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The gut is considered the seat of good health in Ayurvedic medicine. The first step in Ayurvedic treatment for any disease is to correct the imbalances in the large intestine. G.G. Gangadharan, joint director, Institute of Ayurveda and Integrative Medicine, Bangalore, goes one step further, “In Ayurveda, the large intestine is considered even more important than the brain."

Western medicine is now confirming this with research evidence. Over the past two decades, research has found connections between an unhealthy gut and several diseases, many of which you wouldn’t imagine have anything to do with your stomach. Disorders like irritable bowel syndrome and ulcerative colitis are associated with an unhealthy gut, and surprisingly, so are diseases like diabetes, rheumatoid arthritis, depression, chronic fatigue syndrome, and obesity. So much so that in a review of the literature on gut health and its impact on metabolic diseases like diabetes and obesity, authors S.A. Joyce and C.G. Gahan concluded that new therapies for metabolic diseases should be designed keeping gut health in mind. The review was published in the March issue of the journal Current Opinions in Gastroenterology.

There are two interdependent features that determine gut health. The intestinal flora or bacteria in your stomach, and the gut barrier, or the integrity of the intestinal wall. There are approximately 100 trillion bacteria in the gut (that’s about 10 times more bacteria than cells in your entire body). A couple of hundred kinds of these play the role of regulating your digestion, protecting your body from infection and keeping your metabolism in good working order. These bacteria are hugely affected by what you eat—certain foods like fermented vegetables and yogurt encourage the growth of good bacteria while others like sugars and fats encourage the growth of harmful, disease-causing bacteria. Excessive use of antibiotics causes the most damage by leading to an immediate and profound loss of the variety and number of bacteria in your gut.

This loss of good bacteria can be recouped by taking probiotic supplements. Probiotics contain helpful living bacteria that bring the intestinal flora back in balance by recolonizing the intestines and crowding out the bad bacteria. Sanjay Salunkhe, consultant, gastroenterology, Columbia Asia hospital, Pune, says: “If you are taking antibiotics and are on medication for heart disease or diabetes, or if you know you suffer from antibiotic-associated diarrhoea, do take probiotic supplements. A good rule of thumb is to take a probiotic that is a blend of more than one kind of bacteria at a concentration of at least one billion colony forming units per dose or capsule. And remember to take the probiotic half an hour before you eat anything and not with the antibiotic which should be taken after your meal."

A study published in December in the British Journal of Nutrition found that a probiotic supplement (Lactobacillus rhamnosus) helped obese women lose more weight. Both groups of women—those who were taking the supplement and those who weren’t—were on a low-calorie diet and while both groups lost weight, the obese women on the probiotic lost 9.7 pounds (4.4kg) on an average compared with the 5.7 pounds (2.6kg) lost by those who didn’t take the supplement. Obese men were included in the study but didn’t show any difference in weight loss with the supplement.

While the bacterial ecosystem is critical to your gut health, what also matters is the integrity of your intestinal wall. A healthy intestinal wall prevents bad bacteria from multiplying and cooperates with healthy bacteria in the proper digestion of food. Painkillers, particularly those containing ibuprofen, naproxen sodium and ketoprofen, tend to irritate the intestinal wall and their prolonged use can affect the integrity of the intestinal wall. Liver disease also leads to greater intestinal vulnerability as the secretion of bile, important for digestion and the protection of the intestinal wall, is reduced with liver disease.

While increased intestinal permeability likely plays a role in many pathologies, there are no practical diagnostic tests for testing the condition, says Craig McClain, chief of research affairs, division of gastroenterology, hepatology and nutrition, University of Louisville School of Medicine, US.

Till a test for assessing gut permeability is found, there are some things that you can add to your diet to promote good gut health. Shirish Barve, professor of medicine, pharmacology and toxicology, University of Louisville, says that “while the research on probiotics is very promising, till conclusive evidence is found on the right dose and combination of bacteria that are useful in treating a particular disease or preventing it, it’s best to include fermented products like live culture yogurt in your diet".

Dr Gangadharan offers similar advice: “In Ayurveda we say that you can eat what you please, as long as you finish your meal with a glass of salted buttermilk." Buttermilk is a fermented dairy product like live culture yogurt.

Sujata Kelkar Shetty, PhD, writes on public health issues and is a research scientist trained at the National Institutes of Health in Bethesda, US.

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