|
|
It's hard to distinguish between a true fructose intolerance...and knowing that fructose can be an IBS irritant. How do you draw the line between some and not too much. Or does everyone even have to worry about too much?
It's hard for me to separate what's really affecting my body negatively, and what I fear is effecting it because of something I've read. 
--------------------
IBS-C with pain and bloat
Print
Remind Me
Notify Moderator
|
|
|
There is no difference between suffering from fructose malabsorption and an IBS trigger. There is clinical evidence to show that many IBS suffers are also fructose malabsorbers.
One way to determine how much you can handle is to eat something with fructose in it. For example, if you eat a peppermint contain HFCS and it does it give you gas, bloating, cramping and/or D but two mints do then you know roughly how much fructose you can handle.
Personally I think that if you find you cannot handle HFCS then it is quite likely that you should avoid high fructose fruits. If you can handle HFCS then you likely won't have any problems with high fructose fruits.
AND of course you can always have a breath test to determine if you are a fructose malabsorber. I don't think the test is commonly available. Usually it is determined by a process of elimination.
--------------------
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
Print
Remind Me
Notify Moderator
|
|
|
I called all over my state.
Unfortunately, I always have gas, bloat, cramps...so I, personally, would not be able to tell one way or another by testing.
--------------------
IBS-C with pain and bloat
Print
Remind Me
Notify Moderator
|
|
|
Print
Remind Me
Notify Moderator
|
|
|
Since its introduction, obesity has become a huge problem in the US. They put it in so many things. It's not a coincidence HFCS causes obesity...it's a wannabe sugar.
Print
Remind Me
Notify Moderator
|
|
|
Not sure; after starting the IBS diet, I promptly threw out things like syrup and ketchup, etc. that contained HFCS and replaced them with more "natural" stuff. But things like apples and honey (I tend to binge on the honey glazed snack mix once in awhile  ) don't seem to bother me at all.
--------------------
~~~~~~~~~~~~~~~~~~~~~~~~
Lisa, IBS-C (Vegan)
Stable since July 2007!
Mommy to Rhiannon Marie (Dec. 13, 2008)
Print
Remind Me
Notify Moderator
|
|
|
--------------------
IBS-C with pain and bloat
Print
Remind Me
Notify Moderator
|
|
|
Quote:
There is no difference between suffering from fructose malabsorption and an IBS trigger.
First of all, I really need an empirical definition of fructose malabsorption. I haven't seen a definitive definition of fructose malabsorption in the form of:
A person is considered to suffer from fructose malabsorption if s/he is unable to absorb x grams of fructose ingested over y period of time.
If fructose malabsorption cannot be emprically defined, then perhaps we can think of a it as someone who cannot absorb excess fructose in reasonable amounts. The Skoog-Bharucha 2004 literature review you have repeatedly cited suggests a "reasonable" fructose consumption of 2 servings of excess fructose foods and drinks per meal - including up to 12 ounces of fruit juice or HFCS-sweetened soda as a serving. That's a lot more fructose than is in one little old apple.
Until we have an empirical definition of fructose malabsorption, I'll assume we mean the reasonable consumption definition and go from there.
I agree that fructose will not cause GI symptoms unless your body is unable to absorb it effectively. However, this is not an on/off switch. How well a person absorbs fructose depends on the fructose load as well as on the person's inherent ability to absorb fructose.
My distinction between fructose malabsorption and having IBS has partly to do with the fact that even people who wouldn't be considered to be suffering from fructose malabsorption will, in fact, be unable to absorb fructose if the level ingested is high enough. This is why I avoid HFCS (why add to my fructose load?) and fruit juices (it is, as Heather says, too easy to ingest a lot of fructose very quickly).
There is clinical evidence to show that many IBS suffers are also fructose malabsorbers.
My reading of the literature is that non-IBS suffers also suffer from fructose malabsorption at roughly the same rates. The Skoog-Bharucha 2004 literature review you have cited repeatedly states that "the prevalence of incomplete fructose absorption (25 g. 10%) in healthy subjects is as high as 50%". By contrast the 2003 Choi Iowa paper (I can only find a summary of this) reports 37.5% of the 80 IBS-diagnosed patients tested showed fructose malabsorption.
