ADVANCED REHABILITATION & FITNESS ACADEMY

COURSE
DIET & NUTRITION
BASIC

DATE : 1 APRIL 2020

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MODULE 1
 HUMAN ANATOMY
DIGESTIVE SYSTEM

The digestive system breaks food down into basic nutrients that can be used by the body. The
digestive tract is a long, muscular tube that extends from the mouth through the stomach and
intestines to the anus. As food moves along the digestive tract, it is digested. This means it is
changed into substances that can be absorbed into the bloodstream. Certain organs (such as
the liver, gallbladder, and pancreas) help with this digestion. Parts of food that can't be
digested are turned into stool. This is waste material that is passed out of the body. ie stool
leaves the body. The digestive system is made up of the digestive tract. This consists of a long
tube of organs that runs from the mouth to the anus and includes the esophagus, stomach,
small intestine, and large intestine, together with the liver, gallbladder, and pancreas, which
produce important secretions for digestion that drain into the small intestine.
The digestive tract in an adult is about 30 feet long.
  Mouth and Salivary Glands
 Digestion begins in the mouth, where chemical and mechanical digestion occurs.
Saliva or spit, produced by the salivary glands (located under the tongue and near
the lower jaw), is released into the mouth. Saliva begins to break down the food,
moistening it and making it easier to swallow. A digestive enzyme (amylase) in the
saliva begins to break down the carbohydrates (starches and sugars). One of the
most important functions of the mouth is chewing. Chewing allows food to be
mashed into a soft mass that is easier to swallow and digest later.
 Movements by the tongue and the mouth push the food to the back of the throat
for it to be swallowed. A flexible flap called the epiglottis closes over the trachea
(windpipe) to ensure that food enters the esophagus and not the windpipe to
prevent choking.
 Esophagus
 Once food is swallowed, it enters the esophagus, a muscular tube that is about 10
inches long. The esophagus is located between the throat and the stomach.
Muscular wavelike contractions known as peristalsis push the food down through
the esophagus to the stomach. A muscular ring (cardiac sphincter) at the end of
the esophagus allows food to enter the stomach, and, then, it squeezes shut to
prevent food and fluid from going back up the esophagus.
  Stomach
 The stomach is a J-shaped organ that lies between the
esophagus and the small intestine in the upper abdomen. The
stomach has 3 main functions: to store the swallowed food and
liquid; to mix up the food, liquid, and digestive juices produced
by the sto mach; and to slowly empty its contents into the
small intestine.
 Only a few substances, such as water and alcohol, can be
absorbed directly from the stomach. Any other food substances
must undergo the digestive processes of the stomach. The
stomach's strong muscular walls mix and churn the food with
acids and enzymes (gastric juice), breaking it into smaller
pieces. About three quarts of the gastric juice is produced by
glands in the stomach every day.
 The food is processed into a semiliquid form called chyme.
After eating a meal, the chyme is slowly released a little at a
time through the pyloric sphincter, a thickened muscular ring
between the stomach and the first part of the small intestine
called the duodenum. Most food leaves the stomach by four
hours after eating.
 Small Intestine

