What is Irritable colon or Irritable Bowel Syndrome?

Irritable colon is also known as mucous colitis, irritable bowel syndrome, or spastic colon. It’s a bowel disease that causes abdominal pain, changes in intestinal transit, and alternating periods of constipation with decomposition or diarrhoea. Due to their symptoms, people who suffer from it may feel insecure about continuing their everyday life. Controlling the diet, that is, the food consumed, is a great help to avoid flare-ups, discomfort and pain and to ensure that the person can carry out daily tasks more calmly. Incidence and prominent symptoms of Irritable Colon

Irritable colon, whose correct name is Irritable Bowel Syndrome (IBS), is a disease that has a very different incidence depending on the country. In industrialised countries, such as Spain, stress is considered one of the leading causes. Therefore it has a psychosomatic origin.

The brain and the gut are closely related. A person’s mood directly influences intestinal secretions. When you feel fear, anger, disgust, or anxiety. Bile is secreted. Bitterness has the function of digesting fats in the intestine, but it is very laxative. Therefore, if a personal situation causes bile to be released in the intestine when digestion is not taking place, it is very likely that it will lead to diarrhoea.

The profile of people suffering from irritable bowel has changed a bit. Initially, it was seen mainly in middle-aged women, very hard-working and responsible, with a high level of self-demand and a controlling character. Currently, this disease also affects young people and even children.

Irritable colon is a chronic disease (although it can be temporary in some cases) that manifests with pain and abdominal distention. In addition, it also produces transit disorders such as diarrhoea, constipation or both alternated. IBS is characterised by abdominal pain or discomfort and changes in bowel movements’ frequency and consistency (ranging from diarrhoea to constipation), frequently accompanied by bloating, gas and abdominal distension.

The diagnosis of Irritable Bowel Syndrome is not easy. Therefore, when diagnosing it, the specialist doctor usually follows the Rome III criteria, which indicates that the abdominal pain must reappear at least three days a month during the last three months, in addition to two or more of the following signs:

• Improvement of symptoms after evacuation.
• The onset of symptoms after a change in stool frequency.
• More symptoms depend on changes in the shape or appearance of the stool.

Diet for irritable bowel

The diet of the person with irritable bowel syndrome should be personalised to each case. As general guidelines, we can highlight:

• Moderate the consumption of insoluble fibre (from whole foods) in the diet to prevent imbalances in intestinal transit.
• Promote the consumption of soluble fibre (in the form of gums, pectins and mucilages) in the diet. It can be done with the help of foods such as quince jelly or apples, although it is also recommended to take dietary supplements of this type of fibre daily.
• Avoid foods rich in fat, citrus fruits (especially oranges) and spinach to reduce and neutralise the laxative effect of bile salts (bile) in the colon.
• Reduce fructose consumption (a simple sugar found mainly in fruits). Choose the fruits that are poorest in sugar and richest in pectin, such as apples with skin. It is not appropriate to drink fruit juices or nectars.
• Eliminate the consumption of sorbitol (a sweetener), spicy foods or spices, gas (in beverages), coffee and tea.
• Drink two litres of water a day. It is essential to ensure hydration when there is decomposition or diarrhoea.
• Even if you comply with all the guidelines above, you should not forget that it is necessary to control stress. Natural help to combat and control stress levels are to take passionflower and valerian.

Foods for irritable bowel

Irritable colon, like other intestinal diseases such as Crohn’s and Ulcerative Colitis, has many personal intolerances. These intolerances caused by the disorder should not be confused with food allergies. The foods that most frequently cause discrimination and that, therefore, are recommended to avoid from the beginning are citrus, onion, chocolate, eggs, gluten (present in most cereals such as wheat, barley, rye and triticale), caffeine (present in coffee, tea and chocolate), the alcohol. Oatmeal deserves a separate mention since it is a cereal that, despite not having gluten, can cause intestinal discomfort in some patients due to prolamins (proteins whose peptide structure is very similar to that of gluten).

Irritable Bowel Syndrome and FODMAP diet

Researchers at Monash University in Australia developed the FODMAP diet. FODMAP is the sum of the initials of the English words in Spanish: Oligosaccharides, Disaccharides, Fermentable Monosaccharides, and Polyols, all of which are short-chain carbohydrates.

