Diabetes Forecast May 2004

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FOR TYPE 1/TYPE 2

Irritable Bowel Syndrome & Diabetes

Having both diabetes and irritable bowel syndrome is frustrating. Here's help controlling both.

By Elizabeth Glynn, MS, RD, CDE

We've all been there. Abdominal cramps, bloating, gas, diarrhea (possibly painful), or constipation.

But most of us haven't had to deal with these severe, painful symptoms day after day, or have them flare up unexpectedly every few months. Those who do may have irritable bowel syndrome.

Although IBS is one of the most common complaints reported to physicians, especially by women, it is not a disease or an infection. And it is not caused by diabetes. It is, rather, a disorder in which the bowel (large intestine) does not work the way it should.

Many things may trigger IBS including a reaction to fatty or fried foods, milk products, alcohol, carbonated beverages, or caffeine, whether in coffee, tea, colas, or herbs.

Hormonal changes can also cause IBS, which is why women with this difficulty may suffer increased symptoms during menstruation.

There is some controversy as to whether stress actually causes IBS, but it can definitely bring on a flare-up in those who already have the problem.

While it's not likely that you can cure your IBS, you can find ways to control it. But first you have to become a detective and discover what foods or combinations of foods trigger your particular problem.

Andrea Yoder, RD, CNSD, of the University of Virginia Medical Center, who specializes in working with people who have gastrointestinal problems, has some suggestions.

"Keep a written record of all the foods that seem to make your symptoms worse. See if you can establish a connection between foods or combinations of foods and IBS symptoms.

"Remember to test only one food at a time and to make your food changes gradually, a few bites at a time, so you can chart the changes easily. This will also help you to avoid aggravating your bowel further or upsetting your diabetes control."

Yoder also advises monitoring your blood glucose (sugar) frequently while you're doing your detective work. That will help you pinpoint the way new foods affect your blood glucose, especially during flare-ups.

"Talk with your doctor or dietitian about eating smaller meals, then filling out your food plan with snacks," Yoder adds. "This will also help keep your diabetes in control while helping prevent IBS flare-ups; smaller meals will produce less stimulation along the gastrointestinal tract."

Is This Your Problem? Does your cramping or bloating start when you chew sugar-free gum or eat sugar-free candy? If so, you may be sensitive to artificial sweeteners. Also check if IBS flare-ups occur after you take a given medication or supplement, including vitamins, minerals, herbs, diet products, and energy or food bars or drinks. Any of these, or a combination of them, may be causing your problem. And if the cramping or bloating begins only after you have a glass of milk or other dairy product, you may have lactose intolerance rather than IBS.

What To Eat?

It's a good idea to eat foods that are good sources of fiber, especially if you are constipated. This will help stool pass through the bowel easily.

Fruits such as cantaloupe, bananas, peaches, apples, and grapes are high in fiber. So are some vegetables, including green beans, potatoes, sweet potatoes, and carrots. (Avoid high-fiber bran cereals; they usually wreak havoc on supersensitive guts.)

Of course, many foods that are high in fiber are also high in carbohydrate. That's a concern when you have diabetes because carbohydrate raises blood glucose rapidly. Yoder's advice is to eat only a small portion of any high-carb food at one time.

Medications

If dietary changes aren't working, talk to your doctor. He or she may prescribe over-the-counter anti-diarrhea medications or prescription laxatives, antispasmodics, or antidepressants to reduce pain. (A new prescription drug, Zelnorm [tegaserod], has also recently been approved by the FDA for those with constipation-related IBS.)

But don't take over-the-counter laxatives on your own. They may be too harsh for your digestive system.

Your doctor may also suggest stress management techniques such as physical activity, meditation, or yoga, which may help you to avoid IBS flare-ups. Try to keep mealtimes stress free, too. Don't talk on the phone or bring up controversial subjects during meals. Just enjoy the food.

 

Living with either diabetes or IBS can be difficult and frustrating. Coping with both conditions can be overwhelming. But you don't have to face this difficult time alone. Keeping in touch with friends or venting to a mental health professional can provide comforting emotional support.

The key is not to give up.

It will take time to figure out what's going on, but with food and lifestyle changes, and possibly medication, it's highly likely that you will eventually be able to control or minimize your IBS.

Elizabeth Glynn, MS, RD, CDE, is a diabetes nutrition educator at the Inova Diabetes Center in Fairfax, Va.

 

Is It Diabetes Related?

Having IBS is a concern in itself, but if you also have had either type of diabetes for a number of years, it's particularly important to have your symptoms evaluated by a gastroenterologist or endocrinologist.

The symptoms of IBS are similar to those of certain diabetes complications relating to digestion. If a diabetic complication is the cause of your IBS, it's important to have it diagnosed and to begin treatment as soon as possible.

Also, once you know you are not dealing with a diabetic complication, you can begin to look elsewhere for the cause of your problem.