Dear Othman, thanks for your questions.

If you're experiencing persistent symptoms such as excessive gas, watery discharge, and mucus in your stool, it's important to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

Excessive gas can have multiple causes, such as swallowing air, or related to one's eating habits, consuming gas-producing foods (like beans, legumes, onions or garlic), or underlying digestive issues like irritable bowel syndrome (IBS) or lactose intolerance (diary products).

Some times gluten sensitivity may cause symptoms such as abdominal pain and discomfort, or bloating and excessive gas. Foods high in gluten include things like; wheat (bread, pasta, cereals), barley, rye.

It is important to exclude conditions such as inflammatory bowel disease as well especially if you have symptoms such as mucoid or bloody stool.

8. Question by ST Leng

Hi Dr, I have two questions:

1) Trend question: What type of gut illness do you see more and more these days? What are the common causes?

2) What are the key considerations in keeping your gut healthy? Things/foods to avoid, or do/eat more of?

*When talking about food, please give actual examples by saying “such as...” because if you say “fibre”, “fermented foods”, or “nutrients”, I may be imagining the wrong things.

Thank you!

Answer by Dr Bernard Koh

Dear ST Leng, thanks for your questions.

1) In fact, a lot of the time, in primary care we do still see a lot of undifferentiated symptoms related to the gastrointestinal tract such as; nausea and vomiting, heartburn and reflux, abdominal pain and diarrhoea, change in bowel habits for investigation. We often work closely with the gastroenterologists in the restructured hospital for further investigations and work up.

Of course the common gut ailments which are seen in primary care are things like acute gastroenteritis (commonly referred to as stomach flu) and we also do preventative and chronic disease monitoring for conditions like chronic viral hepatitis.

Gut health and the concept of gut microbiome and how the gut microbiodata works synergistically with the rest of our bodies' functions is an exciting new area of medicine/gastroenterology.

2) Simple measures you can take to improve your gut health:

Evaluate your diet and consider reducing or eliminating foods that are known to trigger digestive issues, such as high-fat foods, spicy foods, artificial sweeteners, carbonated beverages, and certain types of vegetables (e.g., broccoli, cabbage, onions).

Stay Hydrated: Drink plenty of water to keep your digestive system running smoothly.

Stress can negatively impact gut health, so try relaxation techniques like meditation, yoga, or deep breathing exercises.

Overeating can lead to discomfort and bloating, so try to eat smaller, more frequent meals.

Both alcohol and caffeine can irritate the digestive tract, so consume them in moderation.

Regular physical activity can help improve digestion and promote gut health.

9. Question by Vanessa

Hi Dr,

I have the following queries on gut health:

1) Does probiotics supplements like duolac really help to improve gut health? Does yakult help?

2) How do we know stomach pain and constipation is due to digestive issues or something more serious?

3) What are the natural ways (in terms of food) to improve gut health?

Appreciate your reply. Thanks

Answer by Dr Bernard Koh

Dear Vanessa, thanks for your questions.

1) Probiotics are beneficial bacteria that can support a healthy balance of gut flora and aid digestion. They can be obtained through certain foods and supplements. While yogurt and cheese can be good sources of probiotics, the specific strains and quantities of beneficial bacteria can vary.

If you're looking for a probiotic supplement, it's best to consult with a healthcare professional who can recommend one based on your individual needs and health history.

Remember that while probiotics can be helpful for some people, they may not work the same way for everyone.

2) I agree that tummy aches and constipation are generally rather vague symptoms which can point towards a myriad of different conditions. Only a thorough medical assessment will be able to narrow the possible causes and find out the underlying cause for your symptoms. However, there are several general factors to consider which may suggest something more serious and alert one to seek medical attention urgently.

If the stomach pain and constipation are persistent, severe, or worsening over time, it is advisable to seek medical attention. Chronic or severe symptoms, or new symptoms which change over the course of time, could suggest an underlying condition that requires evaluation.

Some red flag symptoms to pay attention to include: blood in the stool, unexplained weight loss, fever, vomiting, or difficulty or painful swallowing (list not exhaustive).

If you have a family history of gastrointestinal conditions such as inflammatory bowel disease, or colon cancer, it may increase the likelihood of similar issues and warrant closer medical attention.

3) Simple measures you can take to improve your gut health:

Evaluate your diet and consider reducing or eliminating foods that are known to trigger digestive issues, such as high-fat foods, spicy foods, artificial sweeteners, carbonated beverages, and certain types of vegetables (e.g., broccoli, cabbage, onions).

Stay Hydrated: Drink plenty of water to keep your digestive system running smoothly.

Stress can negatively impact gut health, so try relaxation techniques like meditation, yoga, or deep breathing exercises.

Overeating can lead to discomfort and bloating, so try to eat smaller, more frequent meals.

Both alcohol and caffeine can irritate the digestive tract, so consume them in moderation.

