Many people in Nepal are suffering from conditions such as diabetes, heart disease, kidney problems and mental disorders. The focus for the prevention and treatment has always been on medications, changes in lifestyle and easy access to healthcare. However, we hear little about the importance of considering gut/intestinal health.

Gut health simply refers to the proper functioning and well-being of our intestines. Our gut is inhabited by trillions of microbes. Microbes are tiny, microscopic organisms, including bacteria, viruses and fungi. They outnumber the cells in our body. The diverse community of microbes is termed the ‘microbiome,’ whereas the total population of microbes is known as the ‘microbiota.’

Our gut is home to a mix of both beneficial and harmful microbes. Beneficial microbes produce compounds, such as essential vitamins and short-chain fatty acids. These acids are produced when the gut microbiota breaks down the dietary indigestible carbohydrate and helps nourish the intestinal cells to maintain the intestinal barrier. It also supports metabolism and immune function. On the other hand, harmful microbes can interfere with these processes and pose a threat to overall health.

Various factors, such as diet, genetics, age, antibiotics, environmental factors, disease conditions, physical activity, stress, smoking and alcohol consumption, shape the diversity of gut microbiota. In Nepal, it is vital to address these factors, as malnutrition, a growing preference for processed foods, the unregulated use of antibiotics and changing lifestyle patterns are rising. And along with that, the risk of altering gut microbiota composition and the associated health outcomes is increasing, which is alarming.

The impact of these factors is reflected in the public health data through Noncommunicable Diseases Risk Factors: STEPS Survey Nepal 2019. This survey involved people aged 15-69 years. According to this survey, unhealthy behaviour is on top of the list among Nepali people. The survey also found that 50 percent of men use smoke or smokeless tobacco. Those who do not smoke were also affected, as the study found that one-third of the population were exposed to secondhand smoke at home. Moreover, Nepali people consume approximately 10 grams of salt, which is nearly twice the World Health Organisation’s (WHO) recommended daily limit. Regarding the consumption of fruits and vegetables, only 3 percent of people meet the WHO guideline of eating at least five servings daily. Also, one in four adults has higher blood pressure, and a similar proportion is overweight.

Drinking water is another factor that can change the gut microbiota composition. Leaching of arsenic from Earth’s crust into the groundwater contaminates the water sources, and drinking the same water for a long time disturbs metabolic functions in the body, increasing the risk of getting hepatitis, type 2 diabetes and cancer. A study conducted in southern Nepal found that people exposed to arsenic through well water and other sources had altered their gut microbiota. Further investigation revealed that those individuals have higher levels of potentially harmful microbiota and reduced levels of commonly inhabiting beneficial microbiota.

The balance between beneficial and harmful microbiota is very important. When the number of harmful microbiota is higher than the beneficial ones, the balance is lost, a condition termed ‘gut dysbiosis.’ This loss of balance results in poor nutrient absorption, damages gut cells, creates pores in the gut, allows toxins produced by microbiota to enter the system and increases the risk of infections. It may result in chronic inflammation, diabetes, anxiety, metabolic disorders, heart disease and inflammatory bowel disease.

Gut microbiota do not act in isolation. They have been found to form communication networks with other organs, including the liver, heart, lungs, muscle and brain, through gut-liver, gut-heart, gut-lung, gut-muscle and gut-brain axes, respectively. This two-way communication shapes metabolism, guides immune responses and influences brain activity. This also means that these communications can influence how the heart works, how we experience emotions, and how our lungs cope with infections.

Curd (dahi) is a widely consumed probiotic in Nepal, especially after a heavy meal to help digestion. Lactobacillus spp. and Lactococcus spp. produce lactic acid and are present in the curd. These bacteria help break down lactose in curd, support digestion and reduce bloating. One species, Lactobacillus paracasei, has been genetically engineered with the potential to lower blood pressure in animal models.

Another gut microbiota, Faecalibacterium prausnitzii, has been found to lower the risk of chronic kidney disease. Trimethylamine produced by gut microbiota can reduce insulin resistance and exhibit anti-diabetic properties. Gut microbiota can also modify bile acids (produced by the liver to aid in fat digestion) and generate compounds that can increase the ability of immune cells to fight tumours. While future clinical trials are needed to confirm these findings and strengthen their clinical relevance, the preliminary evidence already shows that gut microbiota plays a pivotal role in maintaining overall health. It also provides a strong foundation for considering gut microbiota as a target for prevention and therapy against various disease conditions.

As Nepal struggles with rising rates of chronic diseases, paying close attention to gut health has never been so important. We cannot control gut microbiota-changing factors, such as age and genetics; however, other factors remain in our control. Staying physically active, consuming a balanced diet, incorporating probiotics (live beneficial microbiota) and prebiotics (food that feeds good microbiota), avoiding use of tobacco and alcohol, lowering daily salt intake, using antibiotics responsibly, consuming safe drinking water, and taking care of the gut can support a healthy gut and lay the foundation for a longer, healthier life.