Most digestion and absorption of food occurs in the small intestine. The small intestine
is a narrow, twisting tube that occupies most of the lower abdomen between the
stomach and the beginning of the large intestine. It extends about 20 feet in length.
The small intestine consists of three parts: the duodenum (the C-shaped part), the
jejunum (the coiled midsection), and the ileum (the last section).
The small intestine has two important functions.
1.The digestive process is completed here by enzymes and other substances made by
intestinal cells, the pancreas, and the liver. Glands in the intestine walls secrete
enzymes that breakdown starches and sugars. The pancreas secretes enzymes into
the small intestine that help breakdown carbohydrates, fats, and proteins. The liver
produces bile, which is stored in the gallbladder. Bile helps to make fat molecules
(which otherwise are not soluble in water) soluble, so they can be absorbed by the
body.
2.The small intestine absorbs the nutrients from the digestive process. The inner wall
of the small intestine is covered by millions of tiny fingerlike projections called villi. The
villi are covered with even tinier projections called microvilli. The combination of villi
and microvilli increase the surface area of the small intestine greatly, allowing
absorption of nutrients to occur. Undigested material travels next to the large intestine.
  Large Intestine
 The large intestine forms an upside down U over the coiled small
intestine. It begins at the lower right-hand side of the body and
ends on the lower left-hand side. The large intestine is about 5-6
feet long. It has three parts: the cecum, the colon, and the rectum.
The cecum is a pouch at the beginning of the large intestine. This
area allows food to pass from the small intestine to the large
intestine. The colon is where fluids and salts are absorbed and
extends from the cecum to the rectum. The last part of the large
intestine is the rectum, which is where feces (waste material) is
stored before leaving the body through the anus.
 The main job of the large intestine is to remove water and salts
(electrolytes) from the undigested material and to form solid waste
that can be excreted. Bacteria in the large intestine help to break
down the undigested materials. The remaining contents of the large
intestine are moved toward the rectum, where feces are stored
until they leave the body through the anus as a bowel movement.
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 Functions of the Digestive Organs (Table 3)
Organ Major functions Other functions
•Ingests food
•Chews and mixes •Moistens and
food dissolves food,
•Begins chemical allowing you to taste
breakdown of it
Mouth carbohydrates •Cleans and
•Moves food into the lubricates the teeth
pharynx and oral cavity
•Begins breakdown of •Has some
lipids via lingual antimicrobial activity
lipase

•Propels food from

•Lubricates food and
Pharynx the oral cavity to the
passageways
esophagus

•Propels food to the •Lubricates food and

Esophagus
stomach passageways
 •Mixes and churns food
with gastric juices to form
chyme
•Begins chemical •Stimulates protein-digesting
breakdown of proteins enzymes

Stomach •Releases food into the •Secretes intrinsic factor

duodenum as chyme required for vitamin
•Absorbs some fat-soluble B12absorption in small
substances (for example, intestine
alcohol, aspirin)
•Possesses antimicrobial
functions
•Mixes chyme with
digestive juices
•Propels food at a rate slow
enough for digestion and
absorption

•Absorbs breakdown Provides optimal medium for

Small intestine
products of carbohydrates, enzymatic activity
proteins, lipids, and
nucleic acids, along with
vitamins, minerals, and
water
•Performs physical
digestion via segmentation
 •Liver: produces bile
salts, which emulsify
lipids, aiding their •Bicarbonate-rich
digestion and absorption pancreatic juices help
•Gallbladder: stores, neutralize acidic chyme
Accessory organs
concentrates, and and provide optimal
releases bile environment for
•Pancreas: produces enzymatic activity
digestive enzymes and
bicarbonate
  Digestive system
 The digestive system is made up of the following:
 The mouth. Takes in food, breaks it into pieces, and begins the digestion process.
 The esophagus. Moves food from the mouth to the stomach.
 The stomach. Breaks food down into a liquid mixture.
 The liver. Makes bile that helps digest fat.
 The gallbladder. Stores bile.
 The pancreas. Makes enzymes that help in digestion.
 The small intestine. Digests food further and absorbs nutrients. What is left is passed on to
the colon as liquid waste.
 The large intestine (colon). Absorbs water, salt, and minerals from the waste, forming a
solid stool.
 The rectum. Stores stool until a bowel movement happens.
 The anus. The opening from where the waste products gets excreted.
PHYSIOLOGY OF DIGESTION
  Mechanism of digestion
Mechanical digestion
 Mastigation:
 The teeth are admirably designed for chewing. The anterior teeth (incisors)
provide a strong cutting action, and the posterior teeth (molars) provide a
grinding action.
 Chewing is important for digestion of all foods, but it is especially important for
most fruits
and raw vegetables because they have indigestible cellulose membranes around
their
nutrient portions that must be broken before the food can be digested.
 Furthermore, chewing aids the digestion of food for another simple reason:
Digestive enzymes act only on the surfaces of food particles; therefore, the rate
of digestion is dependent on the total surface area exposed to the digestive
secretions.
 In addition, grinding the food to a very fine particulate consistency prevents
excoriation of the gastrointestinal tract and increases the ease with which food is
emptied from the stomach into the small intestine, then into all succeeding
segments of the gut.
  Swallowing (deglutition)
 Swallowing is a complicated mechanism, principally because the pharynx serves
respiration and swallowing both.
 The pharynx is converted for only a few seconds at a time into a tract for
swallowing of food.
 Tongue helps in mixing of saliva with the food.
 The pharynx is converted for only a few seconds at a time into a tract for
swallowing of food.
 Tongue helps in mixing of saliva with the food.
 Saliva moistens and lubricates the food, which changes into semisolid form called
bolus. The bolus is then swallowed through Oesophagus to the stomach.
 Peristalsis movement of alimentary canal also helps in swallowing.

