Talk:Fructose malabsorption

Fructose Table
A note in the USDA Matthews et. al. (1987) report on the Sugar Content of Selected foods indicates that the values in the report are superceded by the USDA Nutrition Database SR16 and SR16 has now been superceded by SR20. The values in the modified table are taken from SR20 and show the values of fructose and glucose. Food items with no values were removed as they are now mentioned elsewhere (see the Dietary section) —Preceding unsigned comment added by 69.11.51.185 (talk) 16:48, 13 October 2007 (UTC)

This table seems to indicate that sucrose is 50% fructose and 50% glucose. They are three different sugars! Can somebody clarify or correct that? LogicalOctopus (talk) 03:17, 5 May 2010 (UTC) Sucrose is a molecule made from 1 molecule of fructose and 1 molecule of glucose. So the 50/50 split in the table is accurate.

As one of the researchers involved in the development of the low FODMAP diet, and an Accredited Practising Dietitian, I can confirm that sucrose should be deleted from the table. It can cause problems but only in large amounts, such as large serves of soft drink and sweets. Dr Jaci Barrett, PhD, APD. Monash University Eastern Health Clinical School.

Spelt
Sue Shepherd (scroll down) researches Fructose Malabsorbtion and informed me (in a group session for people with the disorder) that spelt has a similar fructans content to wheat and should be avoided. Is there a reference stating that spelt is ok, or is my information otherwise out of date?

Your information is out of date. The research has significantly evolved over the years. Spelt had previously not been tested. True spelt breads are low in fructans, but be careful as some contain added flours such as lentil flour which are high in galactans, another FODMAP. Dr Jaci Barrett, PhD, APD. Monash University Eastern Health Clinical School.

Is 100% spelt flour bread low in fructans, or just the sourdough variety of 100% spelt flour bread? Dr Barrett's comment above implies that the non-sourdough variety is acceptable, yet the most current version of the Monash University FODMAP app only lists sourdough spelt breads as being safe. LA 19/05/2015. — Preceding unsigned comment added by 130.102.158.12 (talk) 05:49, 19 May 2015 (UTC)

dietary fructose intolerance
''Fructose malabsorption is also called dietary fructose intolerance. University of Iowa - Health Care has more information about this disorder.'' Why dont you incorporate this info into the article? Could become more than a stub this way. Dbach 12:54, 25 Jun 2005 (UTC)

They are not the same thing. They have different causes, different symptoms, and different medical diagnosis. However, I'll add a link as I recall their information is still useful. --Couttsie 01:29, 7 February 2006 (UTC)

Just be careful as some types of fructose intolerance require complete fructose restriction, whereas fructose malabsorption only requires restriction of fructose in excess of glucose, but also requires restriction of fructans and likely other types of FODMAPs. Dr Jaci Barrett, PhD, APD, Monash University Eastern Health Clinical School.

Fructose malabsorption (FM) and dietary fructose intolerance (= intestinal FI ) iFI are not 100% identical. FM just means bad resorption of fructose in the small intesine so that not all fructose is resorbed and thus reaches the large intestine: About 1/3 of the population have this FM (several medice papers about H2 breath tests) - this alone is not necessarily connected with symptoms. Only in about 1/3 of these people with FM (1/9 of total), the non-resorbed fructose causes symptoms (wind, diarrhoe, ...), i.e. they are (dietary) intolerant to fructose, because of intestinal reasons (not heredidary because of liver or so). See: Book by M. Ledochowski, H2-Atemteste = H2 breath tests, ISBN 978-3-9502468-0-3 Doing the H2-test, people with iFI suffer symptoms (wind, diarrhoe) and produce H2 (if not non-responer). Doing the H2-test, people with only FM and not iFI have no symptoms but produce H2 (if not non-responer). My explanation: the bacterial population in the large intestine is damaged in those people with iFI, otherwise their large intestine would accept those additional carbohydrates without symptoms, because their amount is usually not so high compared with the normally tolerated amount of carbohydrates per day of 60g/day. Because the bacterial population not tolerating aome substances is the main problem in those suffering iFI, they also often have problems with FODMAPS - and iFI and LI often appear together. For further information see my discussion of German version of Wiki on Fructosemalabsorption Just for clarification:
 * 1) Of course intestinal FI (iFI) is NOT the same as hereditary FI (HFI) where the problem is a missing/demaged enzyme in the liver and the people easily die when eating fructose.
 * 2) You can compare FM/iFI with LM/LI FM can (!) cause iFI and lactase maldigestion (lack of enzyme) can (!) cause LI. My explanation: Only those with bad bacteria in colon get intolerance.

