Wednesday, November 29, 2023

Irritable bowel syndrome – Non-specific digestive problems: Intestines that pose a mystery

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Digestive problems are a widespread phenomenon. In Switzerland, more than one in ten people complain about non-specific gastrointestinal problems. Those affected often do not know the reasons for their suffering. The problem diagnosis is: irritable bowel syndrome.

Lactose-free milk, yoghurt, quark etc. and gluten-free bread, biscuits and cakes now have a permanent place in the shops. When digestion goes on strike and flatulence and diarrhea make everyday life difficult, those affected try to alleviate their suffering through diet. However, self-experiments with lactose- or gluten-free foods are usually not successful. The digestive problems do not subside satisfactorily and those affected are left at a loss.

Diagnosis: irritable bowel syndrome

Anyone who visits a family doctor or gastroenterologist with symptoms such as constant flatulence, diarrhea, constipation, recurring abdominal pain and nausea after eating will be examined in detail. Patients are tested for food intolerances and allergies using blood and breath tests. Any organic causes and illnesses can be identified using stool samples and gastrointestinal gastrointestinal examination. If all tests are negative, the diagnosis is: irritable bowel syndrome.

Depending on the patient’s suffering and lifestyle, different therapies are possible. In the case of cramps and pain, for example, medications called antispasmodics help to relax the intestines. For constipation, fiber and laxatives are part of the basic therapy. Natural remedies are also prescribed as individual or combination preparations. Peppermint oil is one of the oldest remedies for irritable bowel syndrome, but taking turmeric or St. John’s wort also has a positive effect in some patients.

Healthy psyche, better digestion

The brain and intestines exchange information closely. For example, in irritable bowel syndrome patients who suffer from depression or anxiety disorders, digestion also improves when taking antidepressants. Psychotherapeutic methods such as classic psychotherapy, but also cognitive and behavioral therapy methods also seem to have a positive effect.

Finding the appropriate therapy for patients with non-specific digestive problems is often difficult because the symptoms and clinical picture are very different. For most patients, the symptoms can therefore only be adequately alleviated by drug therapy. Diarrhea, constipation and flatulence do not improve satisfactorily for many of those affected.

Diet and stress are crucial factors that affect the intestines. Because stress and excessive strain in professional and social environments usually cannot be reduced quickly, it is obvious that those affected try to get their suffering under control through diet.

FODMAP concept

It is not new knowledge that various foods such as dairy or wheat products or additives can cause allergies and intolerances. About ten years ago, researchers discovered that certain short-chain carbohydrates (particularly sorbitol, fructose and lactose) caused digestive problems in irritable bowel syndrome patients. These are so-called FODMAPs. This is an abbreviation for fermentable Oligo-, Di-, Monosaccharides and Polyols.

Based on this, the scientists researched the micronutrients in our food. They were able to determine how high the FODMAP content is in individual foods. Based on the knowledge gained, they created a list of foods low and high in FODMAPs and used this to develop the FODMAP diet for irritable bowel syndrome patientswhich is now a popular and promising form of therapy.

Its effectiveness has been proven in several studies: gastrointestinal symptoms improved in three out of four patients.

Change in diet with deprivation

Anyone who decides on FODMAP therapy must rigorously restrict their diet for a certain period of time. The diet is divided into three phases:

In the first six to eight weeks, the patient must eat only low-FODMAP foods. Fruits with a high FODMAP content, such as apples, pears, apricots or cherries, are completely removed from the menu during this phase. Bananas, grapes, raspberries or oranges are permitted as alternatives. The same procedure applies to vegetables, legumes, grains, dairy products, oils, fats and sweeteners.

If foods rich in FODMAPs are strictly avoided, the symptoms of those affected usually improve after about two weeks. The intestines can calm down during this time.

To the Renunciation phase they are divided Reintroduction phase and the Tolerance testing phase. The aim of the FODMAP diet and all nutritional advice is a balanced diet. That’s why those affected are gradually allowed to eat forbidden foods from all food groups again and in this way find out whether and in what quantities which food causes them problems. Other foods may prove to be completely unsuitable if the symptoms recur too severely.

