The research articles on this webpage show how the elimination of difficult to digest carbohydrates improves digestion.

"Prompt improvement from diarrhea was induced by elimination of all lactose, disaccharides, and other carbohydrates from the diet. "
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J Pediatr. 1971 Oct;79(4):612-7.

The response of infants to carbohydrate oral loads after recovery from diarrhea.

Lifshitz F, Coello-Ramirez P, Contreras-Gutierrez ML.

PIP: A clinical study was carried out to assess the response of 46 infants to oral loads of carbohydrates after recovery from severe diarrhea. The response was measured by the increases in blood reducing sugars and by the variations in the stool pattern following administration of oral carbohydrates. Disaccharide oral loads were used in the test. During the acute stage of the illness, 38 of the 46 patients had exhibited intolerance to carbohydrates, as evidenced by the excretion of acid stools and/or stools with a greater than .25% carbohydrate content. Prompt improvement from diarrhea was induced by elimination of all lactose, disaccharides, and other carbohydrates from the diet. None of the infants had monosaccharide intolerance during the acute diarrheal stage. The carbohydrate oral loads were administered within 1 week after recovery and serially thereafter. Responses to sucrose and lactose loads were related to the degree of intolerance exhibited during the illness. In infants with diarrhea, the impaired carbohydrate metabolism is temporary. Oral feedings may be administered after cessation of profuse diarrhea and vomiting and after replacement of water and electrolytes. Patients should be back on a milk formula within 3-4 months, depending on the degree of carbohydrate intolerance exhibited during the illness.

PMID: 5094255 [PubMed - indexed for MEDLINE]

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1: Am J Clin Nutr. 1985 Feb;41(2):228-34.

Tolerance to glucose polymers in malnourished infants with diarrhea and disaccharide intolerance.

Fagundes-Neto U, Viaro T, Lifshitz F.

The response of infants with diarrhea and lactose intolerance to feedings containing soy protein and sucrose (Sobee), and/or to a carbohydrate free formula (RCF), to which glucose polymers (GP) were added, was assessed in twenty patients. They all were less than ten months of age and had varying degrees of malnutrition. Eleven had acute diarrhea and nine had chronic diarrhea. None of them had classical enteropathogenic strains and parasites in the stools. All had lactose intolerance when feedings were begun with cow's milk formula and some also had sucrose intolerance when fed sucrose containing soy formulas. They had persistent loose stools and excreted feces with an acid pH and with carbohydrates, thus they were given dietary treatment with RCF with GP. There were 9 patients with acute diarrhea and lactose intolerance (1 of them also had sucrose intolerance), who improved on RCF with GP feedings; but 2 patients (lactose and sucrose intolerant) failed to respond to this diet. There were six patients with chronic diarrhea and lactose intolerance (four of them also had sucrose intolerance), who improved on RCF with GP formula, but there were three patients who failed on this treatment. These data show that some infants with diarrhea, malnutrition, and lactose-sucrose intolerance may also develop intolerance to GP and require further dietary management with glucose as the source of carbohydrate in the diet.

PMID: 3969931 [PubMed - indexed for MEDLINE]

Sugar malabsorption in functional bowel disease: clinical implications.

Fernandez-Banares F, Esteve-Pardo M, de Leon R, Humbert P, Cabre E, Llovet JM, Gassull MA.

Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.

OBJECTIVE: To investigate the relationship of sugar malabsorption to the development of clinical symptoms in functional bowel disease. METHODS: Twenty-five consecutive outpatients [five men, 20 women; mean age 38.7 +/- 2.6 (SEM) yr] with functional bowel disease and symptoms suggestive of carbohydrate malabsorption were studied. Twelve healthy subjects [six men, six women; mean age 35.7 +/- 3.7 (SEM) yr] acted as the control group. Sugar malabsorption was assessed by breath-hydrogen test after an oral load of various solutions containing lactose (50 g), fructose (25 g), sorbitol (5 g), fructose plus sorbitol (25 + 5 g), and sucrose (50 g). The severity of symptoms developing after sugar challenge was studied. In addition, the effect on clinical symptoms of a diet free of the offending sugars, compared to a low-fat diet, was assessed. RESULTS: Frequency of sugar malabsorption was high in both patients and controls, with malabsorption of at least one sugar in more than 90% of the subjects. Median symptom scores after both lactose [median 6; interquartile (IQ) range 3-7] and fructose plus sorbitol (median 2; IQ range 0-4) malabsorption were significantly higher than after sucrose load (median 1; IQ range 0-1.5) in functional bowel disease patients (p = 0.001 and p = 0.007, respectively). However, there were no differences in healthy controls. In addition, symptoms score after both lactose and fructose plus sorbitol malabsorption was significantly higher in patients than in control subjects (p = 0.02 and p = 0.008, respectively). On the other hand, H2 production capacity, as measured following lactulose load, was significantly higher in patients than in controls. The clinical symptoms improved in 40% of the evaluated patients after restriction of the offending sugars. CONCLUSIONS: These results suggest that sugar malabsorption may be implicated in the development of abdominal distress in at least a subset of patients with functional bowel disease.

