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Abstract

Certain long term conditions increase the risks for acquiring biofilms. These long term conditions include IBS, Ulcerative Colitis, Crohn's Disease, Pancreasis, Diabetes and Cystic Fibrosis. Being elderly also increases the risk for acquiring biofilms. What do the elderly and patients with these long term conditions have in common? Carbohydrate malabsorption. A comon cause of carbohydrate malabsorption is exocrine pancreatic insufficiency, an inability of the pancreas to produce the enzymes to digest foods including carbohydrates. The elderly and patients with Pancreasis, Diabetes and Cystic Fibrosis have a higher rate of exocrine pancreatic insufficiency. Tests have also shown that patients with IBS, Ulcerative Colitis, Crohn's Disease have an impairment in the ability to digest carbohydrates.

Biofilms are adherent bacterial colonies that protect themselves from the immune system and antibiotics by building a protective fortress around their colony. The lower part of the human digestive tract is much more vulnerable for biofilm formation than the upper part; the lower digestive tract is a very hospitable environment for microbes unlike the upper digestive tract.

A much larger number of carbohydrates have been found in the lower digestive tract of patients with carbohydrate malabsorption than in healthy controls. Most bacteria living in the human gut are carbohydrate consumers and this abundance of food makes it possible to feed a large population of bacteria. An important difference between people with carbohydrate malabsorption and healthy people is the ability to absorb carbohydrates in the small intestine. Healthy people are able to absorb most carbohydrates in the upper digestive tract; these carbohydrates exit the digestive system and enter the blood supply; this will result in a greatly reduced amount of carbohydrates in the lower digestive tract. Unfortunately, most people with digestive disorders have carbohydrate malabsorption (carbohydrate intolerance). Carbohydrate malabsorption makes it difficult for the body to absorb many carbohydrates in the small intestine and this results in an increase of carbohydrates in the lower digestive tract. This increase in carbohydrates has a profound influence on the gut microorganism that live in the lower digestive tract. These unabsorbed carbohydrates make it possible for a much larger number of bacteria to survive. The larger amount of carbohydrates also encourages biofilm formation by enabling the bacteria to adhere and to construct a thicker fortress around themselves. The toxins found in biofilms are more virulent than those of bacteria that are not part of a biofilm and this enables the biofilm to damage the digestive tract.

Carbohydrate malabsorption is not the only reason for an increase of carbohydrates in the lower digestive tract. Many artificial foods are carbohydrates that are difficult to digest for humans and their consumption will result in an increase of carbohydrates in the lower intestinal tract. Several scientists have found a link between the epidemic of digestive disorders and the consumption of artificial carbohydrates.

About biofilms
According to the Merck Manual, carbohydrate intolerance is the inability to digest certain carbohydrates due to a lack of one or more intestinal enzymes. The Merck Manual states that this condition may results in digestive problems. The Merck Manual includes the following comment about carbohydrate intolerance: "''Bacterial fermentation of carbohydrates in the colon causes produces gases (H2, CO2, and methane), resulting in excessive flatus, bloating and distention, and abdominal pain". ''

It is easy to assume that patients with carbohydrate intolerance would have an excessive amount of bacteria in their digestive tract since the unabsorbed food provides a plentiful source of nourishment for the bacteria. Research to find out if patients with carbohydrate intolerance have an excess of bacteria was only done with infants. That research found that infants with carbohydrate intolerance have bacterial overgrowth and that this overgrowth was related to the severity of carbohydrate intolerance. following: A linear increase in the bacterial counts in duodenal aspirates (<103 to 105) was observed with an increasing severity of carbohydrate intolerance. The least bacterial growth (mean 103) was found in the lactose tolerant infants. A moderate growth occurred in patients with specific lactose (104-5) and disaccharide (106) intolerance; and a severe infection (108) in those with monosaccharide intolerance. The The research article also stated that the proliferation of bacteria within the small bowel of these infants may be related to the presence of undigested carbohydrates.

Certain long term conditions increase the risks for acquiring biofilms. These long term conditions include IBS, Ulcerative Colitis, Crohn's Disease, Pancreasis, Diabetes and Cystic Fibrosis. Being elderly also increases the risk for acquiring biofilms. What do the elderly and patients with these long term conditions have in common? Carbohydrate malabsorption is the common denominator. (section X provides a more detailed explanation with references.) It is easy to understand why patients with carbohydrate intolerance would  have more biofilms in their bodies; their intestine contains a plentiful source of carbohydrates to nourish the large population of bacteria that reside in a biofilm. The unabsorbed carbohydrates found in the intestines of patients with carbohydrate intolerance have a very important role in the formation of biofilms. Not only do they provide food for the biofilm but they also influence the structure of the biofilm and characteristics of the bacteria that reside in the biofilm. In this article we will explain how the undigested carbohydrates encourage the bacteria to form biofilms and to build thicker walls to protect the colony. In this website, we will provide proof and explanation of this very interesting phenomena. We will also examine how certain carbohydrates  the important role unabsorbed carbohydrates found in the intestines of patients with carbohydrate intolerance feed

Bacteria display two life forms. In one form the bacteria appear as single, free-floating cells (planktonic), in the other form bacteria are organized in adhering colonies. The adhering colonies are referred to as biofilm.

These two life forms have serious implications for bacterial infections in humans. Acute infections involve planktonic bacteria and are most often treatable. Chronic infections are most likely caused by bacterial biofilms and are nearly impossible to treat with antibiotics and other antimicrobials.

