Irritable bowel syndrome, when eating becomes a torment

Although it is with us every single day, this subject is almost hushed up: the function of the gastrointestinal tract. As long as everything works the way it should, you hardly have to think about it. For one in seven Germans, however, that is not the case. Instead there is regular rumbling and pain in the stomach area. So it is time to talk about the function of our gut.

If the consistency of your stool varies, sometimes firmer, sometimes softer, that is no drama to begin with. The consistency depends on how much water you have drunk or how much and what you have eaten. If, however, you struggle with bloating, pain, diarrhoea or constipation almost every day, it could be that you have irritable bowel syndrome.

With irritable bowel syndrome (called “colon irritabile” in medical terms) the function of the gut is disturbed. That can be very unpleasant and can lead to stressful situations in everyday life. Depending on which symptoms you have, an “irritable bowel” is divided into 4 types of the condition:

The gut is a winding muscular tube that is divided into the small intestine and the large intestine. The main task of the small intestine is digesting food. Carbohydrates, proteins and fats are broken down into their individual nutrient building blocks by enzymes and are absorbed through the wall of the small intestine. Since a great deal of fluid is created in the process, the purpose of the large intestine is to draw water back out of the food pulp. On average the entire intestinal tract is 4 to 6.5 m long and reaches from the stomach to the anus. A large area on which all sorts of things can happen. There are numerous influencing factors that can throw the balance off and cause an irritable bowel.

The main task of the intestinal muscle is to move food from the stomach to the anus by contracting. This is controlled by a nervous system of its own in the intestinal wall, also called the “gut brain”. When food reaches the gut and stretches the intestinal wall, the gut brain passes on the impulse “tense and relax” to the intestinal muscles. Because the two commands alternate and take place at the right points in the gut, a flow is created that transports the food pulp from top to bottom. Just imagine squeezing out a tube of toothpaste.

If there are errors in the way the nervous system passes on stimuli, that can cause irritable bowel syndrome. If the commands for muscle contraction are passed on incorrectly, the muscles contract too quickly, too slowly or at the wrong moment and the food pulp is no longer transported evenly. The intestinal passage (the time during which the food is travelling through the gut) can run too quickly or too slowly.

An intestinal passage that is too quick causes diarrhoea, because the large intestine does not have enough time to draw the fluid out of the food pulp.

An intestinal passage that is too slow has the opposite effect: the stool becomes hard and constipation occurs.

A third possible disturbance is that the muscles tense too strongly or can no longer relax properly: cramps occur, which is typical of the pain type.

Scientists have found increased immune activity in the intestinal mucosa of people affected by irritable bowel. That means, for example, that there are more immune defence cells in the mucosa. The reason for this is not yet known.

Every cell in the intestinal mucosa is connected to its neighbouring cell by a kind of adhesive bridge (tight junctions). These tight junctions seal the spaces in between and create a barrier, so that pathogens and unwanted substances cannot enter the body. In people with an irritable bowel these connections can be loose. The barrier becomes permeable and pathogens, foreign substances or undigested food particles (allergens) can get into the body and trigger an immune reaction there.

In one in 10 cases, irritable bowel syndrome develops after a gastrointestinal infection. Responsible for the infection is, for example, the bacterium Campylobacter jejuni, which can occur in undercooked poultry meat or raw cow’s milk. The pathogen causes severe abdominal pain, diarrhoea, fever and sometimes also vomiting 2 to 5 days after the meal in question. The irritable bowel syndrome that develops from this infection is usually the diarrhoea type.

Almost everyone has heard about “healthy gut flora” in advertising at some point. But what does that actually mean exactly? In a healthy gut there is a natural mixture of useful bacteria, called the “gut microbiome”. These good bacteria protect the gut, digest fibre and from it form useful substances for the intestinal cells. Together with the intestinal mucosa they also form a barrier against pathogens from food. How? They produce lactic acid, which lowers the pH value inside the gut: very uncomfortable for “bad” bacteria.

If the gut microbiome gets out of balance (for example through antibiotics or a gastrointestinal infection), the immune defence is disturbed as well and pathogens can multiply.

Serotonin is a messenger substance that passes on information in our nervous system, a neurotransmitter. If you are now thinking “that word sounds familiar”: serotonin is often mentioned in connection with chocolate. The cocoa contained in chocolate contains tryptophan. Tryptophan is the precursor of serotonin, which is also called the happiness hormone because in the brain it triggers a feeling of security and contentment.