PMID: 8249972 [PubMed - indexed for MEDLINE

[Comments from the web owner: there would have been even more improvement if starches had also been restricted]

Dietary habits as risk factors for inflammatory bowel disease.

Tragnone A, Valpiani D, Miglio F, Elmi G, Bazzocchi G, Pipitone E, Lanfranchi GA.

Division of Internal Medicine, Bellaria Hospital, University of Bologna, Italy.

OBJECTIVE: To examine the influence of dietary factors in Italian patients with ulcerative colitis and Crohn's disease. DESIGN: We studied dietary habits immediately prior to the onset of disease in 104 patients enrolled in a prospective, epidemiological study of the incidence of inflammatory bowel disease in Italy. METHODS: Each patient was interviewed using a recall questionnaire to provide information on the daily intake of nutrients. The differences in diet between patients and healthy subjects matched for age, sex and city of residence were determined. RESULTS: Our data confirm that patients with Crohn's disease and ulcerative colitis have a high intake of total carbohydrate, starch and refined sugar. This resulted in a significantly higher relative risk (P < 0.001) in both ulcerative colitis and Crohn's disease patients. Total protein intake was significantly higher in ulcerative colitis, but not in Crohn's disease patients, than in controls. Fibre consumption did not differ between patients and controls. CONCLUSIONS: Our results confirm that carbohydrate consumption is significantly higher in IBD patients than in healthy controls. Ulcerative colitis patients also consumed more total protein than controls. The pathogenetic significance of these findings, however, remains unclear.

PMID: 7866810 [PubMed - indexed for MEDLINE]

Increased consumption of refined carbohydrates in patients with Crohn's disease.

Martini GA, Brandes JW.

The nutritional habits of 63 patients with Crohn's disease (C.d.) were explored by means of questionnaires and compared with a control group of 63 persons matched as to age, sex and social status. Before the disease was recognized patients with C.d. consumed 742 grams/week (g/w) sweets and 1380 g/w pastries, during the disease 482 g/w sweets and 905 g/w pastries. The controls only consumed 285 g/w sweets and 563 g/w pastries. The differences between both groups are highly significant. There existed no significant difference in the intake of other foodstuffs such as proteins, fats, vegetables or alcohol. The high intake of refined carbohydrates in patients with C.d. may be partly responsible for its increasing incidence in the developed countries. This might be due to the sugar content as such and/or the food additives.

PMID: 1271690 [PubMed - indexed for MEDLINE]

Consumption of refined sugar by patients with Crohn's disease, ulcerative colitis, or irritable bowel syndrome.

Järnerot G, Järnmark I, Nilsson K.

The daily dietary consumption of refined sugar was studied in four equal-sized groups of 30 patients with Crohn's disease, ulcerative colitis (UC), irritable bowel syndrome (IBS), or minor orthopedic conditions. The latter group was matched for sex and age with the Crohn's disease group. The Crohn's disease patients consumed significantly more refined sugar (88.9 +/- 50.7 (SD) g/day) than the controls (64.3 +/- 45.6 g/day), the UC patients (64.3 +/- 38.7), or the IBS patients (59.9 +/- 33.3). Fifteen patients with Crohn's disease interviewed within 6 months of diagnosis consumed similar amounts of sugar (69.9 +/- 43.9) to those of the subjects in the other three groups. Fifteen other patients with Crohn's disease studied 7-36 months after diagnosis consumed significantly more refined sugar (107.9 +/- 41.2). These results indicate that the high sugar consumption in Crohn's disease is a secondary phenomenon without etiologic importance.