Coeliac Disease: A Relation between Dietary Starch and Fat Absorption

Abstract

In a previous communication (1948) reasons were given for regarding starch intolerance in children with coeliac disease as perhaps of greater etiological importance than the well known failure to absorb the products of fat digestion. These reasons were (1) coeliac disease usually begins between six months and two or thred years of age, and during infancy, at a time when their diet, consists of milk, the children who eventually develop this disorder show no indication of what is to come. It is clear that the constituents of milk present no difficulty to the infant who later develops coeliac disease. (2) The principal dietetic change that occurs during the age when coeliac disease becomes manifest consists of a steadily increasing intake of starches. (3) Abdominal distension, which is so constant a characteristic of coeliac children, is not exhibited to any noteworthy degree in infants who for other reasons are intolerant solely of fat, and in coeliac children this feature is much more attributable to fermentation of carbohydrate than to unabsorbed -fat. Assuming that intolerance of starch exerts a primary etiological role in coeliac children, and that failure to absorb fat is a secondary consequence dependent in some way upon mismanagement of starch, it might be possible to improve fat absorption by eliminating starch from the diet, always provided that the failure of fat absorption does not so alter. conditions in the intestine that once this failure has developed it then persists by its own mechanism. It was decided to put this matter to trial by feeding coeliac children on two consecutive diets, both containing an ample portion of fat, the first diet containing starch and the second being free of starch, and to compare the absorption of fat from each diet by means of fat balances. It was soon *evident that fat absorption was much improved on a diet free from starch. The investigation was then reversed, beginning with a starch-free diet and later changing to one containing starch; again it was demonstrated that the inclusion of starch in the diet lowered the absorption of fat. Experiments on these lines have been conducted on fifteen children with coeliac disease, and the results, which are set out in table 1, form the basis of this communication.