Regular physical activity can help improve digestion and promote gut health.

10. Question by Violet

Dear Dr,

I had been diagnosed with IBS and it is almost a daily problem with bloated stomach, particularly if bowel movements cannot occur daily. I drink prune juice every night, however, it is sourish…how to reduce bloatedness, as it is highly uncomfortable, sometimes resulting in acid reflux at night?

Also, I love yuzu, lemony drinks, coffee…cannot cut it off completely, but is there an advisable moderate level of consumption that would be compatible with an IBS environment

BTW, I am on Vivomixx, Meteospasmy and Dexilant Deslansoprazole. Thank you.

Answer by Dr Bernard Koh

Dear Violet, thanks for your questions!

IBS or irritable bowel syndrome is a common gastrointestinal condition that affects the large intestine. It is a functional disorder, which means that while it does not cause any physical damage or structural abnormalities in the digestive tract, it can lead to symptoms which are bothersome and chronic. Patient with IBS can experience symptoms such as; abdominal pain and discomfort, altered bowel movements, bloating and ga, changes in stool appearance, and mucus in the stool.

Some possible ways to help reduce bloating may include:

1) Identify trigger foods that worsen bloating and gas. Common triggers include certain types of carbohydrates like the FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), spicy or fatty foods, dairy products, and carbonated drinks. Keeping a food diary can help you keep track of what you eat and identify potential triggers.

2) Increasing fibre intake may help with bloating symptoms. Food high in fibre include fruits and vegetables, and whole grains. However some people may find that increased fibre intake may exacerbate symptoms, so do keep tract of your food intake.

3) Eating smaller more frequent meals, while making sure you chew your food thoroughly before swallowing may help with bloating symptoms. This helps aid digestion and thus reduce bloating.

4) Regular exercise can help promote healthy digestion and reduce stress, which eases some symptoms of IBS

5) Smoking and alcohol and irritate the digestive system, thus eliminating this from ones lifestyle can help with symptoms of IBS.

11. Question by Penelope

Hi Dr, I have three questions:

Q1) I have recently come across articles that claim whole grains are not good for our digestive system. Is this true?

Q2) What is the recommended diet to avoid bloating of stomach. This happens to me after every meal even if diary and carbs were not consumed. Tried taking supplements like digestive enzymes, pro-biotics and peppermint gels – all to no avail.

Q3) How can you tell if a person has faecal impaction?

Thank you.

Answer by Dr Bernard Koh

Hi Penelope, thanks for your questions!

1. The statement that whole grains are not good for our digestive system is not entirely true. Whole grains can actually provide several benefits for our digestive health when consumed as part of a balanced diet.

Whole grains, such as whole wheat, brown rice, oats, quinoa, and barley, are grains that contain all three parts of the grain kernel; the bran, germ and endosperm. They are rich in fiber. Fiber is important for maintaining a healthy digestive system as it adds bulk to the stool, aids in regular bowel movements, and can help prevent constipation. It also supports the growth of beneficial gut bacteria, which is essential for optimal digestion.

Additionally, whole grains contain valuable nutrients like vitamins, minerals, and antioxidants, which contribute to overall health and well-being. They also have a lower glycemic index compared to refined grains, meaning they cause a slower and steadier rise in blood sugar levels, which gives sustained energy supply and prevents one from feeling hungry too fast.

However, it's worth noting that some individuals may have specific digestive issues or sensitivities that make consuming whole grains less favorable. For example, people with gluten sensitivity should avoid gluten-containing grains like wheat, barley, and rye. In such cases, alternative grains like gluten-free oats, quinoa, or rice can be suitable options.

If you have concerns about how whole grains may affect you personally, it's always a good idea to consult with a healthcare professional can who can provide personalized advice based on your individual needs.

2. There are various reasons or causes as to why one may experience bloating of the stomach or dyspepsia after meals:

a. Certain gastrointestinal conditions such as irritable bowel syndrome, inflammatory bowel disease, or reflux disease can cause symptoms such as upper abdominal bloating or dyspepsia.

b. Some individuals with food intolerances or sensitivities like lactose intolerance or gluten sensitivity may result in abdominal bloating or gas. It may be worthwhile to seek the opinion of a dietician or medical professional to determine the exact cause.

c. Sometimes one's eating habits may also contribute to the sensation of fullness or gas after meals. Eating too quickly, or consuming large quantities of food can cause stomach distension, leading to feelings of bloating and discomfort. Eating smaller, more frequent meals and eating slowly may help with some symptoms.

3. Fecal impaction may be suspected based on symptoms described by the patient and also during a physical examination by a doctor when a digital rectal examination is performed.

Fecal impaction may occur when large volume of hardened stool gets stuck in the rectum or lower large intestines, leading to symptoms like; constipation, painful defecation, abdominal pain or discomfort/bloating, sensation of imcomplete voiding, and loss of appetite.

