title: Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management.
abstract: Dietary fructose induces abdominal symptoms in patients with fructose malabsorption, but there are no published guidelines on its dietary management. The objective was to retrospectively evaluate a potentially successful diet therapy in patients with irritable bowel syndrome and fructose malabsorption. Tables detailing the content of fructose and fructans in foods were constructed. A dietary strategy comprising avoidance of foods containing substantial free fructose and short-chain fructans, limitation of the total dietary fructose load, encouragement of foods in which glucose was balanced with fructose, and co-ingestion of free glucose to balance excess free fructose was devised. Sixty-two consecutively referred patients with irritable bowel syndrome and fructose malabsorption on breath hydrogen testing underwent dietary instruction. Dietary adherence and effect on abdominal symptoms were evaluated via telephone interview 2 to 40 months (median 14 months) later. Response to the diet was defined as improvement of all symptoms by at least 5 points on a -10- to 10-point scale. Forty-eight patients (77%) adhered to the diet always or frequently. Forty-six (74%) of all patients responded positively in all abdominal symptoms. Positive response overall was significantly better in those adherent than nonadherent (85% vs 36%; P<0.01), as was improvement in individual symptoms (P<0.01 for all symptoms). This comprehensive fructose malabsorption dietary therapy achieves a high level of sustained adherence and good symptomatic response.
authors.affiliation: Department of Gastroenterology and Monash University, Victoria, Australia. susan.shepherd@med.monash.edu.au <susan.shepherd@med.monash.edu.au>
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Shepherd
authors.forename: Peter R
authors.initials: PR
authors.lastname: Gibson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001944:Breath Tests; D004046:Dietetics / Q000592:standards; D005260:Female; D005632:Fructose / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics*; D006801:Humans; D007408:Intestinal Absorption; D043183:Irritable Bowel Syndrome / Q000178:diet therapy* / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D008286:Malabsorption Syndromes / Q000150:complications* / Q000178:diet therapy; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005632:Fructose