 Churning in stomach:
 The wall of stomach undergoes periodic movement as well as contraction
producing churning movement called peristalsis, which results in breakdown of
complex food into simpler form.
 The bolus after mixing with gastric juice, turn into fine soluble form known as
chime.
  Chemical digestion
 It involves the breaking of covalent chemical bonds in organic molecules by
digestive
enzymes.
 Carbohydrates are broken down into monosaccharides, proteins are broken down
into amino acids, and fats are broken down into fatty acids and glycerol.
 Digestion of Carbohydrates
 Ingested carbohydrates consist primarily of polysaccharides, such as starches (rice,
bread), disaccharides, such as sucrose (table sugar) and lactose (milk sugar); and
monosaccharides, such as glucose and fructose (found in many fruits).
 During the process ofdigestion, polysaccharides are broken down into smaller
chains and finally into disaccharides and monosaccharides. Disaccharides are
broken down into monosaccharides.
 digestion of carbohydrates in mouth;
 Carbohydrate digestion begins in the oral cavity with the partial digestion of
starches by
salivary amylase.
 About 30 percent of starch is hydrolysed here by this enzyme amylase (optimum pH
6.8) into a disaccharide – maltose.
 Lysozyme present in saliva acts as an antibacterialagent that prevents infections.
  digestion of carbohydrates in stomach and intestine;
 A minor amount of digestion occurs in the stomach through the action of gastric
amylase
and gelatinase.
 Carbohydrate digestion is continued in the intestine by pancreatic amylase.
 A series of disaccharidases enzymes that are released by intestinal epithelium digest
disaccharides into monosaccharides.

