Mastering the Basics of the

Digestive & Endocrine

Systems
Part 1

RECAP FROM LAST WEEK

What was last weeks lecture?

• End of Module 1
• MNU’s Six Core Skills

The structure of this week

• Part 1 – Digestive System
• Part 2 – Endocrine System

AIMS – PART 1
What is the digestive system?
The role of digestive enzymes
An introduction to appetite hormones
The role and function of the digestive organs
• Mouth and Oesophagus
• Stomach
• Small and Large Intestines
• Liver and Kidneys
Common gastrointestinal issues
What is the digestive system?
Gastrointestinal (GI) tract or “Gut”
• Digestive and absorptive organ system
• Releases enzymes and hormones to digest food

Mouth

Foods vs Nutrients
We eat food not nutrients
• Made up of monosaccharides, fatty acids, amino acids

Monosaccharides
Amino Acids Monosaccharides Amino Acids
Amino Acids Fatty Acids

Different hormonal and digestive response to certain

foods
Different nutrients are broken down by different
enzymes

Digestive Enzymes
Digestive Juices and Enzymes Substance Digested Product Formed

Saliva
Amylase Starch Maltose

Gastric juice
Proteases (pepsin) and Peptides (partly digested
Proteins
hydrochloric acid protein)

Pancreatic juice
Proteases (trypsin) Proteins Peptides and amino acids
Lipases Fats emulsified by bile Fatty acids and glycerol
Amylase Starch Maltose

Intestinal enzymes
Peptidases Peptides Amino acids
Sucrase Sucrose (sugar) Glucose and fructose
Lactase Lactose (milk sugar) Glucose and galactose
Maltase Maltose Glucose
Mouth
Mastication (chewing)
Salivary glands
• Amylase à Starch (polysaccharides) à Maltose
(disaccharide)
• Small amount of lipase, as fat digestion takes considerably
longer
Function - mainly digestive, however, some
absorption can take place
• Soluble drugs
Triggers stomach and other organs to produce acids,
mucus, enzymes and bile

Chewing
More chews ‘per bite’ increases relevant gut
hormones and has been shown to be linked to
subjective satiety – Miquel-Kergoat et al. (2015)

Satiety – ‘the state of being full’

Satiety index – isoenergetic serving of different foods

differ greatly in their satiating capacities – Holt et al.
(1995)

Holt et al. (1995)

Satiety Signalling by Gut Hormones
Hormones Effect on Appetite

CCK
⇩
Ghrelin
⇧
Peptide YY
⇩
GLP-1
⇩
Stephens (2004)

Oesophagus
Mouth à Stomach
Gastroesophageal reflux
• Weak lower oesophageal sphincter?
• Foods to avoid?
• Spicy foods, Caffeine, Alcohol
• Fermentable carbohydrates…
• Significantly greater supine reflux following a late evening
(-2h) meal compared to an early meal (-6h)
– Piesman et al. (2007)

Stomach
Digestive not absorptive organ
• Some drugs e.g. aspirin are absorbed
Hypo/Achlorhydria - production of hydrochloric acid
in gastric secretions of the stomach is absent or low
• pH should be between 1-4
Gastric juice – highly acidic
• Contains hydrochloric acid and digestive enzymes e.g. pepsin
Stretch receptors
• Activated as stomach fills with food or water, signalling the
brain via the vagus nerve
Co-ingestion of foods
Dr. Pickering
• No proteins and starches at the same meal
• No fruits and vegetables at the same meal
• "Eat melon alone, or leave it alone, or your stomach will
moan”
Food Combining is NOT evidence-based
• Food combining diet did not bring any additional loss in
weight and body fat when energy intake and substrate
composition were similar – Golay et al. (2000)
However…
• Eating fat with Vitamin D increases absorption
• Eating Vitamin C increases iron absorption

Gastric Emptying – Myth busting!

Lower gastric emptying rates for a high fat-low
carbohydrate meal than for a high carbohydrate-low
fat meal, both equalised for total calories
• However, the meals differed in total volume (i.e. caloric
density) and the osmolality was not reported

Caloric density... (2.5MJ = 597kcal)

• HC – 581g ÷ 597kcal = 1.02
• HF – 325g ÷ 597kcal = 1.83

Sidery et al. (1994)

Gastric Emptying – The truth!

