I think I have Fructose Malabsorption - reading up and i'm confused
#361321 - 10/06/10 08:38 PM
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My IBS-D symptoms are a TON better since I've eliminated FODMAPs from my diet. However, I'm uncertain about what is exactly happening with my body. It seems that anyone who has something to say about FODMAPs and fructose malabsorption has a different take on it.
It seems that Fructose Malabsorption could be a sign of SIBO. Or perhaps they're somehow related. Lot of stories of people being helped by antibiotics, few stories of permanent relief. Then again, few people will bother to talk about something that has been cured. are antibiotics worth trying?
How long do i need to be on a restricted diet? I've found info that recommends restricting for 2-4 months and then experimenting with adding various FODMAPs to see what you can handle. Why 2-4 months? Why would my fructose tolerance improve? If I make a mistake that results in loose bowel movements, does that 2-4 month period reset?
Should I take probiotics? I tried digestive advantage when i was first having problems but it helped little. Might it help now that my symptoms are more under control? Should I try a different one?
Is a doctor likely to provide guidance? This seems like rather new medicine. I'd prefer not to be put through a battery of tests to confirm what i already know.
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This article, http://www.todaysdietitian.com/newarchives/072710p30.shtml, provides and informative guide to FODMAPs. There are also books available on Amazon, for example, 'IBS free at last,' that provide guidance and information on the FODMAP diet and the processes occurring. Syl, who posts on these boards, has a link, in her profile, to the academic studies from which the above are derived.
If I recall correctly the academic paper states that the diet should be trialled for 6 weeks before challenging problematic foods, however, the book recommends as little as two weeks. I personally think two weeks is too short, however, that is a judgement you'll have to take depending on how you're feeling. If you are fructose intolerant; your intolerance will not increase, you'll just need to limit foods high in fructose/free fructose.
Probiotics such as vsl#3 and Align have been clinically proven to help IBS patients, however, they are expensive and they don't work for everyone.
Best wishes
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IBS A. Managing my symptoms with the EFI/FODMAP diet and probiotics.
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It might be worth while getting a fructose malabsorption breath test. If the test is negative then you don't have to pay attention to the fructose/fructan part of the diet. If the test if positive then you will have to pay close attention to fructose and fructan consumption.
While some individuals with SIBO may have problems with fructose it does not mean that all individuals fructose problems have SIBO. If you think you have SIBO then you need another kind of breath test to confirm it is the case. Then and only then should you try a course of the proper antibiotics. It is not wise to take power antibiotics that seriously disrupt colonic bacteria without showing there is a need.
If you have fructose malabsorption your tolerance will not get better with time if you remove foods with excess fructose from your diet. It is a life long condition.
The reason you add some FODMAPs back into the diet is because there are tolerance levels to many of the foods. For example, a fructose malabsorption test will only tell you if you can or cannot tolerate a load of 25 grams of pure fructose. If you cannot then the test does tell you if you can handle less e.g. a 20, 15 of even 1 gram load. This is something you have figure out by experimenting with the amount you eat.
The FODMAP diet is not particularly new medicine. Most of the foods in this diet have been know to exacerbate GI symptoms for a considerable amount of time. However, it only within the past 5 years or so that an Australian group of GI researchers have put all the pieces together into a cohesive framework where the underlying physiology is completely understood and done clinical trials of GI suffers to test efficacy. In fact, if you look closely at the EFI diet you will see that except for the emphasis of soluble and lack of emphasis on fructose/fructans they are similarly. The FODMAP diet leaves the adjustment of fiber to the physicians and dietitians supervising the patient. If you do decide to seek a doctors guidance then it might be wise to take a copy of the latest paper with you which is the last link in my signature.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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HI! It is probably true that you are Fructose Intolerant, since most IBS-D sufferers are. It is easy to be tested, non- invasive and accurate just like Lactose intolerant testing. Have you taken the Hydrogen Breath Test? It is worth the effort to find a center that does it. I'm Lactose, Fructose Intolerant and recently learned that I am Histamine Intolerant. That was easy, too. I am IBS-D and since learning about the Histamine Intolerance, I've been able to control all my IBS issues with diet and 1 over the counter antihistamine tablet daily that lasts for 24 hours. What was amazing to me was that the antihistamine addition made a huge difference in a matter of a few days!
You will want to read about the difference betw Fructose Intolerance and Malabsorption. It's less likely that you have the genetic malabsorption but the intolerance of fructose is very common because of the way our food is sweetened with the cheapest ingredient, High Fructose Corn Syrup. It is a disaster of IBS-D. Read this: http://www.foodintol.com/sugar.asp
I would be happy to help you find more worthwhile articles. I am trained as a Genetic Counselor and Educator and I've had IBS a LONG time. I'm still learning because the research is always updating the subject. Take Care, Eileen
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Clincal research shows that about 50% of IBS suffers of any subtype have fructose malabsorption. If you have access to online research publication you might check the reference below. Table 2 gives the percentage of the population in each GI disorder that tested positive for fructose malabsorption. The results showed that 55% of IBS-C, 44% of IBS-D and 50% of IBS-A were tested positive for fructose malabsorption.
You probably know fructose intolerance is a genetic disorder usually detected in childhood which if not dealt with quickly can lead to very serious consequences. Consumption of HFCS does not precipitate fructose malabsorption; it only exacerbates it as do other food high in excess fructose such as honey.
Fructose malabsorption and lactose intolerance belong to a larger class of short chain carbohydrate malabsorption. This group of carbohydrates are referred to as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). Check the link in my signature for more information on FODMAPs.
Reference
Barrett, J. S., et al (2009). Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders . Alimentary Pharmacology & Therapeutics, 30(2), 165-174
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Sounds like going to the doctor could help me understand a lot more about this. I'm curious what route might be taken, which tests.
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You need three tests to cover the bases: a SIBO glucose breath test ( not the lactulose test originally recommended by Pimental ), a fructose breath test and a lactose breath test. The SIBO test will tell if a course of specific antibiotics are required. The later will tell you if you are a fructose and/or lactose malabsorber.
Assuming the SIBO test is negative then the other tests will tell you which of five categories in the FODMAP are most pertinent for you to manage GI symptoms.
It is important to remember that the most authors that discuss the FODMAP approach don't discuss the other critical issues that Heather covers fully such as the role of soluble fiber, other GI stimulants such as caffeine and alcohol and problems with dairy. These issues are normally left to one's physician and/or to the dietitian advising you on how to use the FODMAP approach.
At the moment because this approach is so new there are few physicians that know about it and even fewer dietitians that fully understand it and how it integrates with other established dietary principles for managing IBS symptoms.
It is worth while integrating Heather's EFI diet and FODMAP approach as a basic dietary approach for managing IBS symptoms. This approach has been beneficial for me 
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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