#HEALTH: What lies beneath

GUT health is being studied extensively now as more people are becoming aware of the role it plays in overall well-being.

Our digestive system does much more than digest and absorb the food we eat.
The gastrointestinal tract is closely connected to our immune system and contains a complex community of microorganisms known as the gut microbiome.

The gut also communicates continuously with the brain through what is known as the "gut brain axis". This two-way communication is one reason why the gut is sometimes referred to as "he second brain".

Stress and emotional changes can affect gut function, while signals from the gut can also influence how we experience certain sensations and symptoms. All this leads to the question of how to identify an unhealthy gut.

There is no single symptom that can tell us whether the gut is healthy or unhealthy, says Sri Kota Specialist Medical Centre consultant gastroenterologist and hepatologist Dr Suresh Sithambaram.
What matters is the type, frequency, persistence and severity of symptoms.

Common digestive symptoms include bloating, abdominal discomfort, constipation, diarrhoea, excessive gas, changes in bowel habits and recurrent heartburn.
Dr Suresh says some of these symptoms can occur occasionally without indicating a serious problem.

However, symptoms that are persistent, recurrent or progressively worsening should not be accepted as normal.

While food is an important factor, gut health is not determined by diet alone.
One common mistake is having a diet that is consistently low in fibre and vegetables.

This is particularly relevant in Malaysia as the National Health and Morbidity Survey 2023 indicates that 95 per cent of Malaysian adults do not consume adequate amounts of fruit or vegetables.
Beyond diet, other factors can affect digestive health. These include physical inactivity, inadequate hydration, poor sleep and stress.

For people with conditions such as irritable bowel syndrome (IBS), stress can be particularly relevant as it is a disorder of gut-brain interaction and symptoms can be influenced by stress and other factors, says Dr Suresh.

Some people may experience bloating and immediately conclude that they have IBS, food intolerance or a "damaged microbiome".

These conditions require proper assessment, and removing multiple foods or taking supplements without understanding the cause may not solve the problem, says Dr Suresh.

Bloating is a symptom, not a diagnosis, he stresses. It can occur for many reasons, including dietary factors, constipation, food intolerances, functional gastrointestinal disorders and other digestive conditions.

"Bloating can occur as part of IBS, but experiencing bloating alone does not mean someone has IBS."

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DIET RESTRICTIONS

Do certain foods benefit the gut while others don't? Many people think so.

Dr Suresh says instead of focusing on "superfoods", a healthy diet should include vegetables, fruits, whole grains, legumes, nuts and other nutrient-rich foods.

"Fibre is particularly important for normal bowel function and increasing fibre gradually can be beneficial for people who are not consuming enough."
At the same time, there is no universal list of foods that everyone with digestive symptoms must avoid, he adds.

Some people may have specific food triggers, while others may not. For someone with a diagnosed gastrointestinal condition, dietary advice should be individualised rather than based on blanket restrictions.

"The goal is not to create an unnecessarily restrictive diet. It should be to identify what works for the individual while ensuring they still receive adequate nutrition."

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ARE PROBIOTIC SUPPLEMENTS NECESSARY?

Many parents today give their children probiotic supplements but are they important for gut health?

Dr Suresh says parents should not assume that every child needs a probiotic supplement simply because it is marketed as beneficial for gut health.

There is evidence that certain probiotic strains may be useful in specific situations, including some cases of antibiotic-associated diarrhoea.

However, the evidence varies considerably depending on the strain, dose, age of the child and condition being treated, he explains.

"There is not enough evidence to say that all probiotics provide the same beneits."

For a healthy child who is growing normally and eating a varied diet, the priority should be a balanced diet rather than automatically adding supplements.

Leading health bodies similarly advise that healthy children generally do not need unnecessary supplementation when they are receiving a varied diet.

"Ultimately, good gut health does not have to involve expensive products," says Dr Suresh.

The fundamentals remain important: a varied and balanced diet, adequate fibre and fluids, regular physical activity, sufficient sleep and appropriate management of stress.

WARNING SIGNS

Some symptoms warrant medical assessment. These include:

*Blood in the stool.

*Unexplained weight loss.

*Persistent vomiting.

*Significant or ongoing abdominal pain, anaemia, or a significant change in bowel habits.

GUT MISCONCEPTIONS

More intervention means better gut health

There is a growing market around probiotics, supplements, detox drinks and "gut cleansing" products, but people should be careful about claims that promise to "reset", "cleanse" or completely "heal" the gut.

Everyone needs probiotic supplements

Probiotics are not one single product. Different products contain different microorganisms and strains, and their effects can vary depending on the specific condition and individual. Current evidence does not support treating probiotics as a universal solution for everyone.

Bloating is always harmless

Occasional bloating can happen, but persistent or troublesome symptoms deserve attention. If someone is experiencing persistent bloating together with other concerning symptoms, one shouldn't assume it is simply "gas" or poor digestion. The underlying cause needs to be assessed.