Stomach pH

Arguments from analogy may be very plausible, and are certainly very allowable, when the subject presents no other mode ; but they are not conclusive. We cannot judge of the mode of digestion in the human stomach by that of animals, particularly the granivorous and ruminating animals. Carnivorous animals most resemble man in their digestive apparatus. One thing is certain, and it is capable of demonstration in the stomach of the subject of these experiments, that old and new food, if they are in the same state of comminution, are readily and speedily mixed in the stomach.

Dr. William Beaumont

In April 1837, the fi rst issue of the Graham Journal of Health and Longevity became available to the public. The journal served as a catalyst for a significant shift in the development of proto-vegetarianism. The new journal promoted Sylvester Graham’s diet as well as his writings, lecture tours, and other public appearances, helping to expand the diet’s prominence and reputation. Graham regularly contributed to the journal, providing both new essays as well as excerpts from his previously published books and pamphlets. However, the journal—despite bearing the name of the movement’s founder—was published independently of Sylvester Graham, who was not directly involved in its production. Thus while the Graham Journal of Health and Longevity helped further expose the masses to Sylvester Graham and his ideology, it also emphasized that the actions of individuals helped determine its success. The journal helped further develop a nationwide community that, for the time being, bore Graham’s name. However, the journal relied on the work of other writers, editors, and reformers to accelerate the spread of meatless dietetics.  

The publisher of the new journal was David Cambell, owner of the first Graham boardinghouse in Boston. The journal quickly spread its reach throughout the United States. During its first three months of publication, only thirty-eight local agents were listed as selling the Graham Journal in twelve states. By October of the same year, 108 agents were selling the journal in fift een states, as far west as St. Louis; south to Macon, Georgia; and throughout all of New England. 123 In 1839, its final year of publishing, New Jersey was added to this list of states, and the journal was sold by a total of 140 agents.  

The journal featured a wide variety of articles and followed a similar structure in each of its biweekly issues. It opened with a series of letters and endorsements, offering the familiar conversion narrative structure of redemption. Nathaniel Perry of Boston, writing in the first issue, recollected that soon after marrying he “began to indulge in what is called by most people, good living,” consisting of “roast and fried meats, of all kinds, and poultry with their rich gravies.” Meat and alcohol led to a battle with rheumatism, constant headaches, canker sores, and tooth decay.  

Perry hit bottom when a dyspeptic stomach left him unable to attend to his business dealings or even leave his house. After hearing Graham lecture in Boston, Perry “became interested in the principles he taught; and finally adopted them in diet and regimen.” The results were nearly immediate, Perry reported, with all maladies gone within a month. He slept soundly, and at fifty years of age could attest to “good health,” “the keenest relish for my food,” and an “elastic, energetic, untiring” ability to labor.  Both lay Grahamites and professional medical doctors wrote testimonials, attempting to lend populist and professional credibility to the cause. 

In each issue Sylvester Graham himself was represented by an article, often a summary, excerpt, or reworking of themes and arguments made in lectures and published works on the science of human life or bread making.  The journal also included articles focused on anatomy and the inner workings of the human body as proof of the benefits of a meatless diet. Charts, figures, and drawings frequently accompanied these articles, attempting to make scientific arguments accessible to the average reader.  

In a series of articles appearing in the journal, William Beaumont—a famed U. S. army surgeon—wrote on his observations of human digestion. Beaumont’s research was based on fi rsthand observation of Alexis St. Martin, a patient who had been accidentally shot in the stomach. This wound caused a fistula, an observable hole in St. Martin’s stomach leading to the digestive track. Beaumont placed various foods on a string in order to observe how food stuff s were broken down, leading to the observation that stomach acids helped digest food into various nutrients. Beaumont’s experiments illustrated that vegetables were easily broken down by stomach acid, in contrast to various meat products, which were “partly digested,” observable proof of Grahamites’ claims that meat was difficult to break down into digestible matter.  

Issues also included recipes, further linking Grahamites through common gastronomy. The recipes expanded the Grahamite diet beyond cold water and Graham bread, teaching meatless epicures how to properly prepare vegetables, bake pies, and prepare grains. By expanding the repertoire of meatless cookery, the Graham Journal ironically further shifted proto-vegetarianism away from Graham. The publication closed with an advertising section, offering information on where to buy the journal and find Grahamite boardinghouses, literature, and dietary products.  

