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However, in standard clinical practice, the management of IBS seldom addresses dietary fructose. Several reasons may explain this. First, fructose malabsorption may be considered uncommon and as such is a separate disease distinct from IBS. However, more than one in three adults with symptoms of IBS are unable to absorb a fructose load of 25 to 50 g and, therefore, have fructose malabsorption. Second, fructose malabsorption is not specific to patients with IBS. The limited data available suggest that its prevalence in the IBS population is similar to that in asymptomatic controls (9). As outlined earlier, the response to fructose is exaggerated in patients with IBS compared with those without IBS. Third, there are no dietary guidelines published to construct an appropriate diet. Previous dietary intervention studies have used "fructose-free" diets without describing their nature (6,7). It would be unfeasible for the dietary management of the condition to require total removal of fructose from the diet, a near impossible task because of its abundant presence in our food supply. Finally, the potential contribution of fructans has been ignored, as illustrated by a recent review (9), despite the fact that they are not digested or absorbed in the small intestine, are rapidly fermented by luminal bacteria (8,10,11,12), and can induce IBS-like symptoms by themselves (13,14).

Reference
Shepherd SJ, Gibson PR (2006). Fructose malasborption and symptoms of irritable bowel syndrome: guidelines for effective dietary management . Journal of the American Dietetic Association 106 (10): 1631–9.

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