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In functional medicine, we’re fully aware of the complexity of the human condition. Especially, as it pertains to health and sickness.

My Taoist teacher, Liu Ming used to point out that the antidote to complexity is simplicity. These are simple yet profound words. And, as this piece focuses on digestion, and all the related possible disturbances (diarrhea, constipation, bloating and gas, abdominal pain, IBS, leaky gut and inflammation), there is a simple way to look at how we can address these issues.

What we do is go north to south.  There is a hierarchy, in terms of digestion. What’s crucial is that we fix what is happening at the top, and then work down.

So, are you chewing your food thoroughly, and also taking oral care into consideration?

Is your mouth making enough saliva?

Does your stomach produce enough acid to break down proteins?

As your food travels through you, down and out of the acidic environment, it goes into to a very alkaline environment. The duodenum, the first part of your small intestine. That is why we ask things like, is your Gall Bladder secreting enough bile to process fats?

Next, enzymes are produced by the pancreas and come into the digestive tract.  So, are there enough digestive enzymes?

And further down, we’re looking at the microbiome.  Primarily, its diversity.

There’s still so much we don’t know about all the incredible functions of a microbiome. But, one thing is clear: the more diverse it is, the more stable and healthy it is.

What we’ve covered so far, is a quick and simple way to look at and treat an upset digestive system. In the most basic terms, if any one of these processes aren’t working well, it will disturb whatever else occurs further downstream.

This is why we must tend to these things, in order. From north to south.

Let’s go through this a bit more closely.

Even before you eat, it’s good to have a well-developed and “polarized” digestive system.  A very beneficial way to do this (if you’re not dealing with a blood sugar issue) is to wait to get hungry, before eating.  

Just by thinking about food, we prime the digestive system. Seeing food and smelling it of course also cultivates this polarity, and stimulates different digestive juices. If we smell or imagine eating protein, or something bitter, we start to produce hydrochloric acid.  If we smell something sweet the pancreas will start releasing insulin.

It’s so basic to our instincts to understand that our digestion works better if we are in a home that smells of delicious food. We can cultivate our digestive system by waiting to eat until we are hungry. Then, cook for ourselves and have the food smells waft around the home. These are some of the simple practices that support our digestive health.

We also need to pay attention to our saliva production and chewing.

Saliva helps break down food, and shows us that the brain is involved in the digestive process. 

Chewing activates the brain stem and the cranial nerves involved in creating saliva. This helps the process of swallowing, the blood flow to the gut, and the release of enzymes. Chewing well is critical.  Many issues come from a lack of chewing.

We, as modern day people, chew far less than our ancestors. This is due to the quality of our manufactured food, the ways it has changed and become too soft and processed. 

If you have a chronic dry mouth or need to have drink with meals, or are a very slow eater, it could be because of saliva production insufficiency. This can be due to the saliva glands themselves, or possibly brain pathways not working well. Some patterns of autoimmunity can create antibodies to your own saliva glands. Diabetes and certain medications can also lead to less saliva production.

Problems with swallowing are also a red flag that something’s wrong with the early stages of digestion. The “northern” stages.

Swallowing involves the glossopharyngeal and vagus nerves (Cranial Nerves 9 and 10), which is why swallowing and chronic constipation can indicate problems in the upper brainstem, including Parkinson’s disease. In fact, trouble swallowing, stiffness and rigidity are all early signs of Parkinson’s.  These can sometimes present long before a tremor develops.

Further south, we get to the Stomach and the production of hydrochloric acid. We need a strongly acidic environment in our stomach, to break down proteins.

If you have bloating right after you eat, especially after high protein meal, this shows hypochlorhydria, or insufficient acid. We need a strongly acidic environment, because this triggers the action of the rest of the digestive tract. It also sterilizes the rest of the gut so we are less susceptible to pathogens and bacterial overgrowth. In addition, it helps the “polarity” of the system and makes the next step of the digestion more alkaline, which can kill other pathogens like yeasts.

There are many reasons why you might not produce enough hydrochloric acid, including infections like H.Pylori, the lack of Vit 12, or by being a long time vegetarian. The good news about this is it’s easy to experiment taking hydrochloric acid, and then see if there’s a benefit from taking it. It’s one of the cheapest supplements, and the effect is instant if hydrochloric acid is the issue.

The next thing that gets triggered by hydrochloric acid is the release of pancreatic enzymes, which help to breakdown food.

If you’re bloated and distended after eating starches and proteins, you might not be producing and secreting enough enzymes. In the north to south paradigm this could be because the stomach isn’t producing enough acids to trigger the pancreas. Or, other things can play a role. Hypothyroidism, inflammatory conditions, dysglycemic patterns, and poor diet can also limit production of enzymes.

The Gall Bladder secretes its bile through the common bile duct, where enzymes that come from the pancreas also are released. Any problem processing fats are an indicator of gall bladder issues, including nausea or bloating after eating fats. If you burp after having fish oils (a way to test of the gall bladder) this is a clear symptom of incomplete gall bladder function.

Many people have gall bladder sludge. Or even worse, gallstones. If the sludge or stones are there, the gallbladder has a difficult time secreting bile, which is the substance used to digest fats. Woman especially have this issue, and many just learn to live with the issue or cut back on fats, which can limit the beneficial aspects of these fats.

Moving along, our food comes to the Small Intestine.  Hopefully, by this stage, it’s been acted upon fully by each of the previous steps.

In the Small Intestine, there are small microvilli that line the intestine. These microvilli are very sensitive to inflammation, which can prevent you from properly absorbing nutrients. This can lead to permeability (aka leaky gut), which might be best understood by the analogy of a screen.  Only very small particles should be able to make it through the intestinal lining (“the screen”). But, due to inflammation there can be much larger gaps in the lining, which then lets larger particles into the blood stream. The body cannot manage particles that are too large, which then creates more inflammation.

Often people with this condition are also eating very inflammatory diets.  Inflammatory diets include the major digestive irritants such as sugar, high carbs, and not enough vegetables.

A leaky gut can create a host of other problems, and in this top to bottom approach we can see the effects on the Microbiome.

The Microbiome is the living bacteria in the gut, and does so many things that help your health.  

If the stages we’ve covered so far don’t indicate any issues related to the occurrence of a digestive disturbance, we’d arrive at this point.  Where now, we consider the health of the microbiome.

There is so much interesting research being done on the microbiome.  Yet much is still unknown. It’s very analogous to a rainforest, and how more there is to discover.  But what we clearly know, without question, is that diversity equals health and stability. Therefore, the less diverse the microbiome it is, the more unhealthy and unstable it is.

The things that feed the helpful bacteria of the gut microbiome are diversity of fibers, low glycemic fruits, and fermented foods.

Perhaps a side note, but a crucial one: the US has the least diverse diet in the world, an interesting fact considering the wealth and abilities we have.

The easy take away from all of this?  

We need each of the processes of digestion to be working well, in order for our food to move “from north to south”, and be acted upon appropriately to each stage. If we don’t chew our food and make saliva, the stomach has a harder time processing it, and so on. Breakdown within any of the stages is going to create gastrointestinal issues.

The art of it all is to pay attention to each stage, and learn how to tend to what you find. And, taking probiotics will not fix all GI issues.

The gut is the most essential place we take in nourishment. Any problems there will raise the risk of further problems. Including autoimmune disease, brain degeneration, chronic inflammatory problems, heart disease, etc. 

In a future piece, I’ll share more about the “how” of eating —  how much to eat, when to eat, when to stop eating, etc.