Module 4: Digestion and Elimination
MODULE 4
Digestion and Elimination
Copyright © 2016 Nutritional Therapy Association, Inc.
MODULE 4 OBJECTIVES 1
State the Big Ideas for Digestion
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Describe the way Digestion is supposed to work
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Explain at least 3 things that can go wrong in the Digestive System
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Locate and describe the test points for the Digestion Functional Evaluation
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Perform the Functional Evaluation for Digestion
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Describe how to prioritize test points used in the LNT process
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Define the 3 possible reactions a client can have to a nutritional protocol Copyright © 2016 Nutritional Therapy Association, Inc.
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Module 4: Digestion and Elimination
Introduction to Digestion Copyright © 2016 Nutritional Therapy Association, Inc.
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DIGESTION DEFINED Digestion is the mechanical and chemical breakdown of food
The goal of digestion is to reduce food to molecules so small that the nutrients can be absorbed and used by the cells Copyright © 2016 Nutritional Therapy Association, Inc.
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DIGESTIVE SYSTEM
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THE SIX DIGESTIVE FUNCTIONS 1
Ingestion – Intake of food
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Secretion – Water, acid, buffers, enzymes
3
Mixing/Propulsion – Moving the food through the GI tract
4
Digestion – Breakdown of food
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Absorption – Passage of nutrients into the blood and lymph
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Defecation – Elimination of the “leftovers”
ate and describe the test points for the Digestion Functional Evaluation
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THE BIG IDEAS 1 Digestion is a North to South process
2 The big three organs from a nutritional standpoint are: • Stomach • Pancreas • Gallbladder Copyright © 2016 Nutritional Therapy Association, Inc.
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THE BIG IDEAS (CONTINUED) 3
Digestion is fundamental to nutritional therapy
Every cell that makes up every tissue that makes up every organ depends on the body’s Digestive System to provide the nutrients it needs to keep on functioning.
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Digestion: Proper Function
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DIGESTION STARTS NORTH 1. Digestion begins in the brain The sight and smell of food triggers the salivary glands to begin producing saliva
2. The mouth is the
physical gateway to the digestive system Mechanical and chemical breakdown of the food begins
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IN THE MOUTH
The teeth physically break down food into smaller parts (mastication)
Saliva = 99.5% water + 0.5% solutes
The salivary glands secrete saliva to moisten the food and help with swallowing
One solute is the enzyme, salivary amylase, which begins the chemical breakdown of carbohydrates
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DIGESTION CONTINUES SOUTH
When you swallow, bolus enters the esophagus for passage to the stomach The cardiac sphincter at the bottom of the esophagus opens to allow the bolus to pass into the stomach
3. The stomach continues the mechanical breakdown of food, along with a number of chemical activities
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THE STOMACH
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IN THE STOMACH Bolus enters the stomach
Gastric juice is secreted from millions of tiny gastric glands located in the mucosal lining of the stomach • • •
HCl triggers gastrin to be released into the bloodstream
Mucous Pepsinogen/Pepsin Hydrochloric Acid (HCl)
HCl and pepsinogen begin breaking down proteins into peptides (smaller strings of amino acids)
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KEEP IN MIND The stomach is all about ACID Designed for a normal pH of 1.5 – 3.0
HCl is excreted into the stomach at a pH of 0.8…that’s almost pure acid Roles of Acid:
• • • • • •
Baths the stomach Disinfects the stomach Kills bacteria and parasites Activates pepsin, so we can digest proteins Stimulates gastrin Breaks down proteins
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DIGESTION CONTINUES SOUTH
Chyme is released into the upper part of small intestine (duodenum) through the pyloric sphincter
After the stomach churns the bolus and mixes it with gastric juice, the food breaks down even more into a paste called chyme (very acidic)
Chyme
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THE SMALL INTESTINE
Duodenum
