OH SH!T: Diabetes-friendly diets could trigger bowel issues

People with diabetes are usually advised to cut down on simple carbohydrates and opt for fibre and protein-rich food to manage their blood sugar levels. However, if the diet lacks a proper balance and if people are unaware of the allergies they could develop, it could lead to a series of gut and gastric complications, especially Irritable Bowel Syndrome (IBS) accompanied by constipation or diarrhoea.

Diabetes and IBS

Experts point out that people with diabetes (both type 1 and type 2) could be more prone to irritable bowel syndrome. Some of the common diabetic medications could also lead to a change in bowel habits.

Dr B S Ravindra, director, department of gastroenterology and hepatology, Fortis Hospitals, Bengaluru, says, “IBS is defined as a change in bowel habits with regard to the passage of stools. High blood sugar levels change gut flora [when bad bacteria are more in the intestines], making people more prone to IBS. The usual reasons are a change in gut flora, intestine motility problems and nerve issues in the intestine.” Gut motility refers to stretching and contractions of the muscles in the gastrointestinal (GI) tract that aid in digestion.

IBS symptoms

• Abdominal discomfort
• Constipation or diarrhoea
• Relief from pain after passing stool
• Bloating
• Flatulence

Ryan Fernando, celebrity nutritionist and founder of Qua Nutrition, says that people with diabetes are usually recommended a high protein or high fibre diet because it helps lower the glycaemic index or sugars of foods.

“High-fibre food binds to the intestines, lowers fermentation and the release of carbohydrates or sugars. Protein gives you satiety and thereby, you don’t eat frequently,” he adds.

Fernando also says that an abnormal amount of fibre or protein in your diet can slow down the passage of food to the gut and lead to bad fermentation in the gut (putrefaction).

“The anaerobic bacteria produce gases that cause abdominal distension and bloating. And in the worst-case scenario, it affects gut health,” he says.

Experts say an excessive amount of fibre can cause loose stools and excessive protein in the diet can cause constipation.

Can diabetes medications trigger IBS?

Dr Anshul Kumar, founder of Dr Anshul’s Diabetes and Endocrine Care Center, New Delhi, says, certain diabetes medications, especially alpha-glucosidase inhibitors which inhibit carb absorption in the diet can also cause gastric troubles.

“When carbs are not being absorbed, you can develop IBS symptoms like flatulence, bloating and diarrhoea,” he says.

The link between diabetes and gastric problems

A 2017 study, titled, ‘Diabetes Mellitus and the Colon’ published in the journal, Current Treatment Options in Gastroenterology states that people with diabetes are at increased risk for a variety of gastrointestinal (GI) complications that span the entire GI tract. It further suggests that roughly 75 per cent of people with diabetes have associated GI symptoms, which can include bloating, abdominal pain, diarrhoea, constipation and faecal incontinence.

Diabetic gastroparesis and IBS

Many people with diabetes could have IBS symptoms and the condition can be misdiagnosed, say experts. Dr Ravindra adds, “All people with diabetes get nerve problems and gut motility issues, and that is why they can present with symptoms similar to IBS that include diarrhoea or constipation.”

Dr Kumar says diabetes in itself can cause gastric symptoms. It’s called diabetic gastroparesis, wherein the peristalsis (contractions that move the food through the digestive tract) of the intestine decreases and patients feel full for longer periods. “They are then prescribed medicines for better peristalsis of the intestine so that the food is propelled further. If a person also develops gastroparesis, it can worsen their IBS by 15 to 20 times more,” he adds.

Diabetes and IBS diet

Fernando says every person is a bio-individual and responds differently to the way food is digested, fermented and absorbed. It depends on their genetics or their gut microbiome. He also suggests getting a food intolerance test done, so that one is aware of what foods they are allergic to.

“Some experts recommend chia seeds to lower blood sugar levels, but you could also be allergic to the soluble fibre in chia seeds,” he says.

Living with diabetes and irritable bowel syndrome

Ansar Ali, a 65-year-old Kolkata-based retired bank official has been living with IBS since the age of 25. He was also diagnosed with type 2 diabetes in 2017. He says in an IBS episode, he has the urge to empty the bowels but when he goes to the restroom, he is unable to empty them completely, which makes him want to go again.

Ali has been controlling his IBS and diabetes through a regimented lifestyle. He says he avoids eating outside and exercises regularly.

“I eat small home-cooked meals at regular intervals. With age, my bowel function has deteriorated and eating spicy and carb-rich food like biryani is out of the question,” he says.

IBS management tips for people with diabetes

• Maintain good sugar control
• Always ensure proper balance in fibre and protein intake
• Have at least one or 1.5 litres of water daily
• Leave a gap of five to six hours between breakfast and lunch
• Have an early dinner, preferably around 7 pm
• Exercise for at least 30 to 45 minutes
• Avoid stress
• Consult your doctor if diabetes medications are causing bloating, diarrhoea or constipation

Takeaways

People with diabetes are usually advised to have high fibre or high protein food because it helps lower glycaemic index. But it can also trigger gastric complications like irritable bowel syndrome (IBS), depending on the genetic or microbiome population of the gut of a person. Certain diabetes medications can also trigger IBS. The symptoms of IBS include flatulence, bloating and diarrhoea or constipation. Experts advise a food allergy test and a genetic test to understand one’s response to certain food in their diet. One size does not fit all. Proper exercise, diet and avoiding stress can help one manage diabetes and IBS.