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Interviewer: All right, it's time to play the game ER or Not, where you get to play along and decide whether or not something that has happened is worth going to the emergency room. We're here with Dr. Troy Madsen, emergency room physician at University of Utah Hospital.

ER or Not? You're eating a chicken wing and you accidentally swallow a bone.

Dr. Madsen: This is tough one, Scot, so I want to know, what do you think?

Interviewer: All right, so I'm going to say that we did one on toothpicks before . . .

Dr. Madsen: Yes.

Interviewer: . . . that if you swallow a toothpick and it goes into your abdominal area it could puncture through.

Dr. Madsen: Sure.

Interviewer: I'm going to guess based on the kind of chicken wing or the chicken bone, that could be a problem here.

Dr. Madsen: Yes.

Interviewer: A bigger, duller bone, I don't know. It could be painful coming out, but it probably could pass through. I don't know. I don't know. I don't know.

Dr. Madsen: See? I'm going to put you to work in the ER. Look how much you've learned and how much you know. I'm so impressed. Those are the exact processes that are going on in my mind. I'm imagining myself having a family member call me and say, "I'm having chicken wings tonight. I was watching a game and I don't know what I did, but I swallowed a chicken bone."

My first question for them is, "Are you sure you swallowed it? Are you sure it's not in your airway?" If it's in the airway, that's an entirely different issue. Absolutely, you need to get to the ER if it feels like it's stuck in there, you're having a hard time breathing, maybe there's like a high-pitch wheezing sound, that's ER, absolutely.

Interviewer: Anytime there's an airway issue, ER.

Dr. Madsen: Yes, ABC; A stands for airway. If it affects the airway, get to the ER.

Then the next question is, let's say, okay, it's not in the airway, what are we talking about in terms of a chicken bone here? I'm thinking number one, is it something that's going to somehow puncture their intestines as it's passing through? Was this a piece of a chicken bone that splintered, and then they swallowed it down? Or is it a really big chicken bone? And by a big chicken bone, I'm talking about something usually longer than about three inches.

Interviewer: Okay, so it would've been really hard to swallow something like that.

Dr. Madsen: It would have been, exactly. If you're talking about something three inches or longer, that's really tough to swallow, and a chicken wing isn't the sort of thing that's going to do that. If they tell me, you know, I don't know why they would do this but if somehow they were chewing on this chicken wing while watching a game and swallowed a big sharp piece down there, that would be a reason to go the ER because there you do worry about possibly causing some sort of a puncture wound in the stomach or in the intestines.

Or if they said, "This was not a chicken wing. This was a chicken thigh and this was a big bone," and again, I don't know why they would have done that or swallowed it, but that's another reason to go to the ER.

Interviewer: All right, so the grey area is a dull kind of bone that's not that big.

Dr. Madsen: Exactly.

Interviewer: Maybe a half-inch long, not very big around, is that going to pass through?

Dr. Madsen: It should, yeah.

Interviewer: Do you take the chance?

Dr. Madsen: If you're concerned you can always go to the ER. We can get an X-ray, we can look at it. It's a bone; we're going to see it on an x-ray. We can call the GI doctors and ask them to look at it. My suspicion is they would not go in and put you through anesthesia to go down and fish that out and pull it out. If it's a small chicken bone, maybe half an inch long, an inch long, it should pass through okay.

Interviewer: Okay. I'm nervous now. I mean, this is one of those things where in a couple of instances, you know absolutely what the answer is, but then there's that grey area.

Dr. Madsen: It is definitely a grey area.

Interviewer: Is there a chicken wing hotline I could call, like poison control that can give me some advice?

Dr. Madsen: It's funny, if you call poison control they probably would give you advice.

Interviewer: You think so?

Dr. Madsen: Yeah, they would. And then they would get people on the phone if they needed to. So of it is a grey area and you're not sure, and it's something you've ingested like that, they would probably be able to help you out there.

Interviewer: If it's the grey area, is there a period of time or something that would make you more concerned that this might be an issue?

