Dietary Carbohydrates, Bowel Disease and the Bacterial Microbiome

Feeling nostalgic after last week’s post on autism and carbohydrate malabsorption, I spent some time today flipping through one of my massive binders of research that I’ve been collecting for the last 20 years.  After Alex’s amazing response to the Specific Carbohydrate Diet, I began to look carefully at research supporting its use and it is astounding just how much I found.   Here are just a few examples:

1. An article in the American Journal of Gastroenterology from 1993:  25 people with functional bowel disease (versus 12 controls) were given a variety of sugars including lactose, fructose, sucrose, etc. and at least 90% of those with bowel disease proved to have malabsorption of at least one sugar.  “The clinical symptoms improved in 40% of the evaluated patients after restriction of the offending sugars.”[i]
2. 1997, in the journal, Gut: researchers set out to determine if anything in the diet could be implicated in the subsequent development of IBD.  They assessed the dietary history of 87 patients recently diagnosed and discovered that  “…A high sucrose consumption was associated with an increased risk for IBD.” [ii]
3. From the Israeli Medical Association Journal in 2000: 239 patients were divided into two groups, one with confirmed symptoms of IBS, the 2^nd with more mild functional GI complaints.  They were given 3 different sugar solutions at weekly intervals and tested.  Only 7% of patients with IBS and 8% of the 2^nd group absorbed all 3 sugars normally.[iii]

Remember that carbohydrates are the primary source of food for your gut bacteria, and alterations in the bacterial microbiota can lead to abnormal digestion of these various sugars.  In fact, we are reliant upon our gut bacteria to break down many complex sugars.  What you eat plays a huge role in dictating what grows down there.  For example, look at my latest post on the importance of fiber (which are carbohydrates) on the microbiota.

Looking back over just a little bit of the research in the literature, it amazes me all over again that SCD is still not considered a first-line treatment for bowel diseases.

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[i] Fernandez-Banares, F, Esteve-Pardo, M, de Leon, R, Humbert, P, Cabre, E, Llovet, JM, Gassull, Ma.  Sugar malabsorption in functional bowel disease: clinical implications.  American Journal of Gastroenterology. 1993. 88(12):2044-50.

[ii] Reif, S, Klein, I, Lubin, F, Farbstein, M, Hallak, A, Gilat, T. Pre-illness dietary factors in inflammatory bowel disease.  Gut. 1997. 40(6):754-60.

[iii] Goldstein, R,Braverman, D, Stankiewicz, H. Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints.  Israeli Medical Association Journal. 2000. 2(8):583-7.