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ACCESSORY ORGANS Right Lobe of Liver Left Lobe of Liver
Right Hepatic Duct
Left Hepatic Duct Cystic Duct
Common Hepatic Duct
Liver
Pancreas Pancreatic Duct
Gallbladder Duodenum
Jejunum
Common Duct to Duodenum
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IN THE SMALL INTESTINE 4. Chyme enters the duodenum
The acidic pH (1.5‐ 3.0) of the chyme triggers the small intestine to secrete mucous
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IN THE SMALL INTESTINE (CONTINUED) The small intestine has a dual role as a digestive organ and a gland
At the same time the intestinal walls are secreting mucous, they are also secreting two hormones into the bloodstream: • Secretin • Cholecystokinin (CCK)
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IN THE SMALL INTESTINE (CONTINUED) Secretin stimulates the pancreas to release bicarbonate and pancreatic juice, and CCK stimulates the gallbladder to release bile
Mucous Bile Pancreatic Juice Bicarbonate
Bile is necessary to emulsify and absorb fats Once the chyme pH reaches neutral, the enzyme portion of the pancreatic juice is released to complete the chemical digestion of carbohydrates, proteins, and fats
As part of the pancreatic juice, the pancreas first releases sodium bicarbonate to help raise the pH of the chyme to neutral (7.0)
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BILE FUNCTION
Digestible molecules
Lymphatics
Work throughout the body
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THE SMALL INTESTINE (CONTINUED) By the time chyme leaves the duodenum, it is almost totally digested: Carbohydrates are broken down into glucose molecules Proteins are broken down into amino acids and polypeptides Fats are broken down into fatty acids and glycerol molecules
Peristalsis moves these absorbable molecules into the jejunum
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IN THE SMALL INTESTINE (CONTINUED) Millions of villi and microvilli absorb the nutrient molecules into the bloodstream, where they are carried to the entire body: Glucose, amino acids, and short‐chain fatty acids are carried by the villi to the capillaries and into the liver
Long‐chain fatty acids require bile for proper absorption and end up in the lymphatic system
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DIGESTION CONTINUES SOUTH The leftover chyme from the small intestine (indigestible fibers, bile, water, sloughed off cells) gets passed on to the large intestine through the ileocecal valve
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IN THE LARGE INTESTINE Transverse Colon Right Hepatic Flexure
Left Splenic Flexure Lymph Nodes
Ascending Colon
Descending Colon
Sigmoid Colon Ileocecal Valve Appendix
Anal Canal
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IN THE LARGE INTESTINE The Large Intestine: • • •
•
Recycles the water Recycles the waste material, which nourishes the colon cells Captures any lost nutrients that are still available (with the help of the bowel flora) and converts the nutrients to Vitamins K/B1/B2/B12 and butyric acid Forms and expels feces
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NORTH TO SOUTH SUMMARY 1.
Brain Salivary Glands
Food
2.
Mouth Bolus
3.
Stomach Chyme
Liver/Gallbladder
4. Pancreas
Small Intestine Remains
5.
Nutrients
Large Intestine Feces
Water/Vitamins
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Digestion: Dysfunction
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DYSFUNCTION IS NORTH TO SOUTH Just as proper digestion is a north to south process, so is dysfunction When working with clients, begin north and work your way south
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DYSFUNCTION: BRAIN • As a culture, we are sympathetically stressed Need to be in a parasympathetic state to digest food
• Council your clients to RELAX while they eat Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION: MOUTH If you don’t take the time to properly chew your food (~30 seconds): The brain does not get the message to trigger the proper digestive processes for the foods you’re eating
The brain does not get the message to trigger the proper digestive processes for the foods you’re eating
The production of saliva is not triggered
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DYSFUNCTION: SALIVA Saliva is a complex mixture of electrolytes, hormones, and enzymes Salivary amylase begins the chemical breakdown of starches If the proper enzymes are not secreted, the breakdown of carbohydrates does not begin
The pancreatic enzyme amylase cannot complete the breakdown of starch in the small intestine leaving undigested starch entering the colon
This feeds candida creating general dysbiosis further down the digestive tract
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DYSFUNCTION: STOMACH The stomach is all about acid Normal pH is 1.5 – 3.0 Factors that can inhibit HCl production: • • • • •
