World Digestive Health Day WDHD – May 29, 2016 UNDERSTANDING OF NORMAL GUT HEALTH, continued a disease free gut as far as possible. Good gut-health should be all encompassing so that it covers all perspectives, ranging from the Asian understanding of the gut as the middle of spiritual and physical strength to the Western understanding of the GI barrier as a central body site interacting with the environment and involved in the pathophysiology of many intestinal and extra-intestinal symptoms and diseases.3 INDICATORS OF GUT-HEALTH The GI system is complex and comprised of absorptive mucosa, epithelial transport, gastrointestinal motility, immune system, and gut microbiome; normality in all or most of its constituents provides a healthy gut. Any defect or abnormality in any or many of the above constituents may predispose one to diseases or may cause disease. (see Table 1) HOW TO MAINTAIN GUT-HEALTH? Our knowledge about how to maintain or restore gut-health is limited in evidence-based medicine terms, but general observations suggest that there is a wide range of possible ways to support gut-health and GI well-being. Current medical research is much more focused on the treatment of defined GI disease rather than on the primary and secondary prevention of the diseases. For example, we know of several effective drugs to treat autoimmune liver disease or inflammatory bowel disease (IBD), but very little on how to prevent such diseases.5,6 Evidence-based approaches to maintain gut-health and to prevent GI diseases are limited. This is still an open and relevant field for clinicians, epidemiologists, and scientists to ponder on the enormous value of preventive strategies to maintain a healthy gut and prevent GI diseases. While measures such as regular physical activity, avoidance of smoking, mainatining a balanced diet schedule, and avoidance of saturated fat in the diet have proven to be effective cardioprotective strategies, we need to define similar strategy for good gut-health.7 Certain lifestyle characteristics, such as balanced diet, moderate but regular exercise, avoidance of chronic stress, ingestion of adequate amount of fibers, and use of well-defined and specific pre- and probiotics, have been shown to have a positive effect on gut health. Since the GI system is complex, it follows that any preventive strategy should include measures to address each aspect of the GI system. The following could be proposed as individual preventive steps to maintain different aspects of the GI system. Here we present some guidance for which there is an evidence base but in some aspects this information remains empirical. (see Table 2) GENERAL HYGIENE AND GUT-HEALTH The GI tract, unlike other systems of the body, is exposed to the environment at both its ends and it is exposed to enormous amount of junk, some of which is toxic, on a daily basis. Therefore the hygiene of an individual will impact the hygiene of their GI tract. Any disturbance of the balance between the microbiome and the mucosal immune system will lead to impairment of the GI barrier and subsequently to an increased risk to gut health and the development of GI disease.8-9 In fact many diseases, such as GI infection, antibiotic-associated diarrhea, IBD, irritable bowel syndrome (IBS), food allergy, and so on, are related to the hygiene hypothesis.8-10 Therefore, any Table 2: Preventive strategy to maintain good digestive health • General hygiene - Maintenance of hygiene in food and water - Proper washing of hands • Dietary advices - Healthy and well-balanced diet - Adequate amount of fibre in the diet - Avoidance of processed food - Low FODMAP diet - Eating of food slowly - Avoidance of food that leads to food allergic symptoms - Drinking of lot of fluids (non-sugar based) • Maintenance of healthy gut microbiota - Probiotics and prebiotics - Avoidance of proton pump inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs) – Maintenance of hygiene • Avoidance of injurious agents to gut - Smoking: predisposes to gastroesophageal reflux - Drugs which damages intestinal mucosa, such as NSAIDs - Excess and unindicated use of proton pump inhibitors - Avoidance of excess of alcohol • Maintenance of epithelial integrity - Maintenance of healthy microbiome - Prevention of GI infections • Maintenance of enterocytes 8 WGO Handbook on DIET AND THE GUT World Digestive Health Day WDHD May 29, 2016
WGO Handbook on Diet and the Gut_2016_Final
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