A very important difference between free floating bacteria and biofilm bacteria is ADHERENCE; bacteria build biofilms by adhering to the surface of the biofilm or to each other. Bacteria form biofilms to protect themselves from predators, dehydration, biocides, amoebas, the immune system and antibiotics by building a dense outer layer of cells to protect the interior of the community. One benefit of this environment is increased resistance to antibiotics. In some cases antibiotic resistance can be increased a thousandfold. Bacteria can exchange genes with each other even if they belong to other species. This process is named gene transfer. These properties help them to produce genes that are resistant to antibiotics and other anti microbial treatments.

Biofilms have been found to be involved in a wide variety of microbial infections in the body, A study at the National Health Institute estimate that 80% of all chronic infections are a result of biofilms.

How the bacteria living in intestinal biofilms obtain their food supply
The majority of the bacteria living inside the human intestine are saccharolytic

The definition of saccharolytics is “breaking down sugars in metabolism with the production of energy”. Since carbohydrates are composed of sugar molecules, this means that carbohydrates are the food supply for most of the bacteria in the human intestinal tract. It has been found by scientists that carbohydrate availability is an important factor regulating the composition and metabolic activities of the colonic microbiota.

Both the free floating bacteria and the biofilm bacteria that live in the human digestive tract obtain their nourishment from food that comes through the large intestine. They compete for food. Some types of food will be more likely to feed the biofilm bacteria while other foods will be more likely to be consumed by bacteria that are not in biofilms but are free floating or loosely attached. The structure of the carbohydrate will determine the type of bacteria that will most likely benefit by eating that food.

The bacteria from biofilm have an advantage at consuming very complex carbohydrates. It is unusual for any one microbial species to be able to completely metabolize very complex molecules. However, one specie of bacteria can start the breakdown of the carbohydrate and hand over the remains to another specie in the biofilm. The food is recycled from one specie to another until the food is completely metabolized. This is a very cooperative way to share the food and avoid waste. This process is also advantageous because it provides food for bacteria that cannot metabolize complex carbohydrates. [This website explains it clearly: http://biofilmbook.hypertextbookshop.com/v003/r002/contents/chapters/chapter002/section003/blue/page004.html Scientific studies found that biofilm populations were more efficient in digesting polysaccharides, while the bacteria that were not living in biofilms were able to digest oligosaccharides more quickly.

How the amount and type of carbohydrate affect biofilm formation
The amount of carbohydrates in the environment will have a monumental effect on biofilm formation. An abundance of carbohydrates insures a sufficient food supply for the bacteria living inside the biofilm. If the environment does not contain a large concentration of carbohydrates, then free floating bacteria have the advantage because they can move and search for food. Bacteria that are not moving around will not get enough nutrients to survive in an environment that is not plentiful in carbohydrates. The addition of some types of carbohydrates to the environment will have the ability to transform free floating bacteria into adherent ones. A scientific experiment found that adhesion was stimulated by glucose, fructose, saccharose (sucrose), lactose, and maltose in some strains of the bacteria S epidermis. This increase was highly significant; a 32 to 63 fold increase happened when glucose was added to a soya broth (TSB). This is notable because without adhesion, the bacteria remain free floating and there is no biofilm. There exists a carbohydrate that can stimulate an even more extreme adhesiveness. This carbohydrate is Maltodextrin and it is added to many prepared and processed foods. Maltodextrin enables E. coli, a bacteria that is found in the human GI tract, to attach itself to the ileum.

The quantity of nourishment will also determine other things about the biofilm. Increasing the amount of carbohydrates in a biofilm makes the cell clusters grow rapidly and the thickness of the biofilm increases rapidly. A biofilm that is thicker is more difficult to eliminate since it will be harder for the antimicrobial elements to penetrate it. Reducing the amount of carbohydrates had the opposite effect: the mass of the biofilm was reduced.

The type of carbohydrate also affects the production of EPS, the protective shell of the biofilm. In an experiment with Streptococcus mutans, formation of EPS increased significantly when sucrose and starch were used as nutrients as compared to glucose and sucrose without starch. This increase in the size of the protective shell is a great benefit to the biofilm.

Sucrose
Sucrose was found to have a dramatic impact in experiments that were done on oral biofilms. Sucrose significantly increased the biofilm EPS (or outer shell) in comparison to fructose, galactose, glucose, and lactose. Sucrose produced thicker biofilms and increased the amounts of proteins, lipids, and nucleic acids. This difference was more than 3-fold for biofilms grown in the presence of sucrose than for those biofilms grown in the absence of sucrose.

Furthermore, biofilms grown with sucrose had a more uniform biofilm EPS (or outer shell) than those of biofilms that were grown with fructose, galactose, glucose, and lactose. Sucrose deficiency produced patchy biofilms.

When sucrose is consumed by a healthy person, the enzyme beta-fructosidase separates sucrose into its individual sugar units of glucose and fructose. Both sugars are then taken up by their specific transport mechanisms. The transport mechanisms remove these sugars from the digestive tract. Unfortunately, there are people with carbohydrate intolerance who cannot digest sucrose. The undigested sucrose will then be transported to the large intestine where they will aid biofilm production.

The high density of bioflms compromises the immune system and results in a higher toxic load.
Biofilms enable bacteria to have a very large population. The bacteria that live inside biofilms have devised many complex methods that make it possible for them to optimize population survival and live in communities with very high density.

