(Part 3 of 4)
We decided to sit down and have a chat with our practice owner and MD, Dr. Philip Oubre, and functional nutritionist, Aubree Steen.
Time to dive into the dysfunction of what happens when one part of the digestive cascade goes wrong. It’s a domino effect in the body causing system wide issues and chronic health problems.
We really wanted to breakdown the how the gut works, and the entire process from simply visualizing the food to eliminating it. It’s a pretty magical process, but there’s quite a lot of decisions our body has to make when breaking down and absorbing food. We broke this up into 4 different categories to touch base on the big picture in each segment. While this process is intricate in nature, we hope to breakdown into a really palatable and digestible picture. You see what I did there.
Feel free to watch the video, or read our transcript below.
Philip Oubre (00:00):
Hey guys. In this video we’ve already talked about the function of the upper GI and lower GI. So now we’re going to talk about the dysfunction of the upper GI. In the next video we’ll do dysfunction of lower GI. So when we’re talking about upper GI and just to remind you, if you haven’t seen the previous videos, you need to understand the function in order to understand the dysfunction. But we’re talking about basically from brain all the way to the stomach, pancreas and gallbladder. So the first step of dysfunction is in the brain. So Aubree, how do people mess up their brain and digesting food?
Aubree Steen (00:32):
The biggest thing people do is that they don’t sit and focus on eating … I know, right. So they do it while they’re hurrying on the way to work, while they’re talking on the phone, while they’re working or doing a bunch of different things at once. Your brain doesn’t have the ability to start the entire digestive cascade when it’s overloaded by something else. If you think about it, there’s only a very few people who are actually good at multitasking and the brain is the same way with digesting food. So inevitably, one of the biggest things that you can do is eat in a stressed out or distracted state. So what happens is you can either go into a parasympathetic response, which is going to be your rest and digest, which is what essentially is the best way of eating, or you going into a sympathetic, which is fight or flight.
Aubree Steen (01:14):
If you think of sympathetic as the fight or flight, you’re thinking about in prehistoric days, that fight or flight system was initially created for us to outrun a mammoth or a saber-tooth tiger or something that’s chasing after us. But in today’s society, we live in it all the time. You think about you getting in your car or someone slams the door really easily. You constantly have these triggers. What happens is that when you start to eat in that state, your body shuts down digestion, because essentially when your body’s in a fight or flight state, it doesn’t want to do two things, make babies or digest food. So you inevitably see digestion be the first thing to go. So what happens is that because the brain is the essential start of your digestive cascade, it affects literally everything else after that, your stomach pancreas, liver, gallbladder, your bowel movements, gas, bloating, you name it.
Aubree Steen (02:04):
One thing that it also does is the brain starts to trigger the saliva to produce something called salivary amylase. It’s what help break down the food in the mouth. When you are already in a distracted state, you miss that step and you miss the very first part of physically and chemically breaking down food. Another thing that happens is that it doesn’t just start up here the stomach too, your brain can actually change the blood flow to your small intestines. So if you’re eating in a stressed out or sympathetic state, your intestines aren’t going to be primed and ready as well. So it’s a little bit of a condensed version of it. But the biggest mistake of eating in a stressed out state is just that, actually.
Philip Oubre (02:45):
So the idea is that you can eat the greatest food you want, but a common saying is you are what you eat, but we wanted to say, you are what you absorb and if you’re not doing that part right, you’re not going to absorb and thus, you’re not going to absorb the greatest diets so you’re not the greatest diet.
Aubree Steen (03:01):
Essentially when you start with the north to south process, if you miss that first step, everything is affected. You have to get those first steps down. Your bloating essentially could be not chewing well or not even sitting with your food and giving your brain the realization that it has to break down this substance.
Philip Oubre (03:16):
So after you appropriately sit down with your meals and not rush through it or try to work on the computer, after you swallow your food, the food goes down to the stomach, and this is one of the first steps you have no control over. Now, it is a hundred percent up to control this parasympathetic state that Aubree just talked to you about and you’ve asked your digestive process to be in control of. So the stomach’s one of the first lines of defense to break down the food after the brain, of course, but the first one you have no control over. So that stomach’s main role is to make stomach acid and that stomach acid has to break down the food. One of the most common things we see, and we’ve seen patients go all over the place to this GI doctor and different stuff, and one of the main things they’re missing is they just don’t have enough stomach acid.
