World Digestive Health Day WDHD – May 29, 2016 UNDERSTANDING OF NORMAL GUT HEALTH GOVIND K. MAKHARIA, MD, DM, DNB, MNAMS Professor Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences Ansari Nagar, New Delhi, India DAVID S. SANDERS, MD Academic Unit of Gastroenterology Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust Sheffield, South Yorkshire, UK INTRODUCTION Approximately one third of people in the general population complain of some gut-related symptoms, such as flatulence, bloating, heartburn, nausea, vomiting, constipation, diarrhea, food intolerance, incontinence, and abdominal pain. While most physicians look at these gut-related symptoms in the context of the gastrointestinal (GI) diseases, gut-health related symptoms occur more often in the absence of demonstrable functional and structural diseases in the GI tract. These digestive symptoms may not be life threatening, but they can significantly affect the general wellbeing and quality of life of the affected individuals.1,2 Furthermore, the health of the gut is deeply rooted in the psyche of society and the presence of any of these gut symptoms may prompt an individual to consult a doctor. Ancient medicine, such as Ayurveda, the ‘science of life’ originating in India more than 3,000 years ago, and Asian medicine, suggest that many of the human diseases arise from the gut and that strengthening of the digestive system, with the foods we eat, holds the key to good health.3 HOW TO DEFINE GOOD GUT-HEALTH? ‘What constitutes a healthy gut” is as yet not well defined. As the World Health Organization defines “health” as a positive state of health, rather than “the absence of diseases,” the healthy gut can be defined as a state of physical and mental well-being without gastrointestinal symptoms that require the consultation of a doctor, absence of any disease affecting the gut, and also the absence of risk factors for diseases affecting gut.1,4 Therefore, to maintain good gut-health, one needs to undertake measures not only at the tertiary level of prevention to retard the disease process, but also consider both primary and secondary levels of prevention to maintain Table 1: Indicators of gut health Criteria for a healthy GI system Specific featues of gut-health Effective digestion and absorption of food Effective absorption of food, water, and minerals Regular bowel movement, passage of normal stool No diarrhea, constipation, and bloating Normal nutritional status Absence of GI illness No acid peptic disease, gastroesophageal reflux disease (GERD), or other gastric inflammatory disease No enzyme deficiencies or carbohydrate intolerances No inflammatory bowel disease (IBD), celiac disease, or other inflammatory state No colorectal or other gastrointestinal cancer Normal and stable intestinal microbiota No bacterial overgrowth Normal composition and vitality of the gut microbiota Effective immune status and gut barrier Effective GI barrier function Normal levels of immunoglobulin A Normal number and activity of immune cells Quality of life Normal quality of life Adapted from, Bischoff SC. ‘Gut health’: a new objective in medicine? BMC Med. 2011;9:24. World Digestive Health Day WDHD May 29, 2016 WGO Handbook on DIET AND THE GUT 7
WGO Handbook on Diet and the Gut_2016_Final
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