IBS and Diabetes: The Unholy Alliance

So, I was catching up with a friend who has become a doctor, much to the chagrin of anyone with Indian parents, our discussion landed on the relationship between diabetes and Irritable Bowel Syndrome, as it should (sarcasm). And I got the idea for another blog.

IBS affects 4.2%–7.5% of Indians, while diabetes affects 101 million. Those are sizable numbers, whichever way you look at them. Now, diabetes is a complex disease that basically spells the end of your lifestyle, while IBS, as we often perceive it, is a minor inconvenience. How are these two even related, we hear you ask.

While there is no direct correlation between Irritable Bowel Syndrome and Diabetes, there are some shared risk factors. Why? Because life is unfair like that.

Family history (because your genes said, "Hey, let's make this person's life harder!")

Your genes play a significant role in your risk of developing diabetes. This genetic tendency means your body might have issues effectively managing your blood sugar.

IBS is also genetic. The SCN5A gene, which provides instructions for making a protein that forms part of a sodium channel found in heart muscle cells, mutates to affect the gastrointestinal tract, resulting in constipation.

The same mutation to the gene, SCN5A p.Ser1103Tyr (S1103Y) variant, causes significant impairment to the pancreatic beta cells. These cells produce Insulin, potentially culminating in Type 2 Diabetes.

Obesity (those extra samosas aren't helping, folks!)

All those extra samosas and jalebis can contribute to weight gain, which makes it more challenging for your body to regulate blood sugar levels. Overeating causes obesity and is also a risk factor for diabetes. Extra calories are stored in the body as fat. If you consume a lot of energy and do not use it, most of it will be stored in the body as fat.

Binge eating has been associated with a higher risk of IBS, and people who indulge in binge eating might be more likely to experience upper and lower gastrointestinal symptoms.

Sedentary lifestyle ( Netflix binge-watching doesn't count as exercise, sadly)

Do you sit around a lot? A sedentary lifestyle, which involves long hours of inactivity, significantly increases the risk of developing diabetes. Sitting at your desk or binge-watching Netflix can lead to weight gain and reduced insulin sensitivity. Start exercising and start living healthy.

Exercise regularly to maintain healthy blood glucose levels and reduce the risk of diabetes. If you have a sedentary lifestyle, it is because you are neither burning the calories you consume nor doing any exercise to digest what you are eating. Consuming a lot of high-calorie food results in diabetes, and consuming too much junk food results in IBS.

Stress (Indian traffic, anyone?)

Chronic stress, such as dealing with a troublesome boss, Indian traffic, or other daily pressures, can greatly impact blood sugar levels. Managing stress through techniques like mindfulness, deep breathing exercises, or finding healthy relaxation outlets can reduce its effects on health and consequently lower the risk of developing diabetes.

Stress is also a factor in causing IBS. Stress-induced alterations in neuro-endocrine-immune pathways act on the gut-brain and microbiota-gut-brain axes and cause symptom flare-ups or exaggerations in IBS. IBS is a stress-sensitive disorder; hence, treatment should focus on stress management and stress-induced responses.

Gut Hormones and Glucose Metabolism

Certain gut hormones, GLP-1 (glucagon-like peptide 1) and GIP (gastric inhibitory peptide), greatly impact glucose metabolism. GLP-1 increases insulin secretion and reduces glucagon release, improving blood sugar control. GIP also stimulates insulin release but is less useful in diabetes management.

If you have diabetes, maintaining optimum levels of these hormones through diet, lifestyle, and medication can help manage blood sugar effectively. This brings to the fore the intricate connection between gut hormones and metabolic health. In short, if your gut health is good, you are safe.

Also, the glucagon-like peptide (GLP-1) analogue ROSE-010 is instrumental in relieving abdominal pain in patients with IBS. GLP-1 is an incretin hormone secreted from T cells in response to ingested nutrients. GLP-1 brings down gastrointestinal motility and gastric emptying in healthy subjects. In short, if your gut health is good, you're safe.

Symptoms of IBS, such as bloating, abdominal pain, and changed bowel habits, can impact diabetes management. Chronic gastrointestinal distress might lead to irregular eating patterns and issues with continuous glucose monitoring. Furthermore, the discomfort and stress from IBS can worsen insulin resistance.

Effectively managing IBS through dietary adjustments and stress reduction is vital for people with diabetes to ensure better control of blood sugar levels and improve overall quality of life.

The Gut Microbiome's Role

The gut microbiome plays a vital role in both IBS and diabetes. Gut bacteria imbalances can contribute to IBS symptoms by affecting gut inflammation and motility. Similarly, a disrupted microbiome can influence insulin sensitivity and glucose metabolism, increasing the risk of diabetes.

Maintaining a healthy and diverse gut microbiome through a healthy diet, probiotics, and prebiotics can help manage IBS symptoms and improve metabolic health, highlighting the interconnected nature of gut health and systemic conditions.

IBS can Increase the Risk of Diabetic Neuropathy

IBS can worsen the risk of diabetic neuropathy, a common diabetic complication that impacts nerve function. Chronic gastrointestinal symptoms from IBS, such as frequent pain and discomfort, can contribute to more stress and poor glycemic control.

Stress and inflammation associated with IBS might further impact blood glucose levels, potentially speeding up the development of neuropathy. Effective management of IBS, together with proper diabetes control, is essential to reducing the risk of nerve damage and preserving overall health.