Philip Oubre (03:59):
Nowadays with stress that lower stomach acid production and the amount of people taking Tums and Rolaids and Prilosec and Nexium and all those, all those are stomach acid neutralizers. Now this is a big topic. I’ve got a separate video on just stomach acid, gastritis, all that stuff. You need to look more into that if you want to know more details about it but the theory … there’s not really a theory. The clinical reason for heartburn reflux is actually not enough acid. Not that you have too much acid. Yes, it works to improve symptoms if you wipe out the stomach acid completely with those drugs and antacids, but if you don’t have acid, then you’re not breaking down your food, and the other important part that Aubree reminded before we did this video was the stomach acid also disinfects the food. So we saw one of our favorite patients yesterday who’s completely paranoid about having food poisoning and all this and the-
Aubree Steen (04:47):
We love you. You know who you are [crosstalk 00:04:49]. Jace.
Philip Oubre (04:49):
The problem is that if you don’t have enough stomach acid, you can’t disinfect your food. So making sure you have enough stomach acid primarily to digest the food, but also to neutralize any kind of bacteria that are on it. So we could talk for hours about stomach acid. It is critically important. The main thing we task people with is something called a Betaine Challenge. So Aubree, give them the quick version of the Betaine Challenge that we ask our patients to do. And it’s something they can try at home if they choose to.
Aubree Steen (05:16):
Right. And just real quick, the reason why we brought the brain in before the stomach is because the brain starts the hydrochloric acid production.
Philip Oubre (05:23):
Aubree Steen (05:23):
So I’m going to-
Philip Oubre (05:24):
That’s the growling in your stomach when you’re hungry, the stomach’s already making juices and working. That’s the growling you hear.
Aubree Steen (05:30):
Yeah. One way that you can check is something called a Betaine Challenge. The only clinical way to check is swallowing a tube with a string down it. It’s a very invasive procedure and it rarely actually even happens to be honest with you and no one wants to go through that.
Philip Oubre (05:41):
I’ve never seen it.
Aubree Steen (05:42):
No, and empty. One thing that you can do is buy betaine hydrochloric acid and you essentially need to test it with your largest meal, but the way to see if you have enough acid is actually take the acid yourself. So what you want to do is have a food sandwich, so you want to start halfway of when you’re eating and take one betaine hydrochloric acid. My largest meal is lunch, so I would do that on day one. Day two, you would take two pills in that same time period sandwiched between the food. Day three, you take three and so on.
Aubree Steen (06:11):
You increase every single day at that one meal because you’re trying to find your dose. Eventually you’ll change it for the other meals. But you keep increasing until you feel a little bit of different symptoms. It could be upper GI. So it could be acid reflux, heartburn, indigestion, any of that acidity feeling up in this area, or it could be lower GI kind of like when you have hot tea on an empty stomach or hot coffee, you feel warmth in your belly. It’s very warm and it’s not painful, but for some people it could be a little sensitive. If you hit that dose, let’s say, if you hit that at five, you go down a pill … Right, me too. You go down a pill and now your dose is four. Essentially you have to push it past the level so you know how much acidity your body needs to break down the food.
Aubree Steen (06:55):
If you don’t have enough acidity, essentially that betaine is useless because your stomach has to reach that certain pH to trigger the entire digestive cascade. So now we have our doses at four, that’s my largest meal. You’re going to need to figure out where it is for your other food. If you’re just having carbohydrates by itself, which we don’t recommend, you wouldn’t need any. You don’t need it with an Apple. You need it with protein and fat, essentially fat. But I’ve noticed that most patients with animal protein always, always, always have to have betaine. Betaine hydrochloric acid is usually paired with pepsin, which helps break down animal proteins even further.
Philip Oubre (07:32):
Yeah. So if you’re going to eat a boiled egg, you might need one, but that does have protein and fats. So you may need one, may need two, and it’s going to be something that’s going to be experimentation. Now, because we’re putting this out there in public for people to try betaine. This is available over the counter and things. I must add the asterisk as a physician saying that you should do this directly with your physician if you choose to. If you have peptic ulcer disease or gastritis, whatever it may be, if you take one betaine pill and you get pain, you should probably abort. Go talk to your physician, look up a functional medicine doctor, if you need further help, because anyone and everyone should be able to tolerate two betaine without any trouble. If you cannot tolerate betaine it’s because you don’t have enough stomach mucus lining, and you need more work there before you can add the betaine.
