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Gastrointestinal Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Justine Turner, Sally Schwartz
Fructose, a monosaccharide found in fruits, vegetables and sweeteners, such as high-fructose corn syrup (HFCS), has steadily increased in the diets of children, representing up to 10% of their daily energy intake. The occurrence of fructose malabsorption is common with excessive intake, because fructose is not actively transported. Symptoms of fructose malabsorption may result in bloating, diarrhea, excessive flatulence, and abdominal pain.
Rational Medical Therapy of Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Richard M. Sperling, Kenneth R. McQuaid
Malabsorption of lactose, sorbitol, and fructose has been implicated in some IBS patients. Because lactase deficiency is common in adults with and without IBS, a lactose-exclusion trial should be performed. Bear in mind, however, that milk products can be an important source of calcium. Before restricting milk products permanently, patients who note apparent symptomatic improvement should undergo a formal breath-hydrogen study. Sorbitol is used as a sweetener in a number of sugar-free candies, syrups, gums, and medications. Fructose malabsorption may be a problem in patients ingesting excessive amounts of fruit and certain soft drinks.
Diet and IBS
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
Some people with IBS swear that fructose, sorbitol, and xylitol make their symptoms worse and that avoiding fruit and other foods with a high concentration of fructose helps enormously. It is true that some individuals (both with and without IBS) have difficulty absorbing fructose and sorbitol. (Sorbitol and xylitol are found primarily in “sugar-free” candies and gum.) When these sugar molecules are not absorbed in the small intestine, they pass on to the large intestine, where they will be fermented by bacteria. This can lead to excess gas, a change in intestinal motility, and discomfort, or even diarrhea. Studies have suggested that about 20% of patients with IBS show objective evidence of fructose malabsorption.17 But other studies show most healthy control people show equal evidence of fructose malabsorption and aren’t really bothered by it.18 As with gassy foods, it’s probably the case that patients with IBS and visceral hypersensitivity are simply more bothered by the resulting fermentation when the sugar molecules make it into the large intestine. There have been no good controlled scientific studies yet to test whether limiting consumption of fructose has any positive effect on IBS symptoms beyond a placebo effect. Moreover, it would be extremely difficult, impractical, and probably unwise to eliminate all of these foods from your diet. By all means, cut out soda and other highly processed, nutritionally empty foods that are flavored with high fructose corn syrup. Similarly, try not to consume too much sorbitol and xylitol in “sugar-free” products – fake “foods” that have no nutritional value whatsoever. But eliminating whole fruits like apples, oranges, cherries, and pears will deprive you of vitamins, minerals, and a wonderful source of soluble fiber.
Intragastric fructose administration interacts with emotional state in homeostatic and hedonic brain regions
Published in Nutritional Neuroscience, 2022
Julie Iven, Jessica R. Biesiekierski, Dongxing Zhao, Jan Tack, Lukas Van Oudenhove
First, the 25 g of fructose used in our study might have been too low to observe significant effects at the self-report level as daily intake of fructose varies between 11 and 54 g. However, dosage was chosen to minimize fructose malabsorption, as 25 g is completely absorbed in 50% of the population [36]. Second, we did not perform a hydrogen breath test to exclude fructose malabsorption, however no side effects were reported by any of the participants. Third, our emotion induction paradigm could be considered unsuccessful at the behavioral level, despite the fact that this paradigm has been successfully used in previous studies [9,17]. Fourth, for this study, healthy, young, lean and healthy volunteers were included. Additional studies in patients suffering from mood disorders or emotional eating should be performed to further increase the understanding of the interaction of food and mood in this population. Fifth, we cannot exclude the effects of different molar load or osmolarities of the fructose compared to the milli-Q water used as the placebo, that could have affected hormone secretion and GI motility differentially. Last, although intragastric administration may limit the clinical relevance compared to oral intake, its mechanistic relevance may be higher as it allows for the effect of purely interoceptive gut-brain signals on hedonic outcomes, bypassing all sensory and cognitive effects.
Impacts of high-sucrose diet on circadian rhythms in the small intestine of rats
Published in Chronobiology International, 2019
Shumin Sun, Fumiaki Hanzawa, Miki Umeki, Yasuko Matsuyama, Naomichi Nishimura, Saiko Ikeda, Satoshi Mochizuki, Hiroaki Oda
Excess sucrose intake has been recognized as a primary cause of metabolic syndrome (Lustig et al. 2012; Malik et al. 2010; Sun and Empie 2012; Tappy et al. 2010). Toxicity resulting from excess of fructose, a component of sucrose, was reported as a cause of development of metabolic syndrome as fructose undergoes glycation to proteins and, physiologically, its metabolic substrate rapidly flow into de novo lipogenesis in the liver, which promotes nonalcoholic fatty liver disease (NAFLD) (Bar-On and Stein 1968; Clark et al. 1974; Donnelly et al. 2005; Softic et al. 2016; Tappy et al. 2010). However, the mechanism by which sucrose disrupts hepatic lipid homeostasis is still controversial (Macdonald 2016). Although contributions of excessive sucrose to liver metabolic disorders have received a great deal of attention (Tappy et al. 2010), fewer studies have examined the role of sucrose in the small intestine. Recently, research in mice showed that the small intestine and gut bacteria metabolize the dietary fructose to short-chain fatty acids and glucose, thereby controlling the entry of fructose into the liver (Jang et al. 2018). Moreover, when fructose was not completely absorbed in the small intestine, the excess fructose was carried into the large intestine, resulting in symptoms of fructose malabsorption (Ebert and Witt 2016). Thus, the small intestine plays an indispensable role in controlling fructose toxicity.
Persistent symptoms in patients with Crohn’s disease in remission: An exploratory study on the role of diet
Published in Scandinavian Journal of Gastroenterology, 2018
Maren Jeanette Komperød, Christine Sommer, Tonje Mellin-Olsen, Per Ole Iversen, Arne Gustav Røseth, Jørgen Valeur
In our study, apples and pears, which are high in fructose, were often reported as dietary symptom triggers. Indeed, fructose malabsorption seems to be more frequent in patients with CD compared to healthy controls [23]. Likewise, dairy products and wheat have previously been implicated as symptom triggers in patients with CD [9,24]. Lactose malabsorption is frequent among patients with CD [23]. However, some patients in our study reported reactions to dairy products with a low content of lactose, such as fermented milk or white Gouda cheese, suggesting that other mechanisms than lactose malabsorption may be involved. Of note, proteins from dairy products and wheat are common allergens [11]. Wheat products frequently caused adverse reactions in this study. Reactions to wheat products are often caused by the protein in wheat products, such as gluten, but could also be caused by the high content of fructan [25], or intestinal inflammation caused by amylase trypsin inhibitors (ATIs) [26]. It is possible that some of our CD patients had undiagnosed allergy or hypersensitivity to some of the protein compounds found in wheat. Celiac disease had been thoroughly excluded, but reactions to gluten by other mechanisms (i.e., non-celiac gluten sensitivity) may have contributed [12].