Diabetes Exacerbates IBS Symptoms

Diabetes can worsen IBS symptoms, thus complicating the management of both conditions. Medications used to control diabetes, like metformin, may aggravate gastrointestinal issues. Fluctuations in blood glucose levels can also worsen IBS symptoms by changing gut microbiota and increasing inflammation. Maintaining stable blood glucose levels through carefully thought-out dietary choices and lifestyle adjustments is important for managing both IBS and diabetes effectively.

Increased Risk of Depression and Anxiety

Chronic pain, discomfort and lifestyle restrictions from IBS can result in emotional distress; on the other hand, managing diabetes often includes constant monitoring and dietary limitations, which can cause mental strain.

The relationship between physical symptoms and mental health can further impact overall well-being, making it imperative for people with IBS and diabetes to seek comprehensive care that takes care of both physical and psychological needs.

Effective treatment combines medical management, psychological support, and lifestyle changes to boost quality of life and mental health.

Dopamine neurotransmission - Diabetes can result in dysfunctional dopamine neurotransmission, which can result in motor impairment and neurodegenerative damage. Dopamine and IBS are not directly related. However, their role in gut motility and behaviour might be a factor. Dysregulation might change gut-brain interactions.

Serotonin neurotransmission - Diabetes can change serotonin neurotransmission in the hippocampus, which can result in behavioural and eating disorders. This is quite relevant to LBS. Serotonin is involved in gut motility and mood regulation, and changes in serotonin levels in the gut or brain can contribute to IBS symptoms, including anxiety and irregular eating patterns.

Cholinergic neurotransmission - Diabetes can result in an imbalance in cholinergic neurotransmission, which can result in cerebellar dysfunction. Changes in cholinergic neurotransmission can change gut motility and might be linked to IBS symptoms, especially to autonomic regulation of the gut.

Nicotinic acetylcholine receptors - Diabetes can bring down levels of nicotinic acetylcholine receptors, which can result in neuronal apoptosis and impaired cognitive function. Reduced levels of all these receptors can change neuronal communication in the gut-brain axis, changing mental and emotional aspects related to the cognitive and emotional aspects of IBS.

Oxidative stress - Diabetes can result in oxidative stress, which can result in mitochondrial dysfunction and ER stress. Impaired cognitive function can cause stress and anxiety. Oxidative stress can play a role in gut health, with inflammation and dysfunction in the gut potentially worsening IBS symptoms.

Increasing fibre intake - If you have diabetes, you are at risk of cardiovascular disease. According to evidence, increasing your fibre intake can bring down the risk of cardio-metabolic diseases and colorectal cancer. Ingesting a lot of oat bran also lowers cholesterol levels and blood pressure. Dietary fibre absorbs fluid and increases the bulk of waste matter, so your stools are softer and easier to pass. Foods that have a lot of soluble fibre bring down cholesterol. Increasing your dietary fibre can help with weight management. Such foods are filling and lower in glycaemic index, which can assist in appetite control.

For IBS, fibre can help with symptoms like diarrhoea and constipation, enabling a more stable digestive function. Incorporating fibre in your diet supports better digestive health and glycemic control, making it an essential factor in managing both diabetes and IBS. Fibre is really good for your health.

Stay away from trigger foods - Staying away from trigger foods is imperative in managing both diabetes and IBS effectively. Common triggers are gluten, spicy foods and dairy, which can worsen IBS symptoms like bloating and abdominal pain.

Gluten and dairy can cause digestive discomfort in sensitive stomachs, while spicy foods irritate the gut lining. For diabetes, these foods contribute to blood sugar spikes and inflammation. Identifying and avoiding personal triggers through an elimination diet or food diary can help reduce symptoms and improve overall management.

Indian cuisine is tasty, yes, but focusing on modifying and alternating with other foods can help you enjoy your meals without compromising blood sugar control or gut health.

Probiotics and prebiotics - Including probiotics and prebiotics in your diet can majorly impact gut health, making it great for managing IBS and diabetes. Yoghurt and other fermented foods like kefir and kimchi have probiotics, which introduce beneficial bacteria to your gut. These bacteria can help stabilise the microbiome and aid digestion.

For prebiotics, eat food like garlic, onions, and bananas, which nourish these beneficial bacteria and boost their effectiveness. A sound gut microbiome can help reduce IBS symptoms and improve insulin sensitivity, helping with better blood sugar control.

By supporting your gut bacteria with these dietary additions, you speak for a more balanced digestive system and better overall health. These digestive health supplements are good for your gut. Don't shy away from them.

Embrace lifestyle changes and dietary adjustments to check your gut and blood sugar levels. And don't forget to add a healthy dose of humour to your routine—laughter not only boosts your mood but can also be a great stress reliever. By taking a comprehensive approach that includes practical and light-hearted elements, you'll be better equipped to navigate and manage your health challenges.

Q. What is the connection between diabetes and IBS?

A. While there is no direct correlation between Irritable Bowel Syndrome and Diabetes, there are some shared risk factors. These risk factors trigger multiple changes in the body that result in both IBS and Diabetes.

Q. Does diabetes cause depression and anxiety?

A. Worrying about the symptoms of diabetes causes stress and anxiety. It alters lifestyle and introduces a whole gamut of neurochemical imbalances in the body that result in sometimes mild and sometimes chronic anxiety.

Q. Is Indian cuisine good for diabetes and IBS?

A. Indian cuisine, in its base form, depends on a wide variety of food items which are very good for gut microbiota. Rice and other whole grains are low-GI food sources, while fish, meat, and lentils are good sources of protein. Fenugreek and turmeric are also beneficial in controlling insulin sensitivity. However, it is very dependent on carbohydrates, so the answer is to have a clear understanding of the diet before committing to it.