Health advocates frequently wrote letters to the journal, though not always in support of meatless dietetics. One concerned reformer wrote with the desire to express a few “hasty remarks” regarding the journal’s advocacy for a vegetable diet. Not all advocates of dietary reform were followers of Graham, he argued. While admitting that Graham’s diet had beneficial effects, the writer said he would call “no man master” and was writing to the journal to “protest against the common notion that the efforts of the advocates of physiological reform are designed solely or mainly to bring about the disuse of animal food.” The writer believed that “there are far worse articles of food in common use than healthy flesh-meat. . . . A man may be a pure vegetable liver, and yet his diet be far less favorable to health than a diet of animal food might be.” The letter concluded with a call for further scientific study into the eff ects of all dietary practices, stating that “we do not aim at dietetic reform solely—we advocate physiological reform.”  The anonymous writer raised an important question for those interested in dietary reform to consider: Should the movement focus on a dogmatic dedication to a meatless diet or advocate for scientific study to continually redefi ne the most benefi cial diet?  

The fate of the journal at the end of 1839 seems to have offered an answer to the lingering question over the aims of dietary reformers, indicating that total dietary reform had become preferable to Grahamism. After three years of weekly publication, the Graham Journal of Health and Longevity ceased production, with its last issue dated December 14, 1839. The journal had originally planned to release a fourth edition, promising potential subscribers seven free issues for the remainder of 1839 when opening a new account for the coming year. This enticement to subscribe seems to indicate significant financial diffi culty for Cambell and the journal.

SIMPLE ULCER OF THE STOMACH.

BY W. H. WELCH, M.D.

DEFINITION.—Simple ulcer of the stomach is usually round or oval. When of recent formation it has smooth, clean-cut, or rounded borders, without evidence of acute inflammation in its floor or in its borders. When of long duration it usually has thickened and indurated margins. The formation of the ulcer is usually attributed, in part at least, to a disturbance in nutrition and to a subsequent solution by the gastric juice of a circumscribed part of the wall of the stomach. The ulcer may be latent in its course, but it is generally characterized by one or more of the following symptoms: pain, vomiting, dyspepsia, hemorrhage from the stomach, and loss of flesh and strength. It ends frequently in recovery, but it may end in death by perforation of the stomach, by hemorrhage, or by gradual exhaustion.

TREATMENT.—In the absence of any agent which exerts a direct curative influence upon gastric ulcer the main indication for treatment is the removal of all sources of irritation from the ulcer, so that the process of repair may be impeded as little as possible.

Theoretically, this is best accomplished by giving to the stomach complete rest and by nourishing the patient by rectal alimentation. Practically, this method of administering food is attended with many difficulties, and, moreover, the nutrition of the patient eventually suffers by persistence in its employment. In most cases the patient can be more satisfactorily nourished by the stomach, and by proper selection of the diet, without causing injurious irritation of the ulcer.

At the beginning of the course of treatment it is often well to withhold for two or three days all food from the stomach and to resort to exclusive rectal feeding. In some cases with uncontrollable vomiting and after-hemorrhage from the stomach it is necessary to feed the patient exclusively by the rectum.

The substances best adapted for nutritive enemata are artificially-digested foods, such as Leube's pancreatic meat-emulsion, his beef-solution, and peptonized milk-gruel as recommended by Roberts.109 Beef-tea and eggs, which are often used for this purpose, are not to be recommended, as the former has very little nutritive value, and egg albumen is absorbed in but slight amount from the rectum. Expressed beef-juice may also be used for rectal alimentation. The peptones, although physiologically best adapted for nutritive enemata, often irritate the mucous membrane of the rectum, so that they cannot be retained. It has been proven that it is impossible to completely nourish a human being by the rectum.110 Rectal alimentation can sometimes be advantageously combined with feeding by the mouth.

109 Leube's pancreatic meat-emulsion is prepared by adding to 4-8 ounces of scraped and finely-chopped beef l-2½ ounces of fresh finely-chopped oxen's or pig's pancreas freed from fat. To the mixture is added a little lukewarm water until the consistence after stirring is that of thick gruel. The syringe used to inject this mixture should have a wide opening in the nozzle; Leube has constructed one for the purpose (Leube, Deutsches Arch. f. klin. Med., Bd. x. p. 11).