The fact that they share the food supply with each other also enables them to maximize the amount of bacteria that can be supported by the food available in their environment. This means that patients who have many biofilms in their digestive tract will be at a great disadvantage. The immune system of people who have a high number of biofilms in their gut will have to fight a larger number of invaders.

Furthermore, people with pathogenic biofilms will receive a heavier toxic load from the large population of bacteria. Many bacteria contain toxins. LPS is a very common toxin that is found in the outer membrane of most gram-negative bacteria. Gram-negative infections include those caused by Klebsiella, Acinetobacter, Pseudomonas aeruginosa, and E. coli., as well as many other less common bacteria. A high quantity of LPS may have grave implications because it can damage the intestinal tract, It was found that LPS may affect these issues in digestion. Weight loss

Breakage and depletion of microvilli

Gut inflamation

Digestive symptoms

Disrupted Intestinal Transit

There is a link between LPS, IBD and IBS.

Furthermore, the LPS produced by biofilms is more damaging than the LPS of free floating bacteria for another reason besides the larger amount. The toxin from some biofilm bacteria induces an enhanced inflammatory response in human monocytes compared with the toxin from free floating bacteria,

About carbohydrate malabsorption
Carbohydrate malabsorption is the inability to digest certain carbohydrates due to a lack of one or more intestinal enzymes. Carbohydrate malabsorption may sometimes be referred to as carbohydrate intolerance. This is because people who suffer from this condition have problems tolerating certain carbohydrates after they consume them. The body breaks down carbohydrates and feeds them into the bloodstream. If a person suffers from carbohydrate malabsorption, however, then this process does not work correctly. The carbohydrates remain undigested and continue passing through the intestinal tract. Carbohydrates that are not absorbed in the small intestine may be eaten by bacteria in the lower gut and these bacteria can produce toxic metabolites.

Carbohydrates are made with different arrangements of sugar molecules. Some foods are composed of single sugar molecules while others are composed of two sugar molecules that are linked together. There are also carbohydrates that are composed of three or more attached sugar molecules. Carbohydrates need to be broken down into single sugar molecules in order to exit the GI tract and enter the bloodstream. The breaking down of double sugar molecules into single molecules is the last step in digestion. A very common form of carbohydrate malabsorption is the inability to break down these double molecules. These double molecules are called disaccharides and they include lactose, maltose and sucrose.

The final step in digestion of dietary carbohydrates occurs in the small intestine, in the immediate vicinity of the transporters which will ferry the resulting simple carbohydrates out of the digestive tract and into the rest of the body. The enzymes responsible for this terminal stage of digestion include lactase which helps digest the sugar lactose; sucrase which helps digest the sugar sucrose found in varying amounts in all plant foods, including fruits, vegetables, and sugar cane; and maltase which helps digest the sugar maltose found in cereal grains. The plasma membrane housing these enzymes is composed of numerous microvilli which extend from the cell and constitute the "brush border". Hence, the enzymes embedded in those microvilli are referred to as brush border enzymes. A deficiency in brush border enzymes may result in disaccharide intolerance.

Most acquired digestive disorders, with the possible exception of disorders that are secondary to impairment of the liver and the biliary tract, display a problem in the digestion of carbohydrates The following conditions are examples of carbohydrate malabsorption: IBS, autism

Ulcerative Colitis (UC), and Crohns.

The Merck Manual, the world's best-selling medical textbook, classifies celiac as a disease of carbohydrate intolerance. In celiac disease, the mucosa (or lining) of the small intestine is damaged by gluten. Specifically, the villi become shortened or even completely flattened. This results in a decrease in brush border enzymes, the enzymes that are necessary for the digestion of disaccharides. It is not surprising that children with untreated celiac have a deficiency in brush border enzymes and that they have intolerance to the following disaccharides: sucrose, maltose, and lactose. Undiagnosed celiac is a disease of carbohydrate malabsorption. It results in the same symptoms as other diseases of carbohydrate malabsorption and is often misdiagnosed as IBS.

Diseases such as pancreasis and cystic fibrosis have an impairment in pancreatic enzymes; they also display problems in the digestion of carbohydrate because the pancreas produces amylase, a very important enzyme for the digestion of carbohydrates

A number of healthy people also have an impairment of digestion of carbohydrates, the most famous one being the lactose malabsorption found in adults that is a result of lack of the digestive enzyme lactase. Even healthy people who possess all the enzymes might experience carbohydrate malabsorption if they consume a diet filled with additives. Additionally, many food additives contain carbohydrates that are difficult to digest for humans. Maltodextrin (MDX) is one example of an artificial food that is difficult to digest. MDX is metabolized in the small intestine by specific enzymes. Interestingly, one of these enzymes (maltase-glucoamylase) is inhibited by high levels of MDX, suggesting that a MDX-rich diet could result in increased MDX levels in the large intestine and enrichment of MDX-utilizing bacteria in this location.

Additionally, the ubiquitous inclusion of MDX into foods of the American diet parallels a substantial increase in incidence of Crohn Disease.

How carbohydrate malabsorption produces bacterial overgrowth
The human body contains a large population of bacteria. Many of the bacteria living in the intestine of healthy people are beneficial and perform useful functions. The human body has a clever strategy to prevent these bacteria from overgrowing and transforming into biofilm bacteria. The body prevents the bacteria from living in the areas of the GI tract where there is an abundant supply of carbohydrates. The stomach has a very acid PH and that makes it hard for bacteria to survive there. There is a lower number of bacteria in the small intestine as compared to the large intestine because of the forward peristalsis, bacteriocidal action of gastric acid and bile, reduction by enzymatic digestion and mucus entrapment, low exposure from the environment, and presence of an ileocecal valve.