Stress Excess carbohydrate consumption Nutrient deficiencies Allergies Excess alcohol consumption
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DYSFUNCTION: STOMACH (CONTINUED) Approximately 90 percent of Americans produce too little HCl Jonathon Wright, MD, came to this conclusion using Heidelberg Gastrotelemetry equipment to check the stomach pH of thousands of patients
Dr. George Goodhart, Chiropractor, came to the same conclusion using kinesiological analysis and functional assessment
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DYSFUNCTION: STOMACH (CONTINUED) So, what happens if you do not produce enough HCl? 1. Our first line of defense against pathogenic microorganisms is gone: Yeast, prions, bacteria, viruses, parasites, etc. are actually little proteins
When the pH is correct in the stomach, pepsin digests these microorganisms…they become food
When the pH is not correct, an environment is created in which these organisms thrive and raise havoc in the GI tract
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DYSFUNCTION: STOMACH (CONTINUED) So, is it the environment that causes the illness or the microorganism? Louis Pasteur Believed it is the microorganism
Antoine Bechamp Believed it is the terrain
We We believe it is actually a combination of the two ‐If the microorganism is not present, you will not get sick ‐However, if the environment is optimal, even if you get the microorganism, it cannot survive Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION: STOMACH (CONTINUED) Helicobacter Pylori (H. pylori) According to the Clinical Pearls on gastric cancer, H. pylori, and vitamin C: “It is very important to get from this article that gastric atrophy and reduced hydrochloric acid secretion may be the initiating factors in Helicobacter pylori infection, along with reduced vitamin C secretion in the stomach, thereby increasing the risk of gastric cancer due to the lack of the ability of vitamin C to inhibit mutagenesis.”
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DYSFUNCTION: STOMACH (CONTINUED) Helicobacter Pylori (continued) “It is very interesting that the last thing one would consider regarding H. Pylori infection, since it is associated with ulcer, is a lack of stomach acid. The whole paradox of the use of a variety of antacids or anti‐gastric acid‐secreting agents in ulcers and the relationship to H. Pylori infection, which may be due in part to a lack of stomach acid, is confusing but might be explained in the following way. When vitamin C levels in the gastric area are lowered, that tissue is more susceptible to irritation by any amount of acid which is highly concentrated. Even the amount of acid secreted with gastric atrophy could be irritating. If this is the case, treating with antacid type medications may bring symptom relief in the short run but in the long run may increase the likelihood of recurrence. The treatment might be vitamin C supplementation, probiotics, and appropriate antibiotics or other medical therapies not only for the H. Pylori infection but for other pathogens as well. After the lining has healed, then hydrochloric acid replacement may be of value in keeping other irritating pathogens from growing.” Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION: STOMACH (CONTINUED) 2. People experience Gastroesophageal Reflux Disease (GERD):
These maldigested foods cause a reflux, or backward flow, into the esophagus The esophagus is not made for the acidic foods from the stomach, so it burns
If there is not enough acid in the stomach, foods do not get broken down
Carbohydrates Ferments Proteins Putrefy Fats Rancidify
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THE BIG QUESTION
If the REAL problem is too little acid produced in the stomach, why do antacids seem to relieve the symptoms? Copyright © 2016 Nutritional Therapy Association, Inc.
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THE LUCRATIVE ANSWER Antacids, acid blockers, etc. raise the pH of chyme to neutral, so it doesn’t burn the esophagus. However, now the chyme is much too alkaline for the stomach.
What is this doing to the rest of the digestive system? Copyright © 2016 Nutritional Therapy Association, Inc.
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POOR MENTAL HEALTH PROGRESSION In the words of the holistic medical doctor, Alan R. Gaby:
Big Mac & Fries
Prilosec
Prozac
(Bad Food)
(Acid Blockers)
(Depression)
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DYSFUNCTION: STOMACH (CONTINUED) 3. The pyloric sphincter does not want to release chyme into the duodenum: If the chyme is too alkaline, chyme stays longer in the stomach and begins to degenerate ‐ Carbohydrate Ferment ‐Proteins Putrefy ‐Fats Rancidify
Example: Putrefaction produces organic acids that hurt the mucosal lining of the stomach, allowing microorganism such as h‐pylori to exist Copyright © 2016 Nutritional Therapy Association, Inc.