It is important to inform your primary healthcare provider of such symptoms you are facing so that a thorough assessment can be done to elicit the cause. Potential treatment options include the use of oral laxatives or suppositories or manual evacuation of the hardened stool.

12. Question by Mei Yun

Dear Dr,

Question 1: Does too much gas (from the rear end) has anything to do with our gut health? If yes, what can we do to reduce such gas?

Question 2: Excessive and embarrassing stomach noises - are they due to gut health?

Thank you!

Answer by Dr Bernard Koh

Hi Mei Yun, thanks for your questions! Your questions are related to issues of bloatedness, and some possible ways to help reduce bloating may include:

1) Identify trigger foods that worsen bloating and gas. Common triggers include certain types of carbohydrates like the FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), spicy or fatty foods, dairy products, and carbonated drinks. Keeping a food diary can help you keep track of what you eat and identify potential triggers.

2) Increasing fibre intake may help with bloating symptoms. Food high in fibre include fruits and vegetables, and whole grains. However some people may find that increased fibre intake may exacerbate symptoms, so do keep tract of your food intake.

3) Eating smaller more frequent meals, while making sure you chew your food thoroughly before swallowing may help with bloating symptoms. This helps aid digestion and thus reduce bloating.

4) Regular exercise can help promote healthy digestion and reduce stress, which eases some symptoms of IBS

5) Smoking and alcohol and irritate the digestive system, thus eliminating this from ones lifestyle can help with symptoms of IBS.

13. Question by Ronald

Dear Dr Koh,

I would like to ask Is there a way to reduce gastrocolic reflex?

Answer by Dr Bernard Koh

Dear Ronald,

The gastrocolic reflex is a normal physiological response of the digestive system, but for some individuals, it can be more pronounced of sensitive, leading to increased bowel movements after eating. Reducing its impact can be helpful for people who experience discomfort or urgency due to this reflex.

Large meals may stimulate a stronger gastrocolic reflex, eating smaller more frequent meals while chewing food thoroughly may help alleviate some symptoms.

Some foods, especially those high in fat, oils, spices, or caffeine may stimulate a stronger reflex in certain individuals. Keeping a food diary which tracks your symptoms may help.

14. Question by Christine

Dear Dr Bernard Koh,

My son, age 40 years, is suffering from severe schizophrenia and he is on a list of medications – olanzapine, chlorpromazine, epilim, lexotan and faverin. He is also taking concor for his heart. He is also taking laxatives like lactulose daily and sometimes together with Dulcolax tablets.

I am concerned about his gut health. All his medications from IMH causes severe constipation. He has to be on a low fibre diet for the past 20 years. He can only take fish and eggs and refined bread but not chicken or pork or beef or vegetables. I do give him plenty of water to drink daily and fruits like papaya, kiwi and honeydew. Green leafy vegetables is only one tablespoon a meal. He has been taking the same diet daily for the past years. Any changes to his diet and the constipation will come back.

How can I improve his gut health? He is slightly anaemic and underweight. He has weakened immunity and nutrients deficiency.

Does the laxatives wash all his food nutrients away each time he takes them?

Which brand of probiotics should he take? How about vitamin supplements? He cannot take iron supplements because of his constipation.

Thank you for your advice.

Answer by Dr Bernard Koh

Dear Christine,

Thanks for your questions. I sympathize with your caregiver burden. Caring for a loved one with chronic disease is not easy. Multiple long term medications do have the potential to cause constipation. It is prudent to ensure one’s diet is regular and consistent and also maintaining hydration will help with constipation. Regular exercise and stress relaxation techniques are some simple ways to combat symptoms of constipation. I do advice that if you do suspect he has vitamin o nutrient deficiencies to seek the advice of his regular IMH doctor or a nutritionist/dietician to help advice on supplementation.

15. Question by Sanford

Dear Dr,

Is drinking Kefir more effective for promoting gut health compared to Yoghurt drink? What are the most effective drinks and/or food to consume to promote gut health but without also having too much sugar or sodium/salt or otherwise unhealthy ingredients?

Answer by Dr Bernard Koh

Dear Sanford,

Kefir and yogurt can be effective in promoting gut health due to their probiotic content. Both kefir and yogurt contain live probiotic cultures that can colonize the guy and help balance the gut microbiome. Probiotics can help support overall digestive function and help alleviate symptoms of gastrointestinal issues like diarrhoea and constipation. Kefir and yogurt’s probiotic content can also help regulate the immune response and contribute to a healthy immune system. Some probiotics have also been shown to have anti inflammatory properties, which can be beneficial.

Try to choose plain, unsweetened varieties of yogurt and kefir to avoid added sugars and artificial ingredients. It may also be wise to start introducing these foods into your diet slowly and monitor your response to these ingredients if you are trying them for the first time.