In contrast to the other parts of the digestive tract, the large intestine is much more hospitable; it is an optimal habitat for the beneficial anaerobic bacteria, it has a low oxygen concentration, a neutral PH and a food supply: the carbohydrates that were not absorbed in the small intestine will end up in the large intestine. However, a smaller amount of carbohydrates will end up the large intestine since the small intestine of healthy people will absorb most of the carbohydrates and provide it to the blood supply. The moderate amount of food will prevent bacterial overgrowth.

However, an impairment in the digestion of carbohydrates will result in a greater amount of carbohydrates in the large intestine and in the colon. This increase in carbohydrates would lead to a greater food supply for the bacteria.

A research study found that many patients with carbohydrate malabsorption had excessive amounts of organic acids, the breakdown products that result from the fermentation of carbohydrates in the colon. This shows that a much larger amount carbohydrates are being consumed by the bacteria in the colon. An abundant food supply has the potential to produce a larger bacterial population. Another research reported that infants who had carbohydrate intolerance had a larger amount of bacterial proliferation and the increase in bacteria was related to the severity of the carbohydrate intolerance.

Researchers found that foods that were not absorbed in the small intestine became the food supply of harmful bacteria in the large intestine who produced harmful metabolytes. These metabolites include alcohols, diols such as butan 2,3 diol, ketones, acids, and aldehydes such as methylglyoxal. These toxic chemicals cause a wide range of gut and systemic symptoms, including gas, gut pain, diarrhoea or constipation, severe headaches, severe fatigue, loss of cognitive functions such as concentration, memory and reasoning, muscle and joint pain. The large intestine of people with carbohydrate malabsorption is very vulnerable to bacterial overgrowth. An abundant food supply combined with optimal living conditions results in the perfect opportunity for biofilm production.

How carbohydrate malabsorption makes the biofilm flourish
The large number of UNDIGESTED carbohydrates in the lower intestinal tract of patients with carbohydrate malabsorption produces a greater food supply for bacteria. We have previously shown that this increase in carbohydrates encourages the formation of biofilms and enables the biofilm to sustain a large population.

There are several other reasons that carbohydrate malabsorption induces biofilm formation. The large intestine of people with carbohydrate malabsorption contains a greater amount of carbohydrates with a complex structure since the breakdown of carbohydrates is impaired in these people's digestive tract. Carbohydrates with a complex structure enhance the formation of biofilms.

People with carbohydrate intolerance cannot digest disaccharides, a type of carbohydrate, and these undigested carbohydrates will feed the bacteria. People with an inability to digest disaccharides will not be able to digest sucrose, a disaccharide. Therefore more sucrose will enter their large intestine. We have previously shown that an increase in sucrose will be a big boon for biofilm production since sucrose enhances the biofilm by making it grow more and ensuring that it has a better protective cover.

Furthermore, carbohydrate malabsorption can also increase the adhesion of the bacteria in the large intestine. Many people with carbohydrate malabsorption will not be able to digest sucrose (saccharose), lactose, and maltose because these carbohydrates are disaccharides. These undigested carbohydrates will arrive to the large intestine. In another section of this article, we showed that a large amount of these carbohydrates can transform free floating bacteria into adhering bacteria. The ability to adhere is a crucial requirement for biofilm formation.

Both the quantity and type of undigested carbohydrates found in the large intestine of people with carbohydrate malabsorption are the ideal environment to produce numerous large and thick biofilms.

Unfortunately, even people without carbohydrate malabsorption may increase the adhesiveness of their gut bacteria. It was found that a diet that is high in MDX (maltodextrin) may inhibit one of the enzymes that is required to digest MDX. Therefore, people who eat a large amount of processed foods may end up with a lot of undigested maltodextrin in their large intestine; this will dramatically increase the adhesiveness of their gut microbiotica since maltodextrin has been found to enhance adhesion significantly. Two scientists have shown proof that increased MDX consumption may lead to Crohn in certain susceptible individuals. They wrote: "In our studies, we observed MDX-enhanced biofilm formation by multiple strains of E. coli suggesting that MDX metabolism may be a dietary switch promoting colonization of these strains in new regions of the intestine (i.e. the ileum instead of the colon). These findings indicate that MDX found in commercial sources can stimulate biofilm formation."

The role of biofilms in digestive disorders.
Tests for biofilms have been done on the following common conditions with carbohydrate malabsorption: IBS, Ulcerative Colitis, Crohn's Disease, Pancreasis and Cystic Fibrosis. An abnormal amount of biofilms was found in the digestive tract of patients who have Ulcerative Colitis, Crohn's Disease and IBS. Ulcerative Colitis and Crohn's Disease are referred to as Inflammatory Bowel Disorders (IBD) and are considered to be more severe diseases than IBS.

The article stated: "The mucosal bacteria found in patients with IBD can thus be regarded as intestinal biofilms."....."Although the mucosal bacterial concentrations were higher than 109/ml in 35% of healthy controls and 65% of IBS patients, the mean concentrations of bacteria in both groups were at least 2 powers lower than those in CD patients, and their appearances and compositions were different. The biofilm in untreated IBD patients was thick, dense, and adherent."

People with Pancreasis and Cystic Fibrosis also have abnormal biofilms. Patients with pancreasis have biofilms in their pancreas and patients with cystic fibrosis have life threatening biofilms in the lungs.

