Sunil (name changed), a 33-year-old IT professional from Kochi, was regularly suffering from bloating, gas, and irregular bowel movements. He had a desk job, and a sedentary lifestyle. He didn't sleep well, often ate from restaurants, and treated himself with antibiotics when he got sick. After doctors advised him to exercise regularly, improve his sleep pattern, eat a fibre-rich diet with probiotics like yogurt, and limit processed foods, his condition improved in six weeks without any medication.
Sunil was fortunate as he received prompt treatment for his symptoms, managing to recover without the need for any medication. In stark contrast, the situation of Sandeep (name changed), a Delhi pilot, was much more challenging. At 27 years old, he began experiencing a troubling pattern of stomach pain that reared its head time and again. Accompanied by persistent loose motions and noticeable weight loss, his condition raised alarm bells.
After undergoing a comprehensive series of blood tests and imaging scans, doctors diagnosed him with inflammatory bowel disease (IBD), a chronic condition that can significantly affect one's quality of life. With a targeted treatment plan, he was prescribed a variety of medications aimed at managing his symptoms. Fortunately, he began to show signs of improvement, gradually regaining strength and stability.
But not for long. His health took a downward turn, leading to a relapse that necessitated hospitalisation. He was given corticosteroid injections, which eventually enabled him to return to work. However, his relief was short-lived as he experienced another setback just a few months later, forcing him to confront the lingering complications of his condition once again.
“This pattern of improvement and relapse continued for two years. He was put on biological agents, and his screenings were done at six-month intervals to monitor his progress. Once on biological drugs, he developed certain infections that were difficult to manage with available treatments. Finally, it was decided that surgery would be performed to remove the diseased segment of the intestine,” said Dr Sharad Malhotra, senior consultant and head of gastroenterology, hepatology and therapeutic endoscopy, Aakash Healthcare, New Delhi.
After three years, he went ahead with surgery, and the diseased part of the intestine was removed. “Once the disease toxicity subsided, he started improving and was managed with very simple medications. Now, this gentleman is fine, taking only basic medications for the management of his IBD,” he said. Hippocrates, the father of modern medicine, said, “All disease begins in the gut.” The gut refers to the entire gastrointestinal tract, which starts at the mouth, includes the oesophagus, stomach, small intestine, large intestine/colon, and ends at the anus. This 30-foot-long GI tract works with other parts of one's digestive system to help break food down into smaller molecules of nutrients.
“Our gut is important not only for digestion, but also for absorption and our overall health and well-being. The gut is also a vital immune organ. Keeping it healthy is important,” said Dr Rajeev Jayadevan, a senior consultant, gastroenterologist and former president of the Indian Medical Association (IMA), Cochin.
In fact, gut health starts the moment a baby is born. From day one, the baby is fed breast milk, which provides not only nutrition but also healthy bacteria from the mother along with essential antibodies to keep the baby safe from invading microorganisms.
Experts say the intestinal tract forms a defensive barrier against what we ingest. It prevents harmful substances from reaching the bloodstream. If this barrier is compromised and harmful substances manage to get past, it leads to inflammation, which can negatively impact the body. It is also associated with the development of chronic conditions, including arthritis, diabetes, kidney disease, and colitis, among others. A healthy gut thus depends on a well-balanced diet.
The role of diet
A survey conducted by the Indian Dietetic Association (IDA) and Country Delight among 2,017 people aged 25-50 in three metro cities—Delhi, Mumbai, and Bengaluru—found that 70% of them suffer from digestive and gut health problems because they consume ultra-processed food (UPF) high in sugar, salt, and fat.
According to Dr Abhishek Kathuria, senior consultant, gastroenterology, gastrosciences, Medanta, Gurugram, maintaining a healthy gut not only requires eating a well-balanced diet high in fibre, probiotics and prebiotics, but remaining hydrated, avoiding processed foods, and exercising regularly. Dr Jayadevan adds that the traditional Indian diet is healthy overall because it contains a balance of carbohydrates, healthy fats, fibre, protein, and vitamins. “A balanced diet consisting of correct proportions of carbohydrate, protein, fat, fibre, vitamins, minerals, and fruit intake is necessary.”
In India, there is plenty of choice of carbs ranging from rice, wheat, ragi, and corn, he said, adding that salt and sugar must be used in moderation, and excess of both these ingredients will lead to chronic diseases. Fish, nuts, and seeds, along with plenty of fibre and fermented foods such as curd or yoghurt, help maintain gut health.
Slacking off on sleep?
Dr Kathuria said that sleep and stress play a major role. “Poor sleep impacts the relationship between the gut and the brain, while stress impacts digestion and gut microbes. Managing stress through mindfulness and ensuring quality sleep can help.” Dr Malhotra added that lesser the sleep, higher the number of stress-related hormones. “There is poor digestion when the amount of sleep you get comes down. Many stress hormones increase, changing the circadian rhythm, which leads to poor appetite, digestive patterns, and bowel movements. It also leads to other problems like intestinal cramps, gas, acidity, bloating, discomfort, irregular bowel movements, and abdominal discomfort after meals,” he said.
Managing stress, lifestyle
Stress has become part of human life, says Dr Malhotra. Stress leads to poor appetite, decreased bowel motility, uneasiness, irregular eating patterns, eating the wrong things, and sometimes excessive consumption of substances like tobacco and alcohol.
Stress can also contribute directly by increasing the basal acid output of the stomach, changing the motility of the bowel, and leading to poor digestion. In today’s modern lifestyle, sleep is often compromised, and there are reports of stress levels going up with extended work hours, congestion, and domestic stress, added Dr Jayadevan.
“Increasing use of mobile phones, video games, and social media are cutting into family time and sleep time. Excessive use of television and streaming media not only makes people sedentary but also reduces their sleep hours as well as family time. Such a lifestyle will undoubtedly affect gut health and the composition of gut bacteria. Accordingly, functional bowel disorders are on the rise, which include things like acidity, gas, indigestion and irritable bowel. Bringing regularity to sleep, exercise, and diet patterns are essential for long-term health,” he added.
Signs to look out for
How does one know one is suffering from an unhealthy gut? Dr Pavan Dhoble, Junior Consultant, Gastroenterology, PD Hinduja Hospital and MRC Mahim, Mumbai, said, “The signs include chronic bloating, gas, or diarrhoea, frequent constipation, persistent fatigue, skin issues like acne or eczema, food intolerances, repeated infections or poor immunity, and unexplained mood swings or anxiety.” The most important thing is to look out for red flags or alarm symptoms, which are unexplained loss of weight, persistent loss of appetite, difficulty with swallowing, repeatedly passing blood in bowel movements, vomiting, and jaundice.
“A doctor must be consulted without fail if any of these are persistent. The doctor may order a blood and stool test, scan or endoscopic examination based on the clinical presentation. More common gut symptoms such as acidity, gas, and bloating are not commonly associated with the severe disease,” Dr Jayadevan said.