Dr. Madsen: That's a tough one because some things, you swallow it and it's just going to sit there or it's going to work its way into your intestines. Once it gets in there, you may have no symptoms but it may be too far down to really fish it out. If it is a concern and you're just saying to yourself, "Hey, what do I do about this?" it's worth at least talking to someone, calling your doctor, and you can always go to the ER. It's not a big deal, but certainly talk to someone if you're just wondering, "What do I need to do about this?"

Interviewer: One of those nurse hotlines or something of that nature, perhaps.

Dr. Madsen: Exactly.

updated: July 22, 2020
originally published: April 3, 2016

Interviewer: Chewing your food. Is it as important as your mom said it is? We're going to find out next on The Scope.

Man: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: How important is chewing your food well, really, and what does that even mean? We're with Staci McIntosh. She's a registered dietitian and Assistant Professor at the Department of Nutrition at the University of Utah. How important is chewing your food?

Staci McIntosh: Chewing your food is important. It's the first step of mechanical digestion. It's important for not getting choked when you swallow.

Interviewer: That is important.

Staci McIntosh: More importantly, though, is taking your time throughout the meal however you do that. If you want to swallow your food whole and then take five minutes before you eat another bite, or if you want to chew your food 100 times before you take another bite.

Interviewer: Oh, okay. So, take your time. Why would I take my time? What's the purpose behind that?

Staci McIntosh: Because it takes about 20 to 25 minutes for the hormones in your body to reach your brain to tell you that you're full. If I eat an entire Big Mac meal in five minutes, that's not enough time for my brain to register when I'm full, but if I take 30 minutes to eat my dinner, then my brain is going to know that I'm full well before I finished that same amount of food.

Interviewer: So, inhaling your food is bad because you will overeat every time, it sounds like.

Staci McIntosh: Mm-hmm.

Interviewer: Let's talk about chewing as far as digestion is concerned. I've heard 20, 25 times per bite? You kind of rolled your eyes a little bit there.

Staci McIntosh: Our digestive system is really amazing.

Interviewer: Yeah.

Staci McIntosh: Our stomach, our small intestine will continue to go through all the muscular motions of mechanical digestion. The enzymes are going to get in there and will break apart the food [inaudible 1:46] the surface area until it eventually digests it all. Food doesn't just go through the system without being digested, nor does it sit there forever without being digested. It will eventually be digested. The more you chew it up, the less mechanical work your gut has to do.

Interviewer: What about nutritional assimilation in the body? The more that you chew, do you get more nutritional value.

Staci McIntosh: No.

Interviewer: No, really?

Staci McIntosh: No.

Interviewer: That's a myth?

Staci McIntosh: That's a myth. You will liberate some of the B vitamins from fiber a little bit more, early on, but we have a pretty good record in our gut of absorbing 95-99% of all the macronutrients--carbs, fats, and protein--and, much to a lesser degree, for the micronutrients--the vitamins and minerals--but, whether or not you chew five times or 25 times is not going to make that much of a difference.

Interviewer: So, just chew enough to get it down is the minimum, and if you enjoy it do it more?

Staci McIntosh: Sure.

Interviewer: So then I don't need to swish soft foods around in my mouth, like a banana or something, to mix it with the saliva?

Staci McIntosh: No, no.

Interviewer: You didn't like that too much.

Staci McIntosh: No, I can't imagine swishing a banana around in my mouth.

Interviewer: So, at the end of the day, it sounds like the amount of times that I chew my steak doesn't matter too much.

Staci McIntosh: Again, there is a big difference and there is statistical significance in studies that show the longer you take to consume your meal overall will make a difference in your satiety and your overall amount of calories consumed.

Interviewer: Gotcha.

Staci McIntosh: Whether you do that by taking longer to chew your food or if you take longer just in between bites, it's not going to make that much of a difference. I would certainly recommend that people chew their food appropriately, but counting the number of times you chew your food is a little obsessive.

Interviewer: I'm glad to hear that. So, it's more about just caloric intake than anything else?

Staci McIntosh: Caloric intake and the time. Your time will affect your caloric intake overall, but when it comes down to it, it is the caloric intake.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.