Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-26T08:24:42.608Z Has data issue: false hasContentIssue false
  • English
  • Français

Tolerance to low-digestible carbohydrates: symptomatology and methods

Published online by Cambridge University Press:  09 March 2007

Philippe Marteau  and
Bernard Flourié
Philippe Marteau*
Affiliation:
Gastroenterology Department, European Hospital Georges Pompidou, 75015 Paris, France
Bernard Flourié
Affiliation:
Gastroenterology Department, Centre hospitalier Lyon-Sud, 165 chemin du Grand Revoyet, 69495 Pierre Bénite, France
*
*Corresponding author: Philippe Marteau, fax + 33 1 44396799, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Low-digestible carbohydrates (LDCs) are incompletely or not absorbed in the small bowel and fermented in the colon. They are usually well tolerated but may also have some dose-related undesirable effects due to their natural osmotic potential and/or excessive fermentation: borborygmi, excessive flatus, bloating, abdominal cramps and eventually diarrhoea. There is an important intersubject variability in the tolerance to LDCs because of differences in absorption capacity, motility pattern, colonic response and intestinal sensitivity. There is also a great intrasubject variability, depending on the type of LDC, dosage and type of consumption. Absorption of LDC in the small intestine can be assessed using hydrogen breath test or intubation techniques or analysis of ileostomy effluents. Double-blind, placebo-controlled studies are required to assess the subjective symptoms of intolerance, and the experimental conditions may influence the results.

Keywords

LDCsPolyolsToleranceSymptomsMethods
Type
Research Article
Information
British Journal of Nutrition , Volume 85 , Issue S1 , March 2001 , pp. S17 - S21
Copyright
Copyright © The Nutrition Society 2001

