Are Vitamin D deficiency, stress and unknown food allergies causing your irritable bowel syndrome (IBS)?

Do not pop drugs like Pantocid, which are proton pump inhibitors and stop acid secretion in the stomach. The digestive process needs stomach acids for metabolization and nutrient absorption. Other than giving symptomatic relief for gas, it will not take care of a trigger like food intolerance, says Dr Rommel Tickoo, Director, Internal Medicine, Max Superspeciality Hospital, Saket, Delhi

Irritable bowel syndrome (IBS) is a common disorder (Source: Getty Images/Thinkstock)

The other day I had a young patient who had been on Pantocid for four years but still did not find relief from bloating, gas, cramping and some alternate and unpredictable bouts of constipation and diarrhoea. And in a high stress job, he sought to manage these issues with self-medication, one that clearly didn’t work. That’s because he was dealing with Irritable Bowel Syndrome (IBS) and over the past year, case numbers keep increasing in my OPD. In fact, the patient profile is usually between 20 and 40 years of age cutting across geographies, the proportion of women being slightly higher than men.

SO WHAT IS IRRITABLE BOWEL SYNDROME?

Irritable bowel syndrome (IBS) is a common disorder that affects the stomach and intestines, what we call the gastrointestinal tract. It is basically a reactive syndrome when your intestines behave differently as a result of other body dysfunctions. Symptoms include abdominal pain, bloating, gas, alternating diarrhoea or constipation, or both together, even occurring at certain times of the day, and a sense of incomplete evacuation. It creates a sense of unease that makes it difficult for you to focus elsewhere.

WHAT ARE THE TRIGGERS OF IBS?

(1) Primarily, I have found stress to be the trigger in most of my patients. Any kind of anxiety and depression impacts the gut-brain axis. Since the brain and the gut work together directly, experts believe that a brain under pressure may cause disturbances in the gut. For example, some people react to stressful or trauma news and rush to the loo immediately after, as the bowel movement suddenly changes in the gut. Some IBS patients feel pain even when a normal amount of gas or stool is present in the gut. It is because of this reason that some patients with pronounced symptoms are given anti-depressants.

(2) Sometimes IBS could be the result of a bacterial overgrowth in the intestines. Sometimes it is a lingering side effect of an infection or a drug which has not gone well with you.

(3) But in my experience, most IBS cases arise out of food intolerance or sensitivities, in which certain foods cause digestive symptoms. Among them dairy and gluten intolerance top the list of triggers. Now, many would argue that they have grown up on dairy and gluten and had no complaint whatsoever earlier. But what we forget is that the intolerance may be subtle as to not cause alarm in childhood but becomes pronounced in your 20s and 30s. You may have non-Celiac gluten intolerance. Celiac disease eats into the intestinal walls but in this case, there is no mucosal injury but you suffer intestinal issues.

(4) Leaky gut syndrome: This means that your gut microbiota is not healthy and the intestinal lining may have tears and holes through which toxins and partially digested food seep into the bloodstream instead of being excreted. This triggers inflammation and compromises your immunity. A lot of ongoing research shows that imbalance in intestinal bacteria and inflammation may play a role in the development of common chronic diseases.

(5) Although the jury is out on this one, a study published in BMJ Open Gastroenterology has shown that patients of IBS are vitamin D-deficient. It has since been found that 82 per cent of IBS sufferers are also low in vitamin D (less than 20 ng/mL)2.

TREATMENT AND MANAGEMENT

Only a small fraction of patients have severe symptoms and most can control them by managing diet, lifestyle and stress. Do not pop drugs like Pantocid, which are proton pump inhibitors and stop acid secretion in the stomach. The digestive process needs stomach acids for metabolization and nutrient absorption. Unregulated use can lead to osteoporosis and impact the kidneys. The drug, other than giving symptomatic relief for gas, will not take care of a trigger like food intolerance.

There are no specific tests for IBS, so diagnosis is by elimination. Always remember that IBS doesn’t cause changes in bowel tissue or increase your risk of colorectal cancer. But when a patient complains of fever, bleeding stool and weight loss, we advise colonoscopy in rare cases. Then we find some inflammatory conditions.

But generally it is about lifestyle correction, yoga, meditation, exercise and diet alterations. Usually cutting down on dairy, wheat, nuts, corn, peas, rajma, egg whites and fermented foods works. A food allergy test is expensive, costing around Rs 15,000 but years of practice have shown us that controlling potential triggers improves the health of patients. Yeast intolerance causes IBS, so watch your intake of flavoured yogurt, pickle, packaged and processed foods, bakery products, cheese, mushrooms, miso and soy sauce. Increase intake of Vitamin D if it is not in range. Have more fibre-rich foods and probiotics which build up gut immunity. Anti-spasmodics give some relief.