may have on recovery.
As with any task, modality or treatment, it is understood that the PT has been properly
educated, has had experience and is competent to provide this advice.
PTs may not bill for nutritional advice or advertise that nutritional advice is given.
Nutritional supplements should not be sold by PT practices, as the promotion of the
sale of service, goods, appliances or drugs in such manner as to exploit the patient or
client for financial gain is considered unprofessional conduct.
Supplements should not be sold to patients by physical therapists
.
State Board for Physical Therapy
89 Washington Avenue, 2W Education Building
Albany, NY 12234
phone: 518-474-3817 ext. 180
fax: 518-402-5944
email: [email protected]
web: www.op.nysed.gov/pt.htm