# Starch and inflammation - solving the IBS puzzle



## tummyrumbles (Aug 14, 2005)

Studies suggest that IBS might be a low level autoimmune disease. Bowel dysmotility is believed to be caused by autoimmunity or inflammation. There are higher levels of GnRH IgM antibodies in patients with IBS and dysmotility. IBS patients also tend to have higher levels of C-reactive protein, a biomarker of micro inflammation.

Many believe IBS to be caused by a bacterial dysbiosis, either in the colon or the small intestine as in the case of SIBO.

Klebsiella Pneumoniae is a common bacterial pathogen found in Ankylosing Spondylitis, an inflammatory disease that attacks the spine. Pathogens are bacteria that can cause infection. Klebsiella also appears in about 25% of Crohn's Disease.

There is a strong link between Klebsiella, Crohn's Disease, Inflammatory bowel disease and Ankylosing Spondylitis. Klebsiella is believed to be the cause of Ankylosing Spondylitis.

Klebsiella is an opportunistic bacteria that grows on dietary starch. This bacteria produces a carbohydrate degrading enzyme that breaks down starch. This enzyme mimics an antigen called HLA-B27. The body's immune system not only sees the Klebsiella as a foreign invader but also the body's own proteins such as collagen, which closely resemble this enzyme. In the case of Ankylosing Spondylitis the immune system attacks its own tissues, causing arthritis.

The cure for Ankylosing Spondylitis, Crohn's Disease and Inflammatory bowel disease is believed to involve a low starch diet.

These diseases are relevant to IBS because IBS is also considered to be a low level autoimmune disease. Klebsiella pneumoniae is found in high percentages of SIBO as well as IBS.

Starch in the diet

Man-made starch isn't a healthy food. Carbohydrates are made up of (mostly) indigestible fibre and (mostly) digestible starch. Foods highest in starch are typically man made: grain foods like pasta, all breads and all flours. Potatoes have the highest starch out of the vegetables. Sweet potato also has starch, but not as much. Corn is technically a grain, and has some starch and carrots and beans also have smaller amounts.

Fibrous vegetables are largely indigestible and these include leafy vegetables like lettuce and spinach and cruciferous vegetables like broccoli and cauliflower.

Most carbohydrate digestion takes place in the small intestine through the action of enzymes in the villi of the small intestine wall. Some starches resist digestion (resistant starch) and escape into the colon undigested. Fibre is generally undigested however colonic bacteria can produce enzymes that break down the cellulose to simple sugars which are then fermented to create short chain fatty acids that can then be absorbed. So some calories in fibre can be digested.

Fibrous vegetables are made up of cells. They have much less carbohydrate density than flour, an accelular food. Our gastrointestinal tract wasn't designed to digest such a large, dry concentration of sugars. Up to 20% of starch escapes digestion and travels to the colon to feed bacteria, causing a lot of gas as it does so.

Lipopolysaccarides

Lipopolysaccarides levels increase after eating starch. Lipopolysaccarides are endotoxins found in negative gram bacteria and these cause strong immune responses which can lead to inflammation. Gram negative bacteria figures highly in obesity, and most obesity is believed to be caused by refined starches rather than fats.

Probiotics

Probiotics claim to replenish the "good bacteria" and to reduce flatulence but a lot depends on what is causing the flatulence in the first place. Carbohydrates are generally digested in the small intestine. The better they're digested the less food residue will be in the colon to feed bacteria. Opportunistic bacteria feeds on starch, not on fibre. Our digestive systems didn't evolve to digest heavy concentrations of carbohydrate. Digestive enzymes were designed to digest cellular food with a high water content, e.g. vegetables. Many believe IBS stems from carbohydrate malabsorption. 30 grams of unabsorbed carbohydrate can produce 10 litres of hydrogen gas. How are probiotics going to solve the problem of undigested food residue? It's the action of the bacteria on the undigested food that will cause the gas. Adding more bacteria to the mix isn't going to do much. The answer is to not malabsorb your food in the first place. An ancestral diet of meat, fish and fibrous vegetables will help to eradicate bad bacteria.

Fibre

IBS has different levels of severity and many people with IBS can't tolerate too much fibre. This is because the colon has become hypersensitive due to chronic inflammation. The irritable bowel wasn't caused by fibrous vegetables, which we were designed to eat, but was due to our diet of refined starch causing gastrointestinal distress, which in turn meant that eventually other more wholesome foods can't be tolerated either. Fibre might be a tougher problem for IBS-D than IBS-C or gas-predominant IBS because of the higher existing inflammation. If this is the case, vegetables might need to be boiled for longer or mashed. Low starch vegetables are necessary for healing.

Starch exists in some vegetables, but most calories from starch in a typical diet are usually from manufactured foods made from flour. Klebsiella is only one pathogen in the gut out of many. Not a great deal is known about colonic bacteria in general. If you think you might have a starch intolerance it's probable that the underlying reason is due to the growth of pathogenic bacteria of some sort. A low starch diet is an easy test to see if symptoms improve.