It has also been noted that people with diabetes and the elderly are likely to have pathogenic biofilms. Both the elderly and the diabetic populations have a higher rate of exocrine pancreatic insufficiency. Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. Pancreatic insufficiency might lead to carbohydrate malabsorption since amilase is one of the pancreatic enzymes. The results do suggest a connection between carbohydrate malabsorption and biofilms. Information about biofilms and other digestive disorders is hard to find and it is possible that tests have not yet been done. A search for celiac and biofilms did not produce any information on Pubmed. However, research articles have found dysbiosis in celiac, an imbalance between harmful and protective bacteria, a sign of anbormal gut microbial condition.

A new research article described overgrowth of adhering bacteria in autism. Although the authors did not mention the term biofilm, the density and adherence of the bacteria suggested biofilm formation, The authors of the medical article discovered a connection between the amount of bacteria and the degree of carbohydrate malabsorption in people with autism.

We have previously discussed the fact that people who do not show the symptoms of digestive disorder may also have carbohydrate malabsorption. It is therefore not surprising that biofilms have been found inside the bodies of healthy people. However, the percentage and density of biofilms inside healthy people is not as great as those with IBD. It has also been found that biofilms from healthy people contain bifidus, a bacteria that is considered to be more friendly. The biofilms containing bifidus might be natural or they might be a sign of a very mild asymptomatic intestinal disorder, The availability of fast foods is producing an epidemic of intestinal disorders; It might be possible that this epidemic is affecting even people who do not show symptoms of intestinal distress.

Carbohydrate Intolerance may create damage to other parts of the body
It is possible that the biofilms from the lower digestive tract might be involved in inducing the chronic health conditions found in other parts of the body of people with IBS and IBD.

A research article found that there was an association between carbohydrate malabsorption and early signs of depression. It has been found that people with IBS and IBD have a higher incidence of other conditions such as urinary or psychiatric problems in comparison to healthy controls. Moreover, schizophrenia has been found to be associated with UC, a form of IBD.

One very common comorbid condition of IBS is reflux or GERD. One doctor believed that GERD is caused by CM and wrote a book about it. One study found that a very low carbohydrate diet reduced the symptoms of GERD.

Biofilms have been found to be involved in a wide variety of microbial infections in the body, A study at the National Health Institute estimate that 80% of all chronic infections are a result of biofilms.

It is not surprising that there is the possibility that toxins produced in the digestive tract from undigested carbohydrates can affect other parts of the body. Previously, we have shown that undigested carbohydrates produce alcohol and other toxins. It is common knowledge that alcohol in the gut can affect the brain, the liver and other organs such as the pancreas. Bacterial toxins can produce inflammation; both autism and schizophrenia have been associated with inflammation.

The location of the damage from biofilms may be influenced by genetics. It is possible for a person to have liver or brain alteration from the bacterial toxins without demonstrating digestive symptoms because it has been shown that certain people have carbohydrate malabsorption without the symptoms of digestive disorder. http://link.springer.com/article/10.1023%2FA%3A1018851306328?LI=true http://www.ncbi.nlm.nih.gov/pubmed/18070009

Celiac disease is an example of a digestive disorder that affects many parts of the body and may not always show digestive symptoms. Surprisingly, celiac disease is now more commonly seen without gastrointestinal symptoms Celiac symptoms may include nervous system disorders without any signs of digestive abnormality.

GERD http://www.ncbi.nlm.nih.gov/pubmed/22298249

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.Persons with celiac may have but not show any digestivee symptoms.

The link between carbohydrate malabsorption and biofilms Biofilms have been found in the bodies of people with chronic digestive disorders that display an impairment in the digestion of carbohydrates. Carbohydrate Malabsorption is the name for the inability to digest carbohydrates. The link between carbohydrate malabsorption and biofilms is a growing concern since digestive illnesses are increasing dramatically. --About biofilms-- Bacteria display two life forms. In one form the bacteria appear as single, free-floating cells (planktonic), in the other form bacteria are organized in adhering colonies. The adhering colonies are referred to as biofilm

These two life forms have serious implications for bacterial infections in humans. Acute infections involve planktonic bacteria and are most often treatable. Chronic infections are most likely caused by bacterial biofilms and are nearly impossible to treat with antibiotics and other antimicrobials.

A very important difference between free floating bacteria and biofilm bacteria is ADHERENCE; bacteria build biofilms by adhering to the surface of the biofilm or to each other. Bacteria form biofilms to protect themselves from predators, dehydration, biocides, amoebas, the immune system and antibiotics by building a dense outer layer of cells to protect the interior of the community. One benefit of this environment is increased resistance to antibiotics. In some cases antibiotic resistance can be increased a thousandfold. Bacteria can exchange genes with each other even if they belong to other species. This process is named gene transfer. These properties help them to produce genes that are resistant to antibiotics and other anti microbial treatments.

Biofilms have been found to be involved in a wide variety of microbial infections in the body, A study at the National Health Institute estimate that 80% of all chronic infections are a result of biofilms. How the bacteria living in intestinal biofilms obtain their food supply The majority of the bacteria living inside the human intestine are saccharolytic and thus are able to ferment carbohydrates. It has been found by scientists that carbohydrate availability is an important factor regulating the composition and metabolic activities of the colonic microbiota.