 i. Digestion of Proteins
 Proteins are taken into the body from a number of dietary sources.
 Pepsin secreted by the stomach catalyzes the cleavage of covalent bonds in proteins to
produce smaller polypeptide chains.
 digestion of protein in stomach and intestine;
 Gastric pepsin digests as much as 10%–20% of the total ingested protein.
 The mucosa of stomach has gastric glands.
 Gastric glands have three major types of cells namely –
(i) mucus cells: which secrete mucus;
(ii) peptic or chief cells; which secrete the proenzyme pepsinogen; and
(iii) parietal or oxyntic cells; which secrete HCl and intrinsic factor (factor essential for
absorption of vitamin B12).
 The stomach stores the food for 4-5 hours.
 The food mixes thoroughly with the acidic gastric juice of the stomach by the
churning movements of its muscular wall and is called the chyme.
 The proenzyme pepsinogen, on exposure to hydrochloric acid gets converted into
pepsin.
 Pepsin then converts proteins into proteoses and peptones (peptides).
 The mucus and bicarbonates present in the gastric juice play an important role in
lubrication and protection of the mucosal epithelium from excoriation by the
highly concentrated hydrochloric acid.
 HCl provides the acidic pH (pH 1.8) optimal for pepsins.
 Rennin is a proteolytic enzyme found in gastric juice of infants which helps in the
digestion of milk proteins.
  digestion of protein in intestine;
 The bile, pancreatic juice and the intestinal juice are the secretions released
into the small intestine.
 Pancreatic juice and bile are released through the hepato-pancreatic duct.
 The pancreatic juice contains inactive enzymes – trypsinogen,
chymotrypsinogen, procarboxypeptidases.
 Trypsinogen is activated by an enzyme, enterokinase, secreted by the intestinal
mucosa into active trypsin, which in turn activates the other enzymes in the
pancreatic juice.
 Pancreatic proteinases (all secreted in their inactive forms) digest peptides into
amino
acids:
 Trypsinogen is activated by enterokinase (secreted by duodenum) into trypsin,
which in turn activates the other 3 enzymes –chymo-trypsinogen becomes
chymotrypisn, proaminopeptidase becomes aminopeptidase, and
procarboxypeptidase becomes
carboxypeptidase.
  Digestion of Lipids
 Lipids are molecules that are insoluble or only slightly soluble in water.
 Lipids include triglycerides, phospholipids, cholesterol, steroids, and fat-
soluble vitamins.
 The first step in lipid digestion is emulsification, which is the transformation
of large lipid droplets into much smaller droplets.
 The emulsification process increases the surface area of the lipid exposed to
the digestive enzymes by decreasing the droplet size.
 Emulsification is accomplished by bile salts secreted by the liver and stored in
the
gallbladder.
 Lipase digests lipid molecules .
 The vast majority of lipase is secreted by the pancreas. A minor amount of
lingual lipase is secreted in the oral cavity, is swallowed with the food, and
digests a small amount (<10%) of lipid in the stomach.
 The stomach also produces very small amounts of gastric lipase.
 The primary products of lipase digestion are free fatty acids and glycerol and
few cholesterol and phospholipids.
  Absorption
 Absorption is the process by which the end products of digestion pass through
the intestinal
mucosa into the blood or lymph.
 It is carried out by passive, active or facilitated transport mechanisms.
 Water moves by osmosis; small fat soluble substances, e.g. fatty acids and
glycerol, are able to diffuse through cell membranes; while others are
generally transported inside the villi by other mechanisms.
  Passive transport:
 Small amounts of monosaccharides like glucose, amino acids and some electrolytes like
chloride ions are generally absorbed by simple diffusion.

 The passage of these substances into the blood depends upon the concentration
gradients.

 Active transport:
 Active transport occurs against the concentration gradient and hence requires energy.
 Various nutrients like amino acids, monosaccharides like glucose, electrolytes like Na+
are absorbed into the blood by this mechanism.
 Some substances like glucose and amino acids are absorbed with the help of carrier
proteins. This mechanism is called the facilitated transport.
 Fatty acids and glycerol being insoluble, cannot be absorbed into the blood. They are
first
incorporated into small droplets called micelles which move into the intestinal mucosa.
They are re-formed into very small protein coated fat globules called the chylomicrons
which are transported into the lymph vessels (lacteals) in the villi. These lymph vessels
ultimately release the absorbed substances into the blood stream. The absorbed
substances
finally reach the tissues which utilise them for their activities. This process is called
assimilation.
  Defaecation
 The digestive wastes, solidified into coherent faeces in the rectum initiate a neural
reflex
causing an urge or desire for its removal.
 The egestion of faeces to the outside through the anal opening (defaecation) is a
voluntary process and is carried out by a mass peristaltic movement
 Digestion of Protein fig -----------
  FACTORS AFFECTING INTESTINAL ABSORPTION
 Factors that affect intestinal absorption in humans have used steady-state
perfusion methods in a segment of intestine.
 Absorption of solute by active and passive means promotes water absorption and
the flow of water through the tight junction can act as a conduit, conveying a
heterogeneous sample of the intestinal contents across the intestinal mucosa by
solvent drag.
 Absorption of both water and solute are closely related, and each can assist the
absorption of the other.
 The factors that affect the rate of intestinal absorption of water from ingested
beveragees are as follows :-