Philip Oubre (08:13):
But if you can’t tolerate one, you’ve got a real problem. There was another point I wanted to … Oh, well, yes. As you find your dose, you want to add it to each meal … I thought there was another comment I was going to make on that. Can’t remember.
Aubree Steen (08:26):
Philip Oubre (08:27):
Well, anyway, so once you have enough acid to break down the food … Oh, I remember what it was. It was how to neutralize it.
Aubree Steen (08:34):
Philip Oubre (08:35):
If you’re on the four or five pills and you’re like, “Oh God, I’ve got too much acid. That’s too much.” You can neutralize it. You can take baking soda.
Aubree Steen (08:42):
Yeah, usually a quarter teaspoon and about six ounces of water is totally fine. Have more if you want. It’s happened to me before, where I took too much of the smoothie and you can just go in there, eat more food, drink more water and that will neutralize that well.
Philip Oubre (08:53):
More food can neutralize the betaine. You don’t have to take … so yeah, baking soda, or even just Tums or Rolaids or something, we don’t encourage that over time. But obviously [crosstalk 00:09:01] if you took too much, you got to neutralize it.
Aubree Steen (09:03):
It’s not harmful by any means, to be honest with you. It may be a little discomforting, but it is what it is.
Philip Oubre (09:09):
Yep. Now that we’ve discussed the dysfunction of the stomach and you’ve fixed it with betaine then that chyme or that food drops into the upper portion of the small intestine called the duodenum, and there’s further digestion going on there. And so, Aubree…
Aubree Steen (09:24):
Yeah, so you also have things called accessory organs. It’s going to be the pancreas, liver and gallbladder. When you don’t have enough hydrochloric acid and that pH isn’t at the acidity it needs to be, the pancreas doesn’t get the trigger A, for two different things. Sodium bicarbonate, which essentially neutralizes that acid. It also has other functions in the small intestine as well, but you also don’t release proper enzymes. So now you’re inhibiting the essentially digestion of carbohydrates but other food as well. That’s with the pancreas. But the liver and gallbladder is also an essential trigger. When you don’t have enough pH or the low pH or enough acidity to trigger the gallbladder, that’s when you can have viscous bile, toxic bile, old bile. It sounds strange that you can have that, but you can.
Philip Oubre (10:09):
Aubree Steen (10:10):
Yeah, but it’s essentially needed to break down fat, but it’s also to help remove toxins because there are toxins stored in the bile. So when you can’t trigger that, now you’re back-loading toxins, you’re having sluggish gallbladder bile and then you’re not breaking down your fat appropriately. And that’s when you can get lower GI dysfunction as well, gas bloating, you name it.
Philip Oubre (10:32):
So as far as supplementation, if you’re not making enough digestive enzymes or if you’re worried you’re not making enough digestive enzymes from pancreas, and by the way, that’s an easy stool test called an elastase. Anyone and everyone can check it, a regular doctor can check an elastase. If your elastase is low, you know you’re not making enough pancreatic enzymes and we see it all the time. You can also check breakdown products in a stool study. Most regular doctors won’t do that, but you can see if you’re not appropriately breaking down your food and it’s ending up in your stool.
Aubree Steen (10:58):
You can look at it and you’ll see little food protocols.
Philip Oubre (11:00):
Not the … The stool? Okay.
Aubree Steen (11:02):
You can look at your stool.
Philip Oubre (11:02):
Okay, you can.
Aubree Steen (11:04):
You can. You can look at your stool. If you look in your stool and you see pieces of food in there, I had a patient who thought she was digesting fine and she was like, “Oh yeah, I love these digestive enzymes because I don’t see the lettuce in my stool anymore.” And I was like, “Oh, why didn’t you tell me this? Oh, no.” But it was a good thing. Or if you’re stool floats, that means-
Philip Oubre (11:20):
We do gross things here.
