We, Malaysians love our food. The temptation from high-calorie foods such as ‘nasi lemak’, ‘mee goreng’, ‘roti canai’ and ‘char kway teow’ are just too irresistible to turn down! Apart from overindulgence in calorie-rich or unhealthy foods, eating too fast, increased stress levels and sedentary lifestyles are also the culprits for deteriorating digestive health.
According to the Health Facts Reference Data 2018 by Ministry of Health Malaysia (MoH), digestive system diseases are one of the top 10 principal causes of hospitalization and death in both MoH and private hospitals.1
Often, we tend to neglect the warning signs of digestive malfunction such as bloating, flatulence, heartburn and constipation. We regard those issues as trivial one when it only attacks once in a blue moon. Only by the time when symptoms are getting unbearable, we will start to pay attention to which food to take or avoid and what are the remedies to treat those conditions.
Here, we put together the common digestive complaints affecting many and how supplements can help with these issues.
Bloating can be defined as a sense of gassiness or feeling distended. This occurs primarily due to the foods such as lactose, fructose, fibre and complex carbohydrates like wheat consumed are incompletely digested by our small intestines. Digestive bloating can also be caused by swallowing air, drinking carbonated beverages, or neutralization of acids and alkalis in the upper gastrointestinal tract.2
Remedies for Bloating
Digestives enzymes are substances produced and secreted by our stomach and intestines to help break down food into smaller molecules for the ease of digestion. Each enzyme works exclusively in deconstructing one type of food molecule. For example,
- Amylase converts carbohydrates and starches into simple sugars like glucose as a source of energy.
- Protease converts proteins into small peptides and amino acids.
- Lipase converts fats into fatty acids.
- Lactase converts lactose (milk sugar) into glucose and galactose.
Deficiency in digestive enzymes is one of the contributing factors for developing symptom such as bloating. This explained why certain people with deficiency of the digestive enzyme, lactase develops symptoms after consuming dairy products.
The efficacy of digestive enzymes had been demonstrated in several studies which show that multienzymes supplement alleviates symptoms such as bloating, flatulence and belching that are commonly seen in those who suffer from indigestion.3,4
Approximately 500 different species of bacteria reside within our colon to facilitate digestion and promote overall well-being. Disturbance of the balance of these bacteria can lead to significant changes in gut function with bloating being one of the most noticeable signs. Thus, it is widely known that supplementation of probiotics (the ‘good’ bacteria) is crucial to help keep the balance in check. This is also proven in a study which found an improvement in symptoms of bloating among patients with non-constipated functional bowel disorders after 8 weeks intake of probiotics.5
Do consider prebiotics, if you plan to choose probiotics for your digestive ailments. Prebiotic such as inulin is a dietary fibre fermented by Bifidobacterium species and other lactic-acid producing bacteria to boost the numbers of beneficial bacteria in your gut.6 A randomized controlled study demonstrated that children diagnosed with irritable bowel syndrome (IBS) had a higher percentage of recovery with synbiotic (probiotics + prebiotics) treatment as compared to children who merely relied on prebiotic treatment.7
The fennel seeds have frequently used to relieve flatulence according to traditional Persian medicine.8 It contains an active component, anethole which possesses relaxant effect on intestinal smooth muscle and subsequently reduces abdominal pain that is often accompanied by the sign of bloating among IBS patients.9,10
Constipation may be another not-too-comfortable to talk topic with people around you. Try to ask yourself these few questions:
- Did you have your bowel movements (yes, it means pooping) fewer than 3 times a week?
- Did you experienced difficulty or straining when passing stools?
- Did the stools dry and hard?
If you got YES for most of the questions above, you likely are constipated. Though it is common, please do not take it lightly as chronic constipation is most probably affecting your daily life now. Just take a few seconds to imagine having toxins piled up and stuck in your body and not able to get rid of it properly. Constipation is normally linked with lack of fibres in your diet, not drinking enough fluids, stressful lifestyles and lack of exercises.