References

Beaugerie, L, Flourié, B, Marteau, P, Pellier, P, Franchisseur, C & Rambaud, JC (1990) Digestion and absorption in the human intestine of three sugar alcohols. Gastroenterology 99, 717–723.CrossRefGoogle ScholarPubMed
Beaugerie, L, Flourié, B, Pellier, P, Achour, L, Franchisseur, C & Rambaud, JC (1991) Tolerance clinique, absorption intestinale et valeur energetique de quatre polyols pris a jeun. Gastroentérologie Clinique et Biologique 15, 929–932.Google Scholar
Beaugerie, L, Lemann, M, Jian, R, Flourié, B, Rain, JD and Rambaud, JC (1996) Effect of glucose and lipids on intestinal absorption of sorbitol: role of gastric emptying. Neurogastrointestinal Motility 8, 235–239.CrossRefGoogle ScholarPubMed
Bouhnik, Y, Vahedi, K, Achour, L, Attar, A, Salfati, J, Pochart, P, Marteau, P, Flourié, B, Bomet, F & Rambaud, JC (1999) Short-chain fructo-oligosaccharide administration dose-dependently increases fecal bifidobacteria in healthy humans. Journal of Nutrition 129, 113–116.Google Scholar
Briet, F, Achour, L, Flourid, B, Beaugerie, L, Pellier, P, Franchisseur, C, Bomet, F & Rambaud, JC (1995) Symptomatic response to varying levels of fructooligosaccharides consumed occasionally or regularly. European Journal of Clinical Nutrition 49, 501–507.Google Scholar
Briet, F, Pochart, P, Marteau, P, Flourié, B, Arrigoni, E & Rambaud, JC (1997) Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?. Gut 41, 632–635.Google Scholar
Clausen, MR & Mortensen, PB (1997) Lactulose,disaccharides and colonic flora. Clinical consequences.. Drugs 53, 930–942.Google Scholar
Clausen, NIR, Jorgensen, J & Mortensen, PB (1998) Comparison of diarrhea induced by ingestion of fructooligosaccharide Idolax and disaccharide lactulose. Role of osmolarity versus fermentation of malabsorbed carbohydrate. Digestive Diseases and Sciences 43, 2696–2707.Google Scholar
Florent, C, Flourié, B, Leblond, A, Rautureau, M, Bemier, JJ & Rambaud, JC (1985) Influence of chronic lactulose ingestion on the colonic metabolism of lactulose in man (an in vivo study). Journal of Clinical Investigation 75, 608–613.Google Scholar
Flourié, B, Briet, F, Florent, C, Pellier, P, Maurel, M & Rambaud, JC (1993) Can diarrhea induced by lactulose be reduced by prolonged ingestion of lactulose? American Journal of Clinical Nutrition 58, 369–375.Google Scholar
Fume, JK & Levitt, NW (1996) Factors influencing frequency of flatus emission by healthy subjects. Digestive Diseases and Sciences 41, 1631–1635.Google Scholar
Hammer, HF, Santa Ana, CA, Schiller, LR & Fordtran, JS (1989) Studies of osmotic diarrhoea induced in normal subjects by ingestion of polyethylene glycol and lactulose. Journal of Clinical Investigation 84, 1056–1062.CrossRefGoogle ScholarPubMed
Hammer, J, Pruckmayer, M, Bergmann, H, Kletter, K & Gangl, A (1997) The distal colon provides reserve storage capacity during colonic fluid overload. Gut 41, 658–663.CrossRefGoogle ScholarPubMed
Hartemink, R, Alles, MS & Rombouts, FM (1999) Fermentation of selected carbohydrates by faecal inocula from volunteers on a controlled diet low in fibre. In: Prebiotic effects of non-digestible oligo- and polysaccharides. Thesis by Hartemink R. Landbouwuniversiteit Wageningen.Google Scholar
Hata, Y & Nakajima, K (1985) Studies on relationship between intake of fructooligosaccharides and abdominal symptoms – Estimation of the maximum non-effective dose and 50 % laxative effective dose. Geriatric Medicine 23, 817–828.Google Scholar
Koutsou, GA, Storey, DM, Lee, A, Zumbe, A, Flourié, B, Le bot, Y and Olivier, Ph (1996) Dose-related gastrointestinal response to the ingestion of either isomalt, lactitol or maltitol in milk chocolate. European Journal of Clinical Nutrition 50, 17–21.Google Scholar
Langkilde, AM, Andersson, H, Schweizer, TF & Wursch, P (1994) Digestion and absorption of sorbitol, maltitol and isomalt from the small bowel. A study in ileostomy subjects European Journal of Clinical Nutrition 48, 768–775.Google Scholar
Levitt, NW, Ellis, C & Fume, J (1998) Influence of method of alveolar air collection on results of breath tests. Digestive Diseases and Sciences 43, 1938–1945.CrossRefGoogle ScholarPubMed
Macfarlane, GT & Cummings, JH (1999) Probioties and prebiotics: can regulating the activities of intestinal bacteria benefit health?. British Medical Journal 318, 999–1003.Google Scholar
Marteau, P, Vesa, T & Rambaud, JC (1997) Lactose maldigestion Probiotics pp. 65–88.[R, Fuller, editor]. London: Chapman & Hall.Google Scholar
Molis, C, Flourié, B, Ouame, F, Gailing, MF, Lartigue, S, Guibert, A, Bomet, F & Galmiche, JP (1996) Digestion, excretion, and energy value of fructooligosaccharides in healthy humans. American Journal of Clinical Nutrition 64, 324–328.Google Scholar
Patil, DH, Grimble, GK & Silk, DBA (1987) Lactitol, a new hydrogenated lactose derivative: intestinal absorption and laxative threshold in normal human subjects. British Journal of Nutrition 57, 195–199.Google Scholar
Peuhkuri, K, Vapaatalo, H, Nevala, R & Korpela, R (1999) Influence of the pharmacological modification of gastric emptying on lactose digestion and gastrointestinal symptoms. Alimentary Pharmacology and Therapeutics 13, 81–86.Google Scholar
Ponz de Leon, M & Roncucci, L (1997) Chemoprevention of colorectal tumors: role of lactulose and of other agents. Scandinavian Journal of Gastroenterology Supplement 222, 72–75.Google Scholar
Rambaud, JC & Flourié, B (1994) Mechanism of carbohydrate-induced diarrhoea In Short Chain Fatty Acids. pp. 232–239 [Binder, HJ, Cummings, JHSoergel, K, editors]. Dordrecht: Kluwer Academic.Google Scholar
Rumessen, JJ & Gudmand-Hoyer, E (1988) Functional bowel disease: malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose–sorbitol mixtures. Gastroenterology 95, 694–700.Google Scholar
Saunders, DR & Wiggins, HS (1981) Conservation of mannitol, lactulose, and raffinose by the human colon. American Journal of Physiology 241, G397–G402.Google Scholar
Sobhani, I, Sansarricq, M & Flourié, B (1996) Groupe d'lnvestigateurs d'lle-de-France (GIIF) Effect laxatif et tolérance du lactulose administré en une ou deux prises dans le traitement de la constipation chronique idiopathique. Gastroentérologie Clinique et Biologique 20, 362–366.Google Scholar
Stone-Dorshow, T & Levitt, MD (1987) Gaseous response to ingestion of a poorly absorbed fructo-oligosaccharide sweetener. American Journal of Clinical Nutrition 46, 61–65.Google Scholar
Storey, DM, Koutsou, GA, Lee, A, Zumbe, A, Olivier, P, Le Bot, Y & Flourié, B (1998) Tolerance and breath hydrogen excretion following ingestion of maltitol incorporated at two levels into milk chocolate consumed by healthy young adults with and without fasting. Journal of Nutrition 128, 587–592.CrossRefGoogle ScholarPubMed
Suarez, F & Levitt, M (1997) Assessing food intolerance: don't lose control. Gut 41, 715–716.CrossRefGoogle ScholarPubMed
Suarez, FL, Savaiano, D, Arbisi, P & Levitt, NW (1997) Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. American Journal of Clinical Nutrition 65, 1502–1506.Google Scholar
Teuri, U, Vapaatalo, H & Korpela, R (1999) Fructooligosaccharides and lactulose cause more symptoms in lactose maldigesters and subjects with pseudohypolactasia than in control lactose digesters. American Journal of Clinical Nutrition 69, 973–979.CrossRefGoogle ScholarPubMed
Van Loo, J, Cummings, J, Delzenne, N, Englyst, H, Franck, A, Hopkins, M, Kok, N, Macfarlane, G, Newton, D, Quigley, M, Roberfroid, M, van Vliet, T & van den Heuvel, E (1999) Functional food properties of non-digestible oligosaccharides: a consensus report from the ENDO project (DGXII AIRII-CT94-1095). British Journal of Nutrition 81, 121–132.Google Scholar
Vesa, TH, Seppo, LM, Marteau, PR, Sahi, T & Korpela, R (1998) Role of irritable bowel syndrome in subjective lactose intolerance. American Journal of Clinical Nutrition 67, 710-715.CrossRefGoogle ScholarPubMed