Aubree Steen (11:21):
We do and we talk about it all the time, but it’s normal. We should normalize it. Or if your stool’s floating, it’s meaning that you’re not breaking down your fats well enough and now you have fecal fats. So you can actually look at your stool to see if you’re not breaking down food appropriately. For the pancreatic elastase we do like to see over 500. On certain stool studies they’ll say 200 or more is normal but we like essential optimal function at over 500.
Philip Oubre (11:45):
And the digestive enzymes are actually pretty easy to replace. You want a broad spectrum version. The one we’re using right now is called Digestzyme-V from Ortho Molecular and basically you take two of those pills. They’re really … We’ve only had a couple people react to them this time and most people can tolerate them perfectly fine. You take two, that’s not one that you really need to increase with size of the meal. Two should be plenty. If you’re going to eat a boiled egg, one is fine kind of a deal. So yeah, dial it with a meal a little bit, but it’s pretty hard to overdose on enzymes because they’re not really acidic. If there’s no food to digest, they’re just not going to do anything basically.
Aubree Steen (12:15):
Yeah. And my favorite part about enzymes is that I love this metaphor of, let’s imagine we’re all strong enough to push a car.
Philip Oubre (12:22):
What are you talking about? Of course I am.
Aubree Steen (12:24):
Of course we are.
Philip Oubre (12:25):
A very small one.
Aubree Steen (12:27):
You’re outside with a toy car. You’re like, “I got this, Aubree.”
Philip Oubre (12:30):
Aubree Steen (12:32):
So essentially people are nervous about … the thing about [inaudible 00:12:36] is hormones. If I’m taking this, will it stop my production? Absolutely not. With hydrochloric acid and with enzymes, it helps you and then you can taper away from it. So if you were pushing a car by yourself or I was doing it by myself, I could do it. But if Dr. Oubre came up and helped me, now I just have the extra help. He got the car further and farther along and once I was able to regain my energy, I could push it very well again. It’s the same thing with digestive enzymes. They like Dr. Oubre. They come up and help. They help break down your food a little bit more and then-
Philip Oubre (13:06):
Like a warm hug.
Aubree Steen (13:07):
I know. It is. Enzymes are a warm hug. That’s the whole takeaway.
Philip Oubre (13:12):
The other point is that you’re not addicted to these things if you take them. They’re trying to restore your digestive patterns and if you can restore them, then they go back to normal is the idea. And then last but not least of course is gallbladder support, liver support and so you use bitters and things.
Aubree Steen (13:27):
Digestive bitters are super easy to buy. Honestly, you can go to any herbal shop and you’re looking things for Jin Shin, ginger, dandy lion. I don’t think eating the food is going to be as beneficial. They’re concentrated in these certain amounts to trigger a response in your nervous system starting on your tongue. You’re supposed to taste the bitterness. So I like bitters because they have two different functions. They’re used to break down food, but they’re also used as a therapeutic effect. If you do have an upset stomach where you feel nauseous, you can take bitters because usually nausea and upset stomach is because of…
Philip Oubre (13:57):
Food just setting.
Aubree Steen (14:00):
Yes. It’s not properly digested. So they can do both. And they’re harmless essentially. Obviously just don’t have it if you have an allergy to one of the components, but other than that, put it on your tongue 15 minutes before meals. One of my favorites is called Urban Moonshine from Whole Foods. So you don’t have … I know, it’s pretty good, right? But you don’t have to go to a fancy doctor’s office to get any.
Philip Oubre (14:21):
And bitters are called bitters because they do taste nasty. So if you just can’t tolerate the taste, they do have capsule versions of it and it is still effective. We do believe that the taste is part of triggering the cascade, but if you just can’t tolerate the taste, even just swallowing it whole, it does still work.
Aubree Steen (14:37):
Right. We like CarminaGest by Designs for Health. We’re obviously not affiliated with any of these brands, but we do use them for their efficacy in our clinical research too.
Philip Oubre (14:47):
So that wraps up the upper GI dysfunction. So please like our channels, subscribe to it, hit the little bell on YouTube so you get notifications of our future videos so you can keep learning more. And the next video we’re going to be talking about lower GI dysfunction, which is mostly small intestine and large intestine and of course, pooping.
Aubree Steen (15:06):
Cool. Thanks guys.
Philip Oubre (15:07):
See you then.