Hi All,
A few weeks ago, someone posted a link to an excellent discussion about starches. I'm thinking that Zizzle posted the link, but I could be mistaken. Anyway, at the time, I didn't have time to read the article, so I put it off until this morning. The article to which I'm referring is:
Starch: Pure Evil or Evolutionary Gold?
The article is well-written, and very insightful. And it contains a lot of good information for people who have certain digestive system issues. For those of us living with MC, it contains some very valuable tips that explain why we have certain digestive system problems when our MC is active.
Many/most of us have probably had problems digesting starch at various times when we were/are reacting, but we didn't understand why. The article explains why. Why does broth, or chicken or turkey soup work so well when we are in a flare (or when anyone experiences a period of digestive system upset because of a stomach virus, the flu, or whatever? Because when we're in a flare, or otherwise experiencing enteritis (intestinal inflammation), our digestive system cannot properly digest starches.
The problem is that starch digestion is rather complex, and it requires several steps, all of which must complete properly, if we are to realize any nutritional benefits from starch. The digestive process for starch begins in the mouth, with saliva. Normally, saliva contains an amylase enzyme which begins the process of converting starch to maltose. But anyone who experiences dry mouth, whether because of dehydration, or some other cause (such as an autoimmune side effect), will not be able to properly initiate the digestion of starch, due to a compromised ability to mobilize the salivary amylase enzyme.
Farther down the line (in the digestive process) the next step in the process involves the utilization of pancreatic amylase to finish breaking down the starch to maltose. Unfortunately, when our MC is active, many of us have compromised pancreatic function, so that there may not be enough pancreatic amylase produced to properly convert all of the starch to maltose.
But we can't absorb or utilize maltose, so before we can absorb any nutrients from the starch, the brush border regions of the villi of the small intestine must produce enough maltase enzyme to convert the maltose into glucose. So clearly, even if most of the starch is successfully converted into maltose before it reaches this point, before it can be absorbed, the small intestinal villi must be capable of producing an adequate supply of maltase enzyme, if digestion is to proceed normally. When enteritis is widespread, that may not be possible, in many cases.
So what happens to all the starch that is not successfully converted into maltose, and what happens to all the maltose that is not successfully converted into glucose? It is fermented by bacteria in the colon, to produce gas, bloating, cramps, etc.
The bottom line is that most of us will benefit from minimizing starch (or any other form of carbs) in our diet, when we are in a flare, and we probably should continue that restriction long enough to allow at least some of the damage to our intestines to heal, before we resume eating normal levels of carbs.
Note that this is a dose-dependent effect, because enzyme production in most cases will not cease completely — it will just be reduced. Therefore, most of us should still be able to handle small amounts of starch, but since we all have different tolerance thresholds, due to differing levels of enzyme production, it is impossible to establish a one-size-fits-all safe level. Each of us will do best if we either strive to minimize starch ingestion, or determine approximately how much we can tolerate, before we run into trouble.
Those who have the issues mentioned in the subject line of this post (dry mouth, celiac disease, Sibo, or any other issues that can affect enzyme production) obviously need to be especially cautious about starches in their diet, when they are reacting.
In regard to this, note that there are basically 2 types of starch, amylose and amylopectin. Amylose is affected by the issues mentioned above, which makes it much more difficult to digest than amylopection. Therefore, if we feel that we absolutely have to have starch in our diet, we will be far better off if we choose carbs that contain mostly amylopection starch, with a minimum amount of amylose starch. I've posted about the differences in the digestibility of these starches before, and some of those discussions can be found in the threads at the following links:
http://www.perskyfarms.com/phpBB2/viewtopic.php?t=14357
http://www.perskyfarms.com/phpBB2/viewtopic.php?t=16008
Tex
Tex
Diet Info Related To Dry Mouth, Celiac Disease, SIBO, Etc.
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Diet Info Related To Dry Mouth, Celiac Disease, SIBO, Etc.
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hi Tex,
Yes I posted that article. It makes me wonder if MCers should take digestive enzymes prior to eating starchy foods? Would that help prevent the digestive trouble and even reduce inflammation caused by it, by allowing the starch to be broken down before it reaches the colon?
Incidentally, I had a great chat with my integrative medicine doctor. He calls me out of the blue for updates, even though I haven't had an appointment with him in almost a year! I asked him his opinion of paleo autoimmune protocol diets. I said they seem sooo restrictive, eliminating all nuts, seeds, legumes, grains, sugars, eggs, many meats, etc. in addition to regular paleo rules. I asked if they are truly a one-size-fix-all cure for autoimmune diseases. He said they work at reducing inflammation because they remove any and all foods that have the potential to cause allergies or sensitivities. He agreed they are far too restrictive, and said you can accomplish the same result with a careful elimination diet (and food sensitivity testing), to make sure you are eliminating the foods that cause you trouble (as everyone is different). I guess that's a vote for a Whole 30 type of approach - following the severe diet for 30 days, then adding foods in one at a time.
He recently parted ways with the dietician in his practice who relied on the MRT test. He wasn't sold on it, didn't think it was helping his patients, and agreed with me that it seemed like a "point in time" look at sensitivities. Although I suppose that's what they say about the test - you don't need to cut the foods out forever, just 30-90 days from what I recall.
I wonder whether being on predisone for what will be 20 weeks will be the RESET button I need to tolerate some of those MRT foods? Particularly the fruit and veggie variety. I mean garlic, really?!?
Anyway, we agreed this is my big chance to get my diet right, now that I'm tapering off prednisone. My MC has been in complete remission since I started at 40 mgs, and still no issues at 15 mgs. I need to do everything in my power to keep the intestinal inflammation down if I hope to taper off completely, and keep the DM rash and disease process from flaring. I need to make sure I continue to be one of the lucky people who don't get muscle involvement in DM, or my life will be radically altered.
I'm also wondering whether I might ask my rheumatologist to switch me to Entocort, when I'm in the final stages of weaning from prednisone. I mean, if my autoimmunity starts in the gut, can't I stop it at the gut? What would be the Entocort equivalent to 5 mgs of prednisone?
Yes I posted that article. It makes me wonder if MCers should take digestive enzymes prior to eating starchy foods? Would that help prevent the digestive trouble and even reduce inflammation caused by it, by allowing the starch to be broken down before it reaches the colon?
Incidentally, I had a great chat with my integrative medicine doctor. He calls me out of the blue for updates, even though I haven't had an appointment with him in almost a year! I asked him his opinion of paleo autoimmune protocol diets. I said they seem sooo restrictive, eliminating all nuts, seeds, legumes, grains, sugars, eggs, many meats, etc. in addition to regular paleo rules. I asked if they are truly a one-size-fix-all cure for autoimmune diseases. He said they work at reducing inflammation because they remove any and all foods that have the potential to cause allergies or sensitivities. He agreed they are far too restrictive, and said you can accomplish the same result with a careful elimination diet (and food sensitivity testing), to make sure you are eliminating the foods that cause you trouble (as everyone is different). I guess that's a vote for a Whole 30 type of approach - following the severe diet for 30 days, then adding foods in one at a time.
He recently parted ways with the dietician in his practice who relied on the MRT test. He wasn't sold on it, didn't think it was helping his patients, and agreed with me that it seemed like a "point in time" look at sensitivities. Although I suppose that's what they say about the test - you don't need to cut the foods out forever, just 30-90 days from what I recall.
I wonder whether being on predisone for what will be 20 weeks will be the RESET button I need to tolerate some of those MRT foods? Particularly the fruit and veggie variety. I mean garlic, really?!?
Anyway, we agreed this is my big chance to get my diet right, now that I'm tapering off prednisone. My MC has been in complete remission since I started at 40 mgs, and still no issues at 15 mgs. I need to do everything in my power to keep the intestinal inflammation down if I hope to taper off completely, and keep the DM rash and disease process from flaring. I need to make sure I continue to be one of the lucky people who don't get muscle involvement in DM, or my life will be radically altered.
I'm also wondering whether I might ask my rheumatologist to switch me to Entocort, when I'm in the final stages of weaning from prednisone. I mean, if my autoimmunity starts in the gut, can't I stop it at the gut? What would be the Entocort equivalent to 5 mgs of prednisone?
1987 Mononucleosis (EBV)
2004 Hypomyopathic Dermatomyositis
2009 Lymphocytic Colitis
2010 GF/DF/SF Diet
2014 Low Dose Naltrexone
2004 Hypomyopathic Dermatomyositis
2009 Lymphocytic Colitis
2010 GF/DF/SF Diet
2014 Low Dose Naltrexone
Zizzle,
Researchers are working on enzymes that are claimed to digest the reactive peptides of gluten, and other groups are working on other drugs that are claimed to completely prevent the digestion of gluten (so that the gliadin molecules cannot be released). But IMO, the most practical solution to the gluten problem is to just not eat it in the first place — that totally eliminates the problem by preemption. Likewise, there are so many steps in the digestion of starches that to me, it seems more practical to just not eat them during a flare, then we don't have to worry about finding a combination of enzymes that might work.
Still, if someone just doesn't feel that they can live without starches, then digestive enzymes might be worth a try. My experience with them was not good, though — they made me sick as a dog, for several days.
Regarding the equivalency of budesonide and prednisone, according to the article at the following link, 9 mg of budesonide is equivalent to 40 mg of prednisone, and I believe that is the ratio that Joe has quoted in the past. That would mean that 1.125 mg of budesonide would be equivalent to 5 mg of prednisone (roughly 1 capsule every 3 days).
A Comparison of Budesonide and Prednisone for the Treatment of Active Pediatric Crohn Disease
Tex
Researchers are working on enzymes that are claimed to digest the reactive peptides of gluten, and other groups are working on other drugs that are claimed to completely prevent the digestion of gluten (so that the gliadin molecules cannot be released). But IMO, the most practical solution to the gluten problem is to just not eat it in the first place — that totally eliminates the problem by preemption. Likewise, there are so many steps in the digestion of starches that to me, it seems more practical to just not eat them during a flare, then we don't have to worry about finding a combination of enzymes that might work.
Still, if someone just doesn't feel that they can live without starches, then digestive enzymes might be worth a try. My experience with them was not good, though — they made me sick as a dog, for several days.
Regarding the equivalency of budesonide and prednisone, according to the article at the following link, 9 mg of budesonide is equivalent to 40 mg of prednisone, and I believe that is the ratio that Joe has quoted in the past. That would mean that 1.125 mg of budesonide would be equivalent to 5 mg of prednisone (roughly 1 capsule every 3 days).
A Comparison of Budesonide and Prednisone for the Treatment of Active Pediatric Crohn Disease
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I don't understand why people can take budesonide once every 3 days (or sometimes stop cold-turkey), when I'm warned it can be life-threatening to miss a dose of prednisone. Your body is supposed to make 5 mgs of cortisol a day, but it may not do it when you are trying to taper off a relatively long-course of prednisone (as little as a few months). Until you know your body is making it again, you can end up with Addison's-like complications. Do studies show people on Budesonide still make that critical 5 mg on their own?
1987 Mononucleosis (EBV)
2004 Hypomyopathic Dermatomyositis
2009 Lymphocytic Colitis
2010 GF/DF/SF Diet
2014 Low Dose Naltrexone
2004 Hypomyopathic Dermatomyositis
2009 Lymphocytic Colitis
2010 GF/DF/SF Diet
2014 Low Dose Naltrexone
Wow, regarding the study you just posted, this is the most aggressive/fast prednisone taper I have ever heard of! No wonder thet had treatment failures!!
reatment protocol
All patients were treated initially with either budesonide, 3 mg three times a day, or prednisone, 40 mg as a single a.m. dose. Patients given budesonide received 9 mg daily for 8 weeks, which was then tapered to 6 mg daily on week 9 and to 3 mg daily during week 10. Budesonide was discontinued after week 10. Patients given prednisone received a tapering course as follows: 40 mg/d for 2 weeks, 30 mg/d during week 3, 25 mg/d during week 4, 20 mg/d during week 5, 15 mg/d during week 6, 10 mg/d during weeks 7 and 8, and 10 mg on alternate days for weeks 9 and 10. Prednisone was then discontinued. All patients received mesalamine, 3 to 4 g/d, during weeks 11 and 12.
Medication failure and withdrawal
We used an intention to treat analysis. Patients who required another medication to control the disease, or whose medication could not be tapered according to the treatment schedule through week 10, were considered treatment failures. Patients withdrawn from the study because of exacerbation of the disease were analyzed with the rest of the cohort.
1987 Mononucleosis (EBV)
2004 Hypomyopathic Dermatomyositis
2009 Lymphocytic Colitis
2010 GF/DF/SF Diet
2014 Low Dose Naltrexone
2004 Hypomyopathic Dermatomyositis
2009 Lymphocytic Colitis
2010 GF/DF/SF Diet
2014 Low Dose Naltrexone
Yep, as far as I can tell, most doctors (and researchers) don't actually know how to use corticosteroids (they simply follow drug company recommendations, and there's no reason why drug companies should know how to treat patients). The problem is that doctors don't bother to try to learn from their patients (they'd rather learn from the drug companies).
Budesonide doesn't switch off the adrenals as quickly as prednisone. That's the main difference between the two drugs. Unless one has been on budesonide for around 6 months or longer, one's adrenals should still be able to function pretty much normally. After taking it for a year, though, the adrenals are almost surely dependent on it, and stopping cold turkey at that point would be like stopping a 6-month prednisone treatment.
The reason why people can take a budesonide capsule every third day, is because that is an end-stage part of the treatment. When they get to that point, they have been progressively and slowly tapering the drug for many weeks. It would probably be much better to take a third of a capsule every day, but that's kind of a PITA to do, and fortunately, even though budesonide has a relatively short half life (2 or 3 hours), its physiological effects (pharmacokinetic effects) persist for more than just a few days, (though it maxes out in the blood in about 40 to 45 minutes).
Budesonide doesn't switch off the adrenals as quickly as prednisone. That's the main difference between the two drugs. Unless one has been on budesonide for around 6 months or longer, one's adrenals should still be able to function pretty much normally. After taking it for a year, though, the adrenals are almost surely dependent on it, and stopping cold turkey at that point would be like stopping a 6-month prednisone treatment.
The reason why people can take a budesonide capsule every third day, is because that is an end-stage part of the treatment. When they get to that point, they have been progressively and slowly tapering the drug for many weeks. It would probably be much better to take a third of a capsule every day, but that's kind of a PITA to do, and fortunately, even though budesonide has a relatively short half life (2 or 3 hours), its physiological effects (pharmacokinetic effects) persist for more than just a few days, (though it maxes out in the blood in about 40 to 45 minutes).
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hi, I read a book called " Breaking the Vicious Cycle". The author talks about the dangers of starch as it feeds a " kiesbella bacteria " that lives in the G.I tract. In following a g-f diet they use potato and tapicoa starch as a replacement for flour. G-F egg replacement flours has the same starches. There is current research about starch and how the overgrowth of the bacteria effects our health. I watch my intake of starches and recently tried some corn pasta and was surprised at the amount of starch. I take a digestive enzyme with every large meal. When, I stopped taking the enzyme I noticed a decrease in my energy levels and muscle strength. Jon