Carbohydrates - connecting the dots...
#354769 - 01/22/10 08:23 AM
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PMartin
Reged: 08/05/08
Posts: 140
Loc: Niagara Region
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I'm really trying to determine if and how Carbohydrates, in particular the oatmeal, white rice and banana's that are staples in my day to day diet, may be playing a role in my symptoms. There is something called Complex Carbohydrate Intolerance and after thinking about it, there has probably never been a day in my life when I haven't consumed some form of (complex) carbohydrate. Although I've avoided many complex carbohydrates simply by following the EFI diet as there is some overlap (i.e. many trigger foods/insoluble fiber that are also complex carbohydrates), there are some well known complex carbohydrates that aren't necessarily considered EFI trigger foods like pasta, white bread, potatoes and the ones I previously mentioned. And, if you were to bring FODMAP's which are (as have been previously discussed and acknowledged on this forum) short-chain carbohydrates that can be osmotically active, meaning they may drag water from intestinal vessels into intestinal lumen, thus causing diarrhea, into the picture, you again come across these same foods like oat bran, wheat, rice, potatoes and so on. These are Polysaccarides and Oligasaccarides.
And if you're wondering, a food can be rich in complex carbohydrate but also be refined. White rice and white bread, for example, are refined grain products, but retain their complex carbohydrate.
http://www.nutritionmd.org/consumers/general_nutrition/macro_carbs.html
PLEASE LET ME KNOW WHAT YOU ALL THINK (or at least those of you who feel this could be an avenue for yourself as well) AS LIKE I SAID, I'M STILL TRYING TO CONNECT THE DOTS MYSELF.
And so far, the only way to treat it that I've come across is Beano.
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IBS-D. Or so a doctor says.
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I have also been looking into this and like you there isn't a day that goes by that I don't eat white rice, potatos or pasta. I have never had a stable period in my 3yrs of having my ibs-d/urgency issues. I have also only came across beano has being the way to help it. I to would like to know what other think about this issue.
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Complex carbohydrate intolerance (CCI) occurs due to the absence of the enzyme in the small intestine necessary for the digestion of foods with a high oligosaccharides content. Not all complex carbohydrate are high in oligosaccharides. Foods high in oligosaccharides include some vegetables (Brussels sprouts, broccoli & cauliflower), legumes (bean & peas), nuts, seeds, whole grains and whole grain cereals.
The build-up of gases due to CCI produce discomfort, pain, distension or bloating and is often expulsion of excess gas through burping or flatulence. Beano contains the enzymes alpha-galactosidase and sucrase. The first enzyme is breaks down oligosaccharides into the sugars galactose and sucrose and sucrase breaks down sucrose into glucose and fructose that digestible.
Most of the complex carbohydrates including whole grains that are high in oligosaccharides high in insoluble fiber and are listed on Heather's cheat sheet. They should be eaten with care.
Here is a good list of problem foods for individuals with CCI. White rice, potatoes, pasta, banana, white bread, etc are not on the list because they don't contain high levels of oligosaccharides and contribute little to CCI. 
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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And here's a study that indicates that a diet of very low carbohydrates can help with symptoms and quality of life for those with IBS-D.....
http://www.ncbi.nlm.nih.gov/pubmed/19281859?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=12
For me personally, my symptoms are much improved if I don't eat foods with high carb/sugar/starch content.
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Thanks Kim. I feel there is a connection.
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I looked at that site too Syl. As I don't fit the definition of IBS due to a lack of pain/discomfort, I am naturally seeking an alternative cause (for symptoms of D) and wondering about those foods like Oats, Rice, Potatoes and Pasta of which I consume daily, because they are on the list. Perhaps you have some data you could share but I haven't seen anything that distinguishes these foods based on their levels of oligosaccharides and potential contribution to CCI.
I simply plan to experiment with trying the Beano and seeing if it has any effect.
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IBS-D. Or so a doctor says.
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Hi PMartin,
Check the last page of that website which was prepared by the makers of Beano titled "For Healthcare Professionals". Under the subheading 'Causes' you will see the following
Complex carbohydrates consist of oligosaccharides, long chains of monosaccharides (small sugar units that cannot be further broken down) held together by alpha-galactosidic linkages. Oligosaccharide digestion is necessary because the gastrointestinal tract can only absorb monosaccharides, including glucose and galactose, in the small intestine.
It goes on to say
The inability of the small intestine to adequately transport and absorb glucose, galactose, and other monosaccharides is caused by a lack of a sufficient number of enzymes required to digest oligosaccharide bonds. In particular, all humans lack the intestinal enzyme alpha-galactosidase, which is required to hydrolyze alpha-galactosidic linkages present in complex carbohydrates.
