World Digestive Health Day WDHD – May 29, 2016 UNDERSTANDING OF NORMAL GUT HEALTH, continued conditions that might disturb the intestinal microbiome and the mucosal immune system should be avoided. DIET AND GUT-HEALTH A balanced diet is one of the important ways to keep the digestive system healthy. One of the important reasons for constipation in healthy individuals is inadequate intake of fibers in their diet. Adequate fiber in the diet encourages passage of contents through the digestive system and gives the correct consistency and bulk to stools. The dietary fibers could be soluble or insoluble. While the recommended daily intake of dietary fibers varies between 25-35g/day from country to country, only a proportion of the world’s population is able to meet the recommended daily amount of dietary fibers.11,12 While fiber intake is generally adequate in many Asian countries, the intake however is much lower in both Europe and the USA. Other than its benefit in proper laxation, dietary fibers protect from diverticular disease and colorectal cancer.13 Furthermore, a high-fiber diet has many other benefits, including lowering of cholesterol, control of blood sugar in diabetics, and weight reduction.14 Furthermore, dietary changes have been shown to help prevent major societal diseases such as allergy, obesity, and cancer.15 A low FODMAP diet or gluten free diet has been reported to be beneficial in patients with IBS.16,17 There are evidences to suggest that high-fat, as well as highfructose, diets disturb the GI barrier and induce fatty liver disease and subclinical inflammatory conditions associated with metabolic disturbances.18,19 Therefore, measures to maintain a good gut-health include eating of a healthy and balanced diet, ingestion of adequate amount of fibers, reduction in the ingestion of saturated and processed food, slow and regular eating, and, finally, avoidance of foods that may lead to digestive symptoms. An individualized elimination diet in selected individuals with food intolerances, food allergy, or celiac disease may also contribute to good gut health. 20,21 AVOIDANCE OF FACTORS WHICH CAN INDUCE DAMAGE TO GI TRACT Tobacco abstinence, moderate alcohol consumption, maintenance of normal body weight, avoidance of nonsteroidal antiinflammatory drug (NSAID) ingestion, and control of stress can support gut-health.22 AVOIDANCE OF STRESS The psychological and cognitive factors, including stress, affect the GI motility, GI secretion, and overall function of the GI tract.23 While there is a lack of high quality evidence to support that improvement in lifestyle affect GI functions, there has been increase in the popularity of meditative strategy to calm down the mind. Despite the limitations of the literature, the evidence suggests that meditation programs could help reduce anxiety, depression, and pain in some clinical populations. 24 Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress.24 Furthermore, such methods are now practised by many health professionals for attaining not only the general well-being but for maintenance of a good gut health too. USE OF DRUGS TO PREVENTION OF GI DISEASES Chemoprevention by taking aspirin, cyclooxygenase-2 inhibitors, and calcium may reduce the recurrence of adenomas and/or the incidence of advanced adenomas in individuals with an increased risk of colorectal cancer (CRC), and taking aspirin may reduce the incidence of CRC in the general population.25,26 However, both aspirin and NSAIDs are associated with adverse effects, so it will be important to consider the risk-benefit ratio before recommending these agents for chemoprevention. An interesting idea is whether gut health can be further supported by using modulators of the intestinal microbiome or the GI barrier, such as probiotics or prebiotics. Indeed, it has been shown that chronic bowel diseases, such as IBD, are associated with adherence of commensal bacteria to the otherwise sterile intestinal epithelium and that selected probiotics can prevent the adhesion of pathogenic bacteria to the intestinal mucosa or restore leaky gut by improving the molecular composition of tight junctions.27-30 Moreover, probiotic bacteria can support the normal development of the mucosal immune system. In summary, nearly one third of world’s population suffer from some form of gut related symptoms, most of which may be unrelated to specific structural or functional disease in the GI tract. There is a need to popularize the primary preventive strategies for maintenance of good gut health. World Digestive Health Day WDHD May 29, 2016 WGO Handbook on DIET AND THE GUT 9
WGO Handbook on Diet and the Gut_2016_Final
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