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EXPERIMENT •
Make 1 extra portion at dinner:
• • • • •
Throw it all in a blender Add ½ cup of water Spit in it Blend it all up Find some place warm to set it
Meat, potatoes, veggies, salad, desert
(~98.6 degrees)
•
See how long it takes to get disgusting
This is what happens to the food in your stomach if you are not producing enough HCl Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION: PANCREAS In proper function, chyme enters the duodenum and its acidic pH triggers the release of pancreatic juice If the chyme pH is not correct, secretin is not excreted to trigger the release of pancreatic juice
Sodium bicarbonate is not released to raise the pH of the chyme, and it burns the mucosal lining…this leads to duodenal ulcers Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION: PANCREAS (CONTINUED) Bad pH No Sodium Bicarbonate No Enzyme Action Incomplete Chemical Digestion Intestinal Problems Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION: GALLBLADDER Dysfunction of the gallbladder is related to poor quality fats or low‐fat diets vs. too little acid • Fats are primarily digested by bile salts and pancreatic lipase in the duodenum
• Fat in the chyme stimulates the release of CCK, which stimulates the gallbladder to release bile Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION: GALLBLADDER (CONTINUED) Low fat diets do not trigger the release of bile ‐Low fat diets do not stimulate the release of bile, causing the bile to get old/viscous
‐Bad fat diets cause the bile to become viscous
The gallbladder tries to contract, but is unable to release the viscous bile
No bile leads to no absorption of fats
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DYSFUNCTION: GALLBLADDER (CONTINUED) Normal Function
Digestible molecules
Lymphatics
Work throughout the body
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DYSFUNCTION: GALLBLADDER (CONTINUED) Dysfunction
Undigested globules
Rancidify in Colon
Stress out liver and leaves you fatty acid deficient
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UNDIGESTED PROTEINS Undigested proteins (in fact all undigested foods) impact the villi and microvilli of the small intestine The lining becomes leaky, selectivity as to what passes through the lining is lost (leaky gut syndrome)
Leaky Gut
This allows proteins and fats to pass through the gut in inappropriate sizes, which overwhelms the immune system
What should have been a nourishing food is now one more assault on the immune system Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION: LARGE INTESTINE Once again, the large intestine deals with the leftovers from Digestion In the case of dysfunction, this includes: Maldigested foods full of parasites, microorganisms, and undigested fats
Ileocecal Valve
As this maldigested debris tries to pass into the colon, the ileocecal valve can get clogged or jammed open Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION: LARGE INTESTINE (CONTINUED) • The maldigested foods are degenerating in the colon, causing dysbiosis and disrupting the healthy flora • Without the healthy flora, butyric acid is not produced, which weakens the cells of the colon
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DYSFUNCTION: LARGE INTESTINE (CONTINUED) This leaves the colon subject to inflammation, diverticula, and loss of tone leading to issues such as: • • • •
Irritable Bowel Syndrome Crohn's Disease Colitis Celiac Disease
Each has its own unique etiology, but all are exacerbated by the process Copyright © 2016 Nutritional Therapy Association, Inc.
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DYSFUNCTION SUMMARY 1.
Brain Salivary Glands
Food
2.
Mouth Bolus
3.
Stomach Chyme
Liver/Gallbladder
4. Pancreas
Small Intestine Remains
5.
Nutrients?
Large Intestine Feces?
Water/Vitamins?
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THE ART OF TOUCH
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CONTACT THROUGH TOUCH While we gather a lot of information through our forms and interviewing process, the information we gather through the Functional Evaluation is gathered through touch Contact through touch is a different kind of “dialogue” with your client The client’s comfort is important to your goal of receiving accurate information
Your ability to touch clearly and accurately is key to the client’s comfort and receptivity
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ABOUT TOUCH 1
Learning to touch is a lifelong process
2
The principles of touch include comfort, accuracy, and sensitivity
3
Touch is a healing form of communication; we can speak volumes with a single touch of a hand
Remember, every body is different and everybody is different Copyright © 2016 Nutritional Therapy Association, Inc.
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THE ART OF TOUCH 1 Place your hand on the client in the approximate area of the point
2 Palpate to move to the location of the reflex point 3 Apply pressure gradually to match the resistance of the tissue and/or surrounding area ‐ Think of making an impression in a lump of clay
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Digestion: Functional Evaluation
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DIGESTION: STOMACH Ridler’s Reflex: HCl Point (Z ↓ 1” L) One anatomical inch inferior and lateral to the Xiphoid process, on the medial margin or edge – not on top of, the left rib cage. Press medial to lateral M>L. One finger (or thumb) palpation.
