SUNDAY STAR, 21 JUNE 2020 1

2 Digestive Health & You SUNDAY STAR, 21 JUNE 2020

Taking care of your gut

is key to stronger immunity
THE Covid-19 pandemic has turned
the world upside down, bringing
about an unprecedented new
world order. We are all plagued by
uncertainty, knowing that things
will never be the same as they
were before. However, there are
things we can do to stay in control.
The World Digestive Health Day
2020 is a reminder for us to take
care of our gut. We have all heard
of the saying “health is wealth”. If
the body is a temple, then the gut
is the foundation of that temple.
Hippocrates once said that all
disease begins in the gut. Housing
trillions of both good and bad
bacteria, the composition of
bacteria in the gut environment,
known as the microbiome, greatly
affects both physical and mental
well-being.

Vitagen contains two beneficial

Understanding gut probiotic strains to boost gut
bacteria health and help prevent disease.

The good bacteria – known as

probiotics, work with our cells to
keep us healthy. Apart from
discouraging and fighting off
harmful, invading organisms, the
good bacteria also work to support
our digestion, nutrient absorption
and immune system. Studies have
also indicated that mental health
and emotions are closely linked to
gut health. We have already
established that good gut health is
the cornerstone of good health, but
what is the key to good gut health?
The term probiotics is nothing
new today. Thanks to its function
of restoring gut bacteria to healthy
levels, probiotics have increased in
popularity in recent years. In 2017,
a local landmark clinical research
conducted by Pusat Perubatan
Universiti Kebangsaan Malaysia
titled Modulation of intestinal
dysbiosis in patients with
constipation-predominant irritable
bowel syndrome using lactobacillus-
containing cultured milk drink and
published in Clinical
Good gut health is the cornerstone of good health.
Gastroenterology in 2018,
demonstrated the efficacy of two
probiotic strains – Lactobacillus
acidophilus and Lactobacillus
paracasei – which are found in
Vitagen, to have a positive
impact on gut health and the
immune system.
Statistically speaking, 96% of
respondents showed significant
improvement in relieving
constipation while 45% of
respondents required a shorter
time to defaecate. The study also
showed that by consuming the
probiotics contained in Vitagen,
the body produces less pro-
inflammatory chemicals, which
reduces inflammation and
enhances the immune system.
Reality check to managing
our lifestyles
It goes without saying that living
a healthy lifestyle is our single best
defence against harmful bacteria
and viruses. Every part of the body
can benefit from a healthy diet,
sufficient sleep and a positive,
stress-free environment – all of
which help promote a stronger
immune system that stems from
the gut. However, it is not always
easy to stay healthy.
We are all guilty of excessively
eating unhealthy foods, sometimes
on a regular basis. Add a sedentary
lifestyle to the mix and it is likely
that you are increasing your risk
of developing various digestive
disorders or diseases such as
inflammatory bowel disease and
many non-communicable diseases
such as hypertension and heart
disease. For many, the pandemic
is a wake-up call to start taking
health seriously. We need to stop
abusing our bodies and start
boosting our gut health with
probiotics and foods that will
naturally help build up our
immune systems.
Daily consumption of probiotics
is easy with Vitagen. It is delicious
to drink and contains billions of
live probiotic cultures that are
clinically proven to be beneficial to
gut health. It is recommended that
you take at least two bottles of
Vitagen daily for best results.
This new normal that we are
facing may last for quite some
time. We have all been inundated
with enough information on the
Daily consumption
of probiotics is easy
with Vitagen. It is
delicious to drink and
contains billions of live
probiotic cultures that
are clinically proven
to be beneficial to gut
health.
seriousness of this pandemic, but
how many of us are actually doing
something about it from a health
standpoint? We need to ponder
this question.
In every crisis, there is
opportunity. We have two options:
one is to go back to our old,
unhealthy ways and take life for
granted. The second is to
re-evaluate our habits and cultivate
new, healthy ones that will stay
with us for life. Without our health,
we are nothing, and that is
something that should never be
taken for granted.
n For more information, visit
vitagen.com.my