Both the free floating bacteria and the biofilm bacteria obtain their nourishment from food that comes through the large intestine. They compete for food. Some types of food will be more likely to feed the biofilm bacteria while other foods will be more likely to be consumed by bacteria that are not in biofilms but are free floating or loosely attached. The structure of the carbohydrate will determine the type of bacteria that will most likely benefit by eating that food.

The bacteria from biofilm have an advantage at consuming very complex carbohydrates. It is unusual for any one microbial species to be able to completely metabolize very complex molecules. However, one specie of bacteria can start the breakdown of the carbohydrate and hand over the remains to another specie in the biofilm. The food is recycled from one specie to another until the food is completely metabolized. This is a very cooperative way to share the food and avoid waste. This process is also advantageous because it provides food for bacteria that cannot metabolize complex carbohydrates. [This website explains it clearly: http://biofilmbook.hypertextbookshop.com/v003/r002/contents/chapters/chapter002/section003/blue/page004.html Scientific studies found that biofilm populations were more efficient in digesting polysaccharides, while the bacteria that were not living in biofilms were able to digest oligosaccharides more quickly.

How the amount and type of carbohydrate affect biofilm formation The amount of carbohydrates in the environment will have a monumental effect on biofilm formation. An abundance of carbohydrates insures a sufficient food supply for the bacteria living inside the biofilm. If the environment does not contain a large concentration of carbohydrates, then free floating bacteria have the advantage because they can move and search for food. Bacteria that are not moving around will not get enough nutrients to survive in an environment that is not plentiful in carbohydrates. The addition of some types of carbohydrates to the environment will have the ability to transform free floating bacteria into adherent ones. A scientific experiment found that adhesion was stimulated by glucose, fructose, saccharose (sucrose), lactose, and maltose in some strains of the bacteria S epidermis. This increase was highly significant; a 32 to 63 fold increase happened when glucose was added to a soya broth (TSB). This is notable because without adhesion, the bacteria remain free floating and there is no biofilm.

There exists a carbohydrate that can stimulate an even more extreme adhesiveness. This carbohydrate is Maltodextrin and it is added to many prepared and processed foods. Maltodextrin enables E. coli, a bacteria that is found in the human GI tract, to attach itself to the ileum.

The quantity of nourishment will also determine other things about the biofilm. Increasing the amount of carbohydrates in a biofilm makes the cell clusters grow rapidly and the thickness of the biofilm increases rapidly. A biofilm that is thicker is more difficult to eliminate since it will be harder for the antimicrobial elements to penetrate it. Reducing the amount of carbohydrates had the opposite effect: the mass of the biofilm was reduced.

In general, the production of EPS, the protective shell of the biofilm, increased when additional carbohydrates (glucose) were added to the environment of the biofilm. This also demonstrates that added carbohydrates enable the biofilm to defend itself better.

Sucrose Sucrose was found to have a dramatic impact in experiments that were done on oral biofilms. Sucrose significantly increased the biofilm EPS (or outer shell) in comparison to fructose, galactose, glucose, and lactose Sucrose produced thicker biofilms and increased the amounts of proteins, lipids, and nucleic acids. This difference was more than 3-fold for biofilms grown in the presence of sucrose than for those biofilms grown in the absence of sucrose.

Furthermore, biofilms grown with sucrose had a more uniform biofilm EPS (or outer shell) than those of biofilms that were grown with fructose, galactose, glucose, and lactose. Sucrose deficiency produced patchy biofilms.

Other disadvantages of biofilms. Biofilms enable bacteria to have a very large population. The bacteria that live inside biofilms have devised many complex methods that make it possible for them to optimize population survival and live in communities with very high density.

The fact that they share the food supply with each other also enables them to maximize the amount of bacteria that can be supported by the food available in their environment. This means that patients who have many biofilms in their digestive tract will be at a great disadvantage. Their immune system will have to fight a larger number of invaders and they will have a bigger toxic load. The high toxin output may have grave implications. Bacterial lipopolysaccharide (LPS) is ubiquitous and bacteria inside many biofilms contain LPS. This toxin can damage the intestinal tract, It was found that LPS may affect these issues in digestion. Weight loss

Breakage and depletion of microvilli

IBD and IBS

Gut inflamation

Digestive symptoms

Disrupted Intestinal Transit Furthermore, the LPS produced by biofilms is more damaging than the LPS of free floating bacteria for another reason besides the larger amount. The toxin from some biofilm bacteria induces an enhanced inflammatory response in human monocytes compared with the free floating bacteria, How carbohydrate malabsorption makes the biofilm flourish

The large intestine is the last section of the digestive tract and it is composed of the following parts: the cecum. colon rectum and anal canal. The large intestine contains an incredibly large number of bacteria, at a concentration of 1011-1012 CFU/mL; the highest concentration found in any ecosystem. The colon contains 400 different types of species large. The carbohydrates that were not absorbed in other parts of the digestive tract will end up in the large intestine. Most of these bacteria in the large intestine will consume the carbohydrates that enter the large intestine. This process is known as fermentation. Increasing the amount of carbohydrates that reach the large intestine has the potential to produce bacterial overgrowth and biofilm formation. The digestive tract of healthy people will transport most of the carbohydrates to the blood supply through the small intestine and only a small amount will end up the large intestine.

However, an impairment in the digestion of carbohydrates will result in a greater amount of carbohydrates in the colon and this increase in carbohydrates leads to a greater food supply for the bacteria. A research study found that many patients with carbohydrate malabsorption had excessive amounts of organic acids, the breakdown products that result from the fermentation of carbohydrates in the colon. This shows how a much larger amount carbohydrates are being consumed by the bacteria in the colon. The larger food supply will induce a larger bacterial population. A large number of UNDIGESTED carbohydrates encourages the formation of biofilms.