Chapman Reflex: Stomach/Duodenum (6th L) Found in the left 6th intercostal space, mid mammary line ‐ The 6th in almost always under the bra band on women. One finger palpation, A>P
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DIGESTION: PANCREAS Ridler’s Reflex: Enzyme Point (Z – 1” R) One anatomical inch inferior and lateral to the xiphoid process, on the medial margin or edge – not on top of, the right rib cage. Press medial to lateral M>L. One finger (or thumb) palpation.
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DIGESTION: GALLBLADDER Chapman Reflex: Liver/Gallbladder (6th R) In the right 6th intercostal space, mid‐mammary line ‐ The 6th is almost always under the bra band on women. One finger palpation, A>P
Murphy’s Sign: Liver/Gallbladder‐ Acute (under ribs R) Position client with knees bent; place finger tips 1.5‐2” away from curvature of ribs; Ask client to take deep breath in and when they exhale palpate A>P. Ask the client to take one more breath and on the exhale gently change the direction of your palpation more deeply, Inferior to superior I>S and under the rib cage. With your hand still under the ribcage, ask them to inhale one last time. This allows the diaphragm to push the gallbladder into your fingertips. Be sure to watch client’s face and stop the palpation at any point when they feel discomfort or you cannot fairly easily go further. Rate either tenderness and/or tension. Copyright © 2016 Nutritional Therapy Association, Inc.
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DIGESTION: GALLBLADDER Right Thumb Web (Chronic Gallbladder) Feel the right thumb web on the edge of the skin web and the muscle RIGHT next to the bone at the base of the thumb; To locate pinch the muscle and then slide off and back onto the web until client indicates tenderness or you feel nodulation, much like a BB.
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WORKSHOP 4A Using your Workshop 4a pages work with a partner to perform the Functional Evaluation for the stomach, pancreas, and gallbladder.
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DIGESTION: SMALL INTESTINE Bennett’s Reflexes: Small Intestine (Palpate 2‐3” around umbilicus)
Draw imaginary circle 2‐3 anatomical inches around the umbilicus and divide into 4 quadrants. FIRST PALPATION: palpate with the flat of your fingers gently in all 4 quadrants – you are feeling for resistance or congestion; SECOND PALPATION: change to a deeper palpation, A>P, & imagine you are separating the tissue as you work deeper. Have the client indicate tenderness for each quadrant.
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DIGESTION: SMALL INTESTINE Chapman Reflexes: Small Intestine (8, 9 & 10) Check for tenderness in the spaces between the 8th,9th,10th ribs right and left. Work from the back and draw your hands around the sides letting your fingers fall into the spaces between the tips of the ribs; if the client is ticklish, hold the client’s hands and have them do the palpation on themselves.
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DIGESTION: LARGE INTESTINE Large Intestine/Colon Palpation With the edge of your fingers palpate deeply feeling for resistance/congestion or until the client feels tenderness in the surrounding lymphatic tissues. Start just inside the ASIS, right side, palpate side to side and concurrently A>P across the colon, upward to the rib cage (ascending colon), then across the abdomen, palpating in an upward and downward motion, (transverse colon) and then down the left side, side to side motion, (descending colon). On the exam form the point are indicated A‐B and B‐C (A being the ASIS on the right, B the midpoint of the abdomen and C the ASIS on the left) Record any tenderness in corresponding areas.
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DIGESTION: LARGE INTESTINE Chapman Reflex Colon: Iliotibial Band The iliotibial band runs down the exterior of the leg from the hip (greater trocanter) to the knee in the same place as the stripe on a band uniform. This mirrors the Large Intestine palpation. If you dissected the colon in the middle of the abdomen and drew the ends down the iliotibial band, the palpations for tenderness on the iliotibial band would likely mirror the tender points on the colon. The Chapman should validate your findings for the Colon; If only the iliotibial band is tender at the mid‐point, this is likely an indicator of prostate/uterus weakness, not a colon indicator. Ileocecal Valve Palpation Palpate ½ the distance between the right ASIS and the umbilicus. Palpate A>P feeling for tenderness. Using a slight circular motion (clockwise) to help move the tissue as you probe deeper. Copyright © 2016 Nutritional Therapy Association, Inc.