16. Question by Vicky

Hi Dr,

Is it safe or recommended to be on long-term probiotics supplementation (such as Lactogg) for maintaining gut health and for IBS condition?

Answer by Dr Bernard Koh

Dear Vicky,

In general, probiotics are safe for long term consumption. However do monitor your individual response as probiotics effects can differ from person to person. Some people may experience limited effectiveness or adverse effects from it. Also, if you have other medical co-morbidities, you should consider seeking the advice of a healthcare professional or nutritionist if you plan to take probiotics long term.

17. Question by Mrs Wong

Dear Dr, I’m interested to know:

What are early signs of poor gut health to look out for?

The types of food that can affect gut health - What foods can harm your gut? Are there foods that protect or strengthen it?

Answer by Dr Bernard Koh

Hi Mrs Wong, thanks for your questions.

Some signs of an unhealthy gut includes the following. You should consult a doctor immediately should you experience any of these "red flags"

• Unintended weight loss

• Persistent or severe abdominal pain

• Bloody or black stools

• Fever

• Signs of dehydration (e.g., dry mouth, reduced urination)

• Family history of gastrointestinal disorders or colon cancer

Here are some tips to maintain good gut health with regards to diet and lifestyle:

1) Evaluate your diet and consider reducing or eliminating foods that are known to trigger digestive issues, such as high-fat foods, spicy foods, artificial sweeteners, carbonated beverages, and certain types of vegetables (e.g., broccoli, cabbage, onions).

2) Stay Hydrated: Drink plenty of water to keep your digestive system running smoothly.

3) Stress can negatively impact gut health, so try relaxation techniques like meditation, yoga, or deep breathing exercises.

4) Overeating can lead to discomfort and bloating, so try to eat smaller, more frequent meals.

5) Both alcohol and caffeine can irritate the digestive tract, so consume them in moderation.

6) Regular physical activity can help improve digestion and promote gut health.

18. Question by Carol

Dear Dr Bernard Koh,

What are early signs of poor gut health to look out for?

Types of food that can affect gut health - What foods can harm your gut? Are there foods that protect or strengthen it?

What can I do to improve my gut health?

When should I consult a doctor?

Answer by Dr Bernard Koh

Hi Carol,

Thanks for your questions.

Some signs of an unhealthy gut includes the following. You should consult a doctor immediately should you experience any of these "red flags"

• Unintended weight loss

• Persistent or severe abdominal pain

• Bloody or black stools

• Fever

• Signs of dehydration (e.g., dry mouth, reduced urination)

• Family history of gastrointestinal disorders or colon cancer

Here are some tips to maintain good gut health with regards to diet and lifestyle:

1) Evaluate your diet and consider reducing or eliminating foods that are known to trigger digestive issues, such as high-fat foods, spicy foods, artificial sweeteners, carbonated beverages, and certain types of vegetables (e.g., broccoli, cabbage, onions).

2) Stay Hydrated: Drink plenty of water to keep your digestive system running smoothly.

3) Stress can negatively impact gut health, so try relaxation techniques like meditation, yoga, or deep breathing exercises.

4) Overeating can lead to discomfort and bloating, so try to eat smaller, more frequent meals.

5) Both alcohol and caffeine can irritate the digestive tract, so consume them in moderation.

6) Regular physical activity can help improve digestion and promote gut health.

19. Question by Ivy

Dear Dr Koh,

Can you please tell me the answer for the following:

• What are early signs of poor gut health to look out for?

• Types of food that can affect gut health - What foods can harm your gut? Are there foods that protect or strengthen it?

• What can I do to improve my gut health?

• When should I consult a doctor?

Thanks.

Answer by Dr Bernard Koh

Dear Ivy, thanks for your questions.

Some signs of an unhealthy gut includes the following. You should consult a doctor immediately should you experience any of these "red flags"

• Unintended weight loss

• Persistent or severe abdominal pain

• Bloody or black stools

• Fever

• Signs of dehydration (e.g., dry mouth, reduced urination)

• Family history of gastrointestinal disorders or colon cancer

Here are some tips to maintain good gut health with regards to diet and lifestyle:

1) Evaluate your diet and consider reducing or eliminating foods that are known to trigger digestive issues, such as high-fat foods, spicy foods, artificial sweeteners, carbonated beverages, and certain types of vegetables (e.g., broccoli, cabbage, onions).

2) Stay Hydrated: Drink plenty of water to keep your digestive system running smoothly.

3) Stress can negatively impact gut health, so try relaxation techniques like meditation, yoga, or deep breathing exercises.

4) Overeating can lead to discomfort and bloating, so try to eat smaller, more frequent meals.

5) Both alcohol and caffeine can irritate the digestive tract, so consume them in moderation.

6) Regular physical activity can help improve digestion and promote gut health.

Ref: I23