Suffering from some embarrassing and uncomfortable gut symptoms, and can’t work out why? Dietitian Caitlin Reid shows you how to look after yourself from the inside out.
Bloating, abdominal pain, nutrient malabsorption, anxiety, fatigue, allergies... many of us shy away in embarrassment when it comes to talking about the state of our digestive system, but the truth is, a well-functioning gut can go a long way in boosting our quality of life. With our digestive system consisting of all the organs joined in a long twisting tube that runs from our mouth to our anus, there are a lot of things that can potentially go wrong – so what is affecting your digestive health? And can you actually get rid of those symptoms?
How does digestion work?
Digestion is a process that involves the mixing of food, its movement through the gastrointestinal tract (GIT) and the chemical breakdown of the large food molecules into smaller ones. It begins in the mouth where we mechanically break down our food by chewing, before we swallow it down the oesophagus. The muscles in our GIT allow food and liquid to be propelled down the large, hollow digestive organs in a process called peristalsis.
From the oesophagus food enters the stomach, which has three functions. The stomach must first store the swallowed food and liquid, before mixing it up with the digestive juices it produces. The stomach then empties its contents slowly into the small intestine, where it is digested further with the help of digestive juices released from the pancreas, liver and intestine.
Finally, the digested nutrients are absorbed through the small intestinal wall and transported to the liver via the portal vein. Any waste products such as fibre and older cells that have been shed from the mucosa (cells that line the GIT) are pushed down into the large intestine, where they remain until they are expelled in faeces by a bowel movement.
What can go wrong?
Digestion can be affected by a variety of factors and no organ is immune. In the mouth, teeth can break preventing chewing. Also, as we age, our ability to swallow becomes impaired, thereby reducing our ability to consume certain foods.
Mechanical faults with our organs, such as a faulty oesophageal sphincter or a leaky gut, can impede our digestion, producing abdominal pain, nausea and diarrhoea, to name a few. The inability of hormones, digestive juices and enzymes to function properly can also cause things to go wrong, while diet and lifestyle factors such as alcohol and coffee consumption may also have a negative effect.
Lack of activity
Exercise gets your body moving, which gets the waste moving through your body. So it’s no surprise that there’s a well established link between a lack of physical activity and the risk of colon cancer. In fact, research shows physical inactivity may be responsible for 13–14% of colon cancers, an attributable risk greater than family history. Why? A sedentary lifestyle lengthens GIT transit time; slowing digestion and maximising contact with any potential carcinogens in our system.
At the other end of the scale, extremely intensive exercise, such as that performed by serious athletes, can also lead to digestive problems, such as cramps, diarrhoea and nausea. Cramps and diarrhoea indicate over-activity in the large bowel. Exercise delays stomach emptying, causing people who eat too much too close to exercise to feel over-full or nauseous.
How to fix it
Include a minimum of 30 minutes of moderate intensity physical activity on most, preferably all days of the week. For added health benefits, include some vigorous intensity exercise. To reduce the likelihood of gastro-intestinal (GI) upset when exercising, schedule any big meals for at least two hours before exercise. Make sure your pre-training meal is rich in carbohydrates, moderate in protein and low in fibre and fat. Eating liquid-based foods prior to exercising can also help relieve nausea in some people, while smaller snacks are more suitable 1–2 hours before exercise than large meals.
Constantly stressed? It could be having more of an impact on your digestive health than you realise. Amazingly, your gut contains as many neurons (nerve cells) as your spinal cord, and many chemical messengers that regulate feeding in the brain have similar functions in the gut. In fact, many researchers often refer to them as one entity – the ‘brain-gut axis’. Therefore, what affects the brain will directly affect the gut and vice versa.
When we’re stressed, the function of the intestines is altered. Research suggests that stress disrupts the turnover of enterocytes (cells in the intestine that participate in nutrient absorption), which alters the make-up of the small intestine’s epithelium (cells that line the body’s cavities). This intestinal lining acts as a barrier that normally only allows properly digested fats, proteins and starches to pass through and enter the bloodstream. But when this process is disrupted, the tightly-regulated process of digestion and absorption of nutrients into the bloodstream is upset, increasing the gut’s permeability and allowing bacteria and other antigens to escape through its walls into the body.
Stress also activates mucosal mast cells (immune system cells that are activated with infection or allergy), increasing the sensitivity of the gut and increasing the likelihood of GIT upsets.
How to fix it
With every stressful event you face, take a moment to rate it according to the reality check exercise: rate how stressful the event is on a scale of 0 to 10 (with 0 being not that stressful and 10 being extremely stressful). To put things in perspective, the death of a loved one would rate at 10 whereas if your computer happens to crash, that event should get a much lower ranking. Next, focus on developing coping skills so that you can remain level-headed during hectic times. This will help to keep stress levels at bay.
While antibiotics are great for killing bacterial infections in the body or stopping ‘bad’ bacteria from reproducing (therefore allowing the body to produce its own defense and overcome infection), they can unfortunately also cause harm to the ‘good’ bacteria in the gut.
Good bacteria are important for many aspects of health: they’re involved in the digestive process, producing vitamin B and K, and beneficial short-chain fatty acids. They promote a healthy immune system; and they may even help lower cholesterol, by making sure bile is broken down efficiently and cholesterol is removed from the body in the faeces. Therefore, a lack of good bacteria can negatively impact on your overall health.
