(aka Carbohydrate Malabsorption)
This topic officially falls under the category of food allergies but because the symptoms seem to so closely resemble Fibromyalgia and ME/Chronic Fatigue Syndrome, I decided to give it it's own page.
When I first stumbled upon the idea of Carbohydrate Intolerance, I thought for sure I had found the cause of my illness. The symptoms were strikingly similar to my own. My heart soared and I felt there may actually be an end in site. However, like so many other false hopes, the experiment ended in dissapointment. Of course, it doesn't mean that will be the case for everyone. I still think it's worth a try. The "Two Week Test" is explained below.
Some of the Symptoms of Carbohydrate Intolerance:
- Physical Fatigue
- Mental Fatigue
- Intestinal Bloating
- Weight Gain
- Sugar Cravings
- Shortness of Breath
I completed the "two week test" as suggested by several websites. The diet for ten - fourteen days consisted of very high amounts of protein and very low carbohydrate consumption (see below for specifics). After the two weeks were over I didn't see any change in my condition so I threw the idea upon the pile of tested and failed theories as to the cause of my sickness.
I've been on a strictly vegan diet (no meat, fish or dairy) since March 1, 2012 and I believe I have more energy than I previously had but am not ready to declare it a cure. Needless to say, I definetely feel better now (as well as having a clearer conscience) than I did while eating a high-protein diet.
Carbohydrate Intolerance - The Two Week Test
by Dr. Gangemi
Carbohydrate intolerance simply means that carbohydrates, (sugars and starches in the diet), are not tolerated as well by the body as they should be. The complex part is figuring out why this is the case and to what extent they are affecting your health and your lifestyle.
If left untreated, carbohydrate intolerance, or CI, can result in many varied symptoms including: hypertension, hyperinsulinemia, polycystic ovaries, breast cancer, high blood cholesterol, pain and inflammation, Type II diabetes (“adult-onset”), obesity, stroke, and coronary heart disease. This is because all these problems are related to something called insulin resistance, which first starts as CI.
Insulin resistance is a process in which the body is inefficient at managing sugars and starches you have eaten in your diet. When you eat a carbohydrate, such as a piece of bread or something sweet like ice cream, your body releases insulin from your pancreas to process that sugar. Without insulin, you would not be able to assimilate this sugar, called glucose, from your blood stream into your liver and muscles. In insulin resistance, your body makes too much insulin for the amount of carbohydrate consumed. This extra insulin is what causes so many of the listed problems, both functional problems (those which precede pathological), as well as pathological problems (those with tissue alterations.) Initially, the extra insulin often ends up processing sugar too rapidly and blood glucose levels are driven too low. This is called hypoglycemia or low blood sugar. This adds stress to the body and causes the production of other hormones (especially adrenal gland hormones like cortisol), which increase blood sugar levels. As CI gets worse, more and more insulin is needed to process a small amount of sugar. The insulin eventually becomes ineffective at driving the sugar into the cells where the nourishment is needed. The cells have become resistant to the insulin.
As CI is developing, the extra stress on the hormonal system, particularly to the adrenal glands, overworks these organs. This results in a complex pattern of symptoms that differ from person to person.
Symptoms of CI include but are not limited to sleepiness, drowsiness, lack of concentration, or a feeling of being bloated after a meal, especially one containing sweet foods or starches. Always feeling hungry or having weak legs or knees after eating is also a symptom of CI. These are just a few of the functional symptoms. As carbohydrate intolerance can cause major distress to your life, correcting it can result in major health improvements.
Before you know how to adjust your lifestyle so CI is not a problem, you need to find out how sensitive, if at all, you are to carbohydrates. One very effective method of finding the optimal level of carbohydrates you can handle is to do what is calledThe Two-Week Test.
