# Carbohydrate Malabsorption In IBS and Functional Bowel Complaints



## Mike NoLomotil (Jun 6, 2000)

Isr Med Assoc J 2000 Aug;2(8):583-7Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. Goldstein R, Braverman D, Stankiewicz H Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel.-------------------------------------BACKGROUND: Carbohydrate malabsorption of lactose, fructose and sorbitol has already been described in normal volunteers and in patients with functional bowel complaints including irritable bowel syndrome. Elimination of the offending sugar(s) should result in clinical improvement. OBJECTIVE: To examine the importance of carbohydrate malabsorption in outpatients previously diagnosed as having functional bowel disorders, and to estimate the degree of clinical improvement following dietary restriction of the malabsorbed sugar(s). METHODS: A cohort of 239 patients defined as functional bowel complaints was divided into a group of 94 patients who met the Rome criteria for irritable bowel syndrome and a second group of 145 patients who did not fulfill these criteria and were defined as functional complaints. Lactose (18 g), fructose (25 g) and a mixture of fructose (25 g) plus sorbitol (5 g) solutions were administered at weekly intervals. End-expiratory hydrogen and methane breath samples were collected at 30 minute intervals for 4 hours. Incomplete absorption was defined as an increment in breath hydrogen of at least 20 ppm, or its equivalent in methane of at least 5 ppm. All patients received a diet without the offending sugar(s) for one month. RESULTS: Only 7% of patients with IBS and 8% of patients with FC absorbed all three sugars normally. The frequency of isolated lactose malabsorption was 16% and 12% respectively. The association of lactose and fructose-sorbitol malabsorption occurred in 61% of both patient groups. The frequency of sugar malabsorption among patients in both groups was 78% for lactose malabsorption (IBS 82%, FC 75%), 44% for fructose malabsorption and 73% for fructose-sorbitol malabsorption (IBS 70%, FC 75%). A marked improvement occurred in 56% of IBS and 60% of FC patients following dietary restriction. The number of symptoms decreased significantly in both groups (P < 0.01) and correlated with the improvement index (IBS P < 0.05, FC P < 0.025). CONCLUSIONS: Combined sugar malabsorption patterns are common in functional bowel disorders and may contribute to symptomatology in most patients. Dietary restriction of the offending sugar(s) should be implemented before the institution of drug therapy---------------------------MNL www.leapallergy.com


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## moldie (Sep 25, 1999)

Right on Mike! I really believe that too many doctors resort to meds to control the symptoms when diet can be beneficial with less side-effects, and more than likely to have a greater healing effect. I find that both too much fruit or dairy in my diet gives me a lot of bloating and gas, as well as causes more frequent soft stooling with cramping. The next question I would have is what causes this carbohydrate malabsorption? In my case, it didn't show up (at least severely) until after antibiotic therapy. It sounds like they believe gut fermentation is involved being that they were measuring methane gas. The slow-down of my system occurred while on birth control which probably had something to do with hormonal changes, but also would probably set someone up to be more susceptible to bacterial over-growth. Some might also say that it may have set me up for autoimmune type responses as well. Are you familiar with the Rea research study and Dr. Lewis Maydron's studies as reported by Nancey Appleton, PhD in her book "Lick the Sugar Habit"?


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## Mike NoLomotil (Jun 6, 2000)

HI MOLDIE:Familiar only in passing. I have enough trouble trying to keep up with Pasula, Brostoff, and the other docs I am in contact with and with any new material or finidings in food-chemical-neuroimmune response and trying to follow their incredible understanding of the ultimate black box...immunology. Focus being in rooting out the underlying systemic and local inflammatory mediators and synthesized mediators which findings more and more suggest are at least one large branch of the root problem as their local and systemic release will produce local reaction in the myenteric plexus and in the CNS, leading to the "twitchy gut" and CNS condition. Trying to learn enough about the basics to be able to comprehend what they say and do is hard enough! tell me about what you read. Saves me time!mikeNL_______________ www.leapallergy.com [This message has been edited by Mike NoLomotil (edited 09-27-2000).]


