Irritable Bowel Syndrome: When the Diagnosis is Ambiguous

Irritable bowel syndrome (IBS) is a functional disorder between the autonomic nervous system and the intestinal muscles. According to experts, however, the diagnosis of “irritable bowel syndrome” is often made prematurely.

“Irritable bowel syndrome” is the most frequently diagnosed gastrointestinal disease. Women are affected twice as often as men. The symptoms range from nausea, abdominal pain, flatulence, and a feeling of pressure, and fullness to diarrhea or constipation. A specific trigger for digestive problems is not found in most cases. However, it is not uncommon for those affected not to be systematically examined for other diseases and, according to experts, to be prematurely confronted with the diagnosis of irritable bowel syndrome and left alone. In fact, many people with such symptoms have a treatable cause, such as an allergy.

Causes of IBS

If irritable bowel syndrome is present, this can severely limit the quality of life. For some people, stress literally hits their stomachs and intestines. The intestinal nerves get into a kind of permanent state of excitement, get confused with the regulation of the intestinal movements, and report to the brain: “Pain!”

A disturbed intestinal flora can also be to blame: antibiotics or severe gastrointestinal infections upset the natural mixture of beneficial bacteria in the intestine. After a salmonella infection, for example, the risk of IBS is eight times higher. If the intestinal flora has been damaged over a long period of time (so-called dysbiosis), the intestinal mucosa can also change. It gets “holes”, so to speak, so it becomes more permeable for toxins and pathogens. As a result, some IBS sufferers have more immune cells and their pro-inflammatory messenger substances in the intestine – which in turn irritates the intestinal nerves.

Exclusion of other diseases with similar symptoms

It is often a long way before the diagnosis of IBS is made. First, other diseases with similar symptoms must be ruled out – such as recurring infections, food intolerance (such as fructose intolerance, other or multiple intolerances), food allergies, colon colonization by bacteria, viruses, or fungi, chronic inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis or tumors in the intestine or on the ovaries.

Several examinations should be carried out: gastroscopy and colonoscopy, ultrasound of the abdomen, a blood test with blood count, liver enzymes, salts, thyroid, and kidney values. Parasite infestation can be ruled out with a stool examination. Breath tests can be used to detect intolerance to certain types of sugar.

In a study on irritable bowel syndrome, researchers from Lübeck use an endoscopic procedure (CLE) to investigate how the intestinal mucosa reacts to food. Observe the intestinal cells in 1000x magnification. If the spaces between the cells turn white, there is an allergy – for example to soy.

If there are no organic findings in any of the examinations and if intestinal disorders with the symptoms described occur for at least twelve weeks within a year, then the diagnosis is irritable bowel syndrome.

Irritable bowel therapy with the FODMAP diet

According to Australian studies, a special diet can be very effective in calming the intestines. Since stress and strain can rarely be eliminated in the short term, eating restrictions are the most promising way. The so-called low-FODMAP diet does come with some drastic restrictions: those affected completely avoid all potentially irritating carbohydrates and special types of sugar for a few weeks. But if you do this consistently, you can get your intestinal problems under control. However, a FODMAP-reduced diet should not be tried without medical advice and a clear diagnosis, because it can also aggravate the symptoms, for example with an allergy.

During the low-FODMAP diet, the symptoms sometimes subside quickly or even disappear completely. After four to eight weeks, the FODMAP-containing foods should be tried again step by step, otherwise, deficiency symptoms can occur. It is important to record in the food diary exactly which symptoms occur after the consumption of which food. In this way, you can find out individually what the intestine can tolerate.

Calming remedies for irritable bowel syndrome

Some herbal active ingredients such as peppermint oil or lemon balm leaf extract have also proven effective for calming the intestines. Water-soluble roughage, for example from psyllium husks, can also be helpful, supplemented with probiotics if necessary.

In general, it makes sense for people with IBS to eat more slowly, more comfortably, and socially – and to bring more calm and structure into everyday life overall.


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Written by John Myers

Professional Chef with 25 years of industry experience at the highest levels. Restaurant owner. Beverage Director with experience creating world-class nationally recognized cocktail programs. Food writer with a distinctive Chef-driven voice and point of view.

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