Furthermore, there seems to be some confusion about whether IBSers who suffer fructose malabsorption are more likely to report symptoms than non-IBSers who suffer similarly. Some studies seems to show they do, but the Skoog-Bharucha 2004 literature review says "The only controlled study that has been performed did not demonstrate a higher prevalence of fructose-induced gastrointestinal symptoms or incomplete fructose absorption in patients with functional gastrointestinal disorders."
One way to determine how much you can handle is to eat something with fructose in it. For example, if you eat a peppermint contain HFCS and it does it give you gas, bloating, cramping and/or D but two mints do then you know roughly how much fructose you can handle.
I have to think that anyone who is scared of apples would fail this test on nerves alone. If someone who is fearful about food eats something and then waits to see if IBS symptoms result, the odds are they will. It's simply a variant of the fact that, for example, I have trouble with my IBS when I'm scared of having trouble with my IBS. The psychological component to IBS makes short-term associations between food and symptoms difficult to determine when the IBSer is waiting anxiously to see if those associations occur.
Personally I think that if you find you cannot handle HFCS then it is quite likely that you should avoid high fructose fruits. If you can handle HFCS then you likely won't have any problems with high fructose fruits.
Apparently there are 2 types of HFCS: HFCS-42 and HFCS-55. HFCS-42 contains less fructose than glucose (presumably 42% to 58%) while HFCS-55 contains more fructose than glucose (presumably 55% to 45%). Even someone with absolutely no ability to absorb excess fructose would tolerate HFCS-42 with no trouble but would, of course, react badly to high fructose fruits. (As I side note, I think these correspond to the European glucose-fructose syrup and fructose-glucose syrup.)
Beyond this, there are suggestions in the literature that it is best to consume fructose with meals and with lactose. So someone who could not tolerate a cola made with HFCS-55 when it is ingested on its own may be fine with an apple provided it is not eaten on an empty stomach.
Furthermore - and this is the point I was making in my earlier post - the fact that someone can tolerate the fructose in HFCS-55 is not a sufficient reason to say, "Oh what the heck, go ahead and eat it." My reading of the literature is that if you make the fructose level high enough, as many as 80% of the healthy subjects tested will demonstrate fructose malabsorption. (I suspect that if you made it higher still you could hit 100%.) In other words, everyone has their own break-even point, beyond which they cannot tolerate excess fructose. Your break-even point is apparently quite low. Mine is apparently quite high. Nonetheless I am sure there is a point at which excess fructose will overwhelm my ability to absorb it. Consuming HFCS would simply add to my fructose load without providing any nutrional benefits and may be the straw needed to push me over my load limit.
The post that started this thread demonstrates this very clearly. The poster had no trouble with applesauce provided he ate the unsweetened kind. Clearly his fructose load limit had not been reached. Once he began consuming applesauce combined with HFCS, however, he began experiencing the classic diarrhea of excess fructose malabsorption. It appears that the HFCS has pushed him past his fructose load limit.
AND of course you can always have a breath test to determine if you are a fructose malabsorber. I don't think the test is commonly available. Usually it is determined by a process of elimination.
It appears to me that hydrogen breath tests to determine fructose malabsorption are not entirely reliable. I also found it interesting to read that not everyone who demonstrates fructose malabsorption experiences symptoms consistent with that condition.
I would think that if someone suspects s/he suffers from fructose malabsorption the simplest course would be to simply eliminate excess fructose for a short period of time - surely a week would be enough - and see if his/her symptoms improve.
I do believe that fructose malabsorption is a real problem for some people. I also believe that fructose malabsorption can be misdiagnosed as IBS and that it can co-occur with IBS. And certainly someone who is not finding relief for IBS after trying Heather's approach should be looking at other areas: fructose intolerance, SIBO, and so on.
I do not, however, think that fructose malabsorption causes IBS nor do I believe that all - or even most - IBSers suffer from fructose malabsorption. And I think it's wrong to make people scared of apples - surely we got enough of that with Snow White's stepmother. If someone suspects fructose malabsorption, let them just eliminate fructose for a week and see if things improve. If so, great. If not, check it off the list and move on.
----------
Here are some sources I looked at in addition to the Skoog-Bharucha 2004 literature review (PDF downloads):
Iowa Choi Oct 13 2003 - This is THE study. I have not been able to find a published version of it - it was presented at a GI conference - only references to it. Eighty patients diagnosed with IBS were tested. Thirty (37.5%) of them were fructose intolerant. The ones who followed a fructose-restricted diet reported improved symptoms.
Iowa Choi June 2003: This is the other study. Some reports combine this one with the October one and report the results from this one as if they apply to IBS patients. This study did not look specifically at IBS patients, but rather at patients with unexplained abdominal symptoms. I cannot tell if this included IBS patients or not. Between 39% and 80% of these patients had positive breath tests, depending on the fructose load.
Newsletter - high fructose foods - A caution about high fructose foods
Functional Diarrhea and fructose malabsorption
Nelis 1990: This is a controlled study comparing breath test results in IBS subjects with breath test results in non-IBS subjects following consumption of a fructose-sorbitol combination. The authors sum up with: "In conclusion, fructose-sorbitol malabsorption is frequently seen in patients with irritable bowel syndrome, but this is not different from observations in healthy volunteers. Therefore, fructose-sorbitol malabsorption does not seem to play an important role in the etiology of irritable bowel syndrome." Interestingly, the researchers come to this conclusion despite the fact that far more IBS subjects developed symptoms during the test (31 of 70) than did non-IBS subjects (3 of 85).
Interestingly, the Wikipedia entry on IBS includes tests for lactose and fructose intolerance (presumably meaning malabsorption) as among those necessary for a differential diagnosis of IBS. In other words, fructose intolerance must be excluded before a diagnosis of IBS can be made.
Symons 1992: I don't entirely understand this because it seems to be contradicting itself - or I'm just not getting it. However, this study does seem to show that IBS subjects have worse symptoms with a higher concentration of a fructose-sorbitol mixture than with a lower concentration. (Again, fructose is not studied separately.) I'm not sure what this means because my understanding is that the same would be true of non-IBSers.
Goldstein 2000: A significant percentage of both IBS patients and patients with non-IBS functional complaints had trouble absorbing fructose (44%). The malabsorption rate was much higher for lactose (78%) and a fructose-sorbitol mixture (73%). Patients reported an improvement in symptoms when the offending sugar(s) were removed from their diets.
--------------------
[Research tells us fourteen out of any ten individuals likes chocolate. - Sandra Boynton]
Print
Remind Me
Notify Moderator
|
|
|
Wonderful - you read the paper! You caught an important point. Non-IBS individuals can suffer IBS like symptoms when the level of fructose gets too high. The point you seemed to have missed is that IBS suffers are more likely than non-IBS suffers to also suffer from fructose malabsorption.
Quote:
A person is considered to suffer from fructose malabsorption if s/he is unable to absorb x grams of fructose ingested over y period of time
The review paper does not give such a definition it simply reviews the current literature. It does say that "The absorptive capacity for fructose ranged from less than 5 grams to greater than 50 grams was unrelated to age or sex and was dose and concentration dependent". It goes on to cite a number of studies that show the prevalence of fructose malabsorption in the population with function bowel disorders, including IBS, is 35%-75% higher than normal.
In summary, this review paper suggests that IBS suffers are more likely than normal individuals to be a fructose malabsorber too. There are other papers that suggest IBS suffers are more likely to suffer from lactose digestion problems too. In fact there is a whole body of research that shows IBS suffers have a greater tendency to have troubles with carbohydrates such as lactose, fructose and sorbitol (simple carbohydrate) and IF (complex carbohydrates). Our community call all of these triggers. Of course there are others triggers such as fats and oils.
I know from professional diagnosis and from experience that I am an IBS suffer with fructose malabsorption. I know I have troubles with other carbohydrates too in particular IF. Also, I know from experience that I cannot tolerate 5 grams of fructose at one time. In this message I give an example of how I use this information to my benefit to decide which and how much fruit to eat.
As you know triggers do not have to be a yes or no. A trigger might not kick in until it exceeds a certain level as in the case of 'making sure to have IF with a base of SF'. Fructose and glucose work in a similar way. The paper explains this quite well.
Quote:
I do not, however, think that fructose malabsorption causes IBS nor do I believe that all - or even most - IBS suffer from fructose malabsorption.
I don't think anyone would say the fructose malabsorption would 'causes IBS'. IBS is called a syndrome because it does not have a single cause. It has many triggers of which fructose can be one. I only report my personal experience with IBS and what I read in the research literature in hope that it might be helpful to others. You can choose to not believe what you want.
--------------------
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
Print
Remind Me
Notify Moderator
|
|
|
This post is making me dizzy.
--------------------
IBS-C with pain and bloat
Print
Remind Me
Notify Moderator
|
|
Posts