Serotonin influences not only our emotions but also factors such as appetite, body temperature, the sleep and wake rhythm or the assessment of pain. With an irritable bowel the nervous system can no longer regulate how much serotonin is needed to let normal bowel movement happen painlessly for us. Accordingly we feel pain after eating.

Whether it is trouble at home, hectic days at work, worry, fear or something else…. when you are stressed, that also has effects on the gastrointestinal tract. Bowel movement and the production of gastric juice are increased and the immune defence function of the gut gets out of balance. Not everyone responds to stress with irritable bowel syndrome, though. In principle it can always help to find something that balances out everyday stress for you personally. Sport, cooking, joint activities with friends or indeed Netflix & chill…. that is a matter of type.

Since the possible ways in which an irritable bowel can develop are so varied, the only way to make a diagnosis is this: rule out all other conditions. The right person to talk to about that is a gastroenterologist. That is a specialist in internal medicine who is specialised in conditions of the digestive system. Before you go to see one, you can ask yourself these 4 questions:

• Where exactly do you have pain and in which situations does it occur?
• Do you have diarrhoea or constipation?
• Have you noticed a connection between the pain and particular foods?
• Are you currently in stressful life circumstances?

A good way to uncover the connection between symptoms and causes is a food diary or symptom diary. You write down what you have eaten and when pain, diarrhoea or constipation occurred. That is also a good help for the doctor.

Chronic inflammatory bowel diseases (IBD for short) have symptoms similar to an irritable bowel. Crohn’s disease usually shows itself with cramp-like abdominal pain and bouts of diarrhoea. A typical sign of ulcerative colitis is diarrhoea with traces of blood and mucus. On top of that there is pain, often in the left upper abdomen. Both have in common that the signs occur in flare-ups and that those affected can also be free of symptoms for a while. The disease can never be cured completely, however.

The treatment of an irritable bowel is highly individual, because it always depends on where the complaints come from, how the body behaves and also how someone deals with the situation mentally. You could say, more or less: just as every person is different, every gut is different too.

There are, however, a few tricks that you can try out for yourself at home

• For bloating there is a classic combination: fennel, anise and caraway. Many people still know it from their childhood. Fennel tea made from crushed fennel also helps to ease bloating and cramps. Additional relief can come from an ointment with caraway oil, with which you gently massage the belly in a clockwise direction. But be careful: pure caraway oil irritates the skin. It should therefore always be worked into an ointment, an emulsion or something similar. It is best to get advice at the pharmacy.
• Probiotics: probiotics are viable gut bacteria that can be taken as a food supplement. They support the gut microbiome in keeping a natural balance and can ease complaints.
• Stress: after every phase of tension, regeneration is needed. In our everyday life it often gets too little room. Since the gut is extremely sensitive to stress, it is worth finding activities in which you can regularly recharge your batteries.
• Nutrition: in someone affected by an irritable bowel, the gut reacts very sensitively. So with a therapy through nutrition you have to feel your way forward carefully. With constipation, a diet richer in fibre helps. Fibre consists of indigestible food components that increase stool volume by swelling and therefore lead to more bowel movement. You will find it for example in nuts, seeds and, above all, vegetables. With diarrhoea, psyllium husks are a good idea, because they bind the excess water.

Even with a diagnosis of irritable bowel there are a few measures that can help you to reduce the symptoms of an irritable bowel. The following applies, however: these are only general tips. Everyone has to find out for themselves what works best for them.

• Eat slowly.
• Do not swallow unnecessary amounts of air.
• Many small portions are better than a few large ones.
• Drink enough. Water without carbonation is good, for example.
• Fatty dishes, pulses, strong spices, and sometimes also coffee, alcohol, nicotine or dairy products can cause complaints.
• Some people also react sensitively to white flour products, ready meals and various sugar substitutes.
• Pay attention to how the dishes are put together and at what time of day they are eaten: in that way you can find out what is well tolerated.
• Routine: eat regularly and at fixed times.
• Do not eat too much in the evening.
• Take time for your meals and create a calm atmosphere.

If after all this information you are asking yourself, “What can I actually still eat and how can I combine it so that I do not have the same thing on my plate 365 days a year?”, our team of nutrition experts will be glad to advise you and will create an individual and varied nutrition plan for you. Precisely matched to everything that is good for you and your body.