Does Irritable Bowel Syndrome and Dysmotility have an autoimmune origin?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271243/

The link between Ankylosing Spondilitis, Crohns Disease, Klebsiella and starch consumption
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678459/

Comparison with ancestral diets
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402009/


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## jaumeb (Sep 1, 2014)

I eat a very low starch diet (dairy free SCD). I don't think that starch is the only culprit in my case, as I have not recovered.

I will be sending samples for a stool test that includes, among others, klebsiella.


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## tummyrumbles (Aug 14, 2005)

Have you tried eliminating all fermentable foods including FODMAPs? I had next to no gas the other day at work (a rarity for me) and this is what I ate the previous day:

breakfast: porridge oats (low starch)

during the day: lettuce carrot, cheese, orange (all low FODMAP)

dinner: 2 bowls of ham hock soup (quite fatty and filling) with well-cooked potato, pumpkin, carrot with well-cooked broccoli

banana and yoghurt. A few chocolates.

No diet will help if you don't completely empty your bowels. I stay there until there's no more. Potato and pumpkin are starchy veges, but they had been cooking for a long time. I gradually increased the salad veges back into my diet. The Specific Carbohydrate Diet can allow high FODMAP veges that are fermentable. I don't follow any diet and just experiment with food until I get the least symptoms.


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## rewinj (Apr 19, 2012)

My stool test found klebsiella p., though mainstream docs don't want to consider it. I produce insane amounts of odourless gas & lots of loose stool. I also deal with severe obstructed defecation though... so whether some weird bacteria or just chronic constipation is to blame for my issues, I'm unsure. I cannot avoid carbs as I am significantly underweight. It is a major challenge to maintain, and I'm 6'1'' and only 120 pounds! Interested to read more into this.


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## tummyrumbles (Aug 14, 2005)

Dr Pimentel is a leading researcher of SIBO and IBS and he cited klebsiella in one of his studies in relation to SIBO

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752184/

and klebsiella and irritable bowel is mentioned a lot on Google Scholar. Family doctors aren't really helpful when it comes to IBS. I had a hamburger the other day with fatty Wagyu beef. It was wrapped in lettuce instead of a bun but it would have had a lot of calories. I still eat ice cream, yoghurt, chocolates etc but I'm not certain whether simple sugars feed pathogens as much as starch. I'm not sure about obstructed defecation. It used to take me 4 hours. Today it took half an hour so for me anyway it depends a lot on diet. Also, I get constipated with long delays between BMs if I have trapped gas and I think a lot of that gas is refined starch related.


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## jaumeb (Sep 1, 2014)

I am following Aglaee Jacob's program to find my safe foods. All the foods that I am currently eating are low fodmaps. But I remember from last September that too many carrots caused smelly gas, D, and frequent urination. Carrots also worsened my symptoms last Desember. Now I am taking S. Boulardii and I have eaten carrots for three days and I have not noticed any worsening of my symptoms.


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## rupertluxton (Apr 25, 2017)

Hi,

I have recently done a stool test that came back with me having an overgrowth of klebsiella and some oportunistic yeast.

what carbs are okay to eat and won't feed the klebsiella? can i eat bananas? sweet potato? rice? does it matter how these are cooked etc?

many thanks


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## Rboe (Mar 26, 2017)

Interesting. I am quite sure starch is an issue for me. I am doing SCD and it has made a huge improvement. Way fewer problems.


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## Helena (Apr 13, 2017)

Interesting that this initial post by Tummyrumbles has come up again this year and interesting about all the information. I just found the site called sciencedaily.com In 2014, it said, quote"researchers from the University of Adelaide have discovered that the immune system is defective in people suffering IBS,which is a major reason why sufferers have ongoing issues with pain... Immune cells in healthy people normally secrete opioid chemicals that block pain but they are defective in people with IBS." In the articles Tummyrumbles mentions, inflammation is mentioned as well as lectin resistance etc.


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## richgel999 (Oct 25, 2015)

I strongly feel that, at least in many/most people, IBS is caused by dysbiosis and/or SIBO. The immune system deeply interacts with the gut microbiota, and if the biota gets too far out of balance the immune system can go into overdrive trying to control it. (I say this from direct experience, having survived a very nasty case of SIBO.) Once the immune system is in "overdrive" (trying to keep you alive because your biota is seriously out of balance) you can suffer from depression, autoimmunity, etc.

I realized while trying to overcome SIBO that it's possible for the microbiota to basically become poisonous to the host. When this happens, no amount of probiotics, prebiotics, yogurts, etc. will treat it. It may be possible to find a diet that can prevent the pathogenic organisms from growing and poisoning the host, but this diet may be so simple that you slowly starve to death.

When this happens, you need a protracted course of strong antibiotics, so the pathogenic parts of the biota are killed off. Then you need to repopulate the gut with lots of probiotics and prebiotics, and give it the right nutrition (like vitamin U) to heal it. (I've unfortunately experienced all of this treatment firsthand and I know it works. It's no walk in the park.)

Another possibility is a fecal transplant, which first involves a very strong course of antibiotics. They don't always work though, and to me the thought of nuking my entire flora sounds terrifying.

Perhaps in the future, medical science will be able to sequence your biota and determine exactly which antibiotics to prescribe, to avoid killing off the wrong or too much of the "good" bacteria.


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