Fructose Malabsorption May Be Gender Dependent and Fails to Show Compensation by Colonic Adaptation

Abstract

Fructose malabsorption is linked to gastrointestinal and other unusual symptoms. Polymers of fructose are also recognized prebiotics. While some prebiotics can self-adapt when consumed regularly (resulting in decreased breath hydrogen and symptoms), we wondered whether self-adaptation occurs with basic fructose. We evaluated 90 subjects (61 females). Each completed a diet questionnaire and underwent a fructose challenge. Breath hydrogen and quantified symptom scores were recorded. Group comparisons for sum of breath hydrogen and total symptom scores were evaluated with the Mann-Whitney U test. Spearman's correlation coefficient and chi(2) or Fisher's exact test were used as appropriate. Malabsorption occurred in 29 patients (32.2%) and low-grade symptoms without malabsorption in 30 (33%). Women complained of symptoms more frequently (p = 0.04) and exhibited more fructose malabsorption (p = 0.0527). Breath hydrogen correlated with symptoms (r = 0.516, p = 0.0037). Adaptation with increasing pretest fructose intake was absent. We conclude that gender may influence fructose malabsorption and there is no adaptation to regular consumption.

Carbohydrate Malabsorption and Putative Carbohydrate-Specific Small Intestinal Bacterial Overgrowth: Prevalence and Diagnostic Overlap Observed in an Austrian Outpatient Center

“…This threshold-level originates from the lactose breath testing [25] . Not surprisingly, fructose malabsorption was detected in 29/90 (32.2%) patients using a positive cut-off value of >10 ppm H 2 above baseline in a Canadian study [29] . As there are no standardized cut-off values for a positive fructose breath test defined yet, the main problem of fructose malabsorption testing remains the establishment of an exact diagnosis [30] , with prevalence rates depending on cut-off values, gases measured, and study populations, used for investigation.…”

High fructose intake fails to induce symptomatic adaptation but may induce intestinal carriers

“…It is not clear however, whether adaptation to continued regular fructose could lead to changes similar to lactose (as described above). 17 In an earlier report examining adaptation parameters for fructose, none could be found. 18 However, the study evaluated patients consuming generally less than 25 g daily.…”

Fructose malabsorption: causes, diagnosis and treatment

“…(62) The main products of the metabolism of prebiotics are short chain fatty acids, hydrogen gas, carbon dioxide and bacterial cell mass. (63) However, there has been little research into the relationship of the type of carbohydrate and its fermentability. This research could provide profound insight into the effect prebiotics have upon the symptoms of IBS resulting from SIBO.…”