Carbohydrate Malabsorption

What Is Carbohydrate Malabsorption?

[dropcap]C[/dropcap]arbohydrate malabsorption is a digestive disorder characterized by the inability to properly digest and absorb carbohydrates within the small intestine to supply needed energy to the body.

Q: What carbohydrates should be normally digested and absorbed?

A: In normal digestion, large carbohydrate molecules are digested by enzymes into their component simple sugars. Carbohydrates that should be digested and absorbed within the small intestine are compounds that include monosaccharides, disaccharides, and polysaccharides.

• Monosaccharides, meaning one molecule of sugar, are the simple sugars glucose, fructose, and galactose that normally pass through the intestinal lining, as is, with no need of digestive enzyme action. 
• Disaccharides, meaning two molecules of sugar, are the complex sugars lactose, sucrose, and maltose that must not pass through the intestinal lining without first being split by specific digestive enzymes into their component sugars. Lactose must be split by lactase into glucose and galactose.  Sucrose must be split by sucrase into glucose and fructose. Maltose must be split by maltase into glucose and glucose. 
• Polysaccharides, meaning many molecules of sugar, are complex starches that must not pass through the intestinal lining without first being split by specific digestive enzymes into their component sugars. Starch must be split by salivary and pancreatic amylases into maltose, and from there maltase splits off glucose.

Failure to absorb simple sugars due to inflammation and to split complex molecules due to lack of enzymes allows them to remain in the small intestine and osmotically retain fluid, causing diarrhea, urgency, and distention. The resulting bacterial fermentation of undigested carbohydrates produces gaseous, acidic stool with pH below 6.

There is a poor time relationship of carbohydrate consumption to symptoms. Symptoms result 1- 8 hours after ingesting the offending carbohydrate.

Carbohydrate malabsorption is frequent in patients with functional gastrointestinal disorders and in healthy volunteers and can cause gastrointestinal symptoms mimicking irritable bowel syndrome (IBS).¹

What Is Carbohydrate Malabsorption In Celiac Disease and/or Gluten Sensitivity?

• Carbohydrate malabsorption is a well known symptom in patients with untreated celiac disease causing distressing digestive problems, disabling neurological problems, and metabolic problems that can be life-threatening.

How Prevalent Is Carbohydrate Malabsorption In Celiac Disease and/or Gluten Sensitivity?

Carbohydrate malabsorption is common in patients with untreated celiac disease.²

What Are The Symptoms Of Carbohydrate Malabsorption?

Carbohydrate malabsorption is marked by these symptoms:

• Digestive symptoms include abdominal cramps, bloating, borborygmi, flatus, urgency and diarrhea.
• Neurologic symptoms include hypoglycemia and fatigue.
• Metabolic symptoms include failure to gain weight in a child and unexpected loss of weight in adults.

How Does Carbohydrate Malabsorption Develop In Celiac Disease and/or Gluten Sensitivity?

Carbohydrate malabsorption results secondarily from diffuse villous injury in celiac disease in three ways.

• Swelling and inflammation of the small intestinal lining interferes with the normal process of absorbing simple sugars by diffusion into the bloodstream so that they travel on into the colon.
• Damage to villi destroys the cells located in the brush border of villi that produce the enzymes lactase, sucrase and maltase responsible for digesting complex sugars.
• Pancreatic insufficiency prevents adequate pancreatic amylase production for digesting starches.
• Bacterial overgrowth and candidiasis (yeast infection) further inflame the intestinal lining and use carbohydrates for their growth.

Does Carbohydrate Malabsorption Respond To Gluten-Free Diet?

Yes. Celiac disease-related carbohydrate malabsorption usually resolves on gluten free diet.

In the case of fructose intolerance, restriction of fructose consumption is necessary. In lactose intolerance, restriction of lactose consumption is necessary until lactase production returns in the treated small intestine, although it may not. Maltose intolerance requires restriction of starch. If the problem is the initial breakdown of starch by pancreatic amylase, this enzyme supplement can be taken with meals to help digests starch.

6 Steps To Improve Carbohydrate Malabsorption In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both carbohydrate malabsorption and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.³
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁴
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁴
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁴.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁴
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁴
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁴[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

No nutritional depletions are reported for Imodium as a common non-prescription treatment for diarrhea.

Chemotherapy can be a cause of carbohyrate malabsorption due to inflammation of the small intestinal lining. Ask your doctor or pharmacist about this possible adverse effect if you are taking cancer treatment.

Do not stop prescribed medications without supervision.

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• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Vitamin K as prescribed following blood test for status since this vitamin may be lost to diarrhea.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Carbohydrate Malabsorption In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Unclear abdominal discomfort: pivotal role of carbohydrate malabsorption.” This study investigating the prevalence of symptomatic lactose and fructose malabsorption in 2,390 patients with IBS-like symptoms based on Rome II criteria found that carbohydrate malabsorption is a frequent but underestimated condition in patients with IBS-like symptoms although diagnosis can be easily confirmed by H2 breath testing. Celiac disease was found in 1 of 161 patients by upper endoscopy examination.

Patients with unclear abdominal discomfort underwent lactose (50 g) and fructose (50 g) hydrogen (H2) breath tests and depending on the results further testing with 25 g fructose or 50 g glucose, or upper endoscopy with duodenal biopsies. Additionally, this population was investigated regarding the prevalence of small intestinal bacterial overgrowth (SIBO) based on glucose breath test and celiac disease.

Of the 2,390 patients with IBS-like symptoms, 848 (35%) were symptomatic lactose malabsorbers and 1,531 (64%) symptomatic fructose malabsorbers. A combined symptomatic carbohydrate malabsorption was found in 587 (25%) patients. Severe fructose malabsorbers (pathologic 25 g fructose test) exhaled significantly higher H2 concentrations in the 50 g test than patients with negative 25 g fructose test (P < 0.001).¹

Sources:

1. Goebel-Stengel M, Stengel A, Schmidtmann M, Voort Iv, Kobelt P, Mönnikes H. Unclear abdominal discomfort: pivotal role of carbohydrate malabsorption. J Neurogastroenterol Motil. 2014 Apr 30;20(2):228-35. doi: 10.5056/jnm.2014.20.2.228. [↩] [↩]
2. Murray JA, the widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999; 69(3):354-365. [↩]
3. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
4. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]