What form of carbohydrate should be avoided in short bowel syndrome? Why?

• A. Concentrated sugars
• B. Complex carbohydrates
• C. Fibrous foods
• D. Sugar alcohols

Answer: (A)

Concentrated sugars should be avoided in short bowel syndrome because their high osmolar load overwhelms the reduced absorptive surface of the shortened intestine. When lots of simple sugars aren’t absorbed quickly enough, water is drawn into the gut lumen by osmosis, leading to osmotic diarrhea, bloating, and dehydration. With less surface area and faster transit, the gut can’t handle large amounts of concentrated sugar, making these foods poorly tolerated. In contrast, carbohydrates that are absorbed more gradually and with lower osmolar impact tend to be better tolerated, though individual tolerance varies. Sugar alcohols and fibrous foods can also cause GI symptoms, but the primary reason to limit concentrated sugars is the osmotic diarrhea risk.