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## moldie (Sep 25, 1999)

No problem Mike. Here it is for what it's worth:"Most symptoms of food-additive intolerence occur in the respiratory tract and skin. Common symptoms include respiratory infections, skin irritations, headaches, hyperkinesis, bladder urgency, joint and muxcle pain, diarrhea, and other irritable bowel problems. Additives such as tartazine and sulfites have been noted as frequent ofenders, as well as flavor enhancers such as monosodium glutinate. Dr. Lewis Maydron tested chemicals used as coloring agents for foods and found theat they destroyed both red blood cells and antibodies.A variety of studies have shown that most people with inflammatory bowel disease can control theri symptoms by eliminating foods to which they react. Sugar, wheat, milk , corn, coffee, tea and citrus fruits are some of the most common that may cause problems.If a food to which the body is allergic is continually eaten, eventually the body will adapt to that food. The symptoms of acute reaction disappear, but this does not mean all is well. The reactions have simply grown more complex and chronic.The overuse of sugar and other foods to which we have become allergic causes a mineral malfunction, which in turn causes an enzyme malfunction. When enzymes are incapable of properly digesting food, bits of undigested protein are able to escape in the bloodstream. The immune system properly recognizes these proteins as intruders and digests them just as it would digest a virus. (Rea)"Does all of this agree with what your docs have found to be true?


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## Jackie (Sep 15, 2004)

Good info. but the reason for the carb malabsorption isn't discussed. Intestinal amoebic parasites live on carbs, this is how they survive. Until all IBS people are tested PROPERLY for amoebic parasites this info. is once again only going to alleviate the symptoms and not treat the problem.JackiePS: I've been on this diet now for over a year with a big reduction in symptoms. I have also been diagnosed with an amoebic parasite. http://member.rivernet.com.au/bara/index.htm


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## Mike NoLomotil (Jun 6, 2000)

HI MOLDIE:Yeas, pretty much unequivically EXCEPT in (2) areas, where its equivocal:"If a food to which the body is allergic is continually eaten, eventually the body will adapt to that food. The symptoms of acute reaction disappear, but this does not mean all is well. The reactions have simply grown more complex and chronic."This in a way would be agreed with.The extent and complexity of immunologic response and non immunologic intolerance canm and does grow more complex the longer the offending food is consumed, as multiple pathway reactions can emerge froma single pathway origin when the body is contiually exposed to an allergen. I think the adaptive statement makes it sound like symptomology may diminish, or that adaptive tolerance will occcur, as in desensitization for inhalants. Desensitization gemerally is ineffective with foods, but some other investigators have reported success in the last year or two with enzyme-potentiated desensitization. This is very preliminary, but Pasula (our research immunologist and founder) does seem to belive that this mechanism is possibly feasible and is looking at the other guy's work.--------------------"The overuse of sugar and other foods to which we have become allergic causes a mineral malfunction, which in turn causes an enzyme malfunction. When enzymes are incapable of properly digesting food, bits of undigested protein are able to escape in the bloodstream. The immune system properly recognizes these proteins as intruders and digests them just as it would digest a virus. (Rea)"The exact etiology, sequence and even degree of altered gut permeability in food intolerance conditions is anuthing but agreed upon.While it is known exactly what the effect of immune mediators are on the local vascular permeability and the epithelial permeability, that KNOWN effect is designed to allow transport and infiltration of imune elements (specific cell types and mediators) from the cirulation into the the extravascular space and even into the lumne of the gut.Using current methods of measurement, there is alot of difficulty in consistently demonstrating the widely assumed "inapprpriate transit of large molecules" into the extraluminal compartments, icnlding the vascular bed...much less agreement that the presentation of the inappropriate large-molecule tyoe to the immune system elicits further response.Some would say this is classified as logical, possible, but still conjecture.So, that si what the fellas I ahng out with would probably say, but in a way non-immunologists would not follow.----------------------HI JACKIEWhile the phenomenon of amoebaic parasites is certainly one explanation for the observations, it may be a reach to suggest it is the sole source, and that evry IBS patient must be tested for amobic parasites. It is sort of like suggesting everybody has amoebic dysentery, or (like Dr. Fine does) that evrybody actually has sprue (wheat-gluten-whichever universal intolerance it is). I am familiar with Dr. Fine, a fine GI doc in a fine hospital with good info, we have already seen that not EVERYBODY is reactive to wheat. So let me go look at your link and maybe I will change my mind.PS: ia m very glad to hear your symptoms were briought under control by the diet you have been on. Thats one more for the good-guys!Talk to you later...you too Moldie.Have a DFDMNL______________________ www.leapallergy.com


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## Mike NoLomotil (Jun 6, 2000)

HI JACKIE>Okay now I got it. Great Smokies and D. Fragilis stool testing. I do not think from the data it is unreasonable to suggest stool samples be routinely checked for this in patients with IBS as it may be co-incident with IBS or the patient may have been colonized, have symptoms and be misdiagnosed as IBS.It is not expensive and no harm can certainly come from it and perhaps it should be part of the standard workup. I haven't read up on this in at least, well, some time.Out of curiousity I will look up some of the more recent findings on incidence frequency so I do not talk through my well-worn hat.At least I know the subject now.have a Good WEMNL


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