One of the first symptoms that 38-year-old Indian expat Lohit experienced was a sense of bloating. It was the weekend and the Sharjah-based HR manager was convinced it was the result of the spicy biryani he’d eaten for dinner. Popping an antacid, he continued watching the movie he was enjoying on TV, but soon the bloating sensation was exacerbated by moderate to severe pain in the abdomen. In addition, he noted a skin rash developing, pain in the joints and “brain fog”, all of which he attributed to having originated in his gut.
It was not the first time the father-of-two had noticed that his tummy was beginning to “act up”, and he made a mental note to consult a doctor the next time such symptoms recurred.
He did not have to wait long. A few days later, he again found himself saddled with flatulence and burping, followed by severe abdominal pain.
Quite fed up of consuming over-the-counter antacids that only provided temporary relief, assuaging symptoms briefly, Lohit fixed an appointment with a gastroenterologist, hoping to find a lasting cure for his tummy issues.
A detailed examination later, the doctor sat down Lohit with his diagnosis. “You are suffering from what is commonly known as leaky gut syndrome,” the doctor told him. In simple terms, it is an inflammation of the gut resulting in increased gut permeability, leading to a leakage of good bacteria through the gut lining into the blood stream.
What is gut health
The complex ecosystem of the gut thrives on the delicate interplay between good and bad gut bacteria. These constitute what is known as the gut microbiome – crucial in maintaining overall gut health and immunity, says Dr Rahul Nathwani, an American Board Certified Gastroenterologist who is a consultant gastroenterologist and Adjunct Clinical Associate Professor of Gastroenterology at Dubai’s MBRU.
An imbalance in the levels of bacteria can lead to a variety of symptoms, including abdominal pain, bloating, burping, flatulence and altered bowel habits, which can result in certain digestive disorders.
Among them is irritable bowel syndrome (IBS) caused by hypersensitive nerves and/or altered motility in the gut, says the doctor who practices at the Mediclinic City Hospital and Mediclinic Dubai Mall.
IBS can result in bothersome symptoms that typically undergo cyclical exacerbations and remissions, but never result in any sinister pathology, he says.
Leaky gut syndrome is another issue. In this case, the leakage of good bacteria through the gut lining into the blood stream results in additional non-gut-related symptoms such as headache, fatigue, difficulty concentrating/brain fog, skin rashes and joint pains.
According to the doctor, other results of poor gut health are:
Small intestinal bacterial overgrowth (SIBO): as the name implies, this is an overgrowth of predominantly gas-forming bacteria in the small intestine. The gas produced by these bacteria include hydrogen and methane and can be tested in the breath. The treatment involves taking an antibiotic along with a probiotic. In severe cases, multiple courses of an antibiotic may be required.
Inflammatory bowel diseases (IBD): these include Crohn’s disease and ulcerative colitis, which are auto-immune diseases of the colon wherein the body mistakenly produces antibodies against good bacteria resulting in damage to the intestine. This may require long-term treatment under close medical supervision.
Diagnosing patients with IBD early is critical in preventing progressive bowel damage. Hence a red flag symptom index has been developed that includes symptoms such as gastrointestinal bleeding, unexplained weight loss, anaemia, jaundice, worsening abdominal pain and nocturnal diarrhoea.
One or more of the above symptoms necessitates an urgent visit to a gastroenterologist, says Dr Rahul.
Tips to improve gut health
Diet: High-fibre food (25-30g/day). Include lentils, whole grain, raspberry, artichoke, green peas and broccoli in your daily diet.
Include fermented food such as organic yoghurt, kefir, kimchi, sauerkraut.
Avoid artificial sweeteners.
Probiotics/prebiotics: Probiotics contain live bacteria that are beneficial to gut health, while prebiotics are food for these bacteria.
Ideally, a probiotic should contain both Lactobacillus and Bifidobacterium. Although the jury is still out on the long-term benefit of probiotics, it will definitely do no harm to include them in your diet. A nutritionist will be able to guide you on choosing the right ones.
Prebiotic foods stimulate the growth of beneficial microbiota, and top among them are asparagus, banana, onion, garlic, leeks and whole grain.
A low Fodmap (Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides and Polyols) diet has also shown to be useful in patients suffering from IBS. This diet is based on the principle that certain carbohydrates (Fodmaps) cause gut irritation and are best avoided.
Avoidance of stress: What is commonly referred to as “gut instinct” or “butterflies in the stomach” occur as a result of the brain-gut axis. A variety of stress factors such as psychosocial and environmental stressors, sleep deprivation and disruption of the circadian rhythm can negatively affect gut health.
Practise some deep breathing exercises and certain meditation and mind-calming techniques.
The role of the brain-gut axis cannot be overemphasised. A vast majority of gastrointestinal symptoms have their origin in the brain. Diet and lifestyle changes can have a bigger impact than conventional medical therapy.
Regular exercise: Exercising regularly leads to a change in the composition of gut microbes, specifically reducing the microbes responsible for gut inflammation, says Dr Rahul.
Food intolerance testing is gaining in popularity, but the results are often non-specific and confusing. The vast majority of patients avoid gluten and dairy products based on the results of these tests.
Celiac disease is a form of complete gluten intolerance, for which there is a very specific blood test available.
Celiac disease is uncommon, he says. Patients more commonly have non-celiac gluten sensitivity wherein an improvement in symptoms is noticed by going gluten-free, despite having a negative blood test for celiac disease.
Food intolerances are rarely permanent, and one may outgrow the intolerance over a period of time.
Dr Rahul recommends those suffering from gut-related issues to maintain a food diary. This may be more beneficial than going solely by the results of a food intolerance test.
A healthy gut contributes to a strong overall immune system, says the gastroenterologist. “Take care of your gut health and you will be better able to tackle immunity-related conditions.”