Understanding digestive health
Digestive health is a crucial element for the overall health and wellbeing of the body. The digestive system consists of the gastrointestinal tract (mouth, oesophagus, stomach, small intestine, large intestine, rectum and anus), pancreas, liver and gall bladder. These organs work together to digest food. Through digestion, food is broken down into the components which are used by the body to grow and repair, namely the macronutrients carbohydrates, fats and proteins and micronutrients such as vitamins and minerals (1).
Common digestive diseases feature in the Global Burden of Diseases, Injuries and Risk Factors (GBD) study 2019 (2). It includes gastritis, peptic ulcer, gastroesophageal reflux disease, duodenitis, chronic liver diseases, cirrhosis, abdominal, femoral and inguinal hernias, intestinal obstruction and paralytic ileus, appendicitis, inflammatory bowel disease, pancreatitis, gallbladder and biliary diseases, vascular intestinal disorders and other groups of digestive diseases (2).
In 2019, due to digestive diseases, the disability adjusted life years (DALYs) were 88.99 million globally. This places digestive diseases globally at 13th leading reason of DALYs. Liver cirrhosis and other chronic liver diseases caused the highest proportion of global burden. Furthermore, DALYs were found highest in South Asia and middle sociodemographic index. It was also higher in men than women. Alcohol use is considered the leading causative factor of this situation(3).The United European Gastroenterology (UEG) reported that more than 332 million people in the Europe lived with digestive disorders in 2019 (4).
How does digestive disease work?
Lately, biomedical research has found human intestinal microbiota abnormalities associated with numerous acute and chronic health conditions. In cases like Clostridium difficile enterocolitis (infective inflammation of the large intestine) and intestinal inflammatory disease (IBD), a clinically significant contribution of microbiota abnormalities has been observed. However, in diseases which affect digestive organs other than the intestine, this impact is less evident. It can be concluded that the entire pathophysiology of the body is influenced by microbiota through endocrine, metabolic and systemic mechanisms (5,6).
Dysbiosis occurs when there is an alteration in the composition, or reduction in the diversity, of gut microbiota. Usually, increased pathogenic activity occurs in dysbiosis while the taxa with beneficial activities have a reduced representation. Overall diversity is usually ompromised in addition (7,8).
Dysbiosis is neither a disease nor a symptom, but it is involved with disease processes. It is a condition associated with a variety of diseases and can increase the risk of other health conditions. The microbiome in the human intestine has an immense impact on human pathology due to altering immune system function and levels of inflammation. Usually presenting primarily as digestive conditions to begin with, later stages can progress to influence metabolic, neural or hormonal diseases.
Understanding the root of digestive disease in Ayurveda
According to Ayurveda, the function of digestion, assimilation and metabolism in the body is governed by ‘agni’ or the digestive fire. This agni can be in four states (9):
- Mandagni: When the power or capacity of digestion, assimilation and metabolism is reduced.
- Teekshnagni: When the power or capacity of digestion, assimilation and metabolism is overactive.
- Vishamagni: When the power or capacity of digestion, assimilation and metabolism is unstable. Sometimes it is reduced and sometimes it increases.
- Samagni: When the power or capacity of digestion, assimilation and metabolism is normal.
To protect the body from illnesses one must protect the agni. Out of these four, when the agni is sama (samagni) it leads to good health, normal complexion, longevity, good immunity, normal strength, motivation and growth. The other states of agni are abnormal and lead to various illness.
Out of the three abnormal types of agni, mandagni is most common. It is believed that when the digestive capacity is compromised, the body is unable to digest food properly. When food is not digested well, it forms ‘ama’ (morbid material). Over time, this ‘ama’ starts accumulating in the body and becomes a root cause to many illnesses (10). Initially produced in the digestive tract, ‘ama’ then leaks into the surrounding tissues, leading to chronic inflammation as well as disruption of the tissue function (11).
Signs and symptoms
The classical Ayurvedic signs and symptoms of compromised digestive health are:
- Avipak (Indigestion)
- Gaurav (Lethargy)
- Utklesh (Nausea)
- Tiktamlodgar (Acid eructation)
- Gurukoshthatva (Heaviness in the abdomen)
- Aruchi (Anorexia)
- Vibandh (Constipation)
- Shiroruja (Headache)
- Diminished abhyavaharana (capacity of food intake) shakti (vital energy)
- Diminished jarana (digestive) shakti
- Yastvalpamapyupayukta annam mahata kalena pachati (Intake of small amount of food is digested after a long time)
- Udara gaurava (Heaviness in the abdomen)
- Shiro gaurava (Heaviness in the head)
- Antra kujanam (Gurgling noise in the abdomen)
- Anaha (Flatulence)
- Kasa (Cough)
- Shvasa (Dyspnoea)
- Praseka (Excess salivation)
- Chardi (Vomiting or nausea)
- Mukha shosha (Dryness of mouth)
- Gatra sadanam (Weakness)
- Lack of enjoyment of food
- Repeated episodes Kaphaja vikara
Herbal solutions for digestive disease
Turmeric (Curcuma longa)
Turmeric is renowned and prized for its digestive properties. It modulates the biodiversity of the microbiome. The best-researched chemical constituent is curcumin. Tremendous research has been conducted on the potential of curcumin and it has been found that it has substantial therapeutic and preventive activity against developing stomach ulcers, ulcerative colitis, heart disease, osteoarthritis, neurodegenerative disorders and cancer (12,13).