How to fix it
Include probiotics and prebiotics in your diet. Probiotics (found in fermented milk drinks and some yoghurts) are live microorganisms that improve the balance of good bacteria in your gut, creating an environment where bad bugs are outnumbered. Prebiotics are carbohydrates that pass through the body undigested, increasing bowel function and becoming an important fuel source for probiotics. They are found in foods such as unrefined wheat and barley, onions, leafy green vegetables and legumes and are added to some breads and beverages. Together, they work to boost your gut health.
Like alcohol, smoking can harm all parts of the digestive system, contributing to the development of heartburn and stomach ulcers. Smoking inhibits the production of saliva (which is the body’s defence mechanism against reflux) and adversely affects oesophageal tissue, making it more susceptible to damage from stomach acid.
Smoking also promotes the movement of bile acids from the small intestine to the stomach, making the possible effects of stomach acids more harmful.
Smokers are more likely to develop stomach ulcers than non-smokers, with the ulcers being more difficult to heal and the chance of ulcer relapse also being higher in smokers. And if that’s not bad enough, smokers are at an increased risk of developing Crohn’s disease – an ongoing disorder that causes inflammation of any area of the digestive tract.
How to fix it
If you are a smoker, consider quitting today. Visit your doctor or call the Quitline for help with quitting. It is never too late to reap the health benefits that come from being an ex-smoker.
Too much coffee
Many of us long for our morning coffee, but for some unlucky people the closest they get to enjoying a coffee is smelling the freshly ground coffee beans as they walk past coffee shops on the way into the office! For these people, coffee produces a laxative effect, resulting in loose stools almost immediately after drinking coffee. And caffeine is not the source of the laxative effect – studies show that even decaffeinated coffee has the same effect on the GIT in these people. There are a few potential causes of these symptoms, but they seem to be linked to irritable bowel syndrome or inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.
Coffee also relaxes the lower oesophageal sphincter and elevates stress hormones; diverting blood from the digestive system and increasing the risk of heartburn. It’s highly acidic and can stimulate the hypersecretion of gastric acids.
It’s not all bad news though - some preliminary research conducted earlier this year by Nestlé suggests a moderate consumption of coffee may boost the number of friendly bacteria in the gut, so if your symptoms don’t seem to be associated with coffee, there’s no need to cut it out of your diet.
How to fix it
Find out the level of coffee that you can comfortably tolerate and limit your daily intake to that – but don’t overdo it. If you seem to be able to drink huge amounts of coffee without any GI upsets, be aware that you may be overdoing it on the caffeine. Limit your coffee intake to three to four instant coffees each day. If you’re someone who suffers from irritable bowel syndrome or inflammatory bowel disease, eliminating coffee may help relieve your symptoms.
Too much alcohol
Drinking small amounts of alcohol has several positive benefits, but it also has the potential to affect the structure and function of the entire GIT. Even the first sips cause injury to the mouth and oesophagus, and as the alcohol flows into the stomach and small intestine, the damage continues. Even a single drinking episode can weaken the lower oesophageal sphincter (the muscle between the stomach and the oesophagus), allowing the contents of the stomach to flow back into the oesophagus, causing heartburn. Alcohol can also cause gastritis – inflammation of the stomach.
In the small intestine, alcohol interferes with the enzymes needed for digestion and the absorption of nutrients. Alcohol also causes mucosal damage, which increases the permeability of the gut and allows large molecules that would normally not be allowed to cross the intestinal lining to enter the bloodstream. This increases the amount of toxins associated with certain bacteria (called enterotoxins) transported to the liver, increasing its exposure to these toxins and raising the risk of liver damage. Finally, alcohol has the ability to decrease the muscle movements in the GIT, which can actually reduce the transit time of food and potentially, lead to diarrhoea.
How to fix it
For long-term health benefits, stick to the Australian alcohol guidelines, which recommend drinking no more than two standard drinks each day. A standard drink is equal to 100ml of wine, 30ml of spirits, 285ml of regular beer or 425ml of light beer. Include two alcohol-free days each week as well.
Lack of fibre
Most of us have heard about the benefits of a high-fibre diet: it helps bulk up our stools and keeps us regular. Yet, the average Australian adult still only consumes around 18–25 grams of fibre each day, when the adequate daily intake is 30g for males and 25g for females.
There are two main types of fibre. Insoluble fibre, such as that found in wholegrain wheat, passes through the body undigested. On its journey it absorbs water, which causes it to swell up and bulk up stools, making it easier to eliminate waste from the body. Soluble fibre, such as that found in oats and pulses, is broken down by bacteria in the large bowel in a fermentation process. It is best to include a wide variety of fibre-containing foods to ensure you are getting enough to keep your bowel healthy.
How to fix it
Make sure you are eating a wide range of plant-based foods. Include at least two serves of wholegrain breads and cereal products each day, snack on nuts and seeds and eat at least two serves of fruit and five serves of vegetables every day. Boost the fibre content of meals by adding lentils and legumes to meat dishes, for example, or dried fruit or nuts to yoghurt.
Health conditions that affect your gut
Constant diarrhoea, constipation, nausea, vomiting, heartburn or abdominal pain is not normal and may be a signal of a more serious condition. Some of the possible underlying problems may include coeliac disease, ulcerative colitis or irritable bowel syndrome. If you frequently experience some of the symptoms mentioned above, consult your doctor for a full check-up.