Good guts for life

GIVEN our national affection for food, it is a wonder that we seldom give a second thought to the health of our digestive system.

In year 2009, diseases of the digestive system was the seventh most common cause of hospitalisation and the sixth most common cause of death in public hospitals.

Constipation and diarrhoea are common conditions among Malaysians, and there are more food poisoning cases in Malaysia every year than new malaria and HIV cases combined.

And we may have the hardiness of our digestive system and our own indifference to blame. Mary Easaw John, senior manager, dietetics and food services, of the National Heart Institute (IJN), explains: "The stomach is a very tolerant organ when compared to other organs in our body. It is a strong grinder, and can hold up to one gallon of food and liquid when fully stretched. (This is the upper limit of comfort.)

"It can tolerate a lot of abuse, so people are generally not sensitive to it. So, when they get indigestion, bloatedness or angin, as they like to call it, they generally ignore it until they experience pain or develop constant irritation.

"By that time, the problem has already become serious."

Certainly, our stomach is not the only organ in our digestive system. It also includes other organs in the digestive tract (our mouth, esophagus, small and large intestines, rectum and anus), and supporting organs such as the liver and pancreas.

It may be a complex system, but the things we can do to take care of it are rather simple.

Regular is good

One of the first things we can do for our gut is to make sure that it is able to get rid of the waste products left behind after nutrients from the food we eat have been absorbed into our body (regular bowel movements).

Unfortunately, many of us are unsure of the definition of regular bowel movements because it is a subject we avoid talking or thinking about.

A common question would be: "How often is regular?"

There is no absolute definition as the normal frequency of bowel movements for every individual is different. "Some people can open their bowels once a day, some three times a week, and others on alternate days. This is normal," says Easaw-John.

Some basic rules apply - if we have fewer than three bowel movements a week, we may have constipation; and if we have three or more bowel movements a day with loose or watery stools each day, we may be experiencing diarrhoea.

Both are symptoms of other conditions that affect the gut, and there are ways we can prevent them from occurring.

As diarrhoea can be caused either by infection of the digestive tract, the inefficient absorption of certain foods, or inflammation of the bowels, it can be avoided by washing our hands before eating, making sure the food we take is clean, and avoiding foods that can trigger an episode.

At the other extreme, constipation commonly occurs when we don't have enough fibre and water in our diet, lack exercise, or ignore the urge to have a bowel movement. It can also happen during pregnancy, in old age, or when our biological rhythm is affected by travel or a change of routine. Otherwise, it could be a symptom of conditions like irritable bowel syndrome or other problems with the intestine and the nerves that control it (e.g. after a stroke).

We may not be able to prevent the effects of pregnancy, old age or travel on our bowel movements, but we can decrease it, or, in other situations, prevent it by making good lifestyle and diet choices.

Slow and steady

Slow and steady pleases the gut

Our lifestyle, and hence our stress levels and eating habits, can greatly influence our bowel movements, says Easaw-John. A hectic and stressful lifestyle may make eating healthy, regular meals difficult to achieve.

"When you are stressed, you don't eat regularly, you gulp your food down, and you ill-treat your bowels because you just eat foods that are easily available - like junk food. And when you have stomachache, you simply take things like antacids and other medications to relieve it," she elaborates.

This kind of behaviour will likely irritate the digestive system and set us up for conditions like irritable bowel syndrome and constipation.Grains are also a source of fibre.

But we don't have to drastically change our lifestyles to avoid such pitfalls. All we need is just a few more minutes to chew our food properly.

"The stomach basically acts as a mixer, breaking food into smaller pieces and adding digestive juices to allow for easier absorption. So, if you don't 'grind' your food well in your mouth, your stomach will have to work harder," she explains.

By slowing down a little, we could also put more thought into what we eat daily. And as fibre and water intake is important as the 'softener' and 'lubricant' to ensure smooth bowel movements, we should take note of our daily intake.

On average, a person needs about 25 to 40 grams of fibre. But Malaysians, who consume about 13 to 16 grams of fibre daily, according to a 1995 Institute of Medical Research study, are not even close.

This figure may have improved over the last decade, but Easaw-John doubts Malaysians are getting enough fibre today. "When I look at my patients over the years, at least about 60 to 70% had not achieved their fibre intake, and many of them had not even achieved their five to six servings of fruits and vegetables daily," she notes.

Of course, fruits and veggies are not the only sources of fibre. Grains, beans and oats are also good sources we can choose from.

Various studies have shown that fibre, either in supplements or in its natural form, can relieve chronic constipation, reduce blood cholesterol, and maintain the stability of the digestive tract. On top of that, fibres can provide "food" for the good bacteria in our intestines and make us feel full after our meal (hence stopping us from eating more), says Easaw-John.

Supplements are not the alternative, but it can 'do the trick' for the moment. But supplements are just that - supplements, says Easaw-John. "They are add ons and they are supposed to enhance your diet, not to replace a meal," she notes.

However, a person who is not used to taking a lot of fibre in his diet should not attempt huge servings before his digestive system gets used to it, as it may cause constipation instead. "It is recommended that when you increase your fibre intake, you increase five grams at one time," Easaw-John advises. (Five grams of fibre equals one cup of vegetable or one cup of peas.)

After that, the most important thing is to drink enough water to add fluid to the large intestines and give stools bulk so they can move smoothly out of the body.

When in doubt, go moderate

Is there any food that is good, or bad, for the digestive system? Easaw-John thinks it is all about having common sense when it comes to eating.

"To me, there is no good food or bad food, because what matters is the amount you take and the frequency in which you take it," she says.

"So you've got to be sensible in what you eat and make healthy choices. The idea is to eat in moderation," she adds.

We may not be able to choose our genes or our allergies, but we can choose what we put into our mouths.