Not every food makes it back onto the menu, but one thing always works: With this reintegration process, irritable bowel syndrome patients get to know and assess their digestion in a new way.


not suitable Nectarine, apple, grapefruit, pomegranate, apricot, watermelon, peach, cherry, persimmon, figs, blackberries, plum, pear, mango, plum, unripe fruits
small amounts Dried fruit (bananas, pineapple, papaya, cranberries, raisins, sultanas), lychee, logon fruit, avocado
suitable Pineapple, banana, date, raspberries, strawberries, blueberries, honeydew melon, kiwi, lime, currants, mandarin, orange, papaya, rhubarb, passion fruit, star fruit, grapes, lemon, cassis, cranberry


not suitable Spring onions (white part), garlic, artichoke, cauliflower, sweet potatoes, chicory, kefen, leek, beetroot, rocket, asparagus, taro, Jerusalem artichoke, onions, all mushrooms, dandelion leaves
Small amounts Lettuce, celery, peas, fennel, cabbage, butternut squash, broccoli, Brussels sprouts, okra, sweet corn, cabbage
suitable Alfalfa and bamboo shoots, bean sprouts, eggplant, endive, nutmeg and Hokkaido squash, green beans, cucumber, ginger, potatoes, carrots, lettuce, chard, corn, parsnips, turnips, spinach, yams, tomatoes, zucchini, Chinese cabbage, peppers , chives, spring onion


not suitable Soybeans, soy milk and yogurt, red, black, white beans, borlotti beans, falafel
small amounts canned red lentils, lentils and chickpeas (rinsed well)
suitable Quorn, tofu


not suitable Coconut, pistachios, almonds, cashew
small amounts hazelnuts
suitable Chestnuts, tree nuts, peanuts, poppy seeds, chia seeds, linseeds, pumpkin seeds, macadamia, Brazil nuts, pecans, pine nuts, sunflower seeds, sesame, olives

Milk & dairy products

not suitable Milk, yogurt, buttermilk, kefir and all products made from them such as milk drinks, mueslis, soy milk, coconut milk, rice milk, oat milk
small amounts Cream cheese (quark, ricotta, cottage cheese), cream (sour, half, full cream)
suitable lactose-free milk and yoghurts, butter, all types of cheese, almond milk


not suitable Barley, wheat, rye (in bread, pasta, pizza…), couscous, bulgur, wheat bran
small amounts Amaranth, buckwheat, oats
suitable Corn, rice, (original) spelled, potatoes, chestnuts, quinoa, millet, sorghum (also in pasta and baked goods, cornflakes, etc.), corn starch, tapioca starch

Sugar and sweeteners

not suitable Pear, pear syrup, honey, fructose, fructose (syrup), agave syrup,
suitable Maple syrup, molasses, white and brown sugar, rock sugar, raw and cane sugar, glucose, sweeteners (aspartame, acesulfame, saccharin, stevia), glucose (syrup)


not suitable Fruit juices, chai and chamomile tea, fennel tea, olong tea, chicory coffee (Incarom, Caro, etc.), rum
suitable Vegetable juice, syrups, coffee, black, green, peppermint tea, water, sweet and light drinks, beer & wine

Various foods & snacks

not suitable Functional food with inulin or FOS (prebiotics), tooth-friendly chewing gum and candies, bouillon powder with onions/garlic
suitable all spices, herbs, vinegar

Opportunities and limits

Reducing FODMAPs cannot cure irritable bowel syndrome patients. However, the nutritional principle can be a tool for alleviating your own symptoms and thus making everyday life easier. The effectiveness of the diet has been well researched, but whether there are possible long-term consequences has not yet been clarified.

Those affected who have already tried a lot of things and restricted their eating habits but have never found a solution can use the FODMAP diet to regain confidence and get to know their food tolerances on an evidence-based basis. It is important that preliminary examinations to rule out possible other illnesses and allergies are carried out by your family doctor and intestinal specialist and that the change in diet is professionally supervised.

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