Taking Care of Your Gut

Health food trends come in waves and with the interest in digestive health, there have been loads of articles about the benefits of apple cider vinegar, then alkaline water followed by the current popularity of fermented foods such as kefir and kombucha. We got the lowdown on all these health food trends and to get the necessary information on how to best care for your guts from A/Prof Gwee Kok Ann, Adjunct Associate Professor of Medicine at the National University of Singapore and practicing gastroenterologist at Gleneagles Hospital.

Also, learn how you can win yourself a set of DUOLAC probiotics (worth S$129.80) at the end of the article!

Q: What are some of the common misconceptions about health food trends regarding gut health?

Apple Cider Vinegar

Bragg Organic Apple Cider Vinegar

There is no scientific evidence that apple cider vinegar is effective for bloating or gas. In fact, the only study conducted on apple cider vinegar concludes that apple cider vinegar slows down gastric emptying, which can possibly worsen bloating and gas. However, those with no delayed gastric emptying may still find apple cider vinegar helpful for digestion as it may help to increase stomach acid and may also be antimicrobial in nature.

Alkaline Water

Despite the many health claims made by alkaline water drinkers and sellers, there’s little scientific evidence that alkaline water is healthier than other kinds of drinking water. Given the increasing recognition of the role that gut bacteria play in supporting overall health, perhaps drinking high-grade, reclaimed water such as NEWater in Singapore, could be more useful.

Probiotics and Diarrhoea

Probiotics is proven effective in one particular type of diarrhoea, Clostridium Difficile diarrhoea. This type of diarrhoea is caused by C. difficile colonising the intestinal tract after an alteration of the normal gastrointestinal flora, usually by antibiotic therapy. In such cases, probiotics can help by restoring the normal gut flora.

Probiotics also showed some benefits in traveller’s diarrhoea, IBS-diarrhoea, inflammatory bowel disease such as Crohn’s disease. However, probiotics is not a cure for all types of diarrhoea. For example, bloody diarrhoea i.e. dysentery, when the use of antibiotics can be life-saving.

Vegetarian Diet

The benefits of a vegetarian diet for gut health are dependent on the type of vegetarian food one consumes and should be considered on an individual basis.

Beans and legumes are high in FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) which can cause digestive problems such as bloating and gas for those intolerant to FODMAPs. On the other hand, for others who are not intolerant to FODMAPs, these food products contain prebiotic fibre which helps the growth of the beneficial bacteria in gut.

It is also important to note that while dietary fibre and adequate fluid intake are useful in regulating bowel habits in healthy individuals, it does not work for people who suffer from severe chronic constipation. That is because chronic constipation is not a dietary problem, but due to a problem of gut dysfunction. In fact, scientific faecal analysis informs us that bacteria contribute more to the stool form than dietary fibre intake. Detailed dietary studies also inform us that a vegetarian diet does not protect people from developing colon cancer. Furthermore, the latest scientific research informs us that the gut bacteria may have a protective effect against colon cancer.

Q: Is stool frequency an indication of good gut health?

Stool frequency is not a very good indicator of good gut health as it is highly dependent on individuals. Some people naturally have a bowel movement a few times a day, while others go just a few times a week. It is only when there is a drastic change in your normal bowel movement then you need to be concerned about your gut health.

There is no optimal frequency as it is highly dependent on an individual’s usual bowel habits. Personally, I would think that the optimal frequency is that which allows the person to feel comfortable.

Q: Can a person feel constipated even if he or she passes motion everyday?

Even if you pass motion every day, you may still feel constipated if the stools are too hard, too small and straining to pass. A common complaint from people who feel constipated is the feeling of incomplete bowel emptying.

Q: Can probiotics promote good gut health?

Yes, probiotics are ‘good’ bacteria, and they modify and balance out gut microbiota. In short, probiotics have been shown to useful in the following:

  • Inhibiting the growth of disease-causing bacteria
  • Enhancing the immune system’s barrier functions
  • Helping fight inflammation
  • Reducing gas production by balancing the gut flora
  • Reducing the gut’s sensitivity to gas build up
  • Improving mental health

However, it is important to note that fermented foods are not the same as probiotics (live bacteria conferring health benefits when consumed in adequate numbers). Not all fermented foods contain live organisms. Beer and wine, for example, undergo steps that remove the organisms. Other fermented foods are heat-treated, and as a result, the organisms are inactivated.

Live organisms are present in fermented products to perform the fermentation (i.e., convert milk into yogurt or cheese, or cabbage into kimchi). These cultures do not necessarily have any probiotic functions. Cultures are not probiotic unless they have clinical evidence of conferring a health benefit.

Nonetheless, fermented foods can be incorporated as part of a balanced, healthy diet. Just remember that some fermented food, such as kimchi, can have a high salt content (people with hypertension, heart or kidney disease have to be more cautious).

A/Prof Gwee Kok Ann, who is also the immediate past president of the Asian Neurogastroenterology & Motility Association


Q: What are the criteria consumers should be reviewing when choosing a probiotic supplement? Is looking at the CFU enough?

Colony-forming unit (C.F.U) is a unit of measurement used to quantify the number of actively dividing bacteria cells. A higher C.F.U does not equate to a better outcome. Some analysis suggests that sometimes when the concentration is very high, the amount of bacteria packed into a capsule could become too dense for it to be released in the intestine. Thus, the probiotic capsule would essentially be useless.

The recommended range for daily probiotic consumption is between 1-10 billion CFUs. Nonetheless, some CFU claims may be unreliable as health supplements are usually not monitored. Hence, it is advisable to choose products with scientifically proven heat-protecting technology or heat-stable strains that do not require refrigeration. Technology such as dual-coated technology is also important to improve the stability of bacteria and ensure their survival against gastric acid and bile acid until they reach the large intestine and perform the necessary functions.

Multi-strain probiotics also appear to show greater efficacy than single strains but choosing the right strains is equally important. This is because research has shown that some strains seem to be more effective than others for treating certain conditions.

In Singapore’s context, probiotics ideally should be lactose-free as most of the Asian population is lactose intolerant to a certain extent.

Those with IBS symptoms may also consider gluten-free probiotics as gluten is considered a high FODMAP diet which can worsen the condition.


We have 3 sets of DUOLAC probiotics worth S$129.80 to giveaway! All you have to do is answer this question: “What does FODMAP stand for?” Email your Answer, Name, Address and Contact no. to [email protected] by 15 November 2018. Winners will be announced on 16 November.


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Photos: A/Prof Gwee Kok Ann, DUOLAC, Redmart and Pixabay


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