The milk-gruel is prepared by adding a thick, well-boiled gruel made from wheaten flour, arrowroot, or some other farinaceous article to an equal quantity of milk. Just before administration a dessertspoonful of liquor pancreaticus (Benger) or 5 grains of extractum pancreatis (Fairchild Bros.), with 20 grains of bicarbonate of soda, are added to the enema. This may be combined with peptonized beef-tea made according to Roberts's formula (Roberts, On the Digestive Ferments, p. 74, London, 1881).

There is universal agreement that the dietetic treatment of gastric ulcer is of much greater importance than the medicinal treatment. There is [p. 520]hardly another disease in which the beneficial effects of proper regulation of the diet are so apparent as in gastric ulcer. Those articles of food are most suitable which call into action least vigorously the secretion of gastric juice and the peristaltic movements of the stomach, which do not cause abnormal fermentations, which do not remain a long time in the stomach, and which do not mechanically irritate the surface of the ulcer. These requirements are met only by a fluid diet, and are met most satisfactorily by milk and by Leube's beef-solution.

The efficacy of a milk diet in this disease has been attested by long and manifold experience. By its adoption in many cases the pain and the vomiting are relieved, and finally disappear, and the ulcer heals. In general, fresh milk is well borne. If not, skimmed milk may be employed. If the digestion of the milk causes acidity, then a small quantity of bicarbonate of soda or some lime-water (one-fourth to one-half in bulk) may be added to the milk. Large quantities should not be taken at once. Four ounces of milk taken every two hours are generally well borne. Sometimes not more than a tablespoonful can be taken at a time without causing vomiting, and then of course the milk should be given at shorter intervals. It is desirable that the patient should receive at least a quart, and if possible two quarts, during the twenty-four hours. The milk should be slightly warmed, but in some cases cold milk may be better retained. In some instances buttermilk agrees with the patient better than sweet milk. Although many suppose that they have some idiosyncrasy as regards the digestion of milk, this idiosyncrasy is more frequently imaginary than real. Still, there are cases in which milk cannot be retained, even in small quantity.

For such cases peptonized milk often proves serviceable.111 The artificial digestion of milk as well as of other articles of food is a method generally applicable to the treatment of gastric ulcer. The main objection to peptonized milk is the aversion to it that many patients acquire on account of its bitter taste. The peptonization should not be carried beyond a slightly bitter taste. The disagreeable taste may be improved by the addition of a little Vichy or soda-water. Peptonized milk has proved to be most valuable in the treatment of gastric ulcer.

Leube's beef-solution112 is a nutritious, unirritating, and easily-digested article of diet. It can often be taken when milk is not easily or [p. 521]completely digested, or when milk becomes tiresome and disagreeable to the patient. It is relied upon mainly by Leube in his very successful treatment of gastric ulcer. A pot of the beef-solution (corresponding to a half pound of beef) is to be taken during the twenty-four hours. A tablespoonful or more may be given at a time in unsalted or but slightly salted bouillon, to which, if desired, a little of Liebig's beef-extract may be added to improve the taste. The bouillon should be absolutely free from fat. Unfortunately, not a few patients acquire such a distaste for the beef-solution that they cannot be persuaded to continue its use for any considerable length of time.

112 By means of a high temperature and of hydrochloric acid the meat enclosed in an air-tight vessel is converted into a fine emulsion and is partly digested. Its soft consistence, highly nutritious quality, and easy digestibility render this preparation of the greatest value. The beef-solution is prepared in New York satisfactorily by Mettenheimer, druggist, Sixth Avenue and Forty-fifth street, and by Dr. Rudisch, whose preparation is sold by several druggists.

Freshly-expressed beef-juice is also a fairly nutritious food, which can sometimes be employed with advantage. The juice is rendered more palatable if it is pressed from scraped or finely-chopped beef which has been slightly broiled with a little fresh butter and salt. The meat should, however, remain very rare, and the fat should be carefully removed from the juice.

