Up to 1/3 of people with suspected IBS actually have fructose intolerance

Up to 20% of people in the US have IBS. But with appropriate workup, about 1/3 have been reported to actually have fructose intolerance. Fructose is a sugar that can cause a lot of digestive problems. It is a monosaccharide carbohydrate that is NOT easily absorbed in the gut.  This intolerance leads to abdominal pain, bloating, gas, flatulence, distension, nausea and diarrhea. Sounds like symptoms that may mimic many other diseases, like IBS, SIBO etc, right? Well that’s why many of these patients undergo a whole slew of tests like endoscopy, CT scans, blood and stool tests and when these tests come back negative, then they often mislabeled as functional dyspepsia or bloating or irritable bowel syndrome (IBS) and sent on their way. Infrequently do doctors actually think of fructose malabsorption. 

   
  
 
  
    
  
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  Choi et al. AJG 2003

Choi et al. AJG 2003

Absorption of fructose is an active, energy dependent process and therefore our bodies are limited in digesting and absorbing it. Malabsorption means the fructose stays in the gut lumen and generates an osmotic force which moves water into the lumen to help move the fructose down to the colon, where it is fermented by bacteria, making a whole lot of gas. This gas and excess fermentation leads to abdominal pain, excessive gas and bloating... especially in patients with visceral hypersensitivity.

   
  
 
  
    
  
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     Ebert et al. Molecular and Cellular Pediatrics 2016

Ebert et al. Molecular and Cellular Pediatrics 2016

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Why is this so important to discuss? Because fructose is hiding in so many foods. It is naturally present in a variety of foods but also produced enzymatically from corn as high fructose corn syrup (HFCS), commonly found in things like soda and snuck into all sorts of foods. According to the USDA, HFCS consumption has increased for more than 1000% in the past and this rise in fructose consumption may have resulted in a rise in fructose malabsorption

 

So do YOU have fructose malabsorption? To diagnose this condition, you can either take a fructose breath test for a formal diagnosis or just commit to a trial of fructose dietary elimination and see how you feel!

 

The FRUCTOSE elimination diet:

 Examples of high fructose corn syrup (HFCS)-containing foods

Examples of high fructose corn syrup (HFCS)-containing foods

1. First and foremost: Ditch ANY product with high fructose corn syrup

- Sauces & condiments like BBQ sauces, Heinz® Ketchup, jams/jellies, salad dressings

- Flavored dairy: chocolate milks, ice cream, yogurts, coffee creamer

- Sweetened juice, energy/sports drinks, soda

- Baked goods & snacks: breads, cake, donuts, granola bars, breakfast cereal, cereal bars, chips, cookies, crackers, nutrition bars

- Frozen food (TV dinners, pizzas)

2. Read the label! "fructose" or "crystalline fructose" finds its way into tons of foods.

3. Avoid sweeteners! It may sound tough but once your palate gets used to unsweetened food, you won't miss it! AND you'll shed a ton of weight.

  • Honey
  • Agave syrup
  • Invert sugar
  • Maple-flavored syrup
  • Molasses
  • Palm or coconut sugar
  • Sorghum

#feedyourgut #eatrealfood #gutlove