Fructose Malabsorption – A Cause of Irritable Bowel Syndrome

Do you suffer from

• Gas
• Bloating
• Abdominal pain/discomfort
• Diarrhoea
• Constipation
• Nausea
• Floating or oily stools
• Hypoglycaemia
• Depression
• Fatigue

Then you may have a condition called Fructose Malabsorption

What is Fructose Malabsorption?

Fructose malabsorption is a condition of impaired intestinal absorption of dietary fructose. It is common to mal-absorb this sugar; in fact 33% of healthy individuals have fructose malabsorption without experiencing any symptoms.

Fructose is a sugar found naturally in many foods, including honey, wheat, fruits, onions and vegetables. Fructose is present in a single sugar form and also as a chain of fructose sugar units called fructans. Normally, fructose is absorbed in the small bowel. In fructose malabsorption, the normal absorption of fructose is impaired.

“A much less well known condition, although similar to lactose intolerance, is fructose malabsorption. In fructose malabsorption a persons ability to  absorb fructose, is impaired”.

This results in fructose passing through the intestines and being fermented by bacteria, causing both gastrointestinal symptoms abdominal bloating/cramps, constipation, loose stools, diarrhoea or flatulence and increased proliferation of certain intestinal bacteria and yeast which metabolise fructose. These are common symptoms that can often be called “Irritable Bowel Syndrome”.

Fructose malabsorption only becomes problematic, requiring a low fructose diet, when the individual has a gastrointestinal condition such as IBS, or another functional gastrointestinal disorder. Not every food that contains fructose is a problem for people with fructose malabsorption. It is important to understand how fructose occurs in foods to know which foods are a problem.

These are common symptoms that can often be called   “Irritable Bowel Syndrome”.

 

How is it Diagnosed?

Fructose malabsorption is diagnosed via a hydrogen breath test. It is a similar test as used to diagnose lactose intolerance. Breath hydrogen measurements are taken fasting, 25 grams of fructose is administered and breath hydrogen levels are monitored regularly for 2-3 hours.

Dietary Advice

Dietary strategies to assist with minimising symptoms include

1. Avoid foods that contain excess fructose
2. Avoid dietary sources of fructans
3. Reduce the fructose load

Fructose Foods

Recent literature shows a diet with generally reduced FODMAP content may be the most effective and practicable diet to aim for. The following information will give you details on how to specifically reduce fructose in your diet.

• Fruit and fruit juices: apple, cherry, grape, guava, litchi, mango, melon (honeydew and watermelon), orange, papaya, pear, persimmon, pineapple, quince, star fruit. Cooked fruit generally has lower fructose content than uncooked fruit.
• Most dried fruit, including currant, dates, dried fruit or health bars, fig, raisin.
• Processed fruit: barbecue sauce, chutney, fruit from cans / tins (often in pear juice), plum sauce, sweet and sour sauce, tomato paste.
• Sweets, food and drinks containing high fructose corn syrup (HFCS).
• Honey
• Vegetables in larger quantities (fructan content): artichoke, asparagus, beans, broccoli, cabbage, chicory, leek, onion, peanuts, tomato, zucchini.
• Sweet wines: e.g. dessert wines, muscatel, port, sherry.
• Wheat- based products: flour, pasta, bread, whole-grain breakfast cereals.
• Sorbitol (E420 is sorbitol) and xylitol (E967 is xylitolcontaining foods: diet / ‘light’ and diabetic drinks, sugar-free chewing gum