by SJ Shepherd and PR Gibson
April 11, 2007
Journal: Journal of the American Dietetic Association. 2006 Oct;106(10):1631-9
Authors and affiliations: Shepherd SJ, Gibson PR. Monash University Department of Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia. [E-mail: susan.shepherd@med.monash.edu.au ]
PMID: 17000196
Dietary fructose induces abdominal symptoms in patients with fructose malabsorption, but there are no published guidelines on its dietary management. The objective was to retrospectively evaluate a potentially successful diet therapy in patients with Irritable Bowel Syndrome and fructose malabsorption.
Tables detailing the content of fructose and fructans in foods were constructed. [Note: Fructose is a simple sugar found in varying amounts in many fruits, and honey, corn syrup, and some vegetables; and is produced by the body in the digestion of another sugar – sucrose. Fructans are chains of fructose molecules occurring in a few foods such as artichokes and green beans.]
A dietary strategy comprising...
n Avoidance of foods containing substantial free fructose and short-chain fructans,
n Limitation of the total dietary fructose load,
n Encouragement of foods in which glucose was balanced with fructose,
n And co-ingestion of free glucose to balance excess free fructose ...was devised.
Sixty-two consecutively referred patients with Irritable Bowel Syndrome and fructose malabsorption on breath hydrogen testing underwent dietary instruction. [Note: a hydrogen breath test (HBT) involves taking a base reading of hydrogen levels in the patient’s breath; then administering a small amount of fructose and/or sorbitol (a sugar substitute found in certain stone fruits and berries); and then taking hydrogen level readings every 15 to 30 minutes for two to three hours. If the level of hydrogen rises to 20 points or more above the base reading, and stays at that level at least two readings, this indicates the patient has fructose malabsorption.]
Dietary adherence and effect on abdominal symptoms were evaluated via telephone interview 2 to 40 months (median 14 months) later.
Response to the diet was defined as improvement of all symptoms by at least 5 points on a 1-to-10-point scale. Forty-eight patients (77%) adhered to the diet always or frequently.
Forty-six (74%) of all patients responded positively in all abdominal symptoms. Positive response overall was significantly better in those adherent than nonadherent (85% vs. 36%; P<0.01), as was improvement in individual symptoms (P<0.01 for all symptoms).
This comprehensive fructose malabsorption dietary therapy achieves a high level of sustained adherence and good symptomatic response.
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