However, certain research shows that curcumin may not be effective (14), which is likely due to its poor bioavailability, traditionally countered by incorporating it into fats in cooking and serving it with black pepper, a synergist. Nonetheless, studies report its capability to modulate microbial communities and more thorough research is needed to understand this mechanism (15).
Triphala is ablend of the fruits of three plants, Emblica officinalis (Amalaki), Terminalia chebula (Haritaki) and Terminalia bellerica (Bibhitaki). For most rejuvenating and gastrointestinal disease treatments, triphala is used as a basic ingredient. It is widely used to aid stool evacuation, but its benefits stretch further than that. It modulates stomach acidity and stimulates hunger. Studies have confirmed its immunomodulatory, anti-inflammatory, antibacterial, hypo-glycemic, chemoprotective, adaptogenic, and antioxidant properties. It is reported that triphala contains polyphenols which promote the growth of a metabolically beneficial gut microbiome and inhibit the growth of harmful ones. It is suggested that the anti-inflammatory properties of triphala contributes to these changes (16).
Trikatu is a mixture of three herbs which classically comes under the category of ‘deepaniya gana’, meaning herbs which canignite the digestive fire. The three components are Pippali (Piper longum Linn.), Maricha (Piper nigrum Linn.), Shunti (Zingiber officinale). These herbs are traditional remedies for ‘ama.’ According to the Ayurvedic classical textbooks, trikatu is effective for mandagni (low digestive powder), malabsorption syndrome, piles and other major abdominal disorders (17). Furthermore, research suggests that it has the potential to enhance the bioavailability of other synthetic drugs and phytoconstituent within the body (18).
Psyllium (Psylium ovata)
The most commonly used part of psyllium is the mucilaginous seed coat. It is used for a variety of digestive and metabolic health conditions like inflammatory bowel disease, diarrhoea, constipation, colon cancer, diabetes and so on (19). It aids digestion and acts as a non-irritant natural laxative. It is believed to increase the moisture level of the stool, thereby easing bowel movements in constipation. It has the capacity to hold water and hence is useful in diarrhoea. It decreases gastrointestinal wall pressure and increases bowel movement. It is helpful in diverticulitis and haemorrhoids for the same reasons (20). Several studies have confirmed it as a safe and effective digestive remedy (19).
Ginger (Zingiber officinale)
Commonly found among household spices, ginger is an outstanding ingredient to aid digestion. It is commonly used in many digestive conditions and symptoms like nausea, vomiting, flatulence, dyspepsia, abdominal pain, cramps, colic etc (21, 22). The chief chemical constituents are gingerols, gingerdione and shogaol. The pungent resins and essential oils stimulate the secretion of gastric juices, saliva and bile. It is recommended to prevent motion sickness and sea sickness. Some researchers suggest that it possesses an antiemetic effect and modulate the serotonergic signalling (23).
Many spices like coriander, cumin, cardamom, cinnamon, fennel, fenugreek etc., also contribute to good digestive health.
Holistic solutions
Diet
The digestive health is best maintained with a wholesome diet and lifestyle.
Ayurveda is clear about which foods promote long-term health when consumed frequently and which are likely to undermine health when consumed frequently.
Suitable for regular use:
- Shali rice (varieties of Oryza sativa rice)
- Shashtika rice (Oryza sativa)
- Mudga (Vigna radiata, green gram)
- Amla (Phyllanthus emblica, Indian-gooseberry)
- Rock-salt, yava (Hordeum vulgare, barley)
- Ghee
- Milk
- Fresh water
- Honey
- Flesh of jangala animals (those living in an arid habitat)
Not suitable for regular use:
Foods which are difficult to digest, for example dried vegetables and meat, bisa ( Nymphaea alba Linn., stalk of lotus), shaluka (tuber of lotus meat from unhealthy animals, excessive dairy products, excess grains and heavy pulses.
Physical activity
Physical activity is important for both physical and mental wellbeing. One can choose from the wide range of options available. Some examples are walking, jogging, yoga, breathing exercises, mindful meditation etc. Regular, moderate exercise supports healthy digestion
Routine
Digestive health can be at its peak if one follows and routine. When you have a routine, then your body knows what to expect and when. Routine can help to eliminate unnecessary stress by allowing the body to function efficiently in terms of hormonal and neural signalling.
