Why 68 per cent of urban Indians are prone to obesity, diabetes, and high blood pressure

A survey on gut health of urban India, conducted by Country Delight and Indian Dietetic Association (IDA) - Mumbai Chapter, revealed that 7 out of 10 people suffered from gastric issues. Digestive problems like acidity/heartburn topped the list while constipation and indigestion were found to be frequent among the participants of the survey.

The three-city-wide (Mumbai, Delhi, and Bengaluru) survey was carried out to understand the digestive health of urban Indians and assess their perception of comorbidities associated with gut health. A total of 2017 people from the age group of 25-50 years were surveyed, 50 per cent of the respondents were males and 50 per cent were females. The survey also found that 59 per cent of the respondents complained every week while 12 per cent suffered daily.

Midday Online spoke to Ms. Naaznin Husein (Executive committee Member, IDA), Ms. Zamurrud Patel (President, IDA Mumbai Chapter), and a city-based nutritionist Vipul Sanadhya to understand the factors that affect gut health. Experts also delve into measures to maintain a good gut aura for keeping obesity, high blood pressure, and diabetes at bay.

What are the factors contributing to the poor gut health of Indians?
Digestive/gut health issues are a significant concern for a majority of Indians. Some of the factors that contribute to poor gut health include consuming junk, ultra-processed, and packaged food. As per the Gut Health Survey, binging on junk food is a leading cause of gastric issues. Experts at IDA reveal that there is a strong gut-brain connection that has implications for mental health. Digestive issues can lead to stress, anxiety, and mood swings as well.

The survey reveals that modern-day lifestyle has led to a rise in stress and poor quality of sleep among people, with more than half of the respondents experiencing these issues regularly. Women, in particular, face several health concerns related to lack of energy, mood swings, feeling low, and anxiety. Other long-term lifestyle diseases caused by poor gut health include obesity, high blood pressure, and type-2 diabetes.

The findings of the survey reveal that:
1. 63 per cent of respondents consume junk, processed, and packaged food every week.
2. 68 per cent suffer from gastric issues every week among those who eat processed food.
3. 66 per cent of respondents believe that fast food or chemically processed food caused them gut health issues.

Nutritionist Sanadhya shares how diet plays a major role in affecting gut health. "Surprisingly, 70-80 per cent of calories in a typical Indian diet come from carbohydrates. Most of these carbohydrates are of an inferior quality like sugar, flour-based products, bread, and starchy snacks. Indians on average consume 15 teaspoons of sugar which are 4 times more than what WHO recommends!"

Consequently, the excessive consumption of tea and coffee diluted with sugar has a detrimental effect on our gut health. The growing inclination towards Western fast food like pizza, burgers, fried pasta, etc adds to a load of carbohydrates that our system isn't used to handling. A typical Indian diet is deficient when it comes to first-class sources of protein and protein is the most satiating macronutrient. Lack of protein leads to overconsumption of food and eventually leads to obesity and other lifestyle disorders.

How is gut health linked to obesity?
The bacteria in our gut sit on the linings of the intestine and come in contact with the food we eat. This affects the absorption of nutrients contained in the food. Also, various hormones are responsible for calibrating our appetites like leptin and ghrelin. Some studies have shown that gut bacteria affect how much of these hormones are produced which then impacts our hunger levels. Sanadhya observed that few studies have associated limited gut bacteria diversity with obesity.

Gut health influences how the consumed food gets digested. It has been reported that the gut microbiomes increase energy production from food, cause low-grade inflammation, and impact fatty acid tissue composition. These mechanisms link the gut microbiota with obesity. Gut Health Survey found that 80 per cent of the people affected by poor health developed obesity issues.

How is gut health linked to the case of high blood pressure and diabetes?
Experts at IDA reveal that the ingested food is transformed by the gut microbiome into small metabolites. "These metabolites, food antigens, and gut microbes together contribute to immune homeostasis. Disturbances to the symbiotic relationship between the host and the microbiome can lead directly or indirectly, via the immune system, to changes in blood pressure."

Few studies have discovered an association between lower insulin sensitivity with a particular bacterium called Flavonifractor. On the other hand, higher levels of gut bacteria from a group called Coprococcus, are associated with higher insulin sensitivity. High-fat, high-carbohydrate, low-fiber diets modify the intestinal microbiota. This gut dysbiosis leads to a leaky gut, increased intestinal permeability and, thereby the occurrence of metabolic endotoxemia eventually causing inflammation, insulin resistance, and type-2 diabetes.

What is the composition of a good gut health system?
The gut system is the gastrointestinal tract that includes the mouth, esophagus (food pipe), stomach, small intestine, and large intestine. Gut health covers the health of the entire digestive system of our body which essentially breaks down the food we eat into nutrients that can be used by our body. Good gut health is when a person has healthy gut microbiota, linings of the intestines are intact so that unwanted particles do not cross the intestine and get into the bloodstream, and the person isn't having issues with digesting food like bloating or gas.

The absence of gastrointestinal symptoms such as acidity, heartburn, diarrhoea, and, constipation is also a sign of good gut health. A healthy gut is characterised by a good balance of good bacteria which can be enhanced by leading a healthy lifestyle. This can be achieved with regular physical activity, and consuming a balanced diet consisting of good quality protein, fresh fruits and vegetables, and dairy products. This reduces the predisposition for diabetes, and cardiac disease while also improving mental health.

What are the factors that affect the wellness of gut health?
Sanadhya shares essential elements that comprise the wellness of gut health:

Diet
The food we eat has a major impact on our gut health. It's good to consume prebiotics and probiotics, limit alcohol intake and eat fibre rich diet.

Mental health
A healthy state of mind is directly proportional to a healthy gut. Studies have found that stress and anxiety lead to gastric issues. Constant high levels of stress are detrimental to the overall body, primarily the gut.

Use of antibiotics
Antibiotics do not differentiate between good or bad bacteria and hence end up attacking the good bacteria as well which leads to dysbiosis in the gut microbiome.

Lifestyle Factors
Factors like exposure to toxins, inadequate sleep, smoking cigarettes, and alcohol consumption also impact gut health negatively.

Intolerances
Food intolerances can trigger a host of abnormalities in the gut causing bloating, diarrhoea, fatigue, acid reflux, etc.

What are some steps that can help in maintaining a healthy gut?
Sixty per cent of the surveyed people felt that their diet played an important role in preventing lifestyle diseases or digestive issues. Experts at IDA recommend switching to a balanced diet consisting of chemical-free fresh fruits, vegetables, good quality proteins, complex carbohydrates, high fibre, healthy fats, and low-fat dairy products.

Sanadhya shares that it is good to consume Prebiotics (food for the bacteria) like onion, garlic, chicory roots, asparagus, cocoa, etc, and Probiotics (live strains of bacteria) like curd, yogurt, sauerkraut, kimchi, pickles, etc. Fiber-rich foods like green leafy vegetables are also good for maintaining a healthy gut. Getting adequate sleep and exercising regularly are also essential steps to keep the gut strong.

Gut Health Survey showed that around 67 per cent of people have modified or made changes to their lifestyle by changing their dietary habits and becoming more physically active. Overall, 6 out of 10 people look for chemical-free food items for their daily consumption.

Also Read: Diabetes on rise among youngsters in India: Expert speaks about the reasons behind the chronic disease and ways to manage it