Hold the Starch?

Starch is that stuff that stiffens your shirts. It's also what most people eat for fuel. Wheat, rice, corn, oats, potatoes are all very starchy foods. Many popular diet plans call starch a second-rate food that should be avoided at all costs. No-starch and low starch diets are favored by irritable bowel communities, while former Weight Watchers, Jenny Craig and Atkins enthusiasts love the new Carb Lovers Diet praising starch. Yet, there may be something good about starch even for those with sensitive stomachs. 

Starch is a mixture of long and intermingled molecules digested with different rates and outcomes. Our bodies' response to eating starch depends on its amount and types along with our nature [1] and nurture, including intestinal microbes eating the leftovers [2].

Resistant Starch (RS), also called Functional Fiber, is a type of starch that may have beneficial physiological effects. It is further classified into four or five classes,  like RS2 in potatoes or RS3 (maltodextrin on food labels) formed when starchy foods are cooked and cooled. Resistant starch is not digested in the small intestine of healthy individuals. It is an effective prebiotic as it feeds and stimulates specific bacteria in the gut [3]. Bacteria consuming resistant starch raise levels of short-chain fatty acids (SCFA) and derivatives that can act as a source of energy [2,4] and provide other benefits like protection from inflammatory conditions of the bowel. 

Over 200 nutritional studies showed  that resistant starch increases satiety, reduces food consumption and can prevent weight regain, acting almost like exercise. It also lowered insulin levels and reduced the deposition of fat.

How much resistant starch do we need to eat?

Adults in most developed countries consume between 3-7 grams of resistant starch per day. The Carb lovers diet recommends 10-15 grams. According to an earlier Australian study [5], 20 grams per day may be even more beneficial. However, optimal levels of resistant starch in diet are very individual, depending on body weight, metabolism, microbial makeup and dietary preferences. Flatulence and belching are among potential side effects.

Resistant starch is like other types of fiber and prebiotics – everybody has their own individual threshold and every extra gram leads to production of excessive gas [6].

Fructooligosaccharides (FOS) and inulin, prebiotics selectively stimulating bacteria in the colon, usually lead to mild flatulence starting from about 10 grams per day. Isolated individuals experience discomfort even at 5 grams. 14-15 grams per day usually mark the threshold for significant increase in flatulence, stomach growling and cramping. Resistant starch may have slightly higher sensitivity thresholds [6].

Source	Total starch,  per 100 g	Resistant starch, per 100 g
Lentils	53.3	25.4
Red kidney beans	42.6	24.6
Black-eyed peas	53.9	17.7
Potato chips	29.5	4.8
Long-grained rice, parboiled	25	3.7
Spaghetti, cooked for 9 mins	22	2.9
Mashed potatoes	8.5	2.4
Boiled potatoes	15	2
White bread	46.7	1.9
Rye crisps	67.4	1.4
Puffed wheat cereal	67	1.2
Medium-grained rice, boiled	25	0.6
Spaghetti, cooked for 12 mins	22	0.9
Oatmeal (Oat porridge)	9	0.3

Understanding what amounts are right for you takes careful analysis and evaluation  Don’t forget about the digestible starch that accompanies indigestible starch. Ideally, our enzymes can efficiently break down the digestible starch into glucose, but the process is so lengthy (5-7 hours) that overload could result in more starch leaking through pores in the small intestine before it has a chance to be digested. This leads to endotoxins and an excess of methane and carbon dioxide, in addition to other metabolic end products, in your system.  

So remember:  there are different types of starch and they usually come packaged with other food components for which you might have separate sensitivities. In other words, your mileage may vary.

REFERENCES

[1] Perry GH, Dominy NJ, Claw KG, Lee AS, Fiegler H, Redon R, Werner J, Villanea FA, Mountain JL, Misra R, Carter NP, Lee C, Stone AC.   Diet and the evolution of human amylase copy number variation. Nat Genet. 2007 Oct;39(10):1256-60. Epub 2007 Sep 9.

