Christmas Guts – intestinal function and festivities

Dr David Dowson explains how festive eating can affect your digestion and what you can do to minimise the effects

Some organs we can live without, such as the spleen, reproductive organs and sensory organs, even though the quality (and fun) of life might be affected. Other organs, such as the liver and heart can be transplanted, and artificial machines can take over the function of the kidneys. But, as yet, no artificial intestine has been made, and transplants have been spectacularly unsuccessful. Not only is the gut arguably the most important organ it is also, in terms of active area, the largest. Remember that the surface of the intestine is covered by villi, or finger-like projections, similar to a fluffy towel, and if these were all flattened out the area covered would be enormous. Some authorities say as much as 250 square metres. Nearly the size of a tennis court.

But the contents of the intestine are equally important - the natural, 'friendly' or commensal bacteria, essential not only to digestion but, as evidence is accumulating, to so many other physiological functions necessary to the body. These bacteria are effectively an organ within an organ.

So the intestine is in the front line in terms of health. If it's not working properly, nutrients will not be absorbed, irrespective of what is in the diet. Contrary to popular opinion we are not what we eat, but what we absorb.

A healthy diet contains a balance of six groups of nutrients: proteins, carbohydrates, fats, fibre, minerals and vitamins, and if the process of absorption is inadequate deficiencies of these will result.  Despite the popularity of taking vitamin supplements, if absorption is compromised, mineral deficiencies will probably develop first, resulting in fatigue, mental problems and poor immunity. Later there will be weight loss, skin and hormonal problems and the situation will eventually become self perpetuating as digestive disturbance reduces absorption further.

Symptoms of poor bowel function

Commonly the symptoms suggesting poor bowel function are dismissed as irritable bowel syndrome, a condition thought to affect around 20% of the U.K. population. But a recent study puts this figure at nearer 40%, which would indicate a condition of epidemic proportions. The symptoms are variable bowel action, a sense of bloating, abdominal pain and excess flatulence. Sadly this is often only treated symptomatically with antispasmodics and products containing fibre, and many sufferers are led to believe that it is a condition they have to 'learn to live with'.

If the bowel function is severely affected then secondary symptoms due to deficiencies may develop.  Fatigue, lethargy, poor memory (especially short-term), and reduced resistance to infection will be early signs of this.

Cause of poor bowel function

The most common reason for irritable bowel syndrome and the consequent poor bowel function is a dysbiosis. This is an imbalance of the normal friendly bacteria mentioned already. The facts behind these are mind-boggling. In a healthy intestine are at least a hundred million million bacteria and somewhere between four hundred and a thousand different species. The usual causes for a dysbiosis are stress, antibiotic over-use, other medications which alter acidity in the bowel, and altered diet, all of which are on the increase in the modern world.

Of concern is that in recent years there has emerged more evidence that the bacteria in the intestine are necessary for many other functions apart from optimising digestion. These include improving immunity, regulating cholesterol metabolism, and even probably having anti-cancer effects. Food intolerances (but not allergy) appear likely to be often due to a dysbiosis.


Probiotics are commercially available preparations containing live cultures of bacteria designed to correct and maintain the right balance in the intestine. But the problem is that there is such a wide variation in the formulation of these products - this is especially true in the UK as they are classified as a food product rather than a medication, and quality is consequently unregulated. And because they are regarded as natural rather than synthetic, patents cannot apply so incentive to perform research is minimal because of the lack of financial reward.

Many probiotic preparations emphasise the number of bacteria present, and give the impression that the more the better. But this is actually irrelevant because rapid multiplication of the bugs will take place when in the right environment of the intestine. What matters more is the number of species, because just eight make up the vast majority of the bacterial population. Some probiotics contain as little as two.


Prebiotics are inert chemicals which are not absorbed but act as carriers for bacteria in probiotics and encourage their growth. Usually they are oligo-saccharides, and evidence is accumulating that mineral absorption is enhanced by their presence. Fibre in the diet plays the same role, and perhaps the reason for low mineral levels is because of poor absorption from low intake of fibre. So good quality probiotics should contain a range of bacteria together with a prebiotic.

The function of the colon, or large intestine, is mainly to absorb liquid from the undigested sludge arriving from the small intestine into the more solid texture of normal human faeces. If this function is not performed correctly then diarrhoea develops, and this in turn can result in a dysbiosis. But there are two conditions which can affect the colon, and certainly affect it's function, although whether poor function is a cause is not known. These are ulcerative colitis, so-called because of the ulcers, often bleeding, along the colon, and Crohn's disease, a more severe inflammation, which can also affect the small intestine. Malignant disease of the colon is a relatively common cancer, but whether impaired function plays a role in the causation of this is not clear.

Cancer of the small intestine, on the contrary, is rare, and conditions due to an unhealthy small bowel are, as mentioned, mainly due to poor absorption of essential nutrients.  And it is vital to appreciate that there is little point in taking supplements when absorption is impaired. Poor bowel function may affect the efficiency of the liver and pancreas, but with a healthy diet and a good probiotic to improve intestinal function it is relatively easy to correct an unhealthy gut.

Reducing digestive problems over Christmas

Over the Christmas and New Year period the main risks to health are clearly from excess food and drink. But there is also an increased risk of infection because of increased personal contact with others, and probably a greater risk of injury through inebriation. It seems that there is little one could do to prevent the latter, but support can be given to the immune system and to the intestine and liver, which are the two main organs stressed due to festive behaviour.

The most important mineral for resistance to infection is zinc, and deficiency is common. The main dietary source is fish and other seafood, which is inadequate in most diets. Supplementation for a few weeks would be safe and cheap. There is one herbal medication - echinacea - which has a very long-standing reputation as an immune stimulant. Unfortunately good research on it is poor, contradictory and inadequate, but this is so with most 'natural' medication, probably because of vested interest (or dis-interest). Personal clinical experience has convinced me of its effectiveness, and hundreds of years of use is pretty persuasive evidence, irrespective of trials. It also appears to be a safe medication, and rarely causes side effects.

Another herbal medication, milk thistle, has a reputation as a liver 'tonic' for over 2000 years, again pretty strong evidence, but also hampered by poor quality studies. However an overview of research by the American Agency for Healthcare, Research and Quality, came to the conclusion that "there is strong evidence of legitimate medical benefits". Again clinical experience convinces me of its value, not only in protecting the liver but also in preventing - or at least reducing - hangovers. As milk thistle was used as a food in some cultures it is safe and with minimal side-effects.

There is another medication useful for hangovers, but as a treatment rather than prevention. This is ibuprofen (sold in the UK as Nurofen). It has long been known by medical students and junior hospital doctors, who have a reputation for alcohol excess and the resulting symptoms. Indeed the first use of ibuprofen was for this problem by its inventor, a Dr Stewart Adams, as he developed a hangover through celebrating his discovery and had to address a learned medical audience the morning after.  Following 600mg of ibuprofen he was able to do so with a clear head.


Overindulgence in food places excessive demands on the digestion as a whole, and often protein intake rises markedly around Christmas through increased meat and rich foods. Protein digestion depends particularly on enzymes produced by the pancreas, and these can be taken as a medication to prevent indigestion. 

Traditional yuletide foods are often low in fibre, and a probiotic containing a prebiotic can reduce the risk of digestive upset. Support to liver function, especially if alcohol intake is significantly higher, can help lessen the adverse effects of inebriation, and mineral supplementation can both improve immune function and support energy demand at a busy and sociable time of the year.

For more details on probiotics which might help your guts to cope:


First Published in December 2012

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