GUT HEALTH

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

“Gut health” describes how well your digestive system works—from the mouth to the large intestine—and the balance of trillions of microbes (the gut microbiome) that help digest food, produce vitamins, train the immune system, and communicate with your brain via the gut–brain axis. (The gut-brain axis is an intricate network which allows the gut and brain to influence each other’s functions and health. It connects the central nervous system (brain and spinal cord) with the intestinal nervous system (the nervous system of the gut).)

When this ecosystem is balanced (called eubiosis), digestion, immunity and even mood tend to run smoothly.

When it’s disturbed (dysbiosis), symptoms and disease risks can rise.

International guidelines recognise diet (especially fibre), infections, medication—particularly antibiotics—and stress as major shapers of microbiome health.

GUT HEALTH IN SOUTH AFRICA

Low fibre, high ultra-processed foods: In a 2024 study of low-income South African adults, average fibre intake was 17.4 g/day (below the minimum 25 g/day target), and ultra-processed foods made up a large share of energy intake. Only a minority met fibre guidelines.
Obesity—especially in women: Obesity is far more common in South African women than men; reviews report around 68% of women classified as overweight or obese, with obesity starting young. Excess body fat and low-fibre diets are both linked to gut dysbiosis.
Antibiotic overuse: There was a 50% annual growth in antibiotic use by South Africans between 2020 and 2022, mainly in the private sector—overuse disrupts the microbiome and fuels antibiotic resistance.
Colorectal cancer (CRC): CRC is a major, rising cancer in South Africa; CANSA’s 2024 fact sheet (NCR 2022) and local studies show substantial early-onset disease (people younger than 50 years). South Africans are generally advised to begin screening for CRC from age 50 for average risk, earlier if you’re high-risk.

SYMPTOMS OF AN UNHEALTHY GUT

If you’re experiencing any of the below most days of the week for more than 4–6 weeks, speak to a healthcare provider:

Bloating, abdominal pain, excessive gas, reflux/heartburn
Constipation, diarrhoea, or alternating bowel habits; mucus or blood in stool
Unintentional weight loss, anaemia, persistent fatigue
Skin flares (e.g. acne, eczema), frequent infections, or worsening mood/anxiety (via the gut–brain axis)

CONSEQUENCES OF POOR GUT HEALTH

Nutrient shortfalls (iron, B-vitamins) from restricted diets or malabsorption.
Metabolic risks (weight gain, higher blood sugar, fatty liver) associated with low fibre and high consumption of ultra-processed foods.
Infections and antibiotic resistance: disrupted microbiomes are more vulnerable to disease, while unnecessary antibiotics increase the risk of infection recurrence as well as antibiotic resistance.
Higher risk for gastrointestinal disease, including ulcers (H. pylori), Inflammatory Bowel Disease flares, and possibly colorectal cancer over time.

Common gut conditions include:

1. Eat more fibre - aim for 25-30g/day
Build meals around whole foods: legumes (samp & beans, lentils, cowpeas), whole-grain pap/bread, oats, brown rice, high-bran cereals, vegetables and fruit (especially skins), nuts and seeds.

Aim to eat at least 30 plants per week (count different fruits, veg, grains, legumes, herbs) to feed diverse microbes.

SA dietary guidance advises: “Enjoy a variety of foods” and “Make whole-grain starchy foods the basis of most meals”.
2. Cut back on ultra-processed foods
Ultra-processed foods are linked to lower fibre and higher sugar/salt/fats. Swap sweetened drinks, flavoured yoghurts, processed meats and instant noodles for water/rooibos, plain maas or yoghurt plus fruit, eggs/beans, and minimally processed staples.
3. Consider fermented foods and products
Eating fermented foods daily like amasi/maas, plain yoghurt, kefir, and fermented vegetables can support microbial diversity.

Probiotics may help in specific situations (e.g. some IBS subtypes, antibiotic-associated diarrhoea), but strains and doses matter; use evidence-based products and avoid unrealistic claims.
4. Be antibiotic-smart
Only use antibiotics when prescribed; and ask if a delayed script or narrow-spectrum option is appropriate. Complete the full course when indicated. This protects your microbiome and helps curb South Africa’s rising antibiotic consumption.
5. Move, sleep, de-stress
Regular physical activity, 7–9 hours of sleep, and stress-reduction practices (breathing exercises, walking, social connection) support a healthier gut–brain axis and bowel rhythm. Exercise has been shown to improve constipation and IBS symptoms in trials.
6. Hydrate
Water and rooibos are excellent options. Adequate fluids keep your stool soft and support the benefits of fibre.
7. Track your triggers (especially for IBS)
Keep a 2-week symptom and food diary. Common contributors include poorly absorbed fermentable carbs (FODMAPs)*, very fatty meals, caffeine, alcohol and artificial sweeteners. A short-term, dietitian-guided low-FODMAP trial can help some IBS patients—but be sure not to self-restrict your diet long-term, as food diversity matters.

*Examples of FODMAPs include Fructans (in garlic, onions, and wheat), Fructose (in fruits like apples and honey), Galactans (in beans and lentils), Lactose (in dairy products), and Polyols (in fruits like pears and sugar alcohols like sorbitol). These are carbohydrates poorly absorbed in the small intestine that are fermented in the colon, potentially causing digestive symptoms.
8. Screen when appropriate
In South Africa, average-risk adults are generally offered screening for colorectal cancer from age 50 (earlier if you have symptoms, a family history, inflammatory bowel disease, or are of higher risk). Discuss options like stool tests and colonoscopies with your healthcare provider. Bonitas’ Be Better Benefit provides an annual stool test for colon cancer for members between ages 45 and 75.

H. pylori (bacteria that can infect your stomach): If you have persistent upper-abdominal pain or ulcers, ask about non-invasive testing and evidence-based eradication (considering local antibiotic resistance).

GOOD GUT HEALTH SNAPSHOT

Base every meal on whole-grain starch + veg/fruit + lean protein (beans, fish, chicken, eggs) and add a high-fibre side (beans/lentils/salad).
Include one fermented food daily.
Aim for 8–10 cups of fluid, mostly water/rooibos.
Move most days (walk 30 minutes).
Medicine check-in: review chronic meds with your clinician if you have new gut symptoms; some drugs affect your body’s ability to move through food your gut and/or your gut biome.
Have regular health screens.

GUT HEALTH

GUT HEALTH

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

GUT HEALTH IN SOUTH AFRICA

SYMPTOMS OF AN UNHEALTHY GUT

CONSEQUENCES OF POOR GUT HEALTH

HOW TO IMPROVE AND MAINTAIN YOUR GUT HEALTH

GOOD GUT HEALTH SNAPSHOT

FURTHER READING