[2] Bird AR, Conlon MA, Christophersen CT, & Topping DL (2010). Resistant starch, large bowel fermentation and a broader perspective of prebiotics and probiotics. Beneficial microbes, 1 (4), 423-31 PMID: 21831780

[3] Gray, G. Dietary fibre – from definitions to public health messages (pages 159–161). Article first published online: 13 Aug 2008 | DOI: 10.1111/j.1467-3010.2008.00702

[4] Donohoe, DR, Garge, N, Zhang, X, Sun, W, O'Connell, TM, Bunger, MK, Bultman, SJ. (2011). The Microbiome and Butyrate Regulate Energy Metabolism and Autophagy in the Mammalian Colon. Cell Metabolism 13 (5): 517–26

[5] Baghurst PA, Baghurst KI, Record SJ, Dietary fibre, non-starch polysaccharides and resistant starch – a review. Food Australia, 1996 Vol 48, No. 3:S1-S35.

[6] Brighenti F, Pellegrini N, Casiraghi MC, Testolin G (1995) In vitro studies to predict physiological effects of dietary fibre. European Journal of Clinical Nutrition 49, Suppl. 3, S81±S88

[7] Elmståhl, L.H. Resistant starch content in a selection of starchy foods on the Swedish market. European journal of clinical nutrition: 2002 Jun;56(6):500-5.

The FODMAP diet

"Functional gut" symptoms (bloating, wind, abdominal distension, discomfort, pain, altered bowel habits) can be controlled by diet, but most theories of how exactly food components are linked to symptoms are lacking consistency. In 2005, Peter Gibson and Susan Shepard gave us food for thought by defining highly fermentable but poorly absorbed short-chain carbohydrates and polyols as an important dietary factor contributing to these symptoms ( see their original article that coined the term FODMAPs - Fermentable Oligo-, Di- and Mono-saccharides And Polyols).

Their studies of different patient groups (Irritable Bowel Syndrome, Irritable Bowel Disease, celiac disease, fructose malabsorption, patients who underwent colectomy, etc) showed that reduction of the intake of FODMAPs may help to reduce symptoms, depending on other things these people usually eat.

FODMAPs are types of sugars and fiber, found in wheat-based and other foods:

Fructans and Galactins	Polyols
Fructose Lactose Fructooligosaccharides Galactooligosaccharides	Sorbitol Mannitol Xylitol Maltitol

There is a cumulative effect of these foods, of their osmotic (water moving) and fermentative (bacteria feeding) actions, on IBS symptoms such as  abdominal pain, bloating, gas, altered bowel movements and lethargy. Irritable Bowel Syndrome symptoms could result from many different (and independent) reasons including  low absorptive capacity of the small intestinal epithelium, increased sensitivity of the bowel, rapid transit through the small bowel, and bacterial overgrowth in the distal small bowel.

This means that you may eat some of the problem foods listed in the tables and still fill fine. It's not about the foods eaten in isolation, it's about hundreds of food components that are adding up. To follow the right diet, you need to identify your individual sensitivities and dietary combinations.


For informational purposes only, we are listing candidate dietary components contributing to osmotic load and rapid fermentation thus increasing luminal pressure and distension, along with common high and low FODMAP foods - as listed in scientific publications. Red and green tables were compiled by a FODMAP-sensitive IBS sufferer based on his own experiences - check his post: "Printable FODMAP Diet Chart for your Convenience".  Another FODMAP list compiled by trial and error can be found here.

Fruits: 

•  Serving size is ½ cup 

•  Limit to 1 to 2 servings per day.  

•  Fresh or fresh frozen fruit may be better tolerated than canned fruit. 

•  Keep in mind tolerance may depend on the amount you eat at one time.  

•  Limit concentrated sources of fruit--such as dried fruit and fruit juices  

•  Avoid eating large amounts of any fruit. 

Intestine Friendly	Avoid if FODMAP Intolerant	Questionable May Need to Limit
Bananas (could be gas forming), blackberries, blueberry, grapes (if half a serving or less than 10), grapefruit, honeydew, kiwifruit, lemons, limes, mandarin orange, melons, oranges, papaya, passion fruit, pineapples, raspberries, rhubarb, strawberries, tangelos	Apples, apple cider, apple juice, applesauce, apricots, cherries, dates, grapes, lychee, mango, peaches, pears, pear juice, plums, prunes, watermelon	Other fruit juices or drinks, sugar-free jam/jelly, dried fruit, canned fruit in heavy syrup, other fruits

                                                     Vegetables:
•  Serving size is ½ cup (most vegetables) or 1 cup of leafy green vegetables
•  Limit to 1 ½ to 3 servings per day.
•  Cooked vegetables may be tolerated best as cooking causes a loss of free sugars.
•  Keep in mind tolerance may depend on the amount you eat at one time.