The Two-Week Test (TWT) was originally developed by Dr. Phil Maffetone. Many doctors and dietary advisers have “used” his dietary idea over the years but his original concept is still the best. The TWT is only a test as the name states. Therefore, at the end of the two weeks, it is not advised to continue the diet further without alterations unless your physician advises you to do so. I actually like to think of this as aFour-Week Test. The reason is because the first two weeks will assess your intolerance to carbohydrates and the second two weeks will assess your tolerance to certain carbs as you re-introduce them back into the diet. I’ve seen many people over the years screw up the test after the first two weeks. They go back to eating the way they originally were and never learned what carbohydrates they could tolerate and to what degree. So think FOUR WEEKS! The test will help you decide if you really have a carbohydrate intolerance, and if you do, it will help you find the right level of carbohydrate intake for you.Writing down all your symptoms before you start the Two-Week Test (TWT) is recommended. This will give you a reference point to see how your symptoms have changed, if at all. Many people forget the severity of their problems after they no longer have them. You may also want to record your weight and any body fat measurements, as applicable.
During the TWT you will want to avoid the following:
All carbohydrate foods
. This includes but is not limited to fruit, starches, potatoes, breads, rice and most processed foods. Again – no fruit!
Milk, yogurt, ice cream
“Energy” or “Nutrition” bars, including the 40-30-30 type
All alcohol and soda, including diet drinks (and anything sugar-free *Nutrasweet, Splenda, Truvia, xylitol, sorbitol, etc..). Small amounts of dry wine are okay.
Eat as much of the following foods during the TWT as you like, continuing to stay away from any food you may be allergic to.
Whole eggs, cheese (real cheese, not processed), cream
Meats – all meats are fine except those cured in sugars
All vegetables except corn and potatoes
Fish and shellfish – sushi is fine, keep the avocado, leave the rice!
Pure vegetable juice, including tomato and carrot
All nuts, seeds, and their butter counterparts
All oils, and sugar free spreads such as mayonnaise and mustard (no catsup and no hydrogenated oils)
Lots of water! And herbal tea is okay (decaf) – but no sweeteners – no honey, no stevia
KEY POINTS FOR SUCCESS:
Do not let yourself go hungry. If you are not eating many small meals throughout the day, including vegetables, your blood sugar will drop. This will cause your adrenal glands to be stimulated and, with the aid of your pancreas, mobilize extra sugar into your bloodstream. Your body will perceive this similarly to you having just consumed a few sips of soda. So eat up! Don’t worry about your fat intake or cholesterol levels. This is only for two weeks.
If you decide to eat some form of carbohydrate on the “Avoid List” before the two weeks is up, you will most likely get an invalid response and you will need to start over.
Go shopping before you start. Plan on eating all, or most all, meals at home. This will help you resist the temptations for desserts and snacks.
Consume plenty of water during the test.
Avoid demanding exercise (anaerobic exercise) during the test. Your body chemistry will be changing during the TWT and the sugars needed to run anaerobic activity will not be as readily available from you diet. So keep to aerobic activity during the TWT.
DAY 15: TEST COMPLETED, TIME TO ASSESS THE SITUATION:
Re-evaluate your list of complaints. What symptoms are better? What symptoms are gone? How is your energy level? Your sleep? Your mood?
If you felt better, start adding small amounts of carbohydrates back into your diet. Start very small, such as a piece of fruit for breakfast, an apple at lunch, or some rice with dinner – not all 3 on one day. Just one! Try one carb for a couple days, see how you feel, then perhaps add a second.
Continue to stay away from all refined sugars and white flours!
Add the carbohydrates in during every other meal. Add in the carbohydrates until you notice some symptoms return. This will usually occur a few hours after eating the carbohydrate. It may be bloating, a depressed mood or energy level, craving for more carbohydrates, or any other symptom that improved during the TWT. This is your tolerance level and you will want to back off your carbohydrate intake slightly and maintain, but not exceed, this new level of carbohydrate intake. This should be your optimal dietary intake pattern and you can adjust it as needed; such as more carbs on harder exercise days.
It is the inability of the body to completely process carbohydrates (sugars and starches) due to lack or inadequate amount of one or more of the enzymes needed for their digestion.
Lactose Intolerance is the most common one but the inability to break down starch is also common.
Similar to the fuel of a car, carbohydrates are the primary source of energy and one of the three major nutrients in the human diet. The other two being fat and proteins. Carbohydrates are classified according to their structure. The basic carbohydrate consist of one unit, called a saccharide.
A monosaccharide (a single saccharide) is the simplest carbohydrate and called a simple sugar. They include glucose (the form in which sugar circulates in the blood), fructose (found in fruit and honey), and galactose (produced by the digestion of milk). These simple sugars are readily absorbed by the small intestine without the aid of enzymes. Now, if two single sugars are linked together, they make a disaccharide. The disaccharide sugars present in the diet are maltose (a product of the digestion of starch), sucrose (table sugar), and lactose (the sugar in milk). The intestine us unable to absorb them because they are too bid to go through, hence enzymes produced in the small intestine break down the enzymes into two monosaccharides. Polysaccharides are much more complex carbohydrates made up of many simple sugars, the most important of which are glycogen, which is stored in the liver, and starch (such as that found in rice and potatoes).
Digestion of Sugars
Digestion of food begins in the mouth, moves on to the stomach, and then into the small intestine. Along the way, specific enzymes are needed to process different types of sugars. An enzyme is a substance that acts as a catalyst to produce chemical changes without being changed itself. The enzymes lactase, maltase, sucrase are needed to break down the disaccharides; when one or more is inadequate, the result is carbohydrate intolerance.
Carbohydrate intolerance can be primary or secondary. Primary deficiency is caused by an enzyme defect present at birth or developed over time. Secondary deficiencies are caused by a disease or disorder of the intestinal tract, and disappear when the disease is treated. These include protein deficiency, celiac disease, and some intestinal infections.
Adult lactose intolerance is the most common of all enzyme deficiencies, and it is estimated that 70% of the world population have this condition. Some racial and ethnic populations are affected more than others. Some people feel the symptoms after having certain foods. For example, consumption of rice and/or potatoes may lead to bloating and cramps due to inadequate amount of amylase to break down the starch present in these foods.
Causes & Symptoms
Enzymes play an important role in breaking down carbohydrates into forms that can pass through the intestine and be used by the body. Usually they are named by adding ase to the name of the substance they act on, so lactase is the enzyme needed to process lactose. Cooked starch is broken down in the mouth to a disaccharide by amylase, an enzyme in the saliva. The disaccharides maltose, sucrose, and lactose cannot be absorbed until they have been separated into simple sugar molecules by their corresponding enzymes present in the cells lining the intestinal tract. If this process is not completed, digestion is interrupted.
Although not common, a deficiency in the enzymes needed to digest lactose, maltose, and sucrose is sometimes present at birth. Intestinal lactase enzymes usually decrease naturally with age, but this happens to varying degrees. Because of the uneven distribution of enzyme deficiency based on race and ethnic heritage, especially in lactose intolerance, genetics are believed to play a role in the cause of primary carbohydrate intolerance.
Digestive diseases such as celiac disease and tropical sprue (which affect absorption in the intestine), as well as intestinal infections and injuries, can reduce the amount of enzymes produced. In cancer patients, treatment with radiation therapy or chemotherapy may affect the cells in the intestine that normally secrete lactase, leading to intolerance.
The severity of the symptoms depends on the extent of the enzyme deficiency, and range from a feeling of mild bloating to severe diarrhoea. Undigested sugars remain in the intestine, which is then fermented by the bacteria normally present in the intestine. These bacteria produce gas, cramping, bloating, a "gurgly" feeling in the abdomen, and flatulence. In a growing child, the main symptoms are diarrhoea and a failure to gain weight. In an individual with enzyme deficiency, gastrointestinal distress begins about 30 minutes to two hours after eating or drinking foods containing the offending sugar, such as lactose in the case of lactose intolerance. Food intolerances can be confused with food allergies, since the symptoms of nausea, cramps, bloating, and diarrhoea are similar.
Sugars that aren't broken down into one of the simplest forms cause the body to push fluid into the intestines, which results in watery diarrhoea (osmotic diarrhoea). Diarrhoea may sweep other nutrients out of the intestine before they can be absorbed, causing malnutrition.
Treatment and Cure
In primary conditions, no cure exists to improve the body's ability to produce the enzymes, but symptoms can be controlled by diet. Commercially available digestive enzymes (see Carbozyme) are the only present solution to treat those who either do not wish to diet or cannot help avoid the offending carbohydrates e.g. those added and hidden in so many foods. On the other hand, carbohydrate intolerance caused by temporary intestinal diseases disappears when the condition is successfully treated.
The degree of carbohydrate intolerance varies in different people, hence treatment should be tailored for the individual. Young children showing signs of lactose intolerance should avoid milk products; infants should switch to soy-based formula, or even better drink milk treated with lactase enzymes. Older children and adults can adjust their intake of lactose depending on how much and what they can tolerate. For some, a small glass of milk will not cause problems, while others may be able to handle ice cream or aged cheeses such as cheddar or Swiss, but not other dairy products. Generally, small amounts of lactose-containing foods taken throughout the day are better tolerated than a large amount consumed all at once.
For those individuals who are sensitive to even very small amounts of lactose, the lactase enzyme is available without a prescription. It comes in liquid form for use with milk or in capsules for dairy products. The addition of a few drops to milk will reduce the lactose content by 90% after 24 hours in the refrigerator. Heating the milk speeds up the process, and doubling the amount of lactase liquid will result in milk that is 98% lactose free. Chewable lactase enzyme tablets (Lactaid) are also available. Three to six tablets taken before a meal or snack will aid in the digestion of solid foods, alternatively one capsule of Prolactazyme Forte is sufficient to do the job. Lactose-reduced milk and other products are also available in some stores.
Carbohydrate intolerance can be diagnosed using oral tolerance tests. The carbohydrate being investigated is given by mouth in liquid form and several blood levels are measured and compared to normal values. This helps evaluate the individual's ability to digest the sugar.
Prognosis & Prevention
Since the cause of the enzyme deficiency leading to carbohydrate intolerance is unknown, there is no way to prevent this condition. With good dietary management, individuals with carbohydrate intolerance can lead normal lives. The existence of specific commercially available digestive enzymes to break down carbohydrates make life easier and may help individuals with carbohydrate intolerance being able to eat food containing carbohydrates without suffering the related symptoms.
Carbohydrate Intolerance & Obesity
Studies have shown that Carbohydrate Intolerance plays part in obese people. Moreover it was also found that obese men may not process carbohydrates as efficiently as obese women, a condition that can, ultimately, lead to a decrease in fitness level and the development of metabolic disorders.
A new study published in the CHEST, a journal of the American College of Chest Physicians (ACCP), showed that severely obese men were more carbohydrate intolerant and had less physical endurance than severely obese women, leading researchers to believe that gender plays a strong role in physical fitness and a person's ability to metabolize carbohydrates.
“Carbohydrate intolerance, the inability to metabolize sugar found in carbohydrates, may lead to a build-up of fat deposits on muscle tissue, which can cause a person to gain weight and, eventually, impair physical endurance,” said study co-author Emile F. L. Dubois, MD, PhD, FCCP, Department of Pulmonary Diseases, Hospital Reinier de Graaf Groep, Delft-Voorburg, Netherlands.
“It appears that carbohydrate intolerance is more common in obese men, which would cause them to be less physically fit than obese women.” Researchers also assessed patients for carbohydrate intolerance, according to American Diabetes Society Guidelines. 59 percent of men had overt diabetes or were carbohydrate intolerant, as compared to 35 percent of women. Researchers note that patients with carbohydrate intolerance usually suffer from metabolic syndrome, a group of medical conditions, including obesity, diabetes, and hypertension, that can lead to cardiovascular disease.