Gut feelings: how what you eat could be affecting your health - and what to do about it

Gastrointestinal (GI) involvement affects around 90% of people living with systemic sclerosis (SSc), and this can have a dramatic impact on quality of life. Symptoms vary from person-to-person, and if untreated, there may be long-term complications. The GI tract runs from the mouth all the way to the back passage and although treatment is crucial for controlling symptoms and slowing disease progression, there is also evidence that diet could play a role in managing symptoms and maintaining quality of life.

The human gut is a highly complex aspect of the body that has attracted growing interest in recent years, as we continue to realise the true scope of its role in keeping us well. Whilst nutrition is always important in a healthy lifestyle, when we think about GI tract involvement in SSc this becomes even more significant, because symptoms can affect what someone is able to eat and digest comfortably. There is also evidence to suggest that certain dietary changes may help to control symptoms, and many people (although by no means everyone) report that diet does indeed make a difference.  

Keep a food diary

Just as scleroderma affects everyone differently, there is no ‘one-size-fits-all’ approach to dietary management. It is important therefore to start by looking closely at what you eat and trying to identify any possible reactions.

Keeping a food diary for at least four weeks will help you to understand the relationship between your body and the food you eat. It is not always easy to remember everything, so writing it all down may help to show how certain foods may be affecting how you feel, for better or for worse.

Start a new page each day and try to record how you feel whilst you eat, as well as afterwards and even a day or so later. Sometimes with scleroderma, foods may take longer to digest so any reactions may be delayed. Consider noting not only your GI symptoms, but also your energy and mood that day, along with how you slept during the night.

Balancing bacteria

Gut microbiota or gut flora refer to the trillions of bacteria that naturally live in the human gut. This is an area that has gained momentum over recent years, as we begin to better understand the possible role of gut flora in our health, including immune reactions.

This dense microbiome within the human digestive system has multiple functions, including the absorption of nutrients and preventing disease. ‘Good bacteria’ help to promote health and wellbeing and reduce inflammation. There are also the unfriendly or ‘bad’ bacteria,’ that may actually promote inflammation within the bowel. In fact, the true significance of gut bacteria upon mental and physical health is still very much under investigation.

Dysbiosis means an imbalance amongst the gut bacteria, which can be an aggravating factor in autoimmune diseases, including SSc. This can cause digestive discomfort and even make symptoms worse. A study from the USA in 2016 found that patients with scleroderma had higher levels of the unfriendly bacteria that might promote inflammation, and lower levels of the good bacteria that could protect against this.

Bacteria are largely sustained by the food we eat and are maintained by prebiotic fibres. Diet can therefore affect the microbiota, which may then impact upon health and symptoms. To help maintain the good bacteria, think about what you eat. If you can tolerate them, a wide range of plant-based foods including fruits, vegetables and wholegrains will help to boost your intake of the prebiotic fibres that nourish healthy gut bacteria. There may be plenty of products on the market claiming to have similar effects, however, always talk to your doctor before introducing anything new.

Try to avoid foods that are overly processed, such as processed meats and ready meals. These contain higher levels of artificial additives, which are thought to suppress the good bacteria and even encourage their unfriendly counterparts, which in turn may lead to inflammation and feeling worse. Another American study from 2018 found that certain additives had a negative effect on microbiota balance, leading to issues including inflammation in study participants.

Leaky gut syndrome

Leaky gut syndrome means increased intestinal permeability; and once again there seems to be a growing interest surrounding this concept. The gut lining acts as a barrier that prevents harmful agents from entering the bloodstream. Leaky gut occurs when this barrier is compromised, allowing certain toxins to escape. This may cause inflammation, along with imbalances in gut bacteria, with some studies associating a leaky gut with certain autoimmune conditions. There is evidence to suggest that a change in diet may help a leaky gut, although these generally focus on healthy eating and reducing aspects such as alcohol, added sugar and processed foods.

This information is intended to serve as a general reference only. If you would like to explore any of these aspects further as they relate to your health, please talk to your doctor or visit nhs.uk.

We would like to thank Dr Elizabeth Volkmann, MD, MS., (Assistant Professor of Medicine, Director, UCLA Scleroderma Program, Co-Director, CTD-ILD Program, Division of Rheumatology, Department of Medicine, University of California, Los Angeles); for her support and guidance in producing this article.

References:

Volkmann et al., Association of Systemic Sclerosis With a Unique Colonic Microbial Consortium.  Arthritis Rheumatol. 2016 Jun;68(6):1483-92. 

Cani PD, Human gut microbiome: hopes, threats and promises. Gut 2018;67:1716-1725.