Remedies for Constipation
If you find it hard to gulp greens, try the probiotics. Bifidobacterium and Lactobacillus are the two most widely studied probiotics that shown to confer beneficial effects on overall gut health. These probiotics have shown to be less abundant in patients suffering from constipation.11 A systematic review involved 21 studies concluded that supplementation with products containing these 2 probiotic species increased stool frequency by about 0.8 bowel movements per week and reduced time for food to pass through the gut by about 15 hours in constipated adults.12
The same positive effect was also documented in the consumption of inulin-containing products. Inulin, a soluble dietary fibre that occurs in many plants also acts as a prebiotic in stimulating the growth of beneficial bacteria in our gut. Several studies conducted on constipated subjects found inulin ability in increasing stool frequency and promote bowel function.13,14
Psyllium is a type of fibre derived from the husk of Plantago ovate plant’s seeds. Due to its ability to be utilized by certain bacteria in human intestines as an energy source, it is also considered as a prebiotic. Another notable property of psyllium is its capability in retain water in the human gut, thereby helps to bulk up the stools and promotes regularity.15 Hence, it is important to drink plenty of water when taking psyllium husk fibres for it to work well in our gut. Human studies were carried out and confirmed the use of psyllium husk fibre in improving constipation via increasing the stool frequency, weight and consistency.16,17
Dandelion is a yellow flower plant that has been traditionally used as a remedy for constipation and other minor digestive issues. Dandelion is also one of the rich sources of inulin which is beneficial in alleviating constipation.18 It is believed that dandelion increases the contraction of the stomach and reduces resistance in food moving to the small intestines.19
In contrast with constipation, diarrhoea is described as three or more loose or watery stools a day. For acute diarrhoea, the condition will last less than 2 weeks while chronic diarrhoea will normally last for more than 4 weeks. The major causes of diarrhoea are bacterial or viral infection and other underlying illnesses such as celiac disease and pancreatitis. In the case of infections, the outer layer of the intestinal tract is damaged, thus unable to absorb water from the intestinal lumen which resulted in watery stools.20
Remedies for Diarrhoea
Diarrhoea may be one of the signs telling us that our body has insufficient enzymes to break down food for proper digestion. For example, lactose intolerance causes watery diarrhoea due to lack of the enzyme – lactase causes the unabsorbed lactose to remain in the gut lumen and retains as well as attracts water leading to watery stools.20
A study involved 49 irritable bowel syndrome-diarrhoea (IBS-D) patient demonstrated positive outcome in IBS-D symptoms for cramping, urge to defecate and decrease stooling with the increase in stool firmness after the intake of enzymes-containing supplement.21
In infectious diarrhoea, probiotics act against the pathogens that invaded our gut by competing for available nutrients for growth and increasing our own body immune responses. A clinical review demonstrated the potential roles of probiotics and synbiotics (the combination of probiotics and prebiotics) in improving the conditions of children with acute diarrhoea. The same review also highlighted synbiotic treatment was more effective than probiotic treatment mainly due to the addition of prebiotic in enhancing the survival rate of probiotics during passage through the upper intestinal tract.22
Diarrhoea associated with the used of antibiotics is very common, especially among elderly patients. Lactobacilli, bifidobacteria and streptococcus species of good bacteria have been widely evaluated for the prevention of antibiotic-associated diarrhoea and found to be effective as well as safe to use.23
A sudden unpleasant, sour and acidic taste in your mouth or a feeling of burning sensation near your chest area? If these symptoms happened more than once in a week, it’s time to do something to curb the acid reflux. The heartburn sensation is caused by the stomach acid flowing upwards into the oesophagus (a tube for the passage of food from the mouth to the stomach) and irritates the lining wall over time. Frequent attacks may lead to a more severe condition such as gastroesophageal reflux disease (GERD).
Remedy of Acid Reflux
Dietary and lifestyle changes are the most important remedies, to begin with when dealing with acid reflux and heartburn symptoms. Many people opted for medications which help to reduce or block stomach acid for immediate relief. However, when comes to the natural remedy, turmeric may be a potential option for alleviating the symptoms. Studies found that the active component in turmeric – curcumin is effective in preventing oesophageal mucosal damage caused by acute reflux esophagitis mainly through its antioxidant and anti-inflammatory properties.24,25
- Ministry of Health Malaysia. Health Facts 2019: Reference Data for 2018. MOH/S/RAN/152.19(PT)-e. [Internet]. Malaysia: Health Informatics Centre; 2019 [updated November 2019; cited 28 May 2020]. Available from: https://www.moh.gov.my/moh/resources/Penerbitan/Penerbitan%20Utama/HEALTH%20FACTS/Health%20Facts%202019_Booklet.pdf
- Lacy BE, Gabbard SL, Crowell MD. Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? Gastroenterology & Hepatology. 2011;7(11):729-739.
- Khandke DA, Jain SK, Shirsath PA. Post-marketing surveillance study to assess the efficacy and tolerability of A15zyme – a multienzyme preparation in patients with functional dyspepsia. Indian Med Gazette. 2013;5:181-191.
- Majeed M, Majeed S, Nagabhushanam K, Arumugam S, Pande A, Paschapur M, et al. Evaluation of the safety and efficacy of a multienzyme complex in patients with functional dyspepsia: a randomized, double-blind, placebo-controlled study. Journal of Medicinal Food. 2018;21(11):1120-1128.
- Ringel Y, Ringel-Kulka T, Maier D, Carroll I, Galanko JA, Leyer G, et al. Clinical trial: probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis B9-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders – a double-blind study. J Clin Gastroenterol. 2011;45(6):518-525.
