fructose malabsorption -Causes,diet, Symptoms, and Diagnosis

Fructose Malabsorption definition

As the name implies, Fructose Malabsorption or fructose intolerance is a digestive disorder, characterized by failure to absorb fructose in the small intestines.  This further expresses a deficient on the fructose carriers of the enterocytes found in the small intestines resulting to inability to absorb 25 g of fructose per sitting.  As a result, manifestations of unabsorbed fructose became evident and these include diarrhea and bloating.

Although Fructose Malabsorption is formerly called “Dietary Fructose Intolerance (DFI)”, this condition should not be confused with “Hereditary Fructose Intolerance (HFI)”.  They are two different entities wherein the latter have deficient liver enzymes which split up fructose in our body.

Pathophysiology of Fructose Malabsorption

Fructose molecule pulls water from the surrounding intestinal vessels into the intestinal lumen.  When it reaches the large intestine, unabsorbed fructose causes a further decrease of water absorption and then fructose are metabolized by a bacterium in our colon as it breaks into fatty acids and gas such as carbon dioxide, hydrogen and methane for which explains the symptoms of diarrhea and bloating.  Concomitant with Fructose Malabsorption disease, some individuals may also have impaired absorption of sorbitol, fructans, and other short-chained carbohydrates.  Some of the untoward effects of Fructose Malabsorption are lowering levels of serum tryptophan, folic acid, and zinc which are essential to our body.

Symptoms and causes of Fructose Malabsorption

In general, Fructose Malabsorption symptoms express same typical attributes with intestinal problems.  That’s why the common signs of this illness are mostly abdominal symptoms which include abdominal pain, diarrhea, bloating, flatulence, and a dislike to sweet foods.  Flatulence and bloating are the result of fermentation process brought by our normal colonic bacteria in the small and large intestines.  The other less common symptoms are anxiety, fatigue, headache, sugar cravings, weight loss, and depression.  Fructose Malabsorption symptoms and the other absorption disorders develop depression due to indigestion of essential amino acids such as tryptophan which is vital for the synthesis of hormones and neurotransmitters.  Other nutrient deficiencies and anemia can also be observed because of diarrhea for which some essential nutrients like iron and vitamins are not absorbed.

Fructose Malabsorption is a condition which can affect any healthy person of any age range as well as those with functional bowel diseases.  There are five known possible causes of Fructose Malabsorption and these are the following:

• Inherited abnormality of fructose transporting mechanism
• Increased use of High Fructose Corn Syrup (HFCS), or fruit juices among children
• Increased growth of small intestinal bacteria or SIBO
• Celiac disease
• Damaged intestinal mucosa brought by chemotherapy and radiotherapy
• Dumping syndrome (rapid gastric emptying)

Diagnosis of Fructose Malabsorption

A diagnosis of Fructose Malabsorption is made through medical tests which include hydrogen breath test and identifying evidences of reduced substances in stool.  Hydrogen breath test is a reliable test and it is done since such evidences of increased hydrogen can be found possible due to the retained fructose fermentation by the normal colonic intestinal bacteria.  Examination of the stool for reduced substances such as fructose also provides a strong clinical diagnosis of Fructose Malabsorption.

Fructose Malabsorption treatment

Unfortunately there is no known treatment for Fructose Malabsorption and an appropriate diet is mostly used just to prevent the occurrence symptoms.

Fructose Malabsorption Diet

The main goal of the Fructose Malabsorption Diet is to avoid foods high in fructose, sorbitol, and fructans.  The following food descriptions should be avoided in the Fructose Malabsorption Diet:

• Fructose rich foods or any foods with high fructose content (Fruits: Apple, Pear, Honeydew, Persimmon, Cherry, Lychee, Grape, Mango, Guava, Watermelon; dried fruit or fruit juice; apple and pear concentrate; plum sauce, sweet and sour sauce)
• Foods rich in high fructose corn syrup (HFCS)
• Foods rich in sorbitol
• Foods rich in fructans or other FODMAPs which may only be problematic in some individuals with Food Malabsorption (For example large amounts of wheat and vegetables – Artichoke, Onion, Asparagus, Radicchi, Chikory, Spring onion, Leek)
• Other foods to avoid include coconut milk and cream, honey, soft drinks, cordials and confectionary

REFERENCES:

http://en.wikipedia.org/wiki/Fructose_malabsorption

http://sacfs.asn.au/download/fructosemalabsorptionjune07.pdf

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