Factor Effect
Fast rates of emptying increase intestinal
Gastric emptying rate
absorption

Water absorption rates are faster from

moderately hypotonic beverages (200–260
Osmolality mosmol/kg), but in the duodenum marked
hypotonicity may be more effective;
hypertonicity retards water absorption
 Because the stomach rapidly equilibrates the
temperature of beverages, it is predicable that
Temperature
the luminal contents are always at body
temperature

Steady-state exercise levels below 70%

VO2max have little effect on intestinal absorption
of carbohydrate solutions; however, exercise-
Exercise
induced changes in perfusion of the capillary bed
may interfere with isotopic water tracers
measured in the blood

Actively transported amino acids, peptides, and

Other actively transported solutes organic acids that are linked with sodium absorption
promote intestinal water uptake

Intestinal sodium absorption is closely linked with

water transport, but it is not clear if it is required in
Sodium concentration rehydration beverages, as sodium from the blood
rapidly effluxes into lumen; no other ion has been
shown to be as crucial for water absorption

It is unlikely that commercial beverage formulations

will affect the pH buffering capacity of the intestine;
pH
an acidosis appears to enhance water and sodium
absorption but not that of glucose
 Active cotransport of glucose and sodium facilitates
the absorption of glucose and promotes osmotic
gradients that support water absorption; facilitated
transport of fructose is slower and is less effective in
Carbohydrate content
supporting water uptake; high concentrations of
maltodextrins may assist absorption by producing
relatively lower beverage osmolality than would
occur with the same glucose monomer content
 Common causes of reduced intestinal Absorption.

Bacterial Infection,
Viral Infection,
Inflammation,
Lactase Deficiency,
Difficulty Digesting Certain Foods,
Poor Circulation To The Intestines Or Other Organs,
Ruptured Or Perforated Organs,
Muscle Dysfunction,
Gallstones,
Stress, And
Side Effects Of Anti-inflammatory Drugs.
 Dietary factors
 Overeating,
 Eating Too Much Fatty Food,
 Not Consuming Enough Fiber,
 Consuming Too Much Alcohol.
 Smoking Leading To Ulcers And Gastric Acid Reflux.
  DIET & NUTRITION
 DIET refer to the food and drink a person consumes daily
and the mental and physical circumstances connected to
eating.
 Nutrition involves more than simply eating a “good” diet—it
is about nourishment on every level
 Diet needs to be associated with a person's overall food
intake and it is rather not just focus on restriction or “being
on a diet”.
 Nutrition differs from diet. People need to be aware of
nutrition and how crucial it is to the improvement of their
health. Diet and nutrition are two factors that you need to
know about and it’s important to recognize the difference
between the two
 it refers to the quality of the food itself. Nutrition is food that our bodies need to
consume daily for our bodies to function optimally. This includes complex
carbohydrates, protein, healthy fats, and fibre. We need these foods in a
balanced quantity and ideally, from the cleanest sources possible.
 As a general guide, balanced nutrition for the day should comprise of:
 30% protein
 40% complex carbohydrates
 30% essential healthy fats (ideally omega-3 fatty acids)
 2-4 litres of water
 Proper nutrition should also consist of vitamins, minerals, phytonutrients, and
antioxidants. A few ideal food choices include dark leafy greens, whole grains,
sweet potatoes, raw nuts, seeds, salmon, berries, oats, and avocado.
 Balanced nutrition is critical at all stages of life. From a young age, nutrition is
crucial for growth and development. As a person gets older, proper nutrition is
required for energy, detoxification, and antiaging. Nutrition improves the immune
system, helps build muscle, assists in weight loss, and enhances vitality.
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