Malaysians are constantly surrounded by unhealthy food options, so it is

Just as how Malaysians have adapted to the new normal of social distancing and the wearing of face masks, we crucial to boost gut health with probiotics and foods that will naturally
need to take the necessary steps to maintain good gut health. help build up our immune systems.
SUNDAY STAR, 21 JUNE 2020 3
4 Digestive Health & You
Misconceptions about bloating
BLOATING is one of the most common and
bothersome experiences. In this article, I
will talk about the various causes of
bloating, how to tell if your bloating is
abnormal and how to maintain a healthy
digestive system. I will also touch on food
intolerances and a frequent question
doctors get, which is whether probiotics
will help.
Bloating is a sensation of your stomach
feeling tight and full of air. Your clothes or
belt suddenly feel tight after a meal or you
may feel the inability to pass wind in
either direction. Belching, or flatus,
becomes uncomfortable and even painful
for some people.
Our local term of “angin” is commonly
used to describe a whole plethora of
symptoms but usually it is that feeling of
“trapped air”. Essentially, your
gastrointestinal tract is filled with gas.
Bloating affects 10% to 30% of the
general population and in some cases,
will have an impact limiting their daily
activities. Bloating usually suggests the
presence of excessive gas, but occasionally,
it can be due to fluid (ascites), which is
more worrying.
Is it the same as indigestion?
Bloating, like heartburn, constipation,
and diarrhoea, is a common feature of
indigestion. Indigestion means improper
digestion of food. This could be due to
several reasons ranging from infection to
acid reflux and motility disorders, causing
food to not be broken down and absorbed
properly. Some common reasons are
discussed below:
l Constipation
One of the most common causes of
bloating is constipation. Constipation
is the difficulty in passing stool.
Typically, you pass stools less than three
times a week, the stools take the form of
hard, dry pebbles, you struggle to push it
out and feel pain or feel an
incomplete evacuation.
Stool stored in your rectum and colon is
old food that is being broken down and it
releases gas, which builds up and goes back
into your upper gut, causing the bloated
feeling. This backward flow of gas can also
exacerbate acid reflux, giving rise
to heartburn.
The longer stool stays in the colon, the
more water is reabsorbed and the more
difficult the stool becomes to evacuate. It is
a good habit to look at your stool before
flushing it down. The presence of blood is
not normal.
l Gastroparesis
Gastroparesis is slow gastric emptying or
gastric paralysis. Certain medical conditions
such as diabetes, hypothyroidism and
Parkinson’s disease cause the gut to move
slower than normal.
It is crucial to monitor your stool as it can provide clues to underlying health conditions.
l Aerophagia
Aero (air) phagia (eat) is a condition
where there is excessive swallowing or
gulping of air. This is occasionally seen in
children and adults and is associated with
an underlying psychological disorder such
as anxiety or depression
l Food intolerance
Food intolerance is the inability to digest
certain foods (as opposed to food allergies
where the immune system reacts to the
food). Intolerance to food items such as
lactose, gluten and sugar alcohols (zero
calorie alternatives to sugar) can cause
bloating and abdominal discomfort.
Fermentable oligo-di-mono-saccharides
and polyols, or Fodmaps, are a group of
short-chain carbohydrates found naturally
in many foods. Examples of Fodmaps are
fructose, bread, honey, soft cheese, beer and
apples. Fodmaps may be poorly digested by
some people. Fermentation of the
undigested carbohydrates releases gas and
causes bloating and discomfort. This is very
commonly seen in association with people
with irritable bowel syndrome (IBS).
l IBS
IBS is a functional gastrointestinal (GI)
disorder characterised by abdominal pain
and altered bowel habit in the absence of a
specific and unique organic pathology,
although microscopic inflammation has
been documented in some patients. It is a
benign disorder that does not lead to
cancer. Symptoms, however, can be severe
enough to interfere with normal daily
activities and affect quality of life.
Bloating is a very common symptom
reported by patients with IBS. Up to 30%
feel the pain is intrusive. Bloating may
result from bacterial fermentation of
undigested food, retarded gas transit,
increased sensitivity of gut to normal
luminal gas volumes or dysfunctional gut
muscle wall.
Bloating associated with IBS is seen more
in women than men and may be related to
the menstrual cycle, as well as commonly
seen in constipation-related IBS. Stress,
anxiety, depression and fibromyalgia are
all interlinked with IBS.
When is it abnormal and how
to differentiate?
It is normal to feel bloated occasionally.
If this occurs frequently, causes discomfort,
interferes with daily activities and sleep,
then it is a problem. Passing too much
flatus and burping or belching continuously
to the point it is embarrassing should tell
you it is time to see a doctor.
If at any point you are losing weight
without trying, experience a change in your
