Air pollution can cause digestive issues: Doctors

Experts explain how pollutants ingested through food can disturb gut microbiome

Even ten days after Diwali, Delhi continues to battle with heavy air pollution.  Mumbai, on the other hand, is now in the ‘moderate’ category.  

A recent report by IANS highlighted how doctors in Delhi noted rising cases of digestive issues like irritable bowel syndrome (IBS) and irritable bowel disorder (IBD). Mumbai doctors say that with the current pollution levels, such cases may increase in the future. The AQI classifications are as follows: 0-50 is 'good,' 51-100 is 'satisfactory,' 101-200 is 'moderate,' 201-300 is 'poor,' 301-400 is 'very poor,' and 401-500 is 'severe’.

To raise awareness about the role of air pollution in digestive issues, mid-day.com spoke to Dr Khurshed Vazifdar, consultant gastroenterologist, Holy Family Hospital in Bandra, and Dr Harshad Joshi, principal consultant, gastroenterology, Nanavati Max Super Speciality Hospital in Vile Parle, to understand its effects.

How does air pollution affect the body beyond respiratory diseases?
Vazifdar: Air pollution contributes to cardiovascular issues, neurological disorders, and gastrointestinal problems. Pollutants can disrupt gut microbiota and increase inflammation, leading to various health complications.

Joshi: Air pollution is not limited to harming the respiratory system. It has widespread impacts on multiple organs due to its ability to induce oxidative stress and inflammation. Pollutants like particulate matter (PM) can penetrate deep into the body, affecting the circulatory, nervous, and gastrointestinal systems. 

How does it affect the body in different ways?
Vazifdar: Effects of air pollution on one’s body arise from individual susceptibility, exposure duration, and the specific pollutants involved. For instance, particulate matter can penetrate the gut barrier, affecting immune responses and gut health differently.

Joshi: Airborne pollutants, particularly fine particulate matter (PM2.5), can enter the bloodstream via the lungs, causing systemic effects. Once in circulation, these particles trigger inflammation and oxidative stress, which disrupt normal cellular function across various organs, including the gastrointestinal tract and brain. 

A recent report highlights how Delhi air pollution has led to increasing cases of Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). How does air pollution affect the digestive system? 
Vazifdar: By causing inflammation and altering gut microbiota composition. Pollutants like PM2.5 can trigger stress responses in digestive cells, leading to conditions like IBS and IBD.

Joshi: Pollutants ingested through food or inhaled can disturb the gut microbiome and weaken the intestinal lining, which can lead to systemic inflammation and oxidative damage in the gastrointestinal tract. Air pollution has been shown to alter the gut microbial composition, increase gut permeability, and exacerbate inflammatory pathways, creating conditions favourable for IBS and IBD. 

What are the effects on the digestive system on the whole? 
Vazifdar: Increased permeability of the gut lining, inflammation, and a higher risk of disorders such as IBS, IBD, and gastroesophageal reflux disease (GERD) due to disrupted gut microbiota.

Joshi: Pollutants may aggravate digestive conditions, leading to increased susceptibility to diseases like IBS, IBD, and even appendicitis. 

What are its symptoms?

Vazifdar: Symptoms include abdominal pain, bloating, diarrhoea, and constipation. These symptoms can overlap with other conditions but are often exacerbated by environmental stressors like pollution.

Joshi: In severe cases, it can also lead to flare-ups of conditions like IBS and IBD. Unlike respiratory symptoms, these gastrointestinal symptoms stem from disruptions in gut microbiota and immune responses rather than direct exposure effects. 

Some people already suffer from Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). Does air pollution worsen it for them? 
Vazifdar: For individuals with IBS or IBD, air pollution can worsen symptoms by increasing gut inflammation and disrupting microbiota balance, potentially leading to flare-ups or more severe manifestations of their conditions.

Joshi: This heightened response is due to the systemic inflammatory response and oxidative damage caused by air pollutants.

With Delhi's air quality worsening, is there a possibility of people suffering from these diseases in Mumbai? Have you encountered cases yet or in the past years?
Vazifdar: Mumbai may see rising cases of IBS and IBD due to worsening air quality similar to Delhi. There have been reports of such cases in recent years, indicating a growing concern for digestive health linked to pollution.

Joshi: While Delhi faces more severe air quality issues, Mumbai’s air pollution levels are also concerning. It is plausible for individuals in Mumbai to develop or experience worsening of IBS and IBD due to pollution. While cases may not be as frequently reported as in Delhi, urban pollution in Mumbai could contribute to a rise in gastrointestinal disorders.

Does one particular gender get affected more by air pollution than the other, especially beyond respiratory diseases? Which is the most vulnerable population?
Vazifdar: Gender differences in vulnerability to air pollution exist. Studies suggest women may be more affected due to hormonal factors influencing immune responses. The vulnerable populations include children and those with pre-existing health conditions.

Joshi: Although evidence is limited, some studies suggest that women, particularly young adults, are more susceptible to non-respiratory impacts of air pollution, including gastrointestinal symptoms. Children and the elderly, with their developing or weakened immune systems, are also vulnerable to the systemic effects of pollution.

What is the treatment for issues related to the digestive system due to respiratory diseases?
Vazifdar: The treatment involves managing symptoms through dietary changes, medications for inflammation, and lifestyle modifications aimed at reducing exposure to pollutants.

Joshi: The treatment often involves managing inflammation and symptoms with dietary adjustments, probiotics, and anti-inflammatory medications. Those with IBS or IBD may benefit from tailored therapeutic regimens, including prebiotics, probiotics, and in some cases, biologics to mitigate inflammation.

Can dietary changes help?

Vazifdar: Dietary changes can help prevent IBS and IBD, emphasising whole foods rich in fibre, antioxidants, and anti-inflammatory properties while avoiding processed foods that may exacerbate symptoms.

Joshi: A balanced diet high in fibre, antioxidants, and probiotics can support gut health and potentially lower the risk of inflammation due to pollutants. Foods rich in polyphenols (for example: berries and nuts) and omega-3 fatty acids can also aid in reducing oxidative stress in the gut.

What level of air quality AQI is harmful?
Vazifdar: An AQI above 150 is harmful, particularly for sensitive groups; individuals should limit outdoor activities during high pollution days and consider using air purifiers indoors.

Joshi: Beyond an AQI above 150, exposure to PM2.5 or higher levels can be detrimental to the gastrointestinal system. Avoiding outdoor activities during high AQI days, using air purifiers, and consuming antioxidant-rich foods to combat oxidative stress are practical steps.

Share easy tips to follow to avoid getting sick due to air pollution.
Vazifdar: Staying indoors on high AQI days, using air purifiers, wearing masks outdoors, maintaining a healthy diet, and staying hydrated to support overall health will be helpful.

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