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WORKSHOP 4B Using your Workshop 4b pages work with a partner to perform the Functional Evaluation for the small and large intestines.
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Digestion: Solutions Copyright © 2016 Nutritional Therapy Association, Inc.
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LINGUAL‐NEURO TESTING
Hypothalamus Area
Lateral Horn of the spine
Start here Copyright © 2016 Nutritional Therapy Association, Inc.
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LINGUAL‐NEURO TESTING (CONTINUED) Lingual‐Neuro Testing (LNT) enables you to determine whether a particular nutritional supplement is “right” for your client
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LNT PROCESS 1 Do not touch the supplements with your own hand 2
For capsules, it’s better to open & pour a little on the tongue
3
Have a large glass of water ready
4
Have a small cup available for the supplements the client discards
5
In most cases, you want the client to hold the supplement in their mouth for 15 seconds
‐Do not put the capsule back in the test kit
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PRECAUTIONS Supplements can be safely chewed and tasting/chewing supplements is advised to increase efficacy However, there are some exceptions: • • • •
HCl supplements Oregano or other strong herbs Other acid containing products including Orth phosphoric acid and bile salts Any product with proteolytic enzymes
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SUPPLEMENTS There are several companies that manufacture and/or distribute nutritional supplement lines that will extend professional accounts to NTPs: Biotics Research
Apex Energetics
Metagenics
Priority One
NutriWest
Many Others
Note: that the generic ingredients are listed on the Functional Evaluation sheets and on the left side of the supplement charts Copyright © 2016 Nutritional Therapy Association, Inc.
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LNT PROCESS FOR DIGESTION Though we use many test points to gather information on digestive weakness, we will primarily use seven palpations to LNT: Palpations Points for Digestion • • •
Chapman Reflex: Stomach/Doudenum Chapman Reflex: Liver/Gallbladder Chapman Reflex: Small Intestine
•
Chapman Reflex: Large Intestine
• •
Bennet Reflex (Small Intestine) Ileocecal Valve
•
Large Intestine (Colon)
(on the Iliotibial Band)
Your strategy for selecting the supplements should be based on the BIG IDEA that Digestion is a north‐to‐south process Even though the small intestine may be the only “hot” point, the cause may be an enzyme deficiency and not an intestinal deficiency. In other words, start “north.” Copyright © 2016 Nutritional Therapy Association, Inc.
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LNT EXAMPLE 1 2
4
1 6
8
S 3
3 3
1
2
3
3
3
2
2
2
2
2
1
3
1
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LNT EXAMPLE 2 8
4
1 2
1
M 6
6 6
5
3
6
4
4
4
4
3
3
3
3
4
5
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LNT EXAMPLE 3 9
6
5 4
4
S 8
8 4
4
5
6
4
4
4
4
4
4
4
4
4
5
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LNT EXAMPLE 4 2
2
1 3
2
N 6
9 6
7
9
9
3
3
2
2
4
4
2
4
3
4
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WORKSHOP 6 Using your Workshop 4c pages work with your partner to perform the LNT for Digestion.
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A Few Words on Dosing
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VITAMIN TOLERABLE UPPER LIMIT RANGES Niacin Vitamin B6 Folate Choline Vitamin C Vitamin A Vitamin D Vitamin E Age (yr) (mg/day) (mg/day) (mcg/day) (mg/day) (mg/day) (mcg/day) (mcg/day) (mg/day) Infants 0‐0.5 ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ 600 25‐‐‐‐‐ .05‐1 ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ ‐‐‐‐‐ 600 25‐‐‐‐‐ Children 1‐3 10 30 300 1000 400 600 50 200 4‐8 15 40 400 1000 650 900 50 300 9‐13 20 60 600 2000 1200 1700 50 600 Adolescents 14‐18 30 80 800 3000 1800 2800 50 800 Adults 19‐70 35 100 1000 3500 2000 3000 50 1000 >70 35 100 1000 3500 2000 3000 50 1000 Pregnancy ≤18 30 80 800 3000 1800 2800 50 800 19‐50 35 100 1000 3500 2000 3000 50 1000 Lactation ≤18 30 80 800 3000 1800 2800 50 800 19‐50 35 100 1000 3500 2000 3000 50 1000 Reference: http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/ULs%20for%20Vitamins%20and%20Elements.pdf Copyright © 2016 Nutritional Therapy Association, Inc.