normal stool pattern, notice there is blood,
lose your appetite and cannot sleep because
of pain or discomfort – please see your
doctor immediately.
Heart disease
We should be aware that bloating can
sometimes present as chest discomfort and
it can masquerade a heart attack (these
atypical symptoms are usually seen more in
women). If this discomfort is accompanied
by pain radiating to the jaw, neck or back,
or there is profuse sweating, dizziness or
breathlessness, you should see a doctor
straight away.
Gall bladder disease
Gallstones and gall bladder diseases may
cause bloating, especially after meals.
Gallstones are seen in about 5-10% of the
general population. If it does not bother you,
you can leave it alone. If your symptoms are
that of pain and discomfort after meals
(especially after oily food) or jaundice due to
stone blockage, your doctor may advise you
to remove your gall bladder.
A common question asked is, “What will
happen if I remove my gall bladder?” The
gall bladder is a storage bag for bile, which
is produced in the liver. When it is removed,
you will need to be careful with your diet of
fatty foods for a short while until your body
adjusts to this change. This usually takes two
to four weeks, after which your digestion
should return to normal.
Pancreas
Pancreatic disorders including chronic
pancreatitis and cancer can result in bloating
or discomfort, especially after meals.
Associated back pain, new onset of diabetes
or sudden inability to control existing
diabetes are worrying. Weight loss and lack
of appetite are also worrying symptoms that
should prompt medical consultation. Floaty
or oily stools are also indicative of an
underlying pancreatic problem.
Gynaecological diseases
Bloating can be a symptom of ovarian
disease. Hormonal imbalance leads to
increased water retention and can present
with bloating. Ovarian and peritoneal cancer
may also present with bloating. It is not just
air that makes the abdomen distended.
In some diseases, fluid accumulates
outside the organs. This is called ascites.
This may also be seen in heart failure, liver
cirrhosis, kidney disorders and thyroid
diseases. If any of these are suspected, a
simple ultrasound of the abdomen and
pelvis can tell us if its fluid or gas that you
are dealing with.
Misconceptions about bloating
Bloating or abdominal distension is a
SUNDAY STAR, 21 JUNE 2020
Datin Dr Sharmila Sachithanandan.
very subjective symptom depending on an
individual’s threshold for discomfort.
Bloating means different things to different
people, so the doctor must take detailed
history of the patient and perform a clinical
examination. Often, minor dietary
modifications and monitoring the
consistency of stool will suffice.
However, not all bloating is due to food
and stool. You may need to see a doctor if
symptoms are frequent, persistent or
interfering with your daily activities or sleep.
Any of the worrying symptoms described
earlier should prompt your visit
to the doctor. Remember, not all bloating is
due to air. It could be fluid (ascites), which
is very worrying.
Another frequently asked question is,
“Can probiotics help?” The gut is filled with
trillions of bacteria. This microbiome is
responsible for maintaining our gut health.
Everyone’s microbiome is different. What
we know is that the more diverse the
bacteria, the better protection we get.
Some bacteria help to fight disease while
some promote diseases. It may also be the
reason some people are overweight. The
route we were born (vaginal or caesarean
delivery), the environment we grew up in,
frequent use of antibiotics and stress all
affect our microbiome.
When this microbiome is thrown out of
balance, food is not digested properly and
this can lead to bloating. Manipulating the
gut flora is complex. Taking probiotics after
certain situations such as acute
gastroenteritis, antibiotic therapy and certain
chronic illnesses such as IBS can help.
However, there is no firm evidence that
taking them on a regular basis is beneficial.
In some severely immunocompromised
patients, probiotics may be dangerous.
Advice for a healthy digestive
system
The gut embryo originates from the
endoderm, so what is inside matters on the
outside, and vice versa. The skin and gut
share the same origin and hence they are
both windows to each other’s health. Some
diseases of the gut manifest as skin problems
such as eczema, psoriasis and allergies.
The gut has been called the second brain
because it has so many nerve connections. In
the last 20 years, a plethora of research has
shown that the GI tract is more than a long
food pipe. Gut health has been linked to
sleep quality, mental health, skin conditions,
obesity, diabetes, autoimmune conditions
and even cancer. We should do our best to
maintain a healthy gut by watching what
goes in and what comes out.
Try to reduce the stressors, maintain
regular and sufficient sleeping hours, chew
your food properly and do not rush through
your meals, drink water, and watch your
diet. Simple elimination of certain foods can
help. Avoid highly processed food, animal
fats and refined sugar, and make sure you
pass stool well.
n Datin Dr Sharmila Sachithanandan is a
consultant gastroenterologist at Subang
Jaya Medical Centre