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Tolerance of low-digestible carbohydrates: a general view

Published online by Cambridge University Press:  09 March 2007

Geoffrey Livesey*
Affiliation:
Independent Nutrition Logic, Pealerswell House, Bellrope Lane, Wymondham, Norfolk, NR18 0QX, UK
*
*Corresponding author: G. Livesey, fax +44 (0)1953 600218, email [email protected]
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Abstract

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The tolerance of low-digestible carbohydrates (LDCs) may be measured as the potential to cause abdominal symptoms and laxation. Tolerance of any one LDC is determined by its concentration in the food product eaten, the amount of the food product eaten, the frequency of eating the food and the consumption of other foods (increasing tolerance) and water (decreasing tolerance). Added to these, individuals vary considerably in their response to low-digestible carbohydrates in the reporting of gastrointestinal symptoms. A precise maximum no-response dose is sometimes difficult to obtain because some dose–response curves are distinctly sigmoidal. Food regulators hoping to set a trigger level at which laxation may occur have been unable to take account of all these factors because the necessary information matrices are not available for any one LDC. Nevertheless analysis of the data shows consistent trends and for circumstances when food is consumed throughout the day it now seems feasible to assign specific tolerances to specific low-digestible carbohydrates, especially the polyols for which most is known. The method by which the no-effect dose or laxative threshold is expressed is critical to its application to individual foods.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2001

