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Anatomy & Physiology I

Robin Michaels, PhD

Q: For the past 5 years, I will cough for 5-10 minutes after I eat breakfast. It doesn't matter what I eat (e.g., cereal, oatmeal, pancakes) or if I eat very slowly, the cough always persists. The cough is not productive and typically only occurs after breakfast or occasionally lunch. I've tried acupuncture, eating more slowly, and changing the composition of my breakfast, but nothing works. Do you have any idea what this is and what I can do about it?

A: You don’t say that you’ve consulted a doctor, particularly an ear, nose, and throat (ENT) doctor. Your problem sounds like something they would be very well equipped to diagnose.

Q: What is "prediabetes"?

A: From the American Diabetes Association: “Before people develop type 2 diabetes, they almost always have "prediabetes" — blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during prediabetes. The good news is there are things you can do to prevent or delay the development of type 2 diabetes.” 

Q: Does a young woman who has had lap band surgery need to worry about getting pregnant at a later stage?

A: It’s hard to find solid facts here. From the company that makes Lap-Band: “Warnings: The LAP-BAND® System is a long-term implant. Explant and replacement surgery may be required. Patients who become pregnant or severely ill, or who require more extensive nutrition may require deflation of their bands.” Careful monitoring by an obstetrician should allow a safe pregnancy, it seems, but talk with your own doctors first.

Q: Have you heard of the research possibly classifying Alzheimer’s disease as the new type III diabetes? Can you elaborate on that research?

A: There is no research, just speculation that some of the nervous system malfunctioning in Alzheimer’s could be due to abnormalities of sugar metabolism in the brain (the brain is almost wholly dependent on sugar). But the vast majority of diabetics do not have brain symptoms, and there is a huge amount of literature indicating other causes for Alzheimer’s.

Q: What is the role of fiber in diet as related to glycemic index, the pancreas and resistance to insulin?

A: This is a huge question that would earn a Master’s degree in nutrition for anyone who could answer it completely! Try 

Q: Why doesn't stomach acid kill listeria?

A: Listeria is one tough cookie. That’s why it can cause disease.

Q: Why does listeria reach unborn babies when other food-borne bacteria do not?

A: Listeria infection reduces the number of “regulatory T cells” in the mother, and these are thought to be necessary to keep the mother from recognizing her fetus as foreign and rejecting it; so there are frequent spontaneous abortions. In addition, Listeria gets inside the mother’s white blood cells, and these can transfer through the placenta to the fetus and infect it. Pregnant women should take precautions to avoid the foods that most often contain Listeria organisms.

Q: Why does a flavor like ginger allay nausea?  Is ginger more basic?

A: It takes a quarter to a half teaspoon of fresh or powdered ginger a day to allay some nausea, according to the NIH; artificial ginger flavor does not work. They say (2010) no one knows the mechanism yet. It doesn’t taste basic (like soap) to us.

Q: Don't some of the calories we intake just pass through the GI tract without getting absorbed? If so, what fraction is excreted?  How come some skinny sedentary people can eat upwards of 3000+ calories and not gain a pound, whereas a somewhat active heavier person keeps gaining weight?

A: Very little in the way of nutrients get through a normal human gut without being absorbed, sadly. And no one has figured out how to break the laws of thermodynamics, so if a skinny person is eating 3000 calories (and is healthy, not suffering from malabsorption) then he or she is burning 3000 calories; if they are sedentary, they must be doing a lot of fidgeting (skinny people are said to fidget a lot.)

Q: Have you heard of Barrett's esophagus? What is intestinalization of the esophagus?

A: Chronic reflux from stomach to esophagus can cause the esophagus to develop a thickened lining like the intestines, probably to protect itself; but it is a form of chronic inflammation, and there can be scarring (Barrett’s) and even an increased risk of cancer.

Q: Does drinking hot beverages contribute to reflux? Or is it just acidic beverages, like coffee? What would be better, hot or cold coffee?

A: For heartburn, most experts recommend staying away from coffee. Hot or cold. From Johns Hopkins: “Excessive consumption of caffeinated beverages, which weaken the lower esophageal sphincter pressure and also stimulates acid secretion [worsens heartburn.]. For uncertain reasons, decaffeinated coffee also stimulates acid secretion and can increase the severity of reflux.”

Q: Following the survival of bacteria in the gut question. Can OTC acid reflux meds reduce the "hardiness" of the bacteria and thus its overall efficacy?

A: Not though to do so. In fact, by lowering acid, these drugs may increase risk of, or worsen, bacterial infection (somewhat; don’t panic).

Q: Calorie availability in processed food must be higher than the same unprocessed food. Is it a bit like pre-digested food? E.g. eating fruit vs. smoothie.

A: We aren’t sure about this one. The gut is wonderful at physically breaking down food (you’d be a wreck if you passed through someone’s gut) so it’s not clear that a smoothie and the fruit it’s made from would be differently absorbed.