There are several other reasons that carbohydrate malabsorption induces biofilm formation. The large intestine of people with carbohydrate malabsorption contains a greater amount of carbohydrates with a complex structure since the breakdown of carbohydrates is impaired in these people's digestive tract. Carbohydrates with a complex structure enhance the formation of biofilms.

Carbohydrate intolerance is one form of carbohydrate malabsorption. People with carbohydrate intolerance cannot digest disaccharides and these undigested carbohydrates will feed the bacteria. People with an inability to digest disaccharides will not be able to digest sucrose, a disaccharide. Therefore more sucrose will end up in their large intestine. An increase in sucrose will be a big boon for biofilm production since sucrose enhances the biofilm making by grow more and ensuring that it has a better protective cover.

Furthermore, Carbohydrate malabsorption can also increase the adhesion of the bacteria in the large intestine. Some guts with carbohydrate malabsorption will not be able to digest sucrose (saccharose), lactose, and maltose because these carbohydrates are disaccharides. These undigested carbohydrates will arrive to the large intestine. We know that these carbohydrates can transform free floating bacteria into adhering bacteria that will be capable to live in biofilm.

Both the quantity and type of undigested carbohydrates found in the large intestine of people with carbohydrate malabsorption are the ideal environment to produce numerous large and thick biofilms.

Unfortunately, even people without carbohydrate malabsorption may increase the adhesiveness of their gut bacteria. It was found that a diet that is high in MDX (maltodextrin) may inhibit one of the enzymes that is required to digest MDX. Therefore, people who eat a large amount of processed foods may end up with a lot of undigested maltodextrin in their large intestine; this will dramatically increase the adhesiveness of their gut microbiotica since maltodextrin has been found to enhance adhesion significantly. One scientist has shown proof that increased MDX consumption may lead to Crohn in certain susceptible individuals. They wrote: "In our studies, we observed MDX-enhanced biofilm formation by multiple strains of E. coli suggesting that MDX metabolism may be a dietary switch promoting colonization of these strains in new regions of the intestine (i.e. the ileum instead of the colon). These findings indicate that MDX found in commercial sources can stimulate biofilm formation."

The role of biofilms in digestive disorders.

Most acquired digestive disorders, with the possible exception of disorders that are secondary to impairment of the liver and the biliary tract, display a problem in the digestion of carbohydrates  Biofilms have been found in the digestive tract of patients who have very common digestive disorders such as IBD, IBD and fructose malabsorption. People with Pancreasis and cystic fibrosis also have biofilms. Diseases such as pancreasis and cystic fibrosis have an impairment in pancreatic enzymes; they also display problems in the digestion of carbohydrate because the pancreas produces amylase, a very important enzyme for the digestion of carbohydrates. Patients with pancreasis have biofilms in their pancreas and biofilms have been found in the lungs of patients with cystic fibrosis. Information about biofilms and other digestive disorders is hard to find and it is possible that tests have not yet been done.

A number of healthy people also have an impairment of digestion of carbohydrates, the most famous one being the lactose malabsorption found in adults that is a result of lack of the digestive enzyme lactase. Even healthy people who possess all the enzymes might experience carbohydrate malabsorption if they consume a diet filled with additives. Additionally, many food additives contain carbohydrates that are difficult to digest for humans. Maltodextrin (MDX) is one example of an artificial food that is difficult to digest. MDX is metabolized in the small intestine by specific enzymes. Interestingly, one of these enzymes (maltase-glucoamylase) is inhibited by high levels of MDX, suggesting that a MDX-rich diet could result in increased MDX levels in the small intestine and enrichment of MDX-utilizing bacteria in this location.

Additionally, the ubiquitous inclusion of MDX into foods of the American diet parallels a substantial increase in incidence of Crohn Disease. It is therefore not surprising that biofilms have been found inside the bodies of healthy people. However, the percentage and density of biofilms inside healthy people is not as great as those with IBD. It has also been found that biofilms from healthy people contain bifidus, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1563644/ a bacteria that is considered to be more friendly while people with UC have a lack of bifidus. The biofilms containing bifidus might be natural or it might be a sign of a very mild asymptomatic intestinal disorder,

Children with autism have unusual bacteria
The microorganisms living in the bodies of autistic children are radically different from those of typical children.

The difference is in both the number and type of bacteria. Children with autism have a much higher number of bacteria; they have bacterial overgrowth. The bacteria are giving children with autism a a distinct chemical fingerprint in their urine, with clear and significant differences between children with autism and unrelated controls. This difference is so significant that this might form the basis of an early diagnostic test for autism.

Treatments that eliminate the bacteria from the bodies of autistic children show dramatic changes in reducing autistic behavior. This gives further support to the idea that bacteria cause the symptoms of autism.