The enzyme alpha-galactosidase contained in Beano breaksdown the raffinose, stachyose and verbascose, three oligosaccharides, into their digestible sugar components: glucose, galactose, sucrose and fructose.
The FAO says oligosaccharides are not widely occurring or of great importance in foods and food products, except for a series of galactosylsucroses (often designated as a -galactosides) and fructo-oligosaccharides. The galactosylsucrose family of oligosaccharides include raffinose (a trisaccharide), stachyose (a tetrasaccharide), and verbascose (a pentasaccharide). In vegetables, such as peas, beans, and lentils, the content of these oligosaccharides can range from five to eight percent on a dry matter basis.
If you look at the animation which you can access on the right hand side of the page where it says "Click here to see an animated demonstration of how CCI affects the way carbohydrates are absorbed by the body." You will see the second slide says Complex Carbohydrates are the sugars found in many health foods, beans and other legumes, vegetables, whole grains, nuts and seeds. Complex carbohydrates are made of long chains of sugars called "oligosaccharides".
The list of foods on the CCI site that they claim cause complex carbohydrate intolerance do not include rice (except rice bran), potatoes and pasta. Only oat bran and oat flour are on it because both contain oat bran which contains oligosaccharides. Beano will only help with foods that contain oligosaccharides.
Say - have you asked your GI doc if you have functional-D which is not associated with pain/discomfort and not IBS? Unfortunately, I believe it is managed the same way IBS is managed.
Good luck with your experiments. I hope it gives you some relief
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Thanks for taking the time to provide such thorough and detailed respones Syl.
Perhaps this is a problem with the information age; there's too much of it. I guess it wouldn't be a problem if there wasn't contradiction but this site does note a connection between starches and complex carbohydrates, listing (white) pasta, bread and rice - and this site does list tubers like potatoes.
Now, I really don't want to sound like I'm arguing with you so I will admit that I see no mention of oligasaccharides on either of these sites and they both label complex carbohydrates as polysaccharides. Is this the differentiation?
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IBS-D. Or so a doctor says.
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PMartin, I find these discussions interesting. They encourage me to review basic biochemistry and physiology. Frequently I gain new insights when I review the basics
There are different kinds of complex carbohydrates. Oligosaccharides are a particular kind of complex carbohydrate - a non-starch polysaccharide. As usual in biochemistry the same thing can have different names. Let me explain a bit more.
Carbohydrates are divided into four chemical groupings: monosaccharide, disaccharide, polysaccharide and oligosaccharide.
Here is the confusing bit. Polysaccharides consist of a number of monosaccharides linked together. Oligosaccharide are particular type of polysaccharide. They are non-starch polysaccharides consisting of 3 to 10 monosaccharides linked together.
For dietary purpose carbohydrates are simple (monosaccharide & disaccharide) or complex (oligosaccharide and polysaccharide).
Starches are complex polysaccharide carbohydrates found in potato, rice, wheat, and maize. Our body have the necessary enzymes such as salivary amylase and pancreatic alpha-amylase to break starches in simple sugars.
Dietary fiber consists of non-starch polysaccharides such as cellulose, dextrins, inulin, lignin, waxes, chitins, pectins, beta-glucans and oligosaccharides. Our bodies don't have the necessary enzymes to breakdown many of non-starch polysaccharides such as oligosaccharides into simple sugars. In particular, humans lack the intestinal enzyme alpha-galactosidase. This enzyme found in Beano from the mold Aspergillus niger diminish intestinal gas production by enhancing the breakdown of oligosaccharides before they reach the lower intestine where they would be fermented in the colon producing gas.
Complex carbohydrate intolerance (CCI) (see conclusions section in reference below) is "caused by a deficiency in enzymes to break down oligosaccharides, the difficult to digest sugar units in complex carbohydrates" As explained previously this occurs due to the absence of enzymes in the small intestine necessary for the digestion of non-starch polysaccharides high in oligosaccharide content.
Carbohydrate intolerance is a broader intolerance than CCI which includes difficulty digesting simple and complex carbohydrates such as lactose, fructose, sorbitol, starches and fibers.
The FODMAP restriction diet restricts simple and complex carbohydrates in the form of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols i.e. short chained carbohydrates that are not digested in the stomach or small intestine but reach the colon where they are fermented producing gases and byproducts.
CCI can be manage using the enzyme in Beano, lactose intolerance by taking the enzyme lactase and most of the other carbohydrate intolerances such as fructose and sorbitol malabsorption are managed by avoidance or reduced consumption.