- Harper A, Naghibi MM, Garcha D. The role of bacteria, probiotics and diet in irritable bowel syndrome. Foods. 2018;7(13): foods7020013
- Basturk A, Artan R, Yilmaz A. Efficacy of symbiotic, probiotic, and prebiotic treatments for irritable bowel syndrome in children: a randomized controlled trial. Turk J Gastroenterol. 2016;27(5):439-443.
- Larijani B, Esfahani MM, Moghimi M, Shams Ardakani MR, Keshavarz M, Kordafshari G, et al. Prevention and treatment of flatulence from a traditional Persian medicine perspective. Iran Red Crescent Med J. 2016;18(4):e23664.
- Portincasa P, Bonfrate L, Scribano ML, Kohn A, Caporaso N, Festi D, et al. Curcumin and fennel essential oil improve symptoms and quality of life in patients with irritable bowel syndrome. J Gastrointestin Liver Dis. 2016;25(2):151-157.
- Di Ciaula A, Portincasa P, Maes N, Albert A. Efficacy of bio-optimized extracts of turmeric and essential fennel oil on the quality of life in patients with irritable bowel syndrome. Annals of Gastroenterology. 2018;31:685-691.
- Choi CH, Chang SK. Alteration of hut microbiota and efficacy of probiotics in functional constipation. J Neurogastroenterol Motil. 2015;21(1):4-7.
- Miller LE, Ouwehand AC, Ibarra A. Effects of probiotic-containing products on stool frequency and intestinal transit in constipated adults: systematic review and meta-analysis of randomized controlled trials. Annals of Gastroenterology. 2017;30:629-639.
- Micka A, Siepelmeyer A, Holz A, Theis S, Schon C. Effect of consumption of chicory inulin on bowel function in healthy subjects with constipation: a randomized, double-blind, placebo-controlled trial. International Journal of Food Sciences and Nutrition. 2017;68(1):82-89.
- Watson AW, Houghton D, Avery PJ, Stewart C, Vaughan EE, Meyer PD, et al. Changes in stool frequency following chicory inulin consumption, and effects on stool consistency, quality of life and composition of gut microbiota. Food Hydrcoll. 2019;96:688-698.
- Jalanka J, Major G, Murray K, Singh G, Nowak A, Kurtz C. The effect of psyllium husk on intestinal microbiota in constipated patients and healthy controls. International Journal of Molecular Sciences. 2019;20(433): doi:10.3390/ijms20020433
- Kumar A, Kumar N, Vij JC, Sarin SK, Anand BS. Optimum dosage of ispaghula husk in patients with irritable bowel syndrome: correlation of symptom relief with whole gut transit time and stool weight. Gut. 1987;28:150-155.
- Ashraf W, Park F, Lof J, Quigley EM. Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. Aliment Pharmacol Ther. 1995;9(6):639-647.
- Tsurumaki M, Kotake M, Iwasaki M, Saito M, Tanaka K, Aw W, et al. The pplication of omics technologies in the functional evaluation of inulin and inulin-containing prebiotics dietary supplementation. Nutrition & Diabetes. 2015;5:e185.
- Jin YR, Jin J, Piao XX, Jin NG. The effect of taraxacum officinale on gastric emptying and smooth muscle motility in rodents. Neurogastroenterol Motil. 2011;23(8):766-e333.
- Nemeth V, Zulfiqar H, Pfleghaar N. Diarrhea. [Updated 2019 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448082/
- Money ME, Walkowiak J, Virgilio C, Talley NJ. Pilot study: a randomized, double blind, placebo-controlled trial of pancrealipase for the treatment of postprandial irritable bowel syndrome-diarrhoea. Frontline Gastroenterology. 2011;2:48-56.
- Yang B, Lu P, Li MX, Cai XL, Xiong WY, Hou HJ, et al. A meta-analysis of the effects of probiotics and synbiotics in children with acute diarrhea. Medicine. 2019;98:37(e16618).
- Hickson M, D’souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, et al. Use of probiotic Lactobacillus preparation to prevent diarrhea associated with antibiotics: randomized double blind placebo controlled trial. BMJ. 2007; doi:10.1136/bmj.39231.599815.55
- Mahattanadul S, Radenahmad N, Phadoongsombut N, Chuchom T, Panichayupakaranant P, Yano S, et al. Effects of curcumin on reflux esophagitis in rats. J Nat Med. 2006;60(3):198-205.
- Mahattanadul S, Nakamura T, Panichayupakaranant P, Phadoongsombut N, Tungsinmunkong K, Bouking P. Comparative antiulcer effect of bisdemethoxycurcumin and curcumin in gastric ulcer model system. Phytomedicine. 2009;16(4):342-351.