--User:Libasefrank 07:10, 27 Mai 2010 (Germany) If any questions, contact me per Email at fmMINUSursachenATarcorDOTde MINUS=-, AT=@, DOT=. because I will not read here frequently.

Fructose-Free Products?
I've had a hard time pinpointing foods that have fructose. One source said wheat flour was alright as long as it wasn't whole grain wheat flour. But this site says wheat flour has fructose. Anyone know of a comprehensive list of fructose-free foods? It would be a great link to add here!

A good source of fructose content is Nutrient Data Laboratory Home Page http://www.ars.usda.gov/main/site_main.htm?modecode=12354500

The link in the previous enter is no longer valid. Try http://www.uihealthcare.com/topics/medicaldepartments/foodandnutrition/dfi/index.html

Most of the fructose information available on the net is out of date. Previous laboratory techniques were inaccurate in assessing fructose intake. In addition, its not just about fructose. Fructans, galactans and in some people, polyols, also need to be restricted. Our team have published 3 papers on fructose/FODMAP content of foods in Australia. We have also developed a resource that is available for purchase with proceeds going toward our research. www.med.monash.edu.au/ehcs. Do not buy a copy if you intend on seeing a dietitian for advice. At my practice, all patients educated on a low fructose/FODMAP diet receive a complimentary copy whether a face-to-face consultation, group session or telephone consultation-www.dietsolutions.net.au. Dr Jaci Barrett, PhD, APD, Monash University Eastern Health Clinical School.

Coconut Milk
Coconut milk is listed as a high fructose containing food. The National Public Health Institute of Finland (http://www.fineli.fi/food.php?foodid=29014&lang=en) does not support this observation.

Can some please provide a reference that supports the high fructose content of coconut milk?

Medical Observer in Australia lists a reference to coconut milk http://www.medicalobserver.com.au/displayarticle/index.asp?articleID=6260&templateID=108&sectionID=0&sectionName=

Coconut milk/cream and desiccated coconut have only recently been tested with the latest laboratory techniques. We have not published this work, but I can tell you that 1/2-1 cup of any source of coconut is actual below the limits that indicate high fructose/FODMAP. So we now include these foods in the diet of people with fructose malabsorption. The only thing is that sometimes the fat content can cause symptoms, but this is a separate issue to fructose/FODMAP content. Dr Jaci Barrett, PhD, APD Monash University, Eastern Health Clinical School.

Unfortunately the author of the Australia article appears to be some what misinformed. Under 'Other' wheat is listed. According to the USDA database 100 grams of whole wheat flour has about 0.4 grams of sugar AND enriched white flour has 1.12 grams of sugar of which 0.03 grams free glucose and 0.3 grams of free fructose. Wheat is definitely not a high fructose food compared to 100 grams of honey which has 82 grams of sugar of which 36 grams is free glucose and 41 grams of free fructose OR 100 grams of pears contains 9.8 grams of sugars of which 2.8 grams is free glucose and 6.2 gram is free fructose. (by free I mean glucose and fructose and bounded together in equal amounts in the form of sucrose).

The problem with wheat is not that it contains fructose - rather it is its fructan content that makes it appear on the problem food lists. There is a lot of confusion because everyone thinks its all about fructose, when in fact the other FODMAPs are often just as problematic. Dr Jaci Barrett, PhD, APD. Monash University Eastern Health Clinical School.