References

ANZFA, (1999) Review of the Provisions for Low-joule Foods and Carbohydrate Modified Foods. Canberra: Australia New Zealand Food Authority.Google Scholar
Bornet, FRJ, Blayo, A, Dauchy, F & Slama, G (1996) Gastrointestinal response and plasma and urine determinations in human subjects given erythritol. Regulatory Toxicology and Pharmacology 24, S296S302.CrossRefGoogle ScholarPubMed
British Nutrition Foundation (1990) Complex Carbohydrates in Foods. The Report of the British Nutrition Foundation's Task Force on Complex Carbohydrates. London: Chapman and Hall.Google Scholar
Buemann, B, Toubro, S, Raben, A & Astrup, A (1999 a) Human tolerance to a single, high dose of tagatose. Regulatory Toxicology and Pharmacology 29, S66S70.CrossRefGoogle ScholarPubMed
Buemann, B, Toubro, S & Astrup, A (1999 b) Human gastrointestinal tolerance to D-tagatose. Regulatory Toxicology and Pharmacology 29, S71S77.CrossRefGoogle ScholarPubMed
Canada (1993) Amendment. Food and Drug Regulations SOR/93–276 26012808. Montreal: Health Canada.Google Scholar
Charney, EB & Bodurtha, JN (1981) Intractable diarrhoea associated with the use of sorbitol. Journal of Paediatrics 98, 157158.CrossRefGoogle Scholar
Codex (1991) Codex standard for formula foods for use in weight control diets. Codex Standard 181.Google Scholar
Collins, MD & Gibson, GR (1999) Prebiotics, probiotics and synbiotics: approaches for modulating the microbial ecology of the gut. American Journal of Clinical Nutrition 69, S1052S1057.CrossRefGoogle ScholarPubMed
CummingsJH, JH, (1993) Nutritional management of diseases of the stomach and bowel. In Human Nutrition and Dietetics, pp. 480506. [JS, Garrow & WPT, James, editors]. London: Churchill Livingstone.Google Scholar
Cummings, JH, Bingham, S, Heaton, KW & Eastwood, MA (1992) Faecal weight, colon cancer risk and dietary intake of non-starch polysacchrides (dietary fibre). Gastroenterology 103, 17831789.CrossRefGoogle Scholar
Cummings, JH & MacFarlane, GT (1999) Probiotics and prebiotics: can regulate the activities of the intestinal bacteria, benefits health. British Medical Journal 318, 9991003.Google Scholar
Debongnie, JC & Phillips, SF (1978) Capacity of the human colon to absorb fluid. Gastroenterology 74, 698703.CrossRefGoogle ScholarPubMed
Ellis, FW & Krantz, JC (1941) Sugar alcohols XXIV. The metabolism of sorbitol in diabetes. Annals of Internal Medicine 18, 792796.Google Scholar
European Council Directive (1990) Proposal for a council directive on sweeteners for use in foodstuffs. Official Journal of the European Community 4, (C242).Google Scholar
FDA (1998) Polydexrose. Code of Federal Regulations 21 Ch.184-85. Washington, DC: Food and Drug Administration.Google Scholar
Fritz, M, Siebert, G & Kasper, H (1985) Dose dependency of breath hydrogen and methane in healthy volunteers after ingestion of a commercial disaccharide mixture, Palatinit. British Journal of Nutrition 54, 389400.CrossRefGoogle ScholarPubMed
Gavin, J, Ellis, T, Dewar, AL, Rolles, CJ & Connett, GT (1997) Dietary fibre and the occurrence of gut symptoms in cystic fibrosis. Archives of Digestive Diseases in Childhood 76, 3537.CrossRefGoogle ScholarPubMed
Gryboski, JD (1966) Diarrhea from dietetic candy. New England Journal of Medicine 275, 718.CrossRefGoogle Scholar
Hammer, HF, Santa Ana, CA, Schiller, LR & Fordtran, S (1989) Studies on osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. Journal of Clinical Investigation 84, 10561062.CrossRefGoogle ScholarPubMed
Heredia, D, Terés, J, Orteu, N & Rodés, J (1988) Lactitol vs. lactulose in the treatment of chronic recurrent portal-systemic encephalopathy. Journal of Hepatology 7, 106110.CrossRefGoogle ScholarPubMed
Hill, RE & Kamath, KR (1982) ‘Pink’ diarrhoea: osmotic diarrhoea from a sorbitol-containing vitamin C supplement. Medical Journal of Australia 1, 387389.Google ScholarPubMed
Hyams, JS (1982) Chronic abdominal pain caused by sorbitol malabsorption. Journal of Pediatrics 100, 772773.CrossRefGoogle ScholarPubMed
Hyams, JS (1983) Sorbitol intolerance: an unappreciated cause of functional gastrointestinal complaint. Gastroenterology 84, 3033.CrossRefGoogle Scholar
Jain, NK, Patel, VP & Pitchumoni, CS (1987) Sorbitol intolerance in adults: prevalence and pathogenesis on two continents. Journal of Clinical Gastroenterology 9, 317319.CrossRefGoogle ScholarPubMed
JECFA (1987) Toxicological Evaluation of Certain Food Additives and Contaminants. Series number 20. Geneva: FAO/WHO.Google Scholar
Jenkins, DJA & Kendall, CWC (1998) Dietary fibre, the evolution of the human diet and coronary heart disease. Nutrition Research 18, 633652.CrossRefGoogle Scholar
Jenkins, DJA, Wolever, TM, Taylor, RH, Barker, H, Fielden, H, Baldwin, JM, Bowling, AC, Newman, HC, Jenkins, AL & Goff, DV (1981) Glycemic index of foods: a physiological basis for carbohydrate exchange. American Journal of Clinical Nutrition 34, 362366.CrossRefGoogle Scholar
Johansen, HN & Jensen, BB (1997) Recovery of energy as SCFA after microbial fermentation of D-tagatose. International Journal of Obesity 21 Suppl 1, S50.Google Scholar
Kandelman, D (1997) Sugar, alternative sweeteners and meal frequency is related to caries prevention: new perspectives. British Journal of Nutrition 77, S121S128.CrossRefGoogle ScholarPubMed
Koizumi, N, Fujii, M, Ninomiya, R, Inoue, Y, Kagawa, T & Tsukamoto, T (1983) Studies on transitory laxative effects of sorbitol and maltitol I: Estimation of 50 % effective dose and maximum non-effective dose. Chemosphere 12, 4553.CrossRefGoogle Scholar
