Fructose Malabsorption: How Much Fructose Can a Healthy Subject Tolerate?

Frieling, Thomas; Kuhlbusch-Zicklam, R.; Kalde, Sigrid; Heise, J.; Hülsdonk, A.; Kreysel, C.

doi:10.1159/000329570

Cited by 17 publications

(12 citation statements)

References 32 publications

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“… 21 , 25 , 27 , 41 – 47 , 50 , 51 In a series of 17 healthy controls, increasing fructose consumption from 15–25 g to 50 g resulted in increased prevalence of fructose malabsorption from 5.9% to 52.9%. 43 Another series, which compared 3 doses of fructose load (15, 25, and 50 g), also demonstrated that 100% of healthy volunteers could absorb 15 g of fructose, 90% could absorb 25 g of fructose, but only 20 to 30% could absorb 50 g. 25 Altogether these findings suggest that the physiologic dose of 25 g fructose appears to be relevant to characterize clinically significant fructose malabsorption, higher doses leading to false-positive diagnosis of fructose malabsorption. 42 …”

Section: Discussionmentioning

confidence: 97%

Fructose Malabsorption in Systemic Sclerosis

et al. 2015

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The deleterious effect of fructose, which is increasingly incorporated in many beverages, dairy products, and processed foods, has been described; fructose malabsorption has thus been reported in up to 2.4% of healthy subjects, leading to digestive clinical symptoms (eg, pain, distension, diarrhea). Because digestive involvement is frequent in patients with systemic sclerosis (SSc), we hypothesized that fructose malabsorption could be responsible for intestinal manifestations in these patients.The aims of this prospective study were to: determine the prevalence of fructose malabsorption, in SSc; predict which SSc patients are at risk of developing fructose malabsorption; and assess the outcome of digestive symptoms in SSc patients after initiation of standardized low-fructose diet.Eighty consecutive patients with SSc underwent fructose breath test. All SSc patients also completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated.The prevalence of fructose malabsorption was as high as 40% in SSc patients. We also observed a marked correlation between the presence of fructose malabsorption and: higher values of GSS score of digestive symptoms (P = 0.000004); and absence of delayed gastric emptying (P = 0.007). Furthermore, in SSc patients with fructose malabsorption, the median value of GSS score of digestive symptoms was lower after initiation of standardized low-fructose diet (4 before vs. 1 after; P = 0.0009).Our study underscores that fructose malabsorption often occurs in SSc patients. Our findings are thus relevant for clinical practice, highlighting that fructose breath test is a helpful, noