Complex carbohydrate intolerance is an official medical condition according to WorldHealth Medical Group. A gastrointestinal disorder affects a million Americans and is characterized by the absence of a specific enzyme in the digestive system. Complex carbohydrate intolerance, also called CCI, results in uncomfortable symptoms that can be managed with lifestyle changes and medications.

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Symptoms

Gas, bloating, diarrhea, constipation, and abdominal pain are typical symptoms of CCI and are often mistaken for more serious conditions such as heart attack or gastroesophageal reflux disease. In infants and young children, the condition can cause severe diarrhea and an inability to gain weight. Gulling in the stomach can lead to uncomfortable flatulence. Cramping and discomfort usually starts within 30 minutes to two hours after you eat the offending carbohydrates. Glucose in carbs that have not been digested is flushed out of your system and can lead to watery diarrhea. The severity of symptoms depends on how low your digestive enzyme system is.

Causes

The enzyme alpha-galactosidase is required to convert glucose into complex carbohydrates into digestible hydrolyzed material. When undigested, complex carbohydrates produce hydrogen, resulting in uncomfortable and painful symptoms. Complex carbohydrates are an essential part of a healthy diet and include whole grains, nuts, seeds, grains, and vegetables. Insufficient enzymes prevent the small intestine from properly absorbing and carrying glucose from food.

Side effects

As a result of the discomfort and embarrassment you experience when you eat complex carbohydrates, you may be able to avoid healthy foods, which leads to a higher risk of type 2 diabetes, heart disease, and certain types of cancer. According to WorldHealth Medical Group, complex carbohydrate intolerance is a rare, inherited medical condition and cannot be diagnosed immediately. Undiagnosed patients may need extensive and costly tests to find the root of the problem. Physical performance decreases overall. According to Food Reactions, a non-profit site written by a researcher at the British National Institutes of Health, complex carbohydrate intolerances could play a significant role in obesity. Men are more prone to this condition, which can also lead to metabolic disorders.

Treatment

Enzyme replacement therapy is an effective treatment for CCI. The therapy can be given by your doctor as a powder mixed with liquids and taken at the same time as you eat carbohydrates. The only over-the-counter treatment for complex carb intolerance is alpha-galactosidase, an enzyme that can help you transport carbohydrates more efficiently. Ingredients can help break down complex carbohydrates and aid digestion, according to Langone Medical Center. While it is safe for most people to use, the effects are mostly anecdotal. You should check with your doctor before taking any over-the-counter medications for the relief of digestive upsets. Herbs and over-the-counter medications can interact with other medications you may be taking to treat unrelated conditions. In addition, over-the-counter medications can worsen CCI in some people.

How interested are you in taking your life and health to a new level? If you are really interested in this, we suggest you take a complex carbohydrate tolerance test.

Carbohydrates in nutrition

The problem is that all organisms are individual and tolerate the same foods in completely different ways. For some, it is completely normal to drink milk every morning, eating it with a large butter and cheese sandwich. And for some, such a breakfast will provide terrible bloating and uncomfortable flatulence throughout the day.


You've probably heard a lot about lactose and gluten intolerance by now.
There is also an intolerance to complex carbohydrates. Why is this happening?


The fact is that some people have a deficiency of one or more essential enzymes in the intestines. It is their absence that prevents complex carbohydrates from being absorbed normally. Fats and carbohydrates in the diet need special enzymes for complete assimilation.


The consequences for the body from such a deficiency are not catastrophic. However, if you consume foods that are not normally absorbed on a regular basis, then life will be very uncomfortable. The main side effects are bloating, abdominal pain, and severe gas that can cause colic.


To determine if you have a complex carbohydrate intolerance, you can use this small list of simple questions:
Are you overweight?
Do you often feel tired, especially after a meal high in carbohydrates?
Are you sedentary?
Do you feel like you can't control your appetite?
Do you often crave sweet or starchy foods like bread, pasta, potatoes, or legumes?
Do you feel dizzy when you are hungry?
Is your blood sugar higher than normal?
Do you suffer from anxiety, depression, skin problems? Do you have hormonal problems or sleep disorders?
If you answered yes to one or more questions, try cutting out all grains, legumes, starchy vegetables (carrots, corn, potatoes) and fruits from your diet.


After two weeks, again answer questions 2, 5, 6 and 8. If you see a significant change, most likely you have a complex carbohydrate intolerance.

If you find that you have this intolerance, it is not a problem at all! A healthy, low-carb diet can help normalize blood pressure as well as significantly reduce sugar cravings. The feeling of constant hunger will go away, and the skin and digestion will noticeably improve.

HOW EXACTLY IS IT WORTH CHANGING YOUR DIET?

Get rid of sugar and refined carbohydrates. Add more greens and crucifers to your diet.


Try to either reduce to a minimum or completely eliminate starchy vegetables, as well as cereals and legumes from the diet. You can only eat two or three servings a week. Stop being afraid of fat. Feel free to add avocado and olive oil to your salads. Limit dairy products, because they are very high in carbohydrates. Proteins and carbohydrates in food can play a significant role in your daily well-being.


Eat only unsweetened or frozen fruits: fresh berries, citrus fruits, green apples. If possible, you should give up alcohol. In case of a holiday, give preference to dry wine and never beer or cocktails.


Intolerance to complex carbohydrates is an unpleasant thing, but there is nothing really scary about it. Try to follow these simple rules and replace the foods on the list with their lower-carb options.
Remember, it's not just carbohydrate intolerance that can cause gas! You can find out more about the causes of flatulence on our website.

Digestion of food begins in the mouth, moves into the stomach, and then into the small intestine. Along the way, specific enzymes are needed to process various types of sugars, and they are substances that act as a catalyst to produce chemical changes.

Initial symptoms of carbohydrate intolerance

The severity of symptoms depends on the degree of enzyme deficiency, and ranges from mild flatulence to severe diarrhea. In the case of a lactase deficiency, undigested milk sugar remains in the intestine, where it is then fermented by normal intestinal bacteria.

This causes gas, bloating, and flatulence. In the case of a growing child, the main symptoms are diarrhea and an inability to gain weight. Lactase deficiency causes gastrointestinal distress, beginning thirty minutes to two hours after eating foods containing lactose.

Food intolerances can be confused with food allergies, as symptoms of nausea, bloating, flatulence and diarrhea are present in both the first case and the second. Food intolerances, meanwhile, involve physical reactions to a food or food additive, and are not related to an immune response.

Untreated sugars lead to watery diarrhea (osmotic diarrhea). With diarrhea, other nutrients can be excreted from the intestines before they can be absorbed.

Complex carbohydrates are more difficult to break down than simple carbohydrates because they have a branched molecular structure. While the latter contain only one or two sugar molecules, the former consist of more than three, so their digestion is long and energy-intensive.

It is important to diagnose in a timely manner by contacting a doctor in order to determine further treatment. Find out which foods are potentially uncomfortable by looking at the Complex Carbohydrate List and other articles at the bottom of the page. Biomass residues that are not absorbed by the intestines cause fermentation and other adverse reactions.

• Uncontrolled gas formation is common, causing great inconvenience and awkwardness when a person is at work or in a team. Although this symptom is not always accompanied by pain, flatulence can provoke a stupid position in public places.
• Cramping abdominal pain is an expected sign of carbohydrate intolerance. Colic usually occurs as a result of flatulence in the intestines. As a result, excessive pressure is created inside the abdominal cavity. The movement of methane through the gastrointestinal tract leads to severe pain and irritation.
• Bloating occurs for similar reasons. Unpleasant feelings such as overflow and heaviness in the lower part appear.
• Belching does not necessarily accompany carbohydrate intake compared to other items, but it is still associated with carbohydrate intolerance. It is formed from volatile fermentation secretions that are released in this way.

Causes of carbohydrate intolerance

Enzymes play an important role in the breakdown of carbohydrates into forms that can be absorbed and used by the body. So, starch is broken down into disaccharides by amylase, an enzyme of saliva. The disaccharides maltose, sucrose and lactose cannot be absorbed until they have been broken down into simple sugar molecules by the appropriate enzymes present in the cells of the gastrointestinal tract. If all these processes are not completed, digestion is interrupted.

Although not common, deficiencies in the enzymes needed to digest lactose, maltose, and sucrose are sometimes present at birth. Intestinal lactase enzymes usually decrease naturally with age, but this also occurs to varying degrees.

Digestive illnesses such as celiac disease, intestinal infections, and trauma can also decrease the amount of enzymes produced. In the case of cancer patients, treatment with radiation therapy or chemotherapy can affect cells in the intestine that normally secrete lactase, leading to intolerance.

What to do if you have a carbohydrate intolerance

If you notice the above symptoms in yourself, then you need to see a specialist as soon as possible. The premises can be deceiving, so they are often attributed to other diseases. The cause for concern is justified only if there is a pattern, constant recurrence of violations.

To make sure that the suspicions are correct, an appropriate clinical examination is prescribed. The most reliable way to prevent the unpleasant consequences of intolerance is to avoid excessive consumption of "long" carbohydrates.

Let the diet be dominated by simple compounds that are easy to digest, as opposed to complex ones. The attending physician will conduct tests and, if necessary, create a "black list" of foods such as wheat, rye and barley.

The flip side of the medal lies in the lack of valuable substances, so you can not engage in amateur performances. You may have to follow a special diet, take additional medications. These include various pain relievers, supplements, anti-gas agents, and muscle relaxants that regulate the flora of bacteria.

Although intolerance is difficult, you can live with it without tangible suffering. Follow only qualified recommendations, adhere to the rules of a healthy lifestyle.

Diagnosis of the disease

A diagnosis of carbohydrate or lactose intolerance is made when there are symptoms associated with the condition. In addition, the gastroenterologist can confirm the diagnosis after asking about the patient's physical health, performing a physical examination and based on the results of laboratory tests to rule out other conditions that are similar to carbohydrate intolerance.

If carbohydrate intolerance is suspected, the diagnosis can be confirmed with oral tolerance tests.

If infants and young children are lactose intolerant, pediatricians recommend simply replacing cow's milk with soy formula. If necessary, a stool sample can be tested for acidity.

Treatment of carbohydrate intolerance

The scope of treatment depends on the specific form of the disease. For secondary carbohydrate intolerance, it is usually enough to cure the underlying disease: for example, get rid of pancreatitis, gastritis or enterocolitis.

The situation is more complicated with primary intolerance - that is, caused by a lack or absence of a certain enzyme in the body. In this case, everything depends on the type of fermentopathy. But in general, the basic principle of treatment is the same: diet therapy is prescribed and nutritional therapy is prescribed.

With lactase deficiency in young children who are breastfed, they are prescribed an artificial lactase enzyme. "Artificials" are assigned to be fed with lactase-free mixtures of soy protein.

Sources of carbohydrates for patients with these types of diseases are foods with fructose.

Since the causes of an enzyme deficiency leading to carbohydrate intolerance are unknown, there is no way to prevent this condition.

Nutritional Problems

Since there are significant differences in the degree of intolerance, treatment must be adapted for each patient individually. Dairy products should be avoided in patients with signs of lactose intolerance.

Dairy products are an important source of calcium. Therefore, people who reduce or severely limit their intake of these foods may need to consider other ways to get enough calcium.

Taking calcium supplements or other foods high in this element may be necessary to meet the RDA. In addition, foods high in vitamin A, riboflavin, and vitamin B12 should be included in the daily diet to compensate for the nutrients in cow's milk.

NATIONAL PROGRAM FOR THE OPTIMIZATION OF FEEDING IN THE FIRST YEAR OF CHILDREN IN THE RUSSIAN FEDERATION

Approved at the XVI Congress of Russian Pediatricians
(February 2009)

Moscow
Union of Pediatricians of Russia
2011

EXCERPT

11. NUTRITION WITH CARBON Intolerance

Disorders of hydrolysis and absorption of carbohydrates are manifested by similar symptoms of the so-called "fermentative", "acidic" or "osmotic" diarrhea, which is explained by the same mechanisms of development.

Clinical symptoms of carbohydrate intolerance

• frequent (8-10 times a day or more) liquid, frothy stools with a large water stain and a sour odor;
• bloating, rumbling (flatulence), abdominal pain (colic);
• the presence of carbohydrates in feces (more than 0.25 g% in children of the 1st year of life);
• acidic stool (pH less than 5.5);
• the development of dehydration is possible;
• rarely - the development of severe malnutrition

In the absence or insufficient activity of the enzyme involved in the hydrolysis of one or another carbohydrate, disaccharides and / or monosaccharides not absorbed and remaining in the intestinal lumen, having high osmotic activity, promote the release of water and electrolytes into the intestinal lumen (osmotic diarrhea), stimulate the motility of the upper parts of the gastrointestinal tract, as a result of which the excess of carbohydrates enters the large intestine. In the large intestine, they are actively fermented by the intestinal microflora with the formation of organic acids, hydrogen gas, methane, carbon dioxide and water, which causes flatulence, colic, increased peristalsis and accelerates the passage of the chyme through the intestine. In this case, the pH of the intestinal contents changes to the acidic side. Violation of the normal chemical composition of intestinal contents can contribute to the development of dysbiosis.

Lactase deficiency(ICD-10 E73) the most common form of disaccharidase deficiency, which develops as a result of a decrease or complete absence of the enzyme lactase-phlorizin-hydrolase in enterocytes of the mucous membrane of the small intestine. This enzyme is one of the most vulnerable enzymes in the small intestine. It is superficially located, and its concentration is much lower than that of other enzymes of parietal digestion. In premature babies (from 28 to 34 weeks of gestation), lactase activity is only 30% of its level in term infants. The maximum activity of the enzyme is observed at the age of 2-4 months.

Clinic

The severity of clinical symptoms in FN is due to the total decrease in enzyme activity, the amount of lactose ingested with food, the nature of the intestinal microflora, as well as individual pain sensitivity to intestinal distension by gases.

Distinguish between primary LN associated with congenital enzymatic insufficiency, and secondary LN, which develops as a result of damage to the enterocyte in infectious, inflammatory, autoimmune bowel diseases, as well as lactose intolerance in the syndrome of "short bowel".

Most often, pediatricians meet with hypolactasia in children during the first months of life.

Clinical symptoms (flatulence, colic, diarrhea) usually appear in a child at 3-6 weeks of age, which, apparently, is associated with an increase in the volume of milk or milk formula. In the history of such children, as a rule, there are indications of a complicated course of pregnancy and childbirth (hypoxia), and symptoms of adult-type FN are often detected in the closest relatives. In infants with signs of hypoxic lesions of the central nervous system, the so-called "locking" form of lactase deficiency is sometimes observed, which is characterized by the absence of independent stool in the presence of liquid feces and the other symptoms listed above. Usually, the symptoms in most children stop at 5-6 months (by the time of the introduction of complementary foods) and are not traced in the future, so this type of lactose intolerance can hardly be attributed to primary.

Diet therapy

The approach to treatment should be differentiated depending on the nature

feeding (natural or artificial), the degree of enzymatic deficiency (alactasia, hypolactasia), the genesis of fermentopathy (primary or secondary) table. 35.

Table 35. Scheme of correction of lactase deficiency in children of the first year of life

With primary alactasia of newborns, which is extremely rare, the child is immediately and completely transferred to feeding with a lactose-free milk formula.

With hypolactasia, when the child is breastfed a decrease in the amount of breast milk is undesirable. The best option is to use lactase preparations ("Lactase baby" (National Enzyme Company, USA, in 1 capsule 700 units (7 mg), 1 capsule per feeding). The dose of the enzyme preparation is mixed with 20 30 ml (1/3 of the feeding volume) expressed milk and drink to the baby before breastfeeding.

The effectiveness of the preparations increases if expressed milk with lactase is left for fermentation for 15 minutes, as well as when the entire volume of milk is treated with lactase. It is possible to use "Lactase" (Enzyme Lactase from Nature's Way Products, Inc., USA, in 1 capsule 3450 units, starting from 1/4 capsule per feeding).

If the use of the enzyme is ineffective (which is usually observed with a pronounced decrease in lactase activity), they resort to reducing the lactose load by replacing from 1/3 to 2/3 of the volume of each feeding with a lactose-free milk formula (Table 36), after which the child is supplemented with human milk. The lactose-free mixture is introduced into the diet gradually, at each feeding, bringing within 3-5 days to the required amount, as judged by the decrease in flatulence, the restoration of the normal consistency of feces and stool frequency, a decrease in the excretion of carbohydrates in the feces, and an increase in the pH of the feces. Typically, the volume of lactose-free product is 30-60 ml for each feeding.

Table 36. Chemical composition and energy value of low-lactose and lactose-free milk mixtures (in 100 ml of ready-made formula)

The product's name	Firm, country of origin		Ingredients							Energy value, kcal
						carbohydrates
lactose-free mixtures
Nutrilak lactose-free	Nutritek Group, Russia
NAS lactose-free	Nestlé, Switzerland
Enfamil Lactofree	Mead Johnson, USA
low-lactose mixtures
Low-lactose nutrilak	Nutritek, Russia
Low-lactose nutrilon	Nutricia, Holland
Humana-LP	Humana, Germany
Humana-LP + MCT	Humana, Germany

At artificial feeding it is necessary to select a low-lactose mixture with such an amount of lactose that the patient will tolerate, preventing the appearance of clinical symptoms and an increase in the excretion of carbohydrates in the feces. A low-lactose formula is introduced into each feeding and gradually replaces the infant formula. Small amounts of lactose entering the colon are a natural prebiotic necessary for the proper formation of microflora. Lactose is also the only source of galactose, which is produced when it breaks down. Galactose is used for the synthesis of galactolipids, including cerebrosides, which are necessary for the formation of the central nervous system and myelination of nerve fibers, as well as for the synthesis of mucopolysaccharides (hyaluronic acid) that make up the vitreous humor and synovial fluid.

Complementary foods children with FN are not prepared in the first year of life with milk, but with the low- or lactose-free formula that the child receives. From 4-4.5 months of age, industrial fruit purees or a baked apple are prescribed. It is advisable to prescribe porridge (rice, corn, buckwheat) or mashed vegetables with coarse vegetable fiber (cauliflower, zucchini, pumpkin, carrots) with the addition of vegetable oil as the first main complementary food (from 4.5 to 5 months). After 2 weeks, meat puree is introduced. Fruit juices (diluted with water 1: 1) are introduced into the diet of such children later, as a rule, in the second half of their life. In children of the second half of the year, it is possible to use dairy products, where the lactose content is insignificant - cottage cheese washed from whey, butter, hard cheese.

With primary (constitutional) lactase deficiency a low-lactose diet is prescribed for life.

With secondary hypolactasia symptoms of lactase deficiency are transient. Therefore, after achieving remission of the underlying disease after 1 to 3 months, the diet should be gradually expanded by introducing lactose-containing milk formulas, under the control of clinical symptoms (diarrhea, flatulence) and the excretion of carbohydrates in the feces.

Congenital sucrase-isomaltase deficiency is a fairly rare disease among Europeans and is inherited in an autosomal recessive manner. Enzyme deficiency is not a life-threatening condition. It manifests itself for the first time when sucrose (fruit juices, mashed potatoes, sweetened water or tea) is introduced into the child's diet, less often starch and dextrins (porridge, mashed potatoes) in the form of severe "carbohydrate" diarrhea with dehydration crises. With age, children often acquire the ability to tolerate increasing amounts of dextrins, starch and sucrose without increasing the activity of the enzyme, which is associated with an increase in the absorption surface of the mucous membrane. Often, patients develop an aversion to sweet foods, fruits, starchy foods, that is, self-regulation of the flow of sucrose into the child's body occurs.

Any damage to the intestinal epithelium can lead to secondary deficiency of this enzyme (infectious enteritis, giardiasis, celiac disease, radiation enteritis), but the activity of the enzyme does not drop to that extremely low level, as it happens with primary failure.

Diet therapy

The basis of dietary therapy in this condition is the elimination of sucrose and, sometimes, a decrease in the amount of starch and dextrins in the diet. With primary (congenital) deficiency of sucrase-isomaltase, children, as a rule, tolerate lactose well, with secondary (post-infectious) they cannot, i.e. they develop a combined disaccharidase deficiency. Therefore, when choosing a mixture for a child with primary sucrose-isomaltase deficiency, it is preferable to preserve breastfeeding for the longest possible time, and in its absence, it is necessary to prescribe an infant milk formula with a lactose carbohydrate component.

Children with sucrase-isomaltase deficiency cannot tolerate fruits, berries, vegetables, juices with a high sucrose content (peaches, apricots, tangerines, oranges, melons, onions, beets, carrots, etc.), as well as foods rich in starch (cereals, potatoes, bread, jelly, etc.). It is recommended to start the introduction of complementary foods with vegetable puree, practically free of sucrose and starch (Table 37).

Table 37. Vegetables and fruits containing the minimum amount of sucrose and starch

You can sweeten your food with glucose or fructose. In the second year of life, it is usually possible to expand the diet by introducing a small amount of starch-containing foods (vegetables, cereals, potatoes).

At secondary intolerance to sucrose, the duration of its exclusion depends on the severity of the underlying disease and the success of treatment. It is recommended to compensate for the carbohydrate deficiency by parenteral and / or enteral administration of glucose solutions. The elimination period for sucrose, in contrast to lactose, is shorter and can be limited to 10-15 days.

Starch intolerance can occur in premature babies and children of the first half of life, in whom the activity of pancreatic amylase is physiologically reduced, as well as with exocrine pancreatic insufficiency, therefore they are not shown

the appointment of mixtures including starch in the composition of the carbohydrate component.

At congenital (primary) malabsorption of glucose - galactose there is a defect in the transport systems of the brush border of enterocytes, while the activity of disaccharidases and hydrolysis of carbohydrates are not disturbed. This rare pathology is inherited in an autosomal recessive manner; manifests itself as profuse diarrhea and dehydration after the first feeding of the newborn. Replacing milk with lactose-free and dairy-free mixtures has no effect.

The only monosaccharide that can be absorbed in the small intestine is fructose.

The means of choice is to switch the child to full parenteral nutrition. Against the background of parenteral nutrition, feeding begins with dosed administration of a 2.5% fructose solution, the concentration of which, in the absence of diarrhea, is increased to 7 8%. Next, a source of protein (protein preparation or meat puree), fat (vegetable oil or fat emulsion, starting with 1 2 drops) is introduced. In the future, the expansion of the diet is carried out at the expense of mashed potatoes from fructose-containing vegetables. The prognosis of the disease with total glucose-galactose malabsorption is very serious. Surviving children with a partial defect in the glucose-galactose transport system suffer from chronic diarrhea and are lagging behind in physical development.

Acquired intolerance to monosaccharides manifested by severe chronic diarrhea with delayed physical development. It can accompany the course of severe intestinal infections in children of the first months of life with an unfavorable premorbid background, occur due to atrophy of the villi of the intestinal mucosa in celiac disease, intolerance to cow's milk proteins, protein-calorie deficiency. The baby's diarrhea diminishes when he is fasting and returns when the amount of oral feeding increases. Low pH and high concentration of glucose and galactose in feces are characteristic. Therapy with lactose-free and dairy-free formulas is ineffective.

Acquired intolerance to monosaccharides is a transient state, however, it has a total character: glucose, galactose, fructose are not absorbed, and the hydrolysis of di- and polysaccharides is also impaired. Oral rehydration with standard solutions is ineffective because of the glucose they contain. The patient's condition requires transfer to full parenteral nutrition.

The introduction of glucose orally begins cautiously, with a 2.5% solution against the background of a stable state and the absence of diarrhea, with a gradual increase in the concentration of the solution. When the 5% glucose mixture is well tolerated, parenteral nutrition can be discontinued. The introduction of higher concentrations of glucose, starch can provoke diarrhea again, which requires repeated unloading. When good tolerance of glucose, dextrins, starch is achieved, sucrose solutions are gradually introduced, starting with 3-5% concentration, fruit puree, juices diluted with water 1: 1, and no earlier than after 1-2 months, you can try to introduce infant milk mixture with moderately reduced concentration of lactose.

Materials for this chapter are also provided by: Ph.D. E.A. Roslavtseva