Background: The colonic degradation of carbohydrates (fermentation) to short-chain fatty acids (SCFAs) appears to have major impacts on colonocyte function, sodium and water absorption, and large-bowel energy salvation, but how to quantify the in vivo fermentation in man is still debatable.
Methods: Indicators of colonic fermentation, fecal and plasma SCFAs and breath hydrogen (H2), were measured in 10 short-bowel patients (mean +/- SE; 106 +/- 21 cm) with totally preserved large bowels who were on a 60% high-carbohydrate, 20% low-fat diet, compared with the reversed isocaloric 20% low-carbohydrate, 60% high-fat diet. This human model showed large differences in large-bowel fermentation, as excretions of calories were reduced (40%; 485 +/- 151 kcal/day) and excretions of carbohydrates were unchanged and low with the high-carbohydrate diet as compared with the low-carbohydrate diet, in contrast to unchanged calorie excretion in short-bowel patients with no colonic function.
Results: Fecal concentrations of SCFAs did not change when the diet was changed from the high content to the low content of carbohydrates (82 +/- 11 mmol/l and 79 +/- 9 mmol/l, respectively). The ratio of acetate in feces increased (from 48 +/- 4% to 54 +/- 3%; p = 0.01) on the high-carbohydrate diet, whereas the percentage of the other SCFAs decreased proportionally. Plasma SCFAs 2 h and 6 h after breakfast were also identical when comparing the two dietary regimens. Nor were the peak H2 breath excretion and the area under the H2 excretion-versus-time curve increased by the threefold increase in the intake of dietary carbohydrates.
Conclusions: Fecal and plasma SCFAs and breath H2 excretion are of limited value in the evaluation of even large differences in colonic fermentation of complex dietary carbohydrates.