Irritable bowel syndrome: what you NEED to know.

Irritable bowel syndrome (also known as IBS, Inflammatory Bowel Disease ) is one of the most common gastrointestinal diseases.

Irritable bowel syndrome is a condition characterized by the presence of abdominal pain, intestinal discomfort and embarrassment , in the absence of other diseases in progress. About 15% of the world population is affected. Unfortunately, for those who suffer from it, there is an inevitable decrease in the quality of life. Irritable bowel syndrome in adults is, to date, a problem of global importance.

Irritable bowel syndrome is not to be confused with short bowel syndrome , which causes malabsorption following resection of the intestinal tract, called the small intestine.

What are the main symptoms?

It is a chronic gastrointestinal disorder characterized by variable abdominal pain and discomfort associated with impaired bowel motility. The pains, therefore, are not always constant nor always present.

The most common symptom is abdominal bloating . Others are:

• the urgent need to rush to the bathroom to evacuate ,
• abdominal tension due to the presence of air,
• flatulence
• sometimes presence of mucus in the stool.

Are there various types of IBS?

Yes. IBS subtypes are classified as predominant in diarrhea (IBS D), predominant in constipation (IBS-C), both diarrhea and constipation (IBS-M) or unspecified (IBS-U).

Irritable colon what to eat and what are the foods to avoid?

Nine out of ten individuals report that certain foods are associated with irritable bowel syndrome symptoms.

Two-thirds of individuals with IBS initiate dietary restrictions to improve them, and therefore diet management is an important option as part of medical treatment.

Unfortunately, if not followed by professionals, these food reductions can lead to situations of malnutrition , in particular energy and protein deficiencies that further negatively affect social and working life. Frequent, due to an altered intestinal permeability , is underweight, loss of muscle mass, alterations of the immune system, with consequent easy infections.

The main goal of nutritional treatment is to correct any nutritional deficiencies and achieve the correct nutritional status , as well as try to alleviate the symptoms . It may be necessary to resort to the introduction of a food supplement, based on nutritional needs.

The British Dietetic Association (BDA) first guidelines for the dietary management of IBS were developed several years ago, but lacked a comprehensive critical evaluation for all dietary management strategies, particularly in first-line approaches on a healthy nutrition and lifestyle.

Evidence has been developed on the efficacy of a diet low in oligosaccharides, disaccharides, monosaccharides and polyols (termed FODMAPs ) which certainly need further revision.

But let's focus on the diet . The salient points to pay attention to are the following:

Patients often associate their symptoms with a freshly eaten meal. About 90% of them restrict their diet to prevent or improve their symptoms. At present, there is emerging evidence that supports diets for IBS patients that are gluten-free (such as those with celiac disease) and with low levels of fermentable oligosaccharides , disaccharides, monosaccharides and polyols, including lactose (FODMAP).

Short-chain, poorly absorbed, and highly fermentable carbohydrates are collectively known as FODMAPs and are found in foods such as wheat, onions, some fruits and vegetables, sorbitol, and some dairy products. FODMAPs lead to increased water secretion in the small intestine and colon with fermentation, which causes an increase in the production of short-chain fatty acids and gases that cause flatulence.

FODMAPs do not cause gastrointestinal symptoms in a healthy adult. Conversely, they are a major trigger of meal-related symptoms in IBS patients.

• Fibers also play an important role. Patients with irritable bowel syndrome who experience constipation may have delayed intestinal transit. Therefore, dietary fiber has the task of accelerating it, improving the intestinal condition.

For nutrition, on the subject, there are some common questions and answers, which can be briefly summarized below:

• What effect does alcohol have on irritable bowel syndrome? It can make symptoms worse.
• Does caffeine make IBS symptoms worse? Yes, it would be necessary to evaluate a reduction in consumption
• What about spicy foods? It is good to be careful if you have a sensitivity towards these foods and in this case remove them from the diet
• Instead, the fatty foods? A reduction in fat intake may be helpful in relieving symptoms of IBS, particularly meal-related abdominal pain and discomfort associated with visceral hypersensitivity.
• In irritable bowel syndrome, does stress affect? Yes, it is good to learn to manage it to avoid greater acuity in the symptoms.

Other dietary tips

Following simple rules will help improve bowel syndrome or delay the onset of symptoms between one acute episode and the next.

1. Eat meals regularly, at constant times
2. Avoid skipping one meal, and get to the next with excessive hunger
3. Drink plenty of water, especially between meals
4. Reduce your consumption of other beverages, such as alcohol, soda, coffee and tea
5. In case of diarrhea, reduce the consumption of sorbitol, a famous sweetener found in some drinks and in candies and chewing gums
6. Do not exceed in the consumption of fibers, but at least drastically reduce them
7. Contact a professional to evaluate the possible intake of probiotics, or lactic ferments.

Natural remedies for irritable bowel syndrome:

The best known herbs that help reduce inflammation and intestinal spasms are for example: lemon balm, passionflower, valerian, fennel, chamomile, and grass. Furthermore, they are also useful for promoting digestion and reducing abdominal swelling.

Diagnosis of irritable bowel syndrome:

Patients with irritable bowels may experience constipation, diarrhea, or both. Identifying a patient's predominant bowel disorder plays an important role in both the selection of diagnostic tests and treatment.

Unfortunately, there is no specific diagnostic test , but the doctor, based on the history and the exclusion of other pathologies, can state that it is irritable bowel. It can therefore be said that the diagnosis is based on a symptomatic classification and is therefore called "exclusion".

What therapy is applied in case of irritable bowel syndrome?

There is not a single specific drug for ISB, but action is taken on various fronts. In fact, the following are used:

• Antispasmodic drugs
• Anxiolytic drugs
• Antidepressant drugs
• Antidiarrheal drugs
• And any other medications recommended by the doctor, based on the patient.

Physical activity

Physically active individuals, who therefore practice constant physical activity, show a faster transit of the colon than sedentary individuals. One clinical study found that targeted exercise intervention leads to improvements in IBS symptoms. Therefore, IBS patients should be encouraged to increase their physical activity. A simple recommendation is to take a 20-minute walk every day.

How does lactose intolerance, a subject dear to us, affect irritable bowel syndrome?

In case of lactose intolerance in conjunction with the irritable bowel pathology, it is necessary to have double attention.

The intestine of a healthy but lactose intolerant subject already tends to become inflamed if lactose is ingested. This inflammation can add to the ongoing inflammation in the case of ISB, leading the patient to worsen his physical condition and causing severe pain and colic.

In this case it is of utmost importance not to take foods containing lactose, and in the case of a meal of dubious composition, take a good oral lactase enzyme supplement .

Bibliography

1. William D. Chey et al. (2015) “Irritable Bowel Syndrome. A Clinical Review ". Clinical Review & Education
2. McKenzie et al. (2016) "British Dietetic Association systematic review and evidencebased practice guidelines for the dietary management of irritable bowel syndrome in adults". Journal of Human Nutrition and Dietetics
3. Bijkerk et al. (2004). "Systematic review: the role of different types of fiber in the treatment of irritable bowel syndrome". Aliment Pharmacol Ther 2004; 19: 245–251
4. Cartabellotta et al. (2016). "Guidelines for the management of irritable bowel syndrome in adults". Evidence
5. National Collaborating Center for Nursing and Supportive Care (UK) (2008). Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care.