Irritable bowel syndrome: when digestion causes problems

Abdominal pain, constipation, flatulence, diarrhoea or cramps: around a quarter of Germans suffer from non-specific digestive disorders. This is referred to as irritable bowel syndrome (IBS). As there is no underlying disease, IBS is difficult to diagnose and treat. Find out more about irritable bowel syndrome in our blog post.

A bloated belly every evening? Do you get abdominal pain as soon as you get hectic? If you suffer from the same symptoms over and over again, you may have irritable bowel syndrome. The problem: irritable bowel syndrome does not have a classic symptom. The form of the illness can vary greatly from person to person. In addition, other illnesses or causes that cause similar symptoms (e.g. allergies, intolerances, gastrointestinal infections, side effects of medication) must be ruled out. It is therefore not uncommon for irritable bowel patients to have a veritable odyssey of visits to doctors' surgeries and clinics behind them before a diagnosis is made. Anyone who suspects irritable bowel syndrome should consult a competent gastroenterologist or not shy away from seeking a second medical opinion.

Irritable bowel syndrome: the causes

The exact causes of irritable bowel syndrome are not yet known. Only certain factors are known to play a role in its development. In some patients, for example, a dysregulation of the innate immune system in the gut appears to be partly responsible. Experts have also discovered an increased number of proteases (protein-splitting enzymes) and an activation of certain receptors in the intestinal mucosa. It is assumed that this increases the permeability of the intestinal wall and weakens the barrier function. Certain signalling molecules (e.g. chemokines) also appear to have an influence. A deficiency of IL-8, CXCL-9 and MCP-1 was found in the intestinal mucosa of IBS patients. These signalling molecules are particularly important in intestinal defence reactions. Irritable bowel syndrome can also be triggered by an infection and persist for months to years.

Just like the symptoms, the triggers can also vary greatly from person to person. As a result, there is no single remedy that helps all patients. Drug treatment for irritable bowel syndrome is aimed more at alleviating the symptoms than fighting the cause. Prescription or over-the-counter medicines, probiotics or herbal agents (e.g. flaxseed, fennel and peppermint) are used here. A study shows that some patients can also benefit from supplementation with amino acids L-glutamine. L-glutamine is an important source of energy for the cells of the intestinal mucosa and ensures an intact intestinal wall.

However, it is not only physical causes that can cause irritable bowel syndrome or worsen the symptoms. Psychological factors also play an important role. Stress reduction and relaxation exercises are therefore also important components of treatment.

The right diet for irritable bowel syndrome

Which diet is best for IBS has not yet been sufficiently proven by studies. In addition, there are great individual differences in what is tolerated. In addition to the "what", the "how" also influences the symptoms. You should therefore take your time when eating and eat slowly and consciously. Experts often recommend the so-called FODMAP diet for irritable bowel syndrome. The abbreviation FODMAP stands for fermentable oligo-, di- and monosaccharides and polyols (= fermenting oligo-, di- and monosaccharides and polyols). In the case of hypersensitivity (not to be confused with intolerance), these nutrients are not broken down sufficiently and enter the large intestine, where they are broken down by bacteria with increased gas formation.

Omitting certain carbohydrates and sugar alcohols should therefore improve irritable bowel syndrome. These include Fructose (e.g. in fruit and as a sweetener in processed foods). in fruit and as a sweetener in processed foods),lactose (in milk and dairy products), oligosaccharides (such as in pulses) or the sugar substitutes  sorbitol and xylitol (e.g. in chewing gum). Some experts also recommend avoiding gluten-containing foods such as wheat products. Avoiding spicy, strongly flavoured or salty foods and drinks containing caffeine can also help.

In the FODMAP diet, all foods containing the suspected ingredients are initially banned. One group is then gradually added back to the diet and tested to see how well it is tolerated. Foods that aggravate the symptoms should therefore no longer end up on the plate in the long term.

Vegan diet for irritable bowel syndrome

No wheat and no pulses: The FODMAP diet can be a little monotonous for vegans. Wheat and soya products are important sources of plant-based protein. Milk and dairy product alternatives based on rice, coconut, almonds or oats can be an alternative here. You should also make sure you eat enough cereals such as (gluten-free) oats, rice, buckwheat, amaranth or quinoa. You can use a food and symptom diary to find out which foods are good for you and which are too much for your digestive tract.

Sources

• www.reizdarmselbsthilfe.de
• Q. Zhou et al. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut 2018; doi: 10.1136/gutjnl-2017-315136. [Epub ahead of print]
• P. Layer et al. S3 guideline irritable bowel syndrome. Z Gastroenterol 2011; 49: 237-293