No-starch diet
#367875 - 07/22/12 04:48 PM
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I have ankylosing spondylitis and am positive for the HLA-B27 gene, and I know that there is one line of thinking out there that related IBS can be managed by removing all starch from the diet. Has anyone here heard of this, and if so, what are the thoughts? It's obviously a very different school of thought than Heather's, and my point isn't to argue--I'm just curious if anyone here has tried it or studied it. (I did try it a few years ago, but moreso for some mild AS symptoms. The only thing I experienced was weight loss, but my AS and IBS symptoms are so minimal that I might not have been the best candidate to try such a thing expecting to see much change.) I'd be eager to hear any insights anyone's got.
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I have not seen anything in the clinical research that shows a low starch diet might benefit individuals with IBS. As you know starch are a carbohydrates but not all carbohydrates are starches. There was a small clinical trial using a very low carbohydrate diet that showed some efficacy but the diet was so low in carbs that it is not recommended. The closest thing I have seen is the FODMAP diet that restricts particular carbs that rapidly ferment in the colon. There are some low starch fad diets for managing IBS that are clinically unproven.
Do you know of any research published in peer-reviewed journals that has shown clinical evidence for the efficacy of a low starch diet for managing IBS?
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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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Isn't it rather the case that all fibre, even soluble fibre bloats, so someone not particularly sensitive to fat would have much less bloating from just you know, meat?
In the non-IBS community, many people cut out carbs (or just wheat) and then they tout carbs/wheat as the source of all evil and celebrate that their low-carb diet means all their bloating is gone.
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now: stable through EFI+FODMAP dieting (no lactose/no fructose/some fructans and some polyols)
before: IBS-D(pseudo-diarrhoea), bloating, often unbearable pain esp from too much fat: Apr 2007- Dec 2010
FODMAPs: http://www.todaysdietitian.com/newarchives/072710p30.shtml
[I've tried VSL#3 -> I could tolerate v good amounts of IF (even with less SF), it worked great (but overall I find it too expensive)]
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The only research I'm aware of comes from Dr. Alan Ebringer out of England, based on studies of patients with ankylosing spondylitis--he's written papers, but I'm uncertain whether his work is considered "clinically proven" because my own rheumatologist had never heard of it, insists there's no way to dietarily manage AS and believes pharmaceuticals are the only option. IBS (and IBD--I get that they're different) can be an accompanying disorder, and some people with AS anecdotally report a decrease in IBS/IBD symptoms when they can control their AS symptoms with a no- or low-starch diet. A patient named Carol Sinclair wrote a book, The IBS Starch-Free Diet, that is discussed often on the boards at www.kickas.org, where Dr. Ebringer's research is also referenced. I'm not sure it's appropriate for this site because Ebringer's work deals with AS and only mentions IBS as one possible aspect of the AS package--you'd have to wade through a lot of AS to get to any IBS, and mentions of it would be scant! It would seem to me that most people with IBS don't have AS; a few people with AS might have IBS or one of the inflammatory bowel diseases. I have AS with very mild symptoms on occasion. I also have IBS with (compared to others) very mild symptoms on occasion. Not sure if the two are connected, but a no-starch diet (or low-starch diet) was too much for me in terms of weight loss. Weight loss, for me, is undesired, as I'm naturally very thin.
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Not all fibers are fermented in the colon to produce gas and bloating. Some fibers like inulin are rapidly fermented while others like methylcellulose are slowly or not fermented at all. According to the Linus Pauling Institute at Oregon U "Pectins, beta-glucans, guar gum, inulin, and oligofructose are readily fermented, while cellulose and lignin are resistant to fermentation in the colon". Cellulose and lignins (not a carb) are found in insoluble fibers.
Also, it depends on the unique composition of the colonic flora in each individual. Some soluble fibers may cause some people problems while others with IBS can handled them with no difficulty. There isn't a universal answer as far as I know.
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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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I came across Ebringer paper and a more recent one Gut-mediated and HLA-B27-associated Arthritis: An Emphasis on Ankylosing Spondylitis and Crohn's Disease with a Proposal for the Use of New Treatment. The latter paper suggest it can take 6-9 months on a low starch diet before AS patient experience an significant effect. Other researchers claim that the evidence is too scant to be reliable. Your doctor might find this more recent paper interesting too.
Your question lead me to the AS research where I learned that is related to or overlaps with Crohn's disease which I did not know. Very interesting! 
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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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I feel I need to have rice to have IN,well how would someone go starch free with ibs and have the insoluble fiber?
I want to have canned pumpkin and blended veggies...without starch like rice starch wouldn't I have more problems and pain?
Thanks
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ibs-D & bloating,mucus,gerd,incomplete evacuation.
diet-no preservatives,no table salt,homemade cooking,grains-sushi rice,rice flour,oatmeal,gluten&soy free
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In your book you say not to try the anti-depressant anti-anxiety medicine Paxil. I have had IBS-D since I am 16 years old, I am now 48 and JUST getting the help I need to live a normal life. Paxil and Librax are helping tremendously along with the food guidelines in your books. People should TRY what their doctor suggests, especially a gastro doc familiar with IBS. :-)
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Yes, ankylosing spondylitis comes with a whole package of potential disorders, including iritis, psoriasis, Crohn's . . . I've been fortunate in that I had one major spinal flare about 17 years ago, which resulted in my diagnosis (positive HLA-B27, inflamed SI joints), but the flare was resolved by a few months on Voltaren (NSAID). I went off that during pregnancy and never went back on, and any flares since have been very mild. No changes on x-rays, no reduction in range of motion. My rheumy long ago d/c'd me as a regular patient--I last saw him a couple of years ago when I made the connection between IBS and AS, and simultaneously was having some fingernail psoriasis and tailbone pain. So I have SOME symptoms, on occasion, and they are mild. I'd love to be rid of them all, but would not go on the scary immunosuppressors for such mild symptoms. I'd much prefer dietary management, but there's just not a lot of evidence it works. Also, it's very conflicting. What Heather says here, for example, directly contradicts what Carol Sinclair says about dietary management of IBS. And I would think that IBS that's paired with AS might be triggered by different foods, by a different physiological series of events, than that that's not. In non-AS people, IBS wouldn't be considered autoimmune. In AS people, it can be considered to be part of the autoimmune package, just like the IBDs, psoriasis, iritis, spinal joint inflammation, etc.
Definitely don't want to further hijack the boards with AS talk, though. I'm trying Heather's approach to my IBS-D (sort of)/nausea, and so far so good. If starch was going to cause me trouble, I'd have been sick as a dog this week with all the rice I've been eating!
Thanks for the link, Syl.
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PS~ Heather, your books have changed my life for the better. Living in fear of having an attack is beyond horrible and painful. Thank you Heather! :-) I just started the IBS-D diet a week ago, along with soluable fiber, librax (taken as needed) and paxil. So far, so good. Oh I have your peppermint tummy tamers also but have not used them yet.
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