References
- U.S. Department of Health and Human Services. (n.d.). National Institute of Diabetes and digestive and kidney diseases (NIDDK). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/
- Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., … & Bhutta, Z. A. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1204-1222.
- Wang, R., Li, Z., Liu, S., & Zhang, D. (2023). Global, regional, and national burden of 10 digestive diseases in 204 countries and territories from 1990 to 2019. Frontiers in Public Health, 11, 1061453.
- Hepatology, T. L. G. (2023). Tackling the burden of digestive disorders in Europe. The lancet. Gastroenterology & hepatology, 8(2), 95.
- Ventura, M., Turroni, F., Canchaya, C., Vaughan, E. E., O’Toole, P. W., & van Sinderen, D. (2009). Microbial diversity in the human intestine and novel insights from metagenomics. Frontiers in bioscience, 14(1), 3214-3221.
- Cho, I., & Blaser, M. J. (2012). The human microbiome: at the interface of health and disease. Nature Reviews Genetics, 13(4), 260-270.
- Biagi, E., Franceschi, C., Rampelli, S., Severgnini, M., Ostan, R., Turroni, S., … & Candela, M. (2016). Gut microbiota and extreme longevity. Current Biology, 26(11), 1480-1485.
- Chang, C., & Lin, H. (2016). Dysbiosis in gastrointestinal disorders. Best practice & research Clinical gastroenterology, 30(1), 3-15.
- Charak Samhita. (2023, March 6). Grahani Chikitsa. Charak Samhita. https://www.carakasamhitaonline.com/index.php?title=Grahani_Chikitsa
- Mukta, Rao, M. V., & Arora, J. (2021). Efficacy of Samsarjanakrama in a patient with Agnimandya due to vyadhi sankar: A case study. Journal of Ayurveda and integrative medicine, 12(1), 182–186. https://doi.org/10.1016/j.jaim.2021.01.004
- Wallace, R. K. (2020). The microbiome in health and disease from the perspective of modern medicine and Ayurveda. Medicina, 56(9), 462.
- Aggarwal, B. B., Yuan, W., Li, S., & Gupta, S. C. (2013). Curcumin‐free turmeric exhibits anti‐inflammatory and anticancer activities: Identification of novel components of turmeric. Molecular nutrition & food research, 57(9), 1529-1542.
- McFadden, R. M. T., Larmonier, C. B., Shehab, K. W., Midura-Kiela, M., Ramalingam, R., Harrison, C. A., … & Kiela, P. R. (2015). The role of curcumin in modulating colonic microbiota during colitis and colon cancer prevention. Inflammatory bowel diseases, 21(11), 2483-2494.
- Nelson, K. M., Dahlin, J. L., Bisson, J., Graham, J., Pauli, G. F., & Walters, M. A. (2017). The essential medicinal chemistry of curcumin: miniperspective. Journal of medicinal chemistry, 60(5), 1620-1637.
- Shen, L., Liu, L., & Ji, H. F. (2017). Regulative effects of curcumin spice administration on gut microbiota and its pharmacological implications. Food & nutrition research, 61(1), 1361780.
- Peterson, C. T., Denniston, K., & Chopra, D. (2017). Therapeutic uses of triphala in ayurvedic medicine. The Journal of Alternative and Complementary Medicine, 23(8), 607-614.
- SINGH, B., UPADHYAYA, S., & NUNA, S. (2014). Critical Review of Trikatu in Ayurvedic classics. Dev Sanskriti Interdisciplinary International Journal, 4, 73-78.
- Kaushik, R. (2018). Trikatu-A combination of three bioavailability enhancers. International Journal of Green Pharmacy (IJGP), 12(03).
- Purohit, P., & Rathore, H. S. (2019). Isabgol: Aherbal remedy. World J Pharm Res, 8(7), 579-585.
- Chaplin, M. F., Chaudhury, S., Dettmar, P. W., Sykes, J., Shaw, A. D., & Davies, G. J. (2000). Effect of ispaghula husk on the faecal output of bile acids in healthy volunteers. The Journal of steroid biochemistry and molecular biology, 72(5), 283-292.
- Cupp, M. J. (2000). Toxicology and clinical pharmacology of herbal products (pp. 85-93). M. J. Cupp (Ed.). Totowa, NJ, USA:: Humana Press.
- Capasso, F., Gaginella, T. S., Grandolini, G., Izzo, A. A., Capasso, F., Gaginella, T. S., … & Izzo, A. A. (2003). Plants and the digestive system. Phytotherapy: A Quick Reference to Herbal Medicine, 251-294.
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