IBS and Diabetes: What's the Connection?

With Elliot Rayfield MD

If you’re among the ten percent of Americans living with diabetes, there’s a chance you also have gastrointestinal issues. Recent studies have shown that people with diabetes report more trouble with digestion than the general population.

Managing gastrointestinal side effects can be challenging—after all, it is overwhelming enough to constantly monitor your diabetes without throwing digestive issues into the mix. However, there is hope. Practices such diet modification, exercise, and stress reduction can all mitigate gastrointestinal distress and help you manage your diabetes at the same time. Read on to better understand how diabetes affects your digestion and the techniques you can employ to reduce stomach woes without raising your blood sugar.

IBS and Diabetes: A Complicated Relationship

Though diabetes and gastrointestinal issues might seem like two separate issues, a reported 75% of people with diabetes also experience trouble with their stomach and/or digestion. What’s more, a new study conducted by the University of Sydney found that gastrointestinal issues were “significantly more frequent” among those with diabetes when measured against control subjects without diabetes.

This prevalence could be due in part to Irritable Bowel Syndrome, a condition that refers to a group of symptoms, including pain in the abdomen and changes in bowel movements that occur at least one day a week. IBS affects a not insignificant ten to fifteen percent of the US population, so it makes sense that there is overlap. There isn’t one tool that doctors use to diagnose IBS, so if you are having symptoms, your doctor will give you an exam and go over your medical history to rule out other conditions. The good news? IBS—unlike many other gastrointestinal disorders—does not wreak physical havoc on the intestines or greater digestive system and your digestive tract remains free from signs of damage.

What Is Diabetic Gastroparesis?

According to endocrinologist Elliot Rayfield MD, a Clinical Professor of Medicine in Endocrinology, Diabetes, and Bone Diseases at Mount Sinai, unfortunately, it's more likely that you might be experiencing a more serious condition called gastroparesis.

Gastroparesis, which is caused by high blood sugar, affects the speed at which the muscles in your stomach move food and, unlike IBS, can damage your gastrointestinal tract if not kept in check. “A lot of the complications of diabetes in the different organs relate to the fact that there is elevated blood sugar, which can cause damage to the nerves in your organs,” says Dr. Rayfield.

Diabetic Gastroparesis Symptoms

When the nerves in your GI tract become damaged, the emptying of your stomach becomes impaired. As a result, food moves more slowly through your GI tract, which can lead to feeling full after eating only a small amount of food. Other symptoms include:

  • abdominal pain
  • vomiting
  • constipation
  • diarrhea

Diabetic Gastroparesis Treatments

“Diabetics get diarrhea because there can be overgrowth of bacteria in the GI tract due to the lack of movement,” Dr. Rayfield explains. “This condition—called diabetic diarrhea—can be treated with antibiotics.”

Aside from the unpleasant side effects, gastroparesis can also be dangerous. If untreated for too long, it can cause malnourishment if the gut becomes unable to absorb key vitamins and nutrients from food. Additionally, if it causes you to become prematurely full, the small amount of food you do eat can be insufficient to fully fuel and nourish your body.

To diagnose gastroparesis, your doctor will rule out IBS and other gastrointestinal conditions by administering gastric emptying tests. The main test is called scintigraphy. It involves consuming a special meal or drink that contains a small amount of radioactive material. An instrument that measures radioactive material is then placed over your stomach, which allows it to measure the speed at which food moves through your GI tract. Other tests such as an ultrasound and something called a breath test (which measures in your breath the amount of a substance your body can absorb) are also used to diagnose gastroparesis.

What Is the Best Diet for IBS and Diabetes?

Managing both gastrointestinal issues and diabetes can be a delicate dance. Diabetics are told to incorporate fiber-rich foods such as whole grains, vegetables and beans to stabilize blood sugar. Conversely, conventional wisdom dictates that people with digestive issues such as diarrhea limit dietary fiber.

What to do if you are managing both? Contrary to popular misconception, dietary fiber can reduce symptoms of IBS, the key is to pay attention to which kind. Incorporating soluble fiber (such as psyllium) can firm stool and reduce gas. You can also curtail gastrointestinal trouble while still lowering blood sugar by eating an array of vegetables and legumes, while avoiding those that are more difficult to digest, such as beans and raw cruciferous vegetables.

Dr. Rayfield advises his patients dealing with stomach issues and diabetes to think about changing their dietary habits in terms of how and when they eat too. “It’s better to eat small frequent meals, keep well hydrated and exercise continuous glucose monitoring,” he says. If you’re still experiencing symptoms, he suggests asking your doctor about medications such as Reglan (Metoclopramide), which is prescribed to treat vomiting, loss of appetite and premature fullness.

A sedentary lifestyle can aggravate gastrointestinal problems and diabetes. Research has shown that taking a post-meal stroll—known more formally as a “postprandial walk” —can be helpful, as light exercise promotes glycemic control as well as limits gastrointestinal issues such as diarrhea. Exercise in general encourages gastric emptying, which in turn alleviates symptoms of gastroparesis.

Stress management also plays a big role in gastrointestinal issues. Anxiety can affect how quickly food moves through your digestive tract and can cause painful muscle spasms. It can also affect the degree to which the nutrients in the food you eat are absorbed, which can compound the malabsorption issues that accompany gastroparesis. While stress can’t cause diabetes, it does release hormones such as cortisol and adrenaline, both of which disrupt insulin’s normal functioning and raise blood sugar levels. All of this can put you at risk for more serious complications.

You can help manage your stress by employing techniques to soothe an anxious mind and gut. Therapy, as well as practices such as mindfulness meditation and exercises like yoga and qigong have been proven to reduce stress and promote relaxation.

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