To the articles of diet which have been mentioned can sometimes be added raw or soft-boiled egg in small quantity, and as an addition to the milk crumbled biscuit or wheaten bread which may be toasted, or possibly powdered rice or arrowroot or some of the infant farinaceous foods, such as Nestle's. Milk thickened with powdered cracker does not coagulate in large masses in the stomach, and is therefore sometimes better borne than ordinary milk.

For the first two or three weeks at least the patient should be confined strictly to the bill of fare here given. Nothing should be left to the discretion of the patient or of his friends. The treatment should be methodic. It is not enough to direct the patient simply to take easily-digested food, but precise directions should be given as to what kind of food is to be taken, how much is to be taken at a time, how often it is to be taken, and how it is to be prepared.

Usually, at the end of two or three weeks of this diet the patient's condition is sufficiently improved to allow greater variety in his food. Meat-broths may be given. Boiled white meat of a young fowl can now usually be taken, and agreeable dishes can be prepared with milk, beaten eggs, and farinaceous substances, such as arrowroot, rice, corn-starch, tapioca, and sago. Boiled sweetbread is also admissible. Boiled calf's brain and calf's feet are allowed by Leube at this stage of the treatment.

To these articles can soon be added a very rare beefsteak made from the soft mass scraped by a blunt instrument from a tenderloin of beef, so that all coarse and tough fibres are left behind. This may be superficially broiled with a little fresh butter. Boiled white fish, particularly cod, may also be tried.

It is especially important to avoid all coarse, mechanically-irritating food, such as brown bread, wheaten grits, oatmeal, etc.; also fatty substances, pastry, acids, highly-seasoned food, vegetables, fruit, and all kinds of spirituous liquor. The juice of oranges and of lemons can usually be taken. The food should not be taken very hot or very cold.

For at least two or three months the patient should be confined to the [p. 522]easily-digested articles of diet mentioned. These afford sufficient variety, and no license should be given to exceed the dietary prescribed by the physician. Transgression in this respect is liable to be severely punished by return of the symptoms. When there is reason to believe that the ulcer is cicatrized, the patient may gradually resume his usual diet, but often for a long time, and perhaps for life, he may be compelled to guard his diet very carefully, lest there should be a return of the disease. Should there be symptoms of a relapse, the patient should resume at once the easily-digested diet described above.

Adibi, S. A. (1976). Intestinal phase of protein assimilation in man. The American Journal of Clinical Nutrition, 29(2), 205–215.doi:10.1093/ajcn/29.2.205 

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The importance of dietary proteins to opt imal nutrition and health is well recognized. Digestion and absorption which are necessary for utilization of amino acid constituents of these proteins are quite complex. The initial step in protein digestion is the gastric phase: dietary proteins are denatured in the acidic environment of the stomach. Denaturation renders dietary protein a more suitable substrate for the action of proteolytic enzymes. Although the in vivo digestion of protein in human stomach has not been extensively studied, it is generally assumed that it is minimal (1). In contrast, digestion by pancreatic proteolytic enzymes is considered to be critical in the assimilation of dietary protein. Pancreatic resection or insufficiency results in both a considerable decrease in the intraduodenal hydrolysis of protein (2) and an increase in fecal nitrogen (1). Intraluminal digestion produces free amino acids and small oligopeptides (3, 4). This review examines the protein source and the intestinal fate of these free amino acids and oligopeptides in

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Abstract: The pH in the upper gastrointestinal tract of young, healthy men and women was measured in the fasting state and after administration of a standard solid and liquid meal. Calibrated Heidelberg capsules were used to record the pH continuously over the study period of approximately 6 hr. In the fasted state, the median gastric pH was 1.7 and the median duodenal pH was 6.1. When the meal was administered the gastric pH climbed briefly to a median peak value of 6.7, then declined gradually back to the fasted state value over a period of less than 2 hr. In contrast to the pH behavior in the stomach, feeding a meal caused a reduction in the median duodenal pH to 5.4. In addition, there was considerable fluctuation in the postprandial duodenal pH on an intrasubject basis. The pH in the duodenum did not return to fasted state values within the 4-hr postprandial observation period. There was no tendency for the duodenal pH to be related to the gastric pH in either the fed or fasted phases of the study. Furthermore, pH in the upper GI tract of young, healthy subjects appears to be independent of gender. The differences in upper GI pH between the fasted and the fed state are discussed in terms of dosage form performance and absorption for orally administered drugs.