A search of the research literature using the ISI database revealed nothing that supports fructans as a problem in fructose malabsorption. Also, there is no mention of fructans in relationship to IBS in Skoog, S. M. and A. E. Bharucha, 2004: Dietary Fructose and Gastrointestinal Symptoms: A Review. American Journal of Gastroenterology, 99, 2046-2050. http://www.bashaar.org.il/files/101022005111814.pdf

There is significant research that shows that fructans are just as much of a problem in IBS! Sue Shepherds research involved rechallenge with fructose and/or fructans in fructose malabsorbers and showed that symptoms returned with ingestion of fructose OR fructans AND both. —Preceding unsigned comment added by 58.161.98.169 (talk) 07:52, 29 January 2011 (UTC)

Fructans
I am a fructose malabsorber. If you read the papers in which Sue Shepherd is listed as a co-author, in particular the latest one titled "Review article: fructose malabsorption and the bigger picture", you will read in the abstract "Restricting dietary intake of free fructose and/or fructans may have durable symptomatic benefits in a high proportion of patients with functional gut disorders, but high quality evidence is lacking." Not all fructose malabsorber have difficulty with fructans. Putting this in another context in the paper "Fructan and Free Fructose Content of Common Australian Vegetables and Fruit" it says "Nevertheless, we have recent evidence to suggest that doses (10-20 g/day) [fructans] may exacerbate symptoms in patients who suffer from irritable bowel syndrome (IBS)". A slice of white bread (65 grams) contains just less than 2 grams of fructans (see Shepherd 2006 dietary guidelines). If white bread was the only dietary source of fructans then the lower limit of 10 grams would not be exceed until more than 5 slices of bread had been eaten. There may be individual tolerance differences to free fructose and fructans. It is important not to isolate wheat as a culprit but to put into the perspective of moderating its consumption along with other high fructan containing foods such as onions and Jerusalem artichokes that contain 9-12 grams/100 gram serving.

As a clinically diagnosed sufferer, I have been advised by a professional dietician that Fructans ARE a problem for sufferers of Fructose Malabsorption. dacoutts —The preceding unsigned comment was added by 203.14.223.10 --Couttsie 02:57, 8 February 2007 (UTC)

The article is not very clear on this point as part of it says fructans are not a problem, but then talks about avoiding wheat based breads. I assume because they are high in fructans. Sue shephard has recently published a couple of articles based on a study she has done which indicate fructans are a problem and should be avoided.Skeuu 22:33, 28 March 2007 (UTC) Jeremy.

I think this is clear that there is evidence that wheat should be avoided. Here is more evidence.

http://www.medicalobserver.com.au/displayarticle/index.asp?articleID=6260&templateID=108&sectionID=0&sectionName=

I will remove the assertion that there is no evidence that wheat is a problem. --Couttsie 00:54, 19 July 2007 (UTC)

Fructans are ALWAYS malabsorbed in everyone. In someone without a gut disorder, they may experience some wind/gas, but in people with IBS or another functional gut disorder, the gut is hypersensitive to malabsorption and therefore they experience diarrhoea and/or constipation, excessive wind, pain and bloating with ingestion of fructans. There is no breath test because we would all get a positive response. But the presence of gut symptoms indicates that carbohydrates like fructans (and in fact galactans too) would exacerbate the problem. Thus, everyone with IBS or another functional gut disorder would benefit from a fructan restriction. In fact, people who get a negative fructose breath test, should always see a dietitian anyway for assessment of fructan intake as they should try a fructan/galactan restricted diet in order to improve their symptoms. Our team - myself, Peter Gibson, Jane Muir and Sue Shepherd have proven this malabsorption of fructans/galactans and we can confirm that the majority of IBS sufferers will obtain benefit from restricting these carbohydrates with or without fructose restriction depending on their absorption of that sugar. Dr Jaci Barrett, PhD, APD Monash University Eastern Health Clinical School.

galactans
In some of the fructose Elimination diets I have read, galactans are listed to avoid. Do people with fructose malabsorption have any recorded issues with galactose or galactans? — Preceding unsigned comment added by Jbozz21 (talk • contribs) 20:11, 10 August 2013 (UTC)

glucose/dextrose
The lead section says that eating glucose helps, but there's no reference and no follow-up in the article itself. Is there a reference or at least more information on this point? Jonathan Tweet 14:30, 9 February 2007 (UTC)

Theoretically we presume that adding glucose to high fructose foods should improve absorption, but in the small pilot study we undertook, it wasn't convincing. And it just increases sugar intake so from a dietary perspective we do not recommend it. Dr Jaci Barrett Monash University Eastern Health Clinical School.

some thoughts
A clue: looking at structural formula on the fructan page http://en.wikipedia.org/wiki/Fructan, fructans are fructose complexes. This page also says fructans are "Chains of fructose molecules". It sounds like fructans are fructose analogs of starches, which are complexes, or chains, of glucose molecules. If this is true, fructans would digest, at least partially, to fructose similar to the way starches digest to glucose and fructans would therefore be contributory to fructose malabsorption issues. Other molecules that digest to fructose, such as the sugar alcohol, sorbitol also would contribute to these issues.