I hope this connects a few more dots
Reference
Levine, B., & Weisman, S. (2004). Enzyme replacement as an effective treatment for the common symptoms of complex carbohydrate intolerance. Nutr Clin Care, 7(2)
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Yes Syl, this is helping. Well, helping me to understand Carbohydrates at least. As for how it may pertain to my symptoms it looks like I should focus more on an intolerance to starches/polysaccharides than oligosaccharides?
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IBS-D. Or so a doctor says.
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If you focus on FODMAPs and take Beano whenever you eat an complex carbohydrate on the CCI list you should have almost all of the carbohydrate intolerance covered
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Well now I'm a little confused as I thought we established that polysaccharides (the starch foods like rice, pasta, potatoes) should not be considered in CCI as they are different than oligasaccharides?
I already started looking into glucose polymers (starches) and Amylase. And low and behold, the role of the pancreas comes up again. I don't expect you to know/remember everything about me or that I've posted but I have documented my very puzzling experience with Cholestyramine being the one treatment I've tried over the years that has actually worked. Unfortunately, it was short lived and abandoned by my GI.
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IBS-D. Or so a doctor says.
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Correct.
Starch is digested in two steps. Amylase in the saliva and pancreatic juice breaks the starch into molecules called maltose. Then an enzyme in the lining of the small intestine splits the maltose into glucose molecules that can be absorbed into the blood.
As I recall cholestyramine is a resin belongs known as bile acid sequestrants that binds to bile acids from the gall bladder in the intestine. While, the pancreas and the gall bladder share a common duct they do different things. The pancreas produces digestive enzymes and the gall bladder stores bile produced in the liver. Bile emulsifies fat so pancreatic enzymes can digest it easily. Bile is not an enzyme and it is not involved in carbohydrate metabolism.
Problems with starch digestion is something you would have to talk to a specialist about as this involves problems with other organs not just the intestine.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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My last post was a bit rushed and what I was trying to get at was if the foods I'm questioning aren't triggers for CCI (because they are polysaccharides - not oligosaccharides) then Beano would be a waste of time? And in fact, I can probably move on from considering CCI as I already avoid eating foods/carbohydrates that are oligossachrides?
Like I've said before, it's easier for me to list what I do eat rather than what I don't eat which incidentally helps me to rule out other causes but at the same time is frustrating not only because I'm down to such a small diet but when you are eating so few foods, how can it be so hard to find the problem? So, as I mentioned, I looked for the common denominator between the foods in question (rice, potatoes, oatmeal, bananas etc.) which lead to...
Starches produced by all green plants as an energy store. It is the most important carbohydrate in the human diet and is contained in such staple foods as potatoes, wheat, maize (corn), rice, and cassava.
...and...
Amylase... an enzyme that breaks starch down into sugar. Amylase is present in human saliva, where it begins the chemical process of digestion. Foods that contain much starch but little sugar, such as rice and potato, taste slightly sweet as they are chewed because amylase turns some of their starch into sugar in the mouth.
So, of course the next step is to look at Amylase deficiency and it's symptoms. There are plenty like sinus congestion, itchy watery eyes, fatigue, blood sugar imbalance and frequent headaches but nothing relating to IBS like symptoms.
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IBS-D. Or so a doctor says.
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In traditional Chinese medicine, the spleen (includes stomach and pancreas) is the major organ that controls digestion. Digestion, digestive fire transforms and transports food, nutrients into blood. Blood (nutrients) build, thicken, fuel, heat, cleanse, cool and moisten. Weak digestion transforms and transports less, decreasing nutrient absorption, blood, while increasing waste, as whatever food not digested, absorbed becomes waste sent directly to the large intestine for temporary storage and eventual elimination. Long-term low protein, low fat and high carbohydrate diets, in addition to drugs, surgery, chronic disease, etc. weaken the spleen, digestion, blood (deficiency), structure and function.
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Allisonmary, thanks for sharing. It is so nice to have an holistic view. 
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The experts are in the process of figuring out if the carbohydrates which break down to amino acids and to tryptophan and then create serotonin, effect serotonin in the gut and hence symptoms.
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My website on IBS is www.ibshealth.com
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I am friends with the doctor who did this study.
This is an email from Him to me about it.
Dr Drossman
"These are reasonable comments, however the study was not a clinical trial, nor is it meant to be a recommendation as much as to understand whether CHO restriction might have clinical benefits in IBS. To uncerstand the role of CHO, fructans, serotonin, etc. requires a larger, methodologically different and more complex study, rather than a case series of a few patients;. This is only preliminary and readers should be cautious about what to conclude from this.
Doug
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My website on IBS is www.ibshealth.com
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I guess it wouldn't hurt to experiment with such a diet, even though it is preliminary. A benefit is a benefit, especially when IBS symptoms are concerned.
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Agreed, Kim. It certainly isn't going to hurt.
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