Thus, the FODMAP diet is a diet low in or without fructose, lactose, fructans, Galatians, and polyols. Present in the following foods:

• Fruits: like apple and pear.
• Vegetables: such as onion, asparagus and garlic.
• Legumes: such as peas, soybeans and lentils.
• Cereals: wheat and derivatives, rye and barley.
• Nuts.
• Dairy: such as milk, cheeses, ice cream and yoghurt. Assess tolerance.

What is the relationship between IBS and the FODMAP diet?

In some people, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols are not 100{15ad0633ef6f5d8a564bc2368b62315400163fe975a881d19c270b4a5569e8a8} absorbed in the small intestine. So these unabsorbed molecules continue on their way to the large intestine, where they act as food for the bacteria that usually live in it. There the bacteria digest/ferment the FODMAPs and cause the symptoms described in the definition of Irritable Bowel Syndrome.

Therefore, a low-FODMAP diet could help reduce the symptoms of Irritable Bowel Syndrome and other inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease.

Should gluten be eliminated from the diet?

The first thing is to determine who could benefit from a gluten-free diet. For this, it is essential to take the test to determine whether or not there is celiac disease or allergy to wheat. If the test is positive, then there is no question: remove gluten or grain from the diet. But if the opposite is the case, that the test is negative, a diet without gluten or wheat is not justified.

However, some people who are not celiac or allergic to wheat have a sensitivity to gluten that causes symptoms similar to IBS that usually disappear after a gluten-free diet. Therefore, it is essential to Know that foods that contain gluten, such as wheat, barley, rye and their derivatives, are high in FODMAPs. However, not all gluten-free foods are low in FODMAPs (such as onions) and not all foods with gluten are high in FODMAPs.

What do the studies say? Is there a consensus?

As a result of the first Australian investigations in 2005, several studies have been conducted to assess the FODMAP diet’s possible effect on Irritable Bowel Syndrome.

Research and health professionals doubt the design and efficacy of the diet as a treatment for IBS. This is because some studies have found little evidence to support the hypothesis. Furthermore, the studies available so far have significant limitations without forgetting that it is essential to follow the FODMAP diet by a dietitian-nutritionist to ensure compliance and avoid dietary-nutritional imbalances and that, at least in Spain, where there are no dieticians-nutritionists in Social Security, is complicated.

Concerning following a gluten-free diet when gluten sensitivity and IBS are present, several studies showed that the symptoms improved when gluten was removed from the diet and reappeared when it was reintroduced. Even so, in this case, too, not all experts agree and conclude that there are limitations in the published studies and doubt whether it is gluten or another wheat protein component responsible for the symptoms.

Steps to follow if you have Irritable Bowel Syndrome

1. Go to a gastroenterologist who, after confirming the diagnosis, will follow you up.
2. Make an appointment with a dietitian-nutritionist who will introduce the corresponding diet or guidelines after individually assessing your case. Generally, an exclusion diet is followed for 2-6 weeks until the symptoms disappear and food is gradually reintroduced. Always avoid very restrictive diets (they reduce beneficial bacteria for our intestine) and observe the food eaten and the signs from a record. Certain foods can be tolerated again by controlling the amount and frequency of consumption.
3. Evaluate psychological treatment. Psychological factors have not been shown to cause or influence IBS, but they can:

• Please lead us to believe that the abdominal symptoms are long-lasting and more severe.
• Reduce the quality of life and increase the use of health care services.

For these reasons, it is common for people with IBS to present anxiety, depression, somatisation, hypochondria, and fears related to the symptoms. In addition, the psychologist can give guidelines when managing stress since stress worsens the gastrointestinal symptoms of IBS.

4. Practice physical exercise. One study observed that after 12 weeks of physical activity (3-5 times per week, moderate-high intensity), nervousness due to gastrointestinal symptoms in patients with IBS was suppressed.
5. Eliminate alcohol and tobacco, sleep well and rest; although there is no clear evidence, they are positive changes.

The role of the dietician-nutritionist in the irritable colon

if you suffer from Irritable Bowel Syndrome, advice from a dietician-nutritionist is essential. At Alimmenta, you will find a team of dietitians-nutritionists specialising in treating inflammatory bowel diseases, a psychologist and a personal trainer who will help you improve your symptoms.