Correction
#355551 - 02/11/10 05:06 AM
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Syl
Reged: 03/13/05
Posts: 5499
Loc: SK, CANADA
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Excess fructose is a relative notion. For a person with fructose malabsorption an excess amount can mean that a food containing as little a couple of grams of excess fructose (i.e. a couple of grams more fructose than glucose) can cause problems. Normally a person with or with or IBS can handle more than 25 grams of excess fructose. Usually a 25 gram load of fructose is used to diagnose fructose malabsorption which is about the amount of excess fructose found in a soft drink sweetened with HFCS. At 50 grams almost everyone exhibits fructose malabsorption. As pointed out previously up to 50% of IBS-C and IBS-D can exhibit fructose malabsorption.
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In patients with fructose malabsorption, the small intestine fails to absorb fructose properly. This results in excess hydrogen caused by an overgrowth of otherwise normal intestinal bacteria.
This is incorrect. It is true that fructose cannot be absorbed properly in the small intestine but there is little evidence that it is caused by an overgrowth of bacteria except in the case of SIBO or that the problem is particularly hydrogen gas. However, there is some evidence that individuals that truly have SIBO may have more problems with excess fructose that clears up when the SIBO is treated. Most bacteria in the colon can digest sugars especially those in the beginning part of the large intestine producing hydrogen, carbon dioxide or methane. The later gas possibly being responsible for C.
This is the way it is described by experts on fructose malabsorption (references below)
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Fructose and fructans are fermented by bacteria, yielding short-chain fatty acids (SCFA) and the gases, hydrogen, carbon dioxide and, in some, methane. Observations in vitro using faecal slurries and in vivo using breath hydrogen testing indicate that fructose and fructans are rapidly fermented by bacteria. It is probable, therefore, that such substrates are totally fermented in the very proximal large bowel and possibly distal small intestine, and that subsequent rapid gas formation might distend the lumen locally before the gas is absorbed or further metabolized.
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Failure to completely absorb fructose in the small intestine (that is, fructose malabsorption) leads to its delivery to the colonic lumen, together with water due to its osmotic effect. Luminal bacteria rapidly ferment fructose to hydrogen, carbon dioxide, and short-chain fatty acids. Thus, if sufficient fructose reaches the colon, luminal distention may occur due to the osmotic load and rapid gas production, which potentially leads to bloating, abdominal discomfort, and motility changes.
One thing I learned in graduate school and I always tell my students is to check the original sources because many times secondary contain errors. 
While not all IBSers have fructose malabsorption in those that do which could be up to 50% of the IBS population excess fructose is serious IBS trigger and should be treated like other IBS triggers -- with caution! When you live with this problem like I do you get to intimately know the details of having IBS and fructose malabsorption
References
Gibson, P. R., Newham, E., Barrett, J. S., Shepard, S. J., & Muir, J. G. (2007). Review article: fructose malabsorption and the bigger picture . Alimentary Pharmacology & Therapeutics, 25(4), 349-363
Shepherd, S. J., & Gibson, P. R. (2006). Fructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for Effective Dietary Management . Journal of the American Dietetic Association, 106(10), 1631-1639
Parrish, C. R. (2007). Malabsorption of Fructose and Other Short-chain Carbohydrates . Practical Gastroenterology
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Excess fructose is bad for IBS individuals with fructose malabsorption. It is not a problem for individuals with IBS who are not fructose malabsorbers. A recent study showed that up to 50% of IBS-C and IBS-D individuals are suspected to have fructose malabsorption.
Sweet potatoes contain about equal amounts of glucose and fructose. They contain about 1/2 gram of fructose and glucose and about 1 gram of sucrose per 100 grams of sweet potato.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
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Glad to see you agree that excess fructose can be an IBS trigger You may have noticed in the discussions with Julie that Prof Whorwell is using a low excess fructose diet as part of a methodology for managing IBS symptoms.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
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It seems like this website has become the anti-fructose diet not the helpforibs diet. While it's a valid truth that fructose can cause problems, I know I, for one have become obsessed with now eating only low fructose foods and I don't even know if I have a problem with fructose. I'm just brainwashed now. I think we need to concentrate on what Heather suggests, and she does include pears and apples in her sample diet in the book EFI!
How do I now become de-brainwashed to fear fructose? Or shouldn't I? This fructose fear is horrible to the mind. 
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LM
#355556 - 02/11/10 07:39 AM
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Cyndy
Reged: 03/05/05
Posts: 1301
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Do you eat fruits with fructose? Or do you stay away from them? I trust your opinion very much.
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Re: LM
#355559 - 02/11/10 07:51 AM
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Syl
Reged: 03/13/05
Posts: 5499
Loc: SK, CANADA
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It isn't a matter of a fruit having fructose. The problem occurs when fruits contain more fructose than glucose such as apples, pears, melons and grapes. Fruits like berries contain fructose but they contain less fructose than glucose. They are safe for IBSers with fructose malabsorption while apples, pears, etc are not.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
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Re: Shawneric
#355560 - 02/11/10 07:53 AM
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Syl
Reged: 03/13/05
Posts: 5499
Loc: SK, CANADA
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If you think fructose is a problem then ask your doctor for a fructose malabsorption breath test. It is a simple test where you drink a solution containing fructose and they do an analysis of your breath. You might read Heather's newsletter articles How can I avoid fructose and sorbitol and Sugar and IBS
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
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Syl, I was afraid you would take this post personally. It was not directed at you, I promise!
I took the lactose intolerance test and it came back fine, yet we are told to avoid dairy. Wouldn't that just be the case if the fructose test came back normal?
Plus, I can't find a place that does this test.
And why does Heather say we can eat pears and apples after IF? She knows they contain excess fructose, yet she eats them and has included them in your sample meal plan. 
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Re: Shawneric
#355564 - 02/11/10 08:58 AM
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Syl
Reged: 03/13/05
Posts: 5499
Loc: SK, CANADA
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Ask you doctor for the test. Most hospitals and medical clinic do the test regularly.
I believe apples and pears are considered okay in EFI diet for those IBSers without fructose malabsorption from what I can infer by reading the newsletters. Over the past 3-5 years many GI centers started recommending IBSers eat a low excess fructose/fructan diet until they are certain that excess fructose/fructans are not a problem.
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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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