Let food be thy medicine
(Hippocrates)
It is the time of the year again when we indulge on food. The Christmas Holidays bring out the foodie in all of us, whether as a chef or as a food critic. Food is given as a gift, plays a central role in family and class reunions, and can make or break any gathering among friends and relatives. But is food and gastrointestinal nutrition also important for palliative and hospice patients?
One of the most neglected aspects of chronic care is nutrition. We are sometimes too focused on curative modalities involving drugs and procedures. Recovery from illness and improving the quality of life entails attention to gastrointestinal health and nutrition, for it allows the body to extract vitamins and minerals that will allow natural healing. Evidence shows that there are better outcomes when adequate nutrition is combined with medications.
The gastrointestinal (GI) tract is a complex system that plays a critical role in our overall health, particularly for individuals with chronic illnesses. A healthy GI tract is essential for processes such as nutrient absorption, immune response, and even mental health, all of which can significantly influence the management and progression of chronic conditions. (1)
At the core of a healthy GI tract's contribution to managing chronic illness is its role in nutrient absorption. The intestines are responsible for breaking down food into its constituent nutrients—vitamins, minerals, fats, carbohydrates, and proteins—that the body requires for energy, growth, and repair. For patients with chronic illnesses, deficiencies in these nutrients can exacerbate their conditions. Conditions like rheumatoid arthritis or inflammatory bowel disease (IBD) can lead to malabsorption issues and nutritional deficiencies, which may worsen inflammation and symptoms. A healthy gut can facilitate better absorption of anti-inflammatory nutrients such as omega-3 fatty acids, vitamins C and E, and other antioxidants.
The GI tract is also vital for effectively managing blood sugar levels. A diet rich in fiber, which promotes a healthy gut microbiota, can lead to improved insulin sensitivity and better blood glucose control.
Individuals with heart disease can benefit from the absorption of heart-healthy nutrients, such as potassium and magnesium, through a well-functioning GI tract, while also obtaining dietary fiber to manage cholesterol levels.
The GI tract houses about 70% of the body’s immune system. A healthy gut influences immune function via the gut-associated lymphoid tissues (GALT), which contain immune cells ready to respond to pathogens. For patients with chronic illnesses—especially those involving autoimmunity or chronic inflammation—the ability to modulate immune responses is particularly important. Conditions such as lupus or multiple sclerosis (MS) are characterized by an overactive immune response. A balanced gut microbiome, supported by a healthy diet rich in probiotics and prebiotics, can help regulate immune responses and reduce inflammation. This balance can also lower the incidence of autoimmune reactions, allowing for better management of symptoms.
For patients with chronic infections like HIV or those undergoing treatments that compromise the immune system, a healthy GI tract can improve overall health by ensuring adequate nutrient intake and facilitating gut health. This strengthens the immune response and may delay the progression of disease.
Emerging research emphasizes the gut-brain connection—how the state of the GI tract can influence mental health, mood, and cognitive function. Chronic illnesses often come with psychological challenges, including depression and anxiety. The gut microbiota produces neurotransmitters like serotonin and gamma-aminobutyric acid (GABA), which are crucial for mood regulation. Individuals with healthy gut flora often experience better mental wellbeing, which is essential since chronic illness can lead to stress and mental health challenges. (2)
Chronic stress can negatively impact gut health, leading to a vicious cycle where poor GI function exacerbates stress and anxiety. A healthy gut can improve resilience to stress and reduce anxiety levels.
Chronic inflammation is a hallmark of many illnesses, contributing to disorders such as diabetes, cardiovascular disease, and even certain types of cancer. To manage chronic inflammation, a healthy GI tract plays a pivotal role. Consuming a diet rich in whole foods, fiber, and fermented products can support a healthy gut microbiota. Foods like fruits, vegetables, whole grains, and probiotics (e.g., yogurt, sauerkraut) can help foster beneficial bacteria that combat inflammation. When fiber is fermented in the gut, it produces Short Chain Fatty Acids (SCFAs), such as butyrate, which can reduce systemic inflammation, fortify the gut barrier, and prevent the entry of harmful substances into the bloodstream. (3)
The GI tract also houses a significant part of the endocrine system. Hormonal balance is crucial in managing chronic illnesses, and a healthy gut plays a role in this balance.
Gut health can influence insulin sensitivity. A balanced microbiome can decrease insulin resistance, which is particularly beneficial for managing diabetes and obesity. Conditions like Hashimoto's thyroiditis highlight the interplay between gut health and endocrine function. The absorption of iodine and selenium—essential for thyroid health—depends on a well-functioning GI tract.
Digestive issues such as bloating, constipation, and diarrhea are common in chronic illness. These symptoms can detract from the quality of life and complicate disease management. Dietary adjustments that enhance gut health, such as increasing fiber intake and staying hydrated, can alleviate digestive symptoms. This, in turn, may improve adherence to treatment protocols and dietary recommendations that benefit overall health. A healthy GI tract maintains its barrier integrity, preventing leaky gut syndrome, where toxins and undigested food particles enter the bloodstream. This syndrome has been linked to various chronic illnesses such as autism, celiac disease, and inflammatory diseases.
For patients with chronic illness, nurturing a healthy gastrointestinal tract can lead to profound beneficial outcomes. Improved nutrient absorption, better immune system function, enhanced mental health, reduced inflammation, hormonal balance, and improved digestive function all contribute to a more effective management of chronic diseases. Thus, focusing on gut health through diet, lifestyle changes, and possibly probiotics can help improve not only quality of life but also the overall management of chronic health conditions. Ultimately, fostering a healthy gut can be a cornerstone strategy in the holistic management of chronic illness.
REFERENCES
Primary Health Care. 21, 6, 48-56. doi: 10.7748/phc.21.6.48.s15
Back to the future of psychoneuroimmunology: Studying inflammation-induced sickness behavior, Brain, Behavior, & Immunity - Health, Volume 18,2021, 100379, ISSN 2666-3546, https://doi.org/10.1016/j.bbih.2021.100379
Blaak, E.E., E.E. Canfora, S. Theis, G. Frost, A.K. Groen, G. Mithieux, A. Nauta, K. Scott, B. Stahl, J. van Harsselaar, R. van Tol, E.E. Vaughan, and K. Verbeke. "Short chain fatty acids in human gut and metabolic health". Beneficial Microbes 11.5 (2020): 411-455