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MINERAL TOLERABLE UPPER LIMIT RANGES Age (yr) Infants 0‐0.5 .05‐1 Children 1‐3 4‐8 9‐13 Adolescents 14‐18 Adults 19‐70 >70 Pregnancy ≤18 19‐50 Lactation ≤18 19‐50
Sodium (mg/day) ‐‐‐‐‐ ‐‐‐‐‐
Chloride (mg/day) ‐‐‐‐‐ ‐‐‐‐‐
Calcium (mg/day) ‐‐‐‐‐ ‐‐‐‐‐
Phosphorus (mg/day) ‐‐‐‐‐ ‐‐‐‐‐
Magnesium (mg/day)
Iron (mg/day)
‐‐‐‐‐ ‐‐‐‐‐
40 40
1500 1900 2200
2300 2900 3400
2500 2500 2500
3000 3000 4000
65 110 350
40 40 40
2300
3600
2500
4000
350
45
2300 2300
3600 3600
2500 2500
4000 3000
350 350
45 45
2300 2300
3600 3600
2500 2500
3500 3500
350 350
45 45
2300 2300
3600 3600
2500 2500
4000 4000
350 350
45 45
Reference: http://www.cengage.com/nutrition/discipline_content/tables/0‐534‐558986‐7_C.pdf Copyright © 2016 Nutritional Therapy Association, Inc.
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ADULT DOSING GUIDELINES The recommended dosing on the bottle is a conservative dose for general maintenance Therapeutic dosing needs to be higher; you have to start out aggressive enough to make a change without overwhelming the client As a very general guideline: Start the client off using 1 – 3 tablets/capsules taken two or three times a day For larger people, start at the top of that range
For smaller people, start at the bottom of that range
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DOSING GUIDELINES FOR CHILDREN Dosing Guidelines for Children For breast‐fed infants
give a full dose to the mother
Infants less than 1 year old (not breast‐fed)
give 1/4 to 1/10 of the adult dose on a pacifier or crushed in formula
Children 1 to 5 years old
recommend 1/3 of the adult dose
Children 6 to 12 years old
recommend 1/2 the adult dose
Children over 12
recommend the adult dose
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PREGNANCY High doses of any specific nutrient may be contraindicated during pregnancy. Be particularly careful not to exceed the tolerable upper limits of vitamins and minerals during pregnancy. Use the following with caution: Vitamin A ‐ over 3,000 mcg/day or 10,000 IU Vitamin C ‐ Over 1 gram/day Vitamin B6 ‐ Over 25 mg/day Botanicals/Herbs – Unless specifically recommended Phosphorus – Without appropriate calcium and magnesium (except for short periods of less than one week) Copyright © 2016 Nutritional Therapy Association, Inc.
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OTHER CONTRAINDICATIONS High doses of vitamins may be contraindicated in liver and kidney disease and with some types of chemotherapy Advise your client to consult with their pharmacist and/or medical doctor for contraindications
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Coca’s Pulse Test
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ALLERGIC SYMPTOMS: DR. COCA
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THE COCA PULSE TEST
Coca’s Pulse Test is a simple, yet extremely effective way to identify foods to which a client may be allergic, intolerant, or sensitive. Quite simply, stress will cause the pulse to increase. Foods to which you are intolerant are stressful and will reveal themselves by speeding up your pulse.