This is not true. Humans do not have an enzyme to breakdown fructans, so they remain in the chain form and are fermented by bacteria producing gas and contributing to IBS symptoms. Dr Jaci Barrett Monash University Eastern Health Clinical School.

A suggestion: Nomally, a fructose molecule "piggy backs" across the basolateral membrane of the small intestine with a glucose molecule in 1:1 ratio via GLUT-5, though this seems to be in some dispute or not generally acknowledged. It seems to be generally thought that glucose facilitates fructose absorption. http://jn.nutrition.org/cgi/reprint/125/8/2156.pdf Though this report is on rat intestine, the experimants are definitive. See page 2161 for a graph of glucose facilitation and page 2163 in the discussion for comments relating to human absoption. It should be made clear in the article that glucose facilitates fructose consumption and simultaneous ingestion of glucose and its precursors, such as starches, facilitate absorption.

A thought: Fructose is a non-essential molecule. No known requirements exist for its consumption. See the dietary reference intakes at the NAS, http://books.nap.edu/openbook.php?record_id=10490&page=265 There is, in fact, no need for any carbohydrates at all beyond infancy. In my view, fructose "malabsorption" is really a protective mechanism, since fructose is a very potent endogenous AGE-former ranging from 6 to 15 times more active than glucose, depending on the report. http://www.ncbi.nlm.nih.gov/pubmed/7599353?dopt=Abstract http://www.ncbi.nlm.nih.gov/pubmed/3132203?dopt=Abstract http://www.ncbi.nlm.nih.gov/pubmed/2675027?dopt=Abstract  http://www.ncbi.nlm.nih.gov/pubmed/15343583?dopt=Abstract  Fructose is strongly linked to obesity and many age-related chronic diseases. http://www.ncbi.nlm.nih.gov/pubmed/12399260?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum http://www.ncbi.nlm.nih.gov/pubmed/18051988?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum http://www.cmi.ustc.edu.cn/3/5/351.pdf http://glycob.oxfordjournals.org/cgi/content/abstract/15/7/16R and there are thousands more references linking fructose and human illnes/dysfunction. Interestingly, this article http://linkinghub.elsevier.com/retrieve/pii/S1521691803001070 suggests that "There are no known defects of fructose absorption." For the above reasons I think this wiki article's focus should be shifted from pathological, i.e. "malabsorption" to a simple informational point of view like "incomplete fructose absorption," or some such title. It could then be a redirect from "malabsorption" for people searching for that.

Just to clarify that it is fructose as a sweetener that has been linked to obesity rather than natural fructose within foods such as fruits and vegetables. Dr Jaci Barrett Monash University Eastern Health Clinical School.

Jwanderson (talk) 21:00, 13 April 2008 (UTC)

Question regarding claim
'Fructose malabsorption is found in approximately 30-40% of the population of Central Europe,[2]'

This claim, and the following one within the same sentence originate from this, as referenced: http://books.google.com/books?id=hLYgFxCuQNoC&pg=PA74&lpg=PA74&dq=%22fructose+malabsorption%22+tyrosine+-forum&source=web&ots=lvwEGCUpmA&sig=dIIEfuRUc-SZOCfAVsq9vNW76tQ#v=onepage&q=%22fructose%20malabsorption%22%20tyrosine%20-forum&f=false

The book above claims that Born et al. - in the following paper (which was hard to find): https://www.thieme-connect.com/ejournals/abstract/zfg/doi/10.1055/s-2000-7512 - suggests 36% is the figure. I cannot check this, frankly given being unwilling to pay up - however, see the following.

