Irritable Bowel Syndrome Message Boards | Role of dietary fructose and fructans in initiating symptoms of IBS in fructose malabsorbers

Volume 6, Issue 7, Pages 765-771 (July 2008)

Dietary Triggers of Abdominal Symptoms in Patients With Irritable Bowel Syndrome: Randomized Placebo-Controlled Evidence
Findings in this article have been presented at the Australian Gastroenterology Week, October 2006 and an abstract published as follows: Shepherd S, Gibson PR. Role of dietary fructose and fructans in initiating symptoms of IBS in fructose malabsorbers. J Gastroenterol Hepatol 2006;18(Suppl):B102.

Susan J. Shepherd, Francis C. Parker, Jane G. Muir, Peter R. Gibson

published online 06 May 2008.

Background & Aims: Observational studies suggest dietary fructose restriction might lead to sustained symptomatic response in patients with irritable bowel syndrome (IBS) and fructose malabsorption. The aims of this study were first to determine whether the efficacy of this dietary change is due to dietary fructose restriction and second to define whether symptom relief was specific to free fructose or to poorly absorbed short-chain carbohydrates in general. Methods: The double-blinded, randomized, quadruple arm, placebo-controlled rechallenge trial took place in the general community. The 25 patients who had responded to dietary change were provided all food, low in free fructose and fructans, for the duration of the study. Patients were randomly challenged by graded dose introduction of fructose, fructans, alone or in combination, or glucose taken as drinks with meals for maximum test period of 2 weeks, with at least 10-day washout period between. For the main outcome measures, symptoms were monitored by daily diary entries and responses to a global symptom question. Results: Seventy percent of patients receiving fructose, 77% receiving fructans, and 79% receiving a mixture reported symptoms were not adequately controlled, compared with 14% receiving glucose (P ≤ 0.002, McNemar test). Similarly, the severity of overall and individual symptoms was significantly and markedly less for glucose than other substances. Symptoms were induced in a dose-dependent manner and mimicked previous IBS symptoms. Conclusions: In patients with IBS and fructose malabsorption, dietary restriction of fructose and/or fructans is likely to be responsible for symptomatic improvement, suggesting efficacy is due to restriction of poorly absorbed short-chain carbohydrates in general.

Abbreviations used in this paper: FM, fructose malabsorption, FODMAPs, Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, IBS, irritable bowel syndrome, ITT, intention to treat, PP, per protocol, VAS, visual analogue scale
Department of Gastroenterology and Monash University Department of Medicine, Box Hill Hospital, Victoria, Australia

Address requests for reprints to: Ms Sue Shepherd, Department of Medicine, Box Hill Hospital, Box Hill, Victoria 3128, Australia. fax: +61-3-9895-0352.

Susan J. Shepherd was supported by a National Health & Medical Research Council postgraduate biomedical scholarship. Foods were donated by the following organizations: ACI packaging, Advanced Brockerage Australia (Liddell's), Bundaberg Sugar, Cerebos Foods, Coles supermarket, Confoil Pty Ltd, Country Life, Duncan Davis Smallgoods, Findus, Freedom Foods (Aust) Pty Ltd, Goodman Fielder Pty Ltd, Greens General Foods Pty Ltd, Heinz, Ingham chicken, Lactos Pty Ltd, Massel Australia Pty Ltd, McCormick Foods Australia Pty Ltd, National Foods, Orgran (Roma Foods), Pace Farm Pty Ltd, Pakval, Purewater, Riviana Foods, Silly Yaks, Simplot Australia Pty Ltd, Sunrice, The Smiths Snackfood Company Ltd, Trialia Foods, Uncle Rick's, Virgona Fruit and Vegetables.

Susan J. Shepherd has published three cookbooks directed toward issues of fructose malabsorption and celiac disease. The term FODMAPs has been registered by Susan Shepherd and Peter Gibson.

We thank Lance Schiapulus for developing and formulating the test drinks, Nia Rosella and Rosemary Rose for technical support, and Paul Rose, Kathryn Stephens, and Martin Shepherd for logistical support.

PII: S1542-3565(08)00151-1

doi:10.1016/j.cgh.2008.02.058

� 2008 AGA Institute. Published by Elsevier Inc. All rights reserved.

http://journals.elsevierhealth.com/periodicals/yjcgh/article/S1542-3565(08)00151-1/abstract

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