In fact, some research suggests 75 percent of people visiting diabetes clinics report having significant gastrointestinal symptoms.
How Diabetic Neuropathy Can Lead to Heartburn and Other Issues
So how might diabetes affect the digestive system? “Advanced diabetes, whether it’s from type 1 or type 2 diabetes, can affect any organ in the body — including those organs in the digestive tract,” says James C. Reynolds, MD, a gastroenterology specialist and clinical medicine professor at the University of Pennsylvania in Philadelphia. Dr. Reynolds notes digestive problems may be caused by the very factors that led to diabetes in the first place, such as obesity, but it’s also possible that digestive problems are the result of diabetes-related complications, such as hyperglycemia, or high blood sugar. One of the most serious diabetes complications that can result from consistent high blood sugar is diabetic neuropathy, or nerve damage. Neuropathy may lead to weakness, pain, and numbness, affecting feeling in your feet, legs, and hands, but the condition can also affect digestive functions like swallowing and constipation, Reynolds explains. If you have diabetes, this potential complication is just another reason it’s crucial to pay attention to your A1C, the average level of glucose over the past two to three months, Reynolds says.
3 Digestive Problems Linked With Type 2 Diabetes
Here are a few of the conditions that advanced diabetes and poorly controlled blood sugar may lead to:
Acid Reflux (GERD)
The stomach contains an incredibly concentrated amount of hydrochloric acid, and if it doesn’t routinely empty that acid, your gastric juices back up, causing damage to your esophagus that can lead to acid reflux, also known as gastroesophageal reflux disease (GERD), Reynolds says. Obesity is one potential cause of these symptoms, though hyperglycemia can also damage nerves along the digestive tract that interfere with this gastric emptying, he says. Reynolds notes that common symptoms of acid reflux include chest pain and difficulty swallowing, though more serious complications include a precancerous condition known as Barrett’s esophagus, which could lead to a deadly form of esophagus cancer. Treatment includes medication, lifestyle changes, like losing weight and quitting smoking, and potentially — as a last resort — surgery.
Gastroparesis
If your stomach is not emptying correctly, you may experience not only acid reflux in your esophagus but also gastroparesis in your stomach, Reynolds says. “Gastroparesis is a disease in which the stomach cannot empty itself of food in a normal fashion,” says Michael Cline, DO, the medical director of the multidisciplinary gastroparesis clinic at the Cleveland Clinic in Ohio. Symptoms of gastroparesis include nausea, vomiting, abdominal bloating and pain, weight loss, and acid reflux itself, according to the Mayo Clinic. Dr. Cline notes that this is a common condition in people who have had diabetes for a long time, regardless of whether it is well controlled, but it’s unclear why these individuals have more sensitive stomachs. According to a review published in March 2015 in the journal Gastroenterology Clinics of North America, women are more likely to deal with gastroparesis than men (about 38 women per 100,000 people versus about 10 men per 100,000 people), and those people with type 1 diabetes are more likely to have the disease than people with type 2 diabetes (about 5 percent of people with type 1 versus about 1 percent of people with type 2). Treatments for gastroparesis include diet changes, such as skipping high-fat or high-fiber foods, medication to help the stomach empty food faster, and surgery.
Diabetes Enteroneuropathy
This condition is caused by damage to nerves in your gut, and can sometimes mimic symptoms of the more commonly known irritable bowel syndrome (IBS), such as constipation and diarrhea, Reynolds says. When glucose levels become excessive in the bloodstream, glucose is deposited onto nerves and become like a syrup that poisons the inside of these cells, he explains. “If that persists for a very long time, the nerves can actually die off,” and that damage to nerves in your gut can also cause other serious complications to diabetes, including kidney dysfunction and retinopathy, or damage to eyes. According to a review published in June 2015 in the journal Revista Española de Enfermedades Digestivas, treatment can include strategies such as decreasing fat and fiber consumption, taking medication that speed up the stomach’s emptying, or using electrical stimulation via a device implanted during surgery.
Gut Check: How to Prevent or Control Digestive Issues in Diabetes
But just because you have diabetes doesn’t mean you have to resign yourself to digestive problems as well. To help keep your digestive system in working order, follow these tips: Keep your blood sugar tightly controlled. Whether you’re looking to prevent or control digestive problems when you have diabetes, it is most important to rigorously pay attention to control blood sugar and keep your A1C within a healthy range, Reynolds says. “A1C elevation is directly proportional to the level at which esophageal function and gastric function is impaired,” he says. Everyone’s A1C goal is different — talk to your doctor to learn yours. Choose a healthy diet low in sugar and refined carbs. “A diet high in refined sugar can mess up the gut bacteria,” Cline says. He recommends staying away from foods high in saturated fat and refined carbohydrates, such as white bread, pasta, and rice, as well as processed sweets and snacks, like refined pastries and granola bars. Research also suggests eating a healthy diet could help minimize disease progression, which is associated with neuropathy. A study published in April 2017 in the journal Nature, for instance, found that a certain substance produced by gut microbes is associated with a reduced likelihood of progression of type 2 diabetes in overweight people with prediabetes. That substance, indolepropionic acid, is linked with dietary fiber intake, the authors noted. It’s well known that prioritizing foods high in fiber — such as berries, whole grains, beans, and veggies like broccoli and artichokes — can be beneficial for people with diabetes. For one, fiber isn’t digested by the body, so it helps slow the rise of blood sugar. Plus, high-fiber foods are satiating, so eating them can help keep your weight in check. Eat small, frequent meals throughout the day. Doing so will help with symptoms of acid reflux and gastroparesis, Reynolds says. Instead of eating a full meal in one sitting, consider eating only half and saving the rest for later. Try not to lie down after eating a meal. Although you may feel sleepy after eating, resist the urge to lie down. Staying upright sitting, standing, or walking for two to three hours after eating will prevent just-eaten food and stomach acid from backing up into your throat if you have acid reflux, Reynolds says. Don’t ignore your GI symptoms. If you are experiencing gastrointestinal (GI) discomfort, make sure you seek medical help and advice from your doctor. For instance, acid reflux symptoms may sometimes be due to other causes, like an infection of candida, so it’s important to get your symptoms checked out before they get worse, Reynolds says.
Preventing Digestive Issues in Diabetes: The Bottom Line
“Keeping blood sugar under control is key to prevent gastrointestinal issues from occurring,” Cline says. If you have any symptoms, make sure to reach out to your medical team: “With gastroparesis, it’s especially important to treat it early,” Cline explains. “With time and if left untreated, more nerve damage to the intestine occurs.” By communicating with your providers, you can settle on a course of treatment and help prevent any severe complications.
