An Interview With No Hot Air

by Peter Muller

Physician's Assistant, Army Medic
With all of these digestion issues, we felt it was time to speak to someone more knowledgeable on the subject.  To get more information on the subjects of digestion and indigestion, we spoke with Cary Malczewski, a certified U.S. Army Combat Medic.  Army medics are a soldier’s first line of aid in the field, and in addition to combat related roles, they also man the military’s field hospitals and clinics, giving them a plethora of experience on common ailments and injuries.  Outside of the military, Mr. Malczewski has a bachelor’s degree in Kinesiology and is currently finishing a master’s degree in Medical Science within a Physician’s Assistant (PA) program.

Occam’s Taser: What makes people hungry?
Cary Malczewski: There are many components of hunger, including two counterbalanced hormones secreted by the stomach that control the feeling of hunger in the brain.  One tells your brain that you’re hungry, the other tells it that you’re full.  Ghrelin is the hormone that stimulates appetite and Leptin works inversely with Ghrelin to let your brain know you’ve had enough food.  It takes a little while for Leptin to alert the brain, so the key is to eat slowly, giving your brain enough time to learn that it’s full.  This is also why eating quickly leads to overeating.

OT: Can you fill us in on the biological basics of digestion?
CM: There are three basic phases of digestion, or gastric stimulation.  The first phase is the cephalic phase where the central nervous system is activated by the thought, smell, and sight of food.  Your body primes itself for digestion by producing saliva in the mouth and acid in the stomach.  Next, in the gastric phase, food is swallowed and enters the stomach where it’s broken down mechanically and chemically through stomach compression and lowering pH levels (increasing acidity).  Finally, in the intestinal phase, the broken down food leaves the stomach and enters the small intestine where nutrients from the food are absorbed.  Later, in the large intestine, liquids are absorbed and the rest is expelled as waste.

OT: What are the most common causes of indigestion?
CM: Again, there are many factors that can cause indigestion.  Some of the most common are gastroesophageal reflux (acid reflux/heartburn), peptic ulcers, and gallbladder disease.
Acid reflux is caused by the lower esophageal sphincter (LES)(see diagram above) being too loose, and allowing stomach acids to back up and enter the esophagus.  The LES can become loosened up from a variety of factors including heredity, anatomical variation, obesity, overeating, smoking, and alcohol consumption.  Certain foods like chocolate, peppermint, and coffee tend to relax the LES, also causing reflux.
Peptic ulcers are caused by a breakdown in the stomach’s protective lining, allowing the acids from digestion to eat away at the walls of the stomach.  Kind of like a bad rug burn on the inside of your stomach, ulcers can be very painful.
Gallbladder disease, as the name implies, occurs in the gallbladder (see diagram below).  The gallbladder stores bile, a fluid necessary in the digestion of fats, before it moves to the small intestine.  If too much bile builds up, it can harden into a gallstone, blocking the secretion of the bile and forcing the gallbladder to expand, causing extreme pain.

OT: What’s the best thing someone can do for indigestion?
CM: Eating small meals throughout the day can help.  Each person will have different symptoms with different foods, so keeping track of problematic foods and avoiding them is helpful. Greasy foods should be avoided with gallbladder attacks.  It’s common for reflux to be worse at night when laying down in bed; gravity will allow the acids to creep up into the esophagus.  A common mistake is to prop a pillow or two under the head, however, this makes things worse by putting a bend in the waist which increases pressure on the stomach.  A quick fix is to raise the head of the bed 6-8 inches with an old book or a block.  This will keep the body straight and use gravity to keep the acid in the stomach where it belongs.  You can also sleep in a chair.
Gas and bloating can be treated by avoiding foods that bring on those symptoms.  The bacteria in our colon differs slightly from person to person, so certain foods may be worse for some than for others.  If you have to have that second helping of Pad Thai from Thai Bowl try taking an over-the-counter anti-gas pill (Simethicone), and for diarrhea try Pepto-Bismol, Kaopectate, or Imodium.  Overall, indigestion is a fact of life, sometimes you just have to deal with it.

OT: What are the worst foods to be eating in terms of indigestion?
CM: Anything high in acidity is going to cause problems.  Primarily citrus, hot peppers, ground beef, onions, chili, etc. (See the complete list)  This is just another reason people are always told to stick with healthy, natural foods.  If you absolutely must have that third cup of rocket fuel coffee in the morning, be sure to eat some food to buffer the stomach and help absorb some of that extra acid, e.g., toast, bagels, a donut (if you must).

Remember: If you have consistent pain in your stomach, pain that is gnawing or shooting to your back while eating, vomiting blood, or blood in the stool, be sure to immediately contact your physician or go to the nearest emergency department for an evaluation.

So, all-in-all this week, we’ve covered the different aspects of digestion, showing you the effects of different foods, how to take digestion to a new level, traditional methods of easing the process, a sport centered around gluttony, and the basics holding it all together.  Keeping the belly in good health is important for everyone and we hope you can incorporate some of these suggestions into your daily life.


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