Koutsou, GA, Storey, DM, Lee, A, Zumbé, A, Flourie, B, Le Bot, Y & Oliver, PH (1996) Dose related gastrointestinal response to the ingestion of either isomalt, lactation or maltitol in milk chocolate. European Journal of Clinical Nutrition 50, 1721.Google ScholarPubMed
Lederle, FA, Busch, DL, Mattox, KM, West, MJ & Aske, DM (1990) Cost-effective treatment of constipation in the elderly: a randomized double blind comparison of sorbitol and lactulose. American Journal of Medicine 89, 597601.CrossRefGoogle ScholarPubMed
Lee, A & Storey, DM (1999) Comparative gastrointestinal tolerance of sucrose and lactitol, or D-tagatose in chocolate. Regulatory Toxicology and Pharmacology 29, S78S82.CrossRefGoogle ScholarPubMed
Lee, A, Zumbé, A & Storey, D (1994) Breath hydrogen after ingestion of the bulk sweeteners sorbitol, isomalt and sucrose in chocolate. British Journal of Nutrition 74, 731737.CrossRefGoogle Scholar
Livesey, G (1990) The impact of the concentration and dose of PalatinitR in foods and diets on energy value. Food Sciences and Nutrition 42F, 223243.Google Scholar
Livesey, G (1992) Energy values of dietary fibre and sugar alcohols for man. Nutrition Research Reviews 5, 6184.CrossRefGoogle ScholarPubMed
Livesey, G, EliaM, M, (1996) Short chain fatty acids as an energy source in the colon: metabolism and clinical implications. In Physiological and Clinical Aspects of Short Chain Fatty Acids pp. 427481. [JH, Cummings, JL, Rombeau & T, Sakata, editors]. Cambridge: Cambridge University Press.Google Scholar
Livesey, G, Wilkinson, JA, Roe, MA, Faulks, RM, Clark, S, Brown, JC, Kennedy, H & Elia, M (1995) Influence of the physical form of barley grain on the digestion of its starch in the human small intestine and implications for health. American Journal of Clinical Nutrition 61, 7581.CrossRefGoogle ScholarPubMed
Miller, JCB & Lobbezoo, I (1994) Replacement of starch with sucrose in a high glycaemic index breakfast cereal lowers glycaemic and insulin responses. European Journal of Clinical Nutrition 48, 749752.Google Scholar
Moynihan, PJ (1998) Update on the nomenclature of carbohydrates and their dental effects. Journal of Dentistry 26, 209218.CrossRefGoogle ScholarPubMed
Murray, PR (1988) Polydextrose. In Low-Calorie Products. pp. 83100. London: Elsevier Applied Science.Google Scholar
Oku, T & Noda, K (1990) Erythritol balance study and estimation of the metabolizable energy of erythritol. In Caloric Evaluation of Carbohydrates, pp. 6575 [N, Hosoya, editor]. Tokyo: Research Foundation for Sugar Metabolism.Google Scholar
Oku, T & Okazaki, M (1996) Laxative threshold of sugar alcohol erythritol in human subjects. Nutrition Research 16, 577589.CrossRefGoogle Scholar
Paige, DM, Baless, TH & Davis, LR (1992) Palatinit digestibility in children. Nutrition Research 12, 2737.CrossRefGoogle Scholar
Passmore, R, Meiklejohn, AP, Dewar, AD & Throw, RK (1955) Energy utilization in overfed thin young men. British Journal of Nutrition 9, 2027.CrossRefGoogle ScholarPubMed
Patil, DH, Grimble, GK & Silk, DAB (1987) Lactitol, a new hydrogenated lactose derivative: intestinal absorption and laxative threshold in normal human subjects. British Journal of Nutrition 57, 195199.CrossRefGoogle ScholarPubMed
Payne, ML, Craig, WJ & Williams, AC (1997) Sorbitol is a possible risk factor for diarrrhea in young children. Journal of the American Dietetic Association 97, 532534.CrossRefGoogle ScholarPubMed
Ravich, WJ, Bayless, TM & Thomas, M (1983) Fructose: incomplete intestinal absorption in humans. Gastroenterology 84, 2629.CrossRefGoogle ScholarPubMed
Serra, J, Azpiroz, F & Malagelada, J-R (1998) Intestinal gas dynamics in humans. Gastroenterology 115, 542550.CrossRefGoogle ScholarPubMed
Shaw, JS, Brooks, JL, Dickerson, JWT & Davies, GJ (1998) Dietary triggers in irritable bowel syndrome. Nutrition Research Reviews 11, 279309.CrossRefGoogle ScholarPubMed
Spengler, M, Somogyi, JC, Pletcher, E & Boehme, K (1987) Tolerability, acceptance and energetic conversion of isomalt (Palatinit) in comparison with sucrose. Aktulle Ernährungsmedizin 12, 210214.Google Scholar
Storey, DM, Koutsou, G, Lee, A, Zumbé, 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, 587592.CrossRefGoogle ScholarPubMed
Thannhauser, SJ & Meyer, KH (1929) Sorbit (Sionin) als Kohlehydraterstz für den Diabeteskranken. Müchener Medizin Wochenschrift 76, 356366.Google Scholar
Thiébaud, D, Jacot, H, Schmitz, M, Spengler, M & Felber, JP (1984) Comparative study of isomalt and sucrose by means of continuous indirect calorimetry. Metabolism 33, 808812.CrossRefGoogle ScholarPubMed
Tramonte, SM, Brand, MB, Mulrow, CD, Amato, MG, O'Keefe, ME & Ramirez, G (1997) The treatment of chronic constipation in adults – a systematic review. Journal of General Internal Medicine 12, 1524.CrossRefGoogle ScholarPubMed
Van Es, AJH, De Groot, L & Vogt, JE (1986) Energy balance of eight volunteers fed on diets supplemented with either lactitol or saccharose. British Journal of Nutrition 56, 545560.CrossRefGoogle ScholarPubMed
Zumbé, A & Brinkworth, RA (1992) Comparative studies of gastrointestinal tolerance and acceptability of milk chocolate containing either sucrose, isomalt or sorbitol in healthy consumers and type II diabetics. Zeitschrift für Ernährungswissenschaft 31, 4048.CrossRefGoogle ScholarPubMed