Carbohydrates, Protein, and Fats vs Calorie density
• Linear relationship between the caloric density of the
test solution and the rate of gastric emptying
32
10
Half-time of gastric emptying (min)

Gastric emptying rate (kcal.min-1)

28 9

24 8
7
20
6
16 5

12 4
3
8
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
Caloric density (kcal.ml-1) Caloric density (kcal.ml-1)

Adapted from Calbet and MacLean (1997)

Gallbladder
Bile is synthesised in the liver
Gallbladder stores bile
• For digesting fat in the duodenum of the small intestines
Gall stones
• Usually made of cholesterol
• Low fat diet to treat symptoms
Gall bladder removal
• Doesn’t mean you can’t eat fat!

Small Intestines
Structure
• Microvilli
• Large surface area
• Most absorption takes place here!
Duodenum, Jejunum and Ileum
• Enterocytes are the absorptive cells in the intestines
Enzymes
• Lipase, amylase, protease
• Proteolytic enzymes from the pancreas

Pancreas
Releases Insulin and Glucagon!
Pancreatic juices
• Digestive enzymes released upon
detection of macronutrients entering duodenum
Enzymes released
• Amylase – polysaccharides
• Lipase – lipids
 Blood Sugar

Blood Glucose

Fasted Glucagon Released by Liver Releases

Alpha Cells of Pancreas
exercise Glucose into Blood

Maintains
Normal Blood
Glucose Levels

Pancreas
CHO
Cells take in
Glucose from
Insulin Released by
Blood
Beta Cells of Pancreas
High
CHO oxidation
Blood Glucose increased

Large Intestines - Colon

Absorption of some nutrients
• E.g. Vitamin K
Gut Flora
• ‘The forgotten organ’
Short chain fatty acids (SCFAs) produced
• Fermentation of indigestible carbohydrate
• Acetate, propionate, and butyrate (95% absorbed/used)
• Anti-carcinogenic, anti-inflammatory, induce apoptosis

Issues in the Intestines

Small Intestinal Bacterial Overgrowth (SIBO)
‘condition in which abnormally large numbers of bacteria are present in the
small intestine, while the types of bacteria found in the small intestine are more
like the bacteria found in the colon’

Most common form of dysbiosis

• Bacteria from the large intestine
• Move into the small intestines
• Where they are harmful
• And they multiply!
Issues in the Intestines…
Constipation - stool remains in the colon – IBS-C
Potential Treatment
• Adequate hydration
• Increase soluble fibre
• Correction of hypothyroidism
Diarrhoea - looser frequent stool – IBS-D
Potential Treatment
• Reduce insoluble fibre
• Reduce caffeine
• Reduce Polyols
• Stress management

Liver
Bile production and secretion
• Synthesised from cholesterol
Storage of carbohydrates and fat soluble vitamins
• Liver glycogen
• Vitamin A, D, E and K
Synthesises glucose
• From amino acids and lactic acid (gluconeogenesis)
Processes hormones, drugs and toxins
• Produces inactive forms for excretion in bile/urine
Over nutrition and insulin resistance
• Lead to non-alcoholic fatty liver disease (NAFLD)

Kidney
Regulates electrolyte balance
• Regulation of blood pressure and blood osmolality
• Antidiuretic hormone (ADH) increase water reabsorption
Maintains pH balance
• Using ammonia and glutamine
Excretes urine to the bladder
High protein diets do NOT harm the
kidney!!!
• A high protein diet (~3 g/kg/d) for one year did not elicit
harmful effects on measures of blood lipids as well as liver
and kidney function – Antonio et al. (2016)
 SUMMARY

The digestive system is very complex

We only need to understand what will help us
synthesise new knowledge
• And most importantly, help our clients!
There is still much for researchers to understand
about the gut
• Don’t be fooled by ‘gut specialists’ with no quals…
Theoretical understanding
• Needs to underpin practical application and
interventions