I believe the 'approximately 30-40%' found here must originate from the fact that Born - later citing the 1994 paper himself here, but in fact regarding another point: http://74.125.155.132/scholar?q=cache:vY0gT5k9NgYJ:scholar.google.com/&hl=en&as_sdt=2000&sciodt=2000 - suggests up to 30% of the Western population likely suffer. I strongly believe this last paper, being published in 2007 in the WJG, ought to be the one quoted. I think I shall now go ahead and change the claim on the page, and if disagreement arises from this (despite the fact that this seems the most evidenced approach to take) then I hope this will be found in favour. —Preceding unsigned comment added by 2.122.34.32 (talk) 22:35, 1 January 2011 (UTC)

Third paragraph makes no sense?
"This condition is common in patients ... although occurrence in these patients is not higher than occurrence in the normal population" makes no sense at all to me. Surely if it is noteworthy / relevantly "common", then it has higher incidence among these patients than normal population. If the incidence is the same, it's not (with any relevance) "common" in these patients. —Preceding unsigned comment added by 14.200.2.233 (talk) 13:01, 31 January 2011 (UTC)

Consolidating "Diet" Sections
A couple of thoughts...

Small quibble: Why is HFCS-90 listed in the USDA table? My understanding is that it basically isn't used in food products, but rather in producing HFCS with lower fructose content (42 or 55 percent). See: http://www.newsdesk.umd.edu/sociss/release.cfm?ArticleID=1470

Larger thought: Can we merge the subsections under "Treatment" into simply "Diet" (as written) and "Dietary Guidelines"? The article seems to be repetitive in this section. IMHO, it would be helpful to read the general guidelines and then read the favorable/unfavorable foods. The USDA table seems extraneous, and the sections "food with high fructan content" and "other problem foods" could all fit under "unfavorable foods." Organo435 (talk) 21:25, 26 April 2011 (UTC)

The following sentence is referenced, but the reference does not appear to make any statement relevant to the claim. "However, some fructose malabsorbers do not have difficulty with fructans from wheat products while they may have problems with foods that contain excess free fructose."

The claim that most beers contain wheat is simply not true. Very few pilsner/lager-style beer contain any wheat, although some may have corn/maize or rice in them. English style beers generally do not contain wheat. Apart from beers that are explicitly brewed in a wheat-beer tradition (weizen, wit, weisse, lambic, geueze etc) you're most likely to find wheat in some Belgian beers, as well some amount in microbrewery beers, even in cases when the beer style do not call for it. Another issue is that beers are mashed, which means that amylase enzymes break down complex sugars to simpler, which the yeast is able to ferment - and thus the amount of fructose and fructans in the ingredients is much reduced during the brewing process. Anchr (talk) 08:54, 28 June 2012 (UTC)

Hereditary fructose intolerance
Please do not remove the See Also link to Hereditary_fructose_intolerance

The two topics should distinguish the two conditions on an agreed best science evidence basis.

G. Robert Shiplett 10:30, 3 August 2013 (UTC)

Contradiction in treatment?
"Treatment

There is no known cure, but an appropriate diet and the enzyme xylose isomerase can help. Xylose isomerase

Xylose isomerase acts to convert fructose sugars into glucose. Dietary supplements are limited in the amount of fructose they can convert, thus the amount of fructose in a meal must be estimated and an appropriate dosage taken to work.[citation needed][8]"

Except the Wikipedia page on Xylose isomerase indicates that it is an enzyme used "to produce high fructose corn syrup from glucose" - which seems like the opposite of what's stated in this article. Which is right? Are they both right? — Preceding unsigned comment added by 204.11.35.221 (talk) 20:17, 27 January 2016 (UTC)

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Add explanation about wheat
From the article, I couldn’t figure out what is going on with wheat. The section "Food-labeling" talks about it, but it never becomes clear if it’s to avoided in Fructose malabsorption or not.

Here in the Talk, there are a few mentions of wheat/spelt, suggesting it should be avoided because of high fructans content, but my expertise in this field isn’t enough to judge those comments and add something to the article about it. Anyone? --Geke (talk) 14:59, 14 April 2018 (UTC)
 * In general, information on foods high in fructose is lacking and is a poorly developed topic. Probably it would be necessary to review in detail the list of foods on the page (I have not done it yet).
 * In this 2015 review PMID 24357350 there is a table of foods and their classification by the fructose content (table 1). It does classify wheat as high in fructose. --BallenaBlanca &#128051; ♂ (Talk)  18:40, 14 April 2018 (UTC)