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THE DIET/PULSE RECORD
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RULES FOR COCA’S PULSE TEST Rule 1: Because accuracy is important, you must always take your pulse for one full minute. Do not do 15 seconds and multiply by 4. Rule 2: If your pulse‐count when standing is at least 6 points greater than your pulse‐count when sitting, this is a positive indication of a food or environmental sensitivity (Sanchez‐Cuenca). Rule 3: If at least 14 pulse‐counts are taken each day and if your daily maximal pulse‐rate is constant (within one or two beats) for three days in succession, this indicates all “food sensitivities” were avoided on those days. Rule 4: If your daily maximal pulse‐rate varies more than two beats (example: 72, then 78, then 76, then 71), you are certainly reactive provided there is no infection. Rule 5: If the ingestion of a frequently eaten food causes an acceleration of your pulse of at least 6 beats, that food can be considered “reactive” for you and should be removed from the diet. Rule 6: If you are sensitive to things in the environment, there is most likely a major food allergy that needs to be addressed. Rule 7: If your minimum pulse‐rate does not regularly occur “before rising” after a night’s rest, this is usually an indication of sensitivity to dust, dust mites, or something in the sleeping environment (perfume, mattress, pillow, etc.) Copyright © 2016 Nutritional Therapy Association, Inc.
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THE LNT COCA’S PULSE TEST
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THE SANCHEZ‐CUENCA TEST A TEST TO DETERMINE GENERAL ALLERGIC TENSION Have the client do the 3‐Day Pulse Journal, if the client shows signs of allergic tension during the Sanchez‐Cuenca Test: Rules for Sanchez‐Cuenca Test • • • • • •
Sit down Take a full one‐minute pulse Stand up Wait 15 – 30 seconds Take a full one‐minute pulse Compare the results:
─ If pulse goes up more than 6 points, it is a positive indication of allergic tension. The more it goes up, the more significant the problem. ─ If pulse goes down, this is a sign of switching (the nervous system acting backwards). Some people go from sympathetic to parasympathetic instead of the other way around. Copyright © 2016 Nutritional Therapy Association, Inc.
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Protocols
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PROTOCOLS FOR DIGESTION In an ideal situation, you want to be able to perform the Functional Evaluation and LNT process to determine the supplement program for your client In cases where that is not possible, you have two “backup” methods: 1. a. Have the client complete the NAQ. b. Run the Symptom Burden Report (which we will learn in Part II of this course) c. Follow the Client Schedule program 2. Use the Nutritional Protocols located on NTTConnect in Reference section
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NUTRITIONAL PROTOCOLS The Nutritional Protocols contain the following information: • • • • • • •
Related Conditions Physiologic Considerations Predisposing Factors Clinical Considerations Recommendations (including dietary) Primary Supplemental Support Secondary Supplemental Support
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PROTOCOL LIST • • • • • • • • •
Acid Indigestion Appetite Excess Appetite Reduction Biliary Insufficiency Celiac Colitis Constipation Crohn’s Disease Diverticulitis
• • • • • • • •
Dry Mouth Dysbiosis Flatulence Gastritis Gum Disease Halitosis Ileitis Irritable Bowel Syndrome
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Possible Reactions to Nutritional Therapy
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POSSIBLE REACTIONS Let your client know they may experience a reaction when beginning any new protocol: Possible Reactions to Nutritional Therapy Digestive Reaction
Looks like a digestive problem Examples: diarrhea, cramping, heartburn, constipation
Sensitivity and/or Allergic Reaction
These look like sensitivity or allergy symptoms Examples: rashes, congestion, etc.
Healing Reaction
Looks like the symptoms you are trying to fix Examples: flu‐like symptoms if you’re working on immune function or nausea if you are working on gallbladder
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HANDLING REACTIONS Handling Reactions to Nutritional Therapy
For Digestive Reaction
Support their digestion
Sensitivity and/or Allergic Reaction Find an alternate therapy Healing Reaction
Mild/Moderate Symptoms: give the client the option to cut back dose or work through it Severe Symptoms: recommend the client call you
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MODULE 4 SUMMARY 1
State the Big Ideas for Digestion
2
Describe the way Digestion is supposed to work
3
Explain at least 3 things that can go wrong in the Digestive System
4
Locate and describe the test points for the Digestion Functional Evaluation
5
Perform the Functional Evaluation for Digestion
6
Describe how to prioritize test points used in the LNT process
7
Define the 3 possible reactions a client can have to a nutritional protocol Copyright © 2016 Nutritional Therapy Association, Inc.
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