What is fructose malabsorption

[Charlie Arnold]

Fructose malabsorption is a digestive disorder in which absorption of fructose is impaired by deficient fructose carriers in the small intestine's enterocytes (cells in the lining of the intestines that absorb particles). This results in an increased concentration of fructose in the entire intestine which draws excess water into the bowel.
Fructose malabsorption is not to be confused with hereditary fructose intolerance, a potentially fatal condition in which the liver enzymes that break up fructose are deficient.

Fructose malabsorption may be confused with irritable bowel syndrome or celiac disease as symptoms can be very similar. In fact some sufferers may also have problems with gluten or lactose tolerance as well.

Symptoms include:
Bloating (from fermentation in the small and large intestine)
Diarrhea and/or constipation
Flatulence
Stomach pain (as a result of muscle spasms, the intensity of which can vary from mild and chronic to acute but erratic)
Vomiting (if great quantities are consumed)
Early signs of mental depression

Other symptoms include:
aching eyes
fuzzy head
fatigue

Diagnosis is made by performing a hydrogen breath test which measure the hydrogen levels in the breath. The patient has to fast for 12 hours then a base line reading is taken. The patient then drinks a fructose solution and the breath test is repeated every half hour over the next couple of hours. If the hydrogen level is raised over a certain level then it is a positive test. This test should be done with medical supervision as very reactive patients may feel quite poorly whilst the test is being done.

This is a very basic description of the condition but there is much more to it as you will find as you use this board. Alot more people suffer from this condition than are known as it seems to take a long time to diagnose, mainly because so little is known about it. Often it is finally diagnosed after many other conditions have been eliminated.

The only treatment is by diet control. A diet formulated in australia being the popular option now. It is called a low FODMAP diet which is based on Fermentable Oligo-,Di- and Monosaccharides And Polyols which are short chain carbohydrates.
Foods not permitted are high fodmap fruits and vegetables and also foods high in fructans (wheat, onions, garlic etc) and galactans (legumes)

I will post in safe ingredients a list of the foods advised in the sheet we were given on our FODMAP diet and then others can add and expand this list.

When starting it is a good idea to eliminate all fructose and sugars for a while to allow all the symptoms to subside and the bowel to settle down and then start adding in permitted foods gradually keeping a note of the effect. It would seem that everyones tolerance levels are different so what may be ok for one may not be for the next person, you need to experiment and see what suits you.

[Charlie Arnold]

Hydrogen Breath Test.

This seems to be the definitive test for fructose malabsorption but how accurate is it. I have found a very good article about the test which can be read through the following link.

www.bhsbrasil.com.br/Hydrogen_Breath_Testing_in_children_07.06.09.pdf

Now one interesting point I picked up is the timing of the reaction and that is something that has been mentioned elsewhere. How do they interpret when the hydrogen levels increase. Well apparently it ties in with whereabouts in the bowel the malabsorption occurs. So I assume early on suggest upper small intestines ie duodenum, jejunum area, later on is nearer the large intestines.

Another point though that I am now thinking is how accurate is the test if the patient is not reacting at the time. When Megan first had hers done she was on probably a slightly reduced fructose diet but she was still having vegetables. I think it was after one hour that she blew the graph. However 2 years later having been as low fructose as is possible but still showing problems her level barely rose and although it was still positive only when up to 29. So did this mean she could tolerate fructose better, or her intestines weren't reactive enough to register on the machine as it could absorb what was being put in that day. So do we need to be reactive well before the test to get a true answer or does it not make any difference.

I asked this of our paed the other day and she is going to ask the gastro team because with the sucrose test Megan showed very clear reaction behaviour wise but her breath only raised to 2 therefore was negative, but she was well that day? Therefore was she not ill enough whereas 5 years ago when they started all this testing she was ill enough?

[Charlie Arnold]

Another thing with this test................. is it done accurately on the day............. In the above article it says that they must hold their breath for 15 seconds before breathing out. Well they certainly have never done that with Megan she just has to do a deep breath out. So maybe the correct depth of breath isn't being used, does the hydrogen maybe build up as you hold your breath.