Intestine Friendly	Avoid if FODMAP Intolerant	Questionable
Bamboo shoots, bok choy, carrots, cauliflower (gas forming), celery, cucumber (gas forming), eggplant (gas forming), green beans (gas forming), green peppers (could be gas forming), leafy greens, parsnip, pumpkin, spinach, sweet potatoes, white potatoes, other root vegetables	Artichokes, asparagus, some beans (baked beans, chickpeas, kidney beans, lentils) beetroot, broccoli, Brussels sprouts, cabbage, cauliflower, fennel, garlic, sugar snap peas, leeks, soy products, okra, onions, peas, shallots	Avocado, corn, mushrooms, tomatoes, other beans

Other

Intestine Friendly	Avoid if FODMAP Intolerant	Questionable
Meat, Fat, Yogurt and hard cheeses, Eggs, Aspartame (Equal® and Nutrasweet®), Saccharin (Sweet ‘n Low®), Sucrose (table sugar), Glucose, Maple syrup	Honey, Flavorings with fructose or sorbitol, Desserts (ice cream, candy, cookies, bars, popsicles) sweetened with fructose or sorbitol, Cereal or other processed foods with sorbitol or fructose on the label, Wheat, Sherry and port wine, Sweeteners such as sorbitol, mannitol, xylitol, maltitol, and isomalt used in sugar-free gum, candies and mints	High-fructose corn syrup, Lactose

And here are two more tables with foods already listed above, just to show why they are problematic for FODMAP-sensitive people.

Note that some of the foods listed as intestine friendly may be less friendly for some people inducing functional gut symptoms. Inulins - often included in prebiotic supplements - are longer chain fructans thus are expected to be more intestine-friendlier than fructans with low degree of polymerization.  Yet inulins often lead to increased wind.

Scientific publications:

Gibson PR, Shepherd SJ. Personal view: food for thought--western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis. Aliment Pharmacol Ther. 2005 Jun 15;21(12):1399-409. Review.  

Barrett, J.S., Gibson, P.R.  Nutrition issues in Gastroenterology, Series # 52  Clinical Ramifications of Malabsorption of Fructose and Other Short-chain Carbohydrates.  Practical Gastroenterology 2007 XXXI:51-65

Gibson PR, Newnham E, Barrett JS, Shepherd SJ, Muir JG. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther. 2007 Feb 15;25(4):349-63. Epub 2007 Jan 8.


Gibson, P. & Shepherd, S. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology 2010 25:252-258.

Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011 Mar;106(3):508-14. Epub 2011 Jan 11

Rangnekar AS, Chey WD. The FODMAP diet for irritable bowel syndrome: food fad or roadmap to a new treatment paradigm? Gastroenterology. 2009 Jul;137(1):383-6. Epub 2009 May 29. 

Other links:

• The FODMAP Theory for IBS
• Does the FODMAP Diet Help IBS?
• IBS and FODMAPs
• Wikipedia article on Fructose malabsorption
• Center of research on FODMAP diet
• A list of individual sensitivities by a sufferer for whom a low FODMAP diet worked
• FODMAP update from Crystal Nelson
• Low Fodmaps discussion on IBSgroup.org
• Foodmap article and discussion on HealthHype.com
• Foodmaps discussion on HealingWell.com
• Foodmap discussion on Celiac Disease forum
• Fodmap questions on Colitis forum 
• Foodmaps discussed on Crohn's forum (J-Pouch group)
• Fodmap diet discussed on Diabetes forum
• Foodmap Diet  discussed by Wedding community
• Low Foodmap diet for IBS on SparkPeople
• Foodmap discussions on Fructose Malabsorption Yahoo forum (subscription required)
• FODMAP diet on Facebook
• FODMAP calculator video
• FODMAP discussions at Aurametrix