Scientific research shows that children with autism can get better when pathogenic bacterias are removed with antibiotics. Eleven children with regressive-onset autism were recruited for an intervention trial using vancomycin, an oral antibiotic that targets gram positive bacteria. (Bacterias are divided into two groups: gram negative and gram positive) Significant improvement was noted in these children after taking the antibiotic. This is very impressive when we consider that vancomycin only eliminates gram positive bacteria. It is possible that even better results would have ocured if both gram negative and gram positive bacteria had been eliminated since both of those types of bacteria have invaded the bodies of children with autism

Unfortunately, Antibiotics are only effective in eliminating the bacteria of children with autism for short periods of time , the bacteria quickly regrow. the improvements from antibiotic do not last because the bacteria return

A research study found that this important fact about the bacteria of children with autism: "Desulfovibrio species and Bacteroides vulgatus are present in significantly higher numbers in stools of severely autistic children than in controls." Both Bacteroides and Desulfovibrio are Gram negative bacteria. This studiy is showing that children with autism are having more gram negative bacteria than typical children. An increase in gram negative bacteria may also be a risk factor for both digestive and neurological problems because gram negative bacteria contain a very virulent poison called endotoxin. Endotoxin has another name: Lypopolysaccharide or LPS The bacterial toxin, LPS, has been found to cause a variety of digestive problems. LPS causes the tight junctions to widen and become disrupted; this alteration plays an important role in creating a leaky gut. The other changes induced by LPS include broken microvilli.

Bacteria Affect the Mind
A researcher in Italy  found that autistic men had significantly more endotoxin (another name for the bacterial toxin, LPS) in their blood than healthy men. Moreover, it was found that the men who had the highest level of LPS were the most socially impaired.

Mice that were injected with LPS developed a form of autism. LPS induces in mice a autistic like syndrome, characterized by body weight loss, reduced locomotor, exploratory, and social behavior. This result has been replicated so many times by different research studies that the names, "Sickness Behavior" and "Endotoxemia" are now applied to this condition.

LPS also produces damage in the amygdala,  the hippo-campus and the white matter. These parts of the brain are impaired in autism.

Bacteria Affect the Digestive Tract
There is a link between bacterial overgrowth and digestive problems. Bacterial overgrowth damages the digestive system. Children with autism also display a higher rate of digestive disorders than typical children. Even children with autism who do not exhibit the usual symptoms of digestive disorders may have hidden defects in the GI tract.

The role of bacteria and their toxins in creating carbohydrate malabsorption is especially significant since most bacteria use unabsorbed carbohydrates as food to survive in the intestinal tract.

Carbohydrate Malabsorption and Bacterial Overgrowth
People with bacterial overgrowth need to have an abnormally large supply of carbohydrates to feed the the huge amount of bacteria found in their GI tract. Since bacteria use unabsorbed carbohydrates as food. (IMPORTANT THE PROOF IS FOUND IN THE SECOND PARAGRAPH OR THE FIRST PARAGRAPH AFTER THE ABSTRACT), it is logical to assume that people with bacterial overgrowth will have problems absorbing foods. . There are scientific articles that show a link between malabsorption and bacterial overgrowth.

Bacterial overgrowth will produce carbohydrate malabsorption by several different processes. Bacterial overgrowth will damage maltase, sucrase and lactase, the brush border enzymes also known as disacharidase. . The brush border enzymes are needed to break down the complex carbohydrates into easy to digest carbs (monosaccharides). It has been found that about 60% of children with autism have a shortage of at least one enzyme needed to digest carbohydrates. Even the children who show no shortage of these enzymes may have carbohydrate malabsorption because the tests for enzymes may provide misleading results. There are several reasons for this. One of the reasons might be due to the fact that bacteria also destroy other parts of the GI tract that are important for the absorption of carbohydrates. For example, the microvilli and the glycocalyx are very important for the absorption of foods; bacteria can destroy both the microvilli and the glycocalyx. Microvilli increase the cellular surface area for absorption and they also increase the number of digestive enzymes that can be present on the cell surface. The glycocalyx is used to aid binding of substances needed for uptake, to adhere nutrients or as protection against harmful elements. Some types of bacteria may damage the villi.

Cells that absorb substances need a large surface area in contact with the substance to be efficient. For this task a large absorption surface is an advantage. The glycocalyx, the villi, and the microvilli provide a much larger surface for absorption. This may be comparable to a sponge or a terry cloth. A smooth surface does not absorb as much.

Treatments for Bacterial Overgrowth
Treatments that eliminate the bacteria from the bodies of autistic children show dramatic changes in reducing autistic behavior. This gives further support to the idea that bacteria cause the symptoms of autism.

Scientific research shows that children with autism can get better when pathogenic bacterias are removed with antibiotics. Eleven children with regressive-onset autism were recruited for an intervention trial using vancomycin, an oral antibiotic that targets gram positive bacteria. (Bacterias are divided into two groups: gram negative and gram positive) Significant improvement was noted in these children after taking the antibiotic. This is very impressive when we consider that vancomycin only eliminates gram positive bacteria. It is possible that even better results would have ocured if both gram negative and gram positive bacteria had been eliminated since both of those types of bacteria have invaded the bodies of children with autism

Unfortunately, Antibiotics are only effective in eliminating the bacteria of children with autism for short periods of time , the bacteria quickly regrow. the improvements from antibiotic do not last because the bacteria return

The Specific Carbohydrate Diet is a treatment that is getting used for the bacterial problems of children with autism. The goal of Specific Carbohydrate Diet is to starve out the gut bacteria by eliminating the foods that cause bacterial overgrowth. To read about the scientific proof for SCD: http://pecanbread.com/f/scienceproof.html

Children with autism should avoid eating the kind of foods that bring bacterial overgrowth. This will prevent both gram negative and positive bacteria from multiplying and producing toxins that destroy the gut and brains of children. Eliminating the destructive bacteria should be the first priority in the war against autism.