Good health starts from the gut

Professor Gwee Kok Ann shares some useful insights on caring for the gut and tips on choosing the right probiotics supplement.

Q1. What are the symptoms of poor gut health? How does one maintain a healthy gut?
Symptoms of poor gut health typically include crampy abdominal pain or varying intensities, diarrhoea, constipation, bloating, belching and changes in bowel habits.

Poor gut health can be caused by reaction to certain food, anxiety and stress, gastrointestinal infection and use of antibiotics. This can arise after food poisoning with severe diarrhoea potentially washing out protective bacteria, causing mild but long-lasting inflammation. With antibiotic treatment, the reduction in protective bacteria could potentially outweigh the clearance of the harmful bacteria.

To ensure a balanced gut environment, one can increase the intake of fermented food such as yogurt and cultured milk. Probiotic supplements, as well, will help to restore the gut environment by delivering beneficial bacteria.

Q2. Is stool frequency an indication of good gut health? Is there an optimal frequency?
Stool frequency is not a very good indicator of good gut health as it is highly dependent on individuals. Some people naturally have a bowel movement everyday while others go just a few times a week. As such, there is no optimal frequency. I think that optimal frequency is that which allows a person to feel comfortable. Only when there is a drastic change in normal bowel movement that one needs to be concerned about gut health.

Q3. There has been increasing emphasis on gut health. Why do you think gut health is important in relation to general wellbeing?
There is now better appreciation that the gut is not just an organ for digestion of food and nutrition, but that what we eat and how we eat have an impact on our overall well-being. This is not a new idea; many of the traditional Asian concepts of health emphasize the philosophy that ‘we are what we eat’. It’s just that the Western model of health with its strong emphasis on cholesterol, fats, salt and calories focused on a limited aspect of health in relation to the heart. This ignored how important it is that we also pay attention to the role that the gut plays in metabolism, a balanced immune system and even happiness. For example, state of the art research shows that how we feed our gut can influence our mood, i.e. our happiness.

In fact, 70-80% of the immune system resides in the intestine. Therefore, maintaining a good gut health will not only help with gastrointestinal problems but also help to promote vitality and stronger immunity.

Q4. Can probiotics promote good gut health? What are the important things to take note of when fermenting or purchasing fermented food off the shelf?
Probiotics are ‘good’ bacteria that modify and balance out gut microbiota. They can inhibit the growth of disease-causing bacteria, enhance the immune system, help fight inflammation, reduce gas production and gut sensitivity while improving mental health.

Although LAB (lactic acid bacteria) in fermented food have displayed anti-inflammatory qualities and act as an antioxidant in intestines, further studies are required to prove that the LAB in fermented foods are relevant and adequate to be incorporated into national dietary guidelines.

It is important to note that fermented foods are not the same as probiotics. Not all fermented foods contain live organisms. Beer and wine, for example, undergo steps that remove the organisms whereas other fermented products are often heat-treated to prolong shelf-life, resulting in the organisms being inactivated

Moreover, live organisms are present in fermented products to perform the fermentation (i.e., convert milk into yogurt or cheese, or cabbage into kimchi). These cultures do not necessarily have any probiotic functions. Cultures are not probiotic unless they have clinical evidence of conferring a health benefit.

Woman giving her daughter piggyback on the beach

Fermented foods can be incorporated as part of a balanced, healthy diet, although it should be recognised that some, such as kimchi, can have a high salt content. Those wanting to ferment at home also need to ensure that food hygiene practices are followed and that the correct ingredients, conditions and storage practices for the particular ferment are used.

In short, above all else, it is important to be aware that only probiotic products with scientific evidence can be safely accepted to manage one’s gut health.

Q5. What are the criteria consumers should be reviewing when choosing a probiotics supplement? Is looking at the cfu enough?
Colony-forming unit (C.F.U) is a unit of measurement used to quantify the number of actively dividing bacteria cells. A higher C.F.U does not equate to better outcome. Some analysis suggest that sometimes when the concentration is very high, the amount of bacteria packed into a capsule could become too dense for it to be released in the intestine. Thus, the probiotic capsule would essentially be useless.

The recommended range for daily probiotic consumption is between 1-10 billion CFUs. Nonetheless, some CFU claims may be unreliable as health supplements are usually not monitored. Random tests in Italy and USA have found that on top of misrepresentation of strain types, there was a large drop in bacterial count within one year of manufacturing date.

Hence, it is advisable to choose products with scientifically proven heat-protecting technology or heat-stable strains that do not require refrigeration. Technology such as dual coated technology is also important to improve the stability of bacteria and ensure their survival against gastric acid and bile acid until they reach the large intestine and perform the necessary functions.

Moreover, multi-strain probiotics also appear to show greater efficacy than single strains but choosing the right strains is equally important. This is because research has shown that some strains seem to be more effective than others for treating certain conditions.

In Singapore’s context, probiotics ideally should be lactose free as most of the Asian population is lactose intolerance to certain extent.

Those with IBS symptoms may also consider gluten free probiotics as gluten is considered a high FODMAP diet which can worsen the condition.

This interview is provided by DUOLAC probiotics.

About Adjunct Professor Gwee Kok Ann
Doctor Gwee Kok Ann is Adjunct Associate Professor of Medicine at the National University of Singapore and practices at Gleneagles Hospital, Singapore. He obtained his medical degree from the National University of Singapore and his PhD in 1998 from the University of Sheffield. His thesis on post-infectious irritable bowel syndrome is one of the early works in this field.

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