Positive Health Online

Two of the most frequent complaints I am faced with in my practice are abdominal bloating and excess gas. Having ruled out a more serious diagnosis from their GP, clients often end up on my doorstep presenting with ‘IBS’ (Irritable Bowel Syndrome). As nutritional knowledge increases amongst the general population, often these people are following wholesome diets. Some have given up eating wheat and/or dairy and still there is no improvement. For these clients, I have found a low starch diet works wonders.

Alan Ebringer professor of Immunology at King’s College, London, pioneered the use of a low starch diet for his patients suffering from a combination of IBS symptoms together with ankylosing spondilitis (AS). AS is a type of arthritis which affects the spine and large joints, and is classed as an auto-immune disease. New Zealander, Carol Sinclair, unaware of Professor Ebringer’s research, wrote a book describing in detail how a low starch diet that she had devised cured her severe IBS. Until she was put in contact with Professor Ebringer, she was unaware that she also had AS and that her diet had unwittingly cured her of her joint symptoms as well.

So what is starch? If you had a good biology teacher you may recall that starch is a storage polysaccharide predominantly found in plants. Being ‘poly’ it has a more complex structure than a single sugar or monosaccharide (e.g. glucose) or a disaccharide which is a double sugar (e.g. sucrose and lactose). Starch is found in grains, seeds, some nuts, peas, beans and lentils, vegetables and a few fruits. Potatoes, cereal grains and plantains are particularly starch rich.

The important point to clarify about starch is that it is not found in all carbohydrates. All starch is carbohydrate but not all carbohydrate is starch!

Digestion of Starch

Starch molecules are arranged in a semi-crystalline structure within the plant. Starch is insoluble in water. But once heated in the presence of moisture, the crystalline structure is ruptured, causing the starch to swell and form a gelatinous mass (think of oats turning into porridge). If the starch is not cooked, for example in the case of raw vegetables, it remains encapsulated in pocket-like structures passing through the digestive system in tact. Hence if starch is a problem, raw vegetables will be better tolerated than cooked ones.

Starch digestion begins in the mouth by amylase in saliva and continues in the small intestine with the influx of pancreatic enzymes. Digestive ability varies from one person to another, depending on factors such as the extent of chewing, transit time, the types of food eaten together and the concentration of digestive enzymes. Excessive stress will impair digestion.

Even if your digestion is highly efficient (which in many people it is not), it is an accepted scientific fact that some types of starch are not digested in the small intestine and enter the colon undigested. This is known as resistant starch and it is a feeding ground for bacteria. Interestingly Klebsiella is one such bacteria, and it frequently shows up in larger than normal amounts in stool tests of clients complaining of IBS symptoms. Professor Ebringer also finds that patients with AS have high Klebsiella counts.

The amount of starch a person can tolerate varies. Carole Sinclair points out that some people do fine on a low rather than no starch diet, and this is my experience in practice. Often cooked vegetables are tolerated. Sometimes rice does not cause a problem. Other grains, lentils, beans and peas usually prove to be the worst culprits, and the ones to remove first from the diet.

In my opinion, removing whole food groups from the diet is always a last resort, and it is advisable to work with a nutrition practitioner to avoid potential deficiencies. My aim with clients is to re-introduce some grain foods back into the diet as soon as possible. The rate at which tolerance increases varies from person to person. For some people a short temporary starch free regime is enough, for others a longer one is needed. I have certainly found huge benefits for clients, particularly those with stubborn IBS symptoms who have not responded to dietary change previously.

I use B Complex supplementation for low starch diets to ensure against deficiency, since grains are a rich source of these vitamins. The liquid from soaked flaxseeds helps prevent constipation, an occasional side-effect of the diet. However, the large amounts of salad, vegetables and fruit usually maintain regularity in most people, and supply a vast array of minerals. People with blood sugar imbalance also do very well on the diet because of the frequent protein containing meals.

LOW STARCH DIET IN PRACTICE
Starchy Foods to Avoid
Grains
Barley, oats, rye, wheat, maize (corn), rice. Potatoes, parsnips, sweet potatoes.
Processed foods; modified starch, cornstarch, rusk, edible starch, thickener, MSG. Many E numbers. [Thickening agent E numbers which are starch free; xanthan gum, guar gum, locust bean gum, carrageenan, agar and pectin.]
Vegetables
Cooked vegetables
Exceptions: Lentils, beans, chick peas, split peas, peanuts.
Fruit
Unripe fruit (contains starch which converts into fructose when ripe). Artificially ripened fruit may contain starch.
Raw or cooked fruit is fine. Includes avocados and olives.
Exceptions: Bananas and rhubarb (vegetable) contain starch.

Starch Free Foods to Enjoy
Honey.
Maple syrup.
Dairy Produce [lactose can cause a problem in some people].
Live yoghurt.
Goat, sheep cheese, halloumi, parmesan, mozzarella (unmelted).
Cottage cheese.
Eggs.
Meat and Fish
Nuts
Almonds (ground are very useful to add to smoothies or in baking).
Pine nuts, must be blanched.
Vegetables
Spinach, asparagus, fennel, garlic, onions and leeks (Starch free even when cooked).
[Some people with IBS may be sensitive to raw garlic and onion.]
All raw green vegetables and salad.
All herbs.
Condiments
Mustards (free of wheat flour).
Mayonnaise.
Olive, flax, hemp seed oil.

Tea and coffee [although recommended in moderation].

Further Reading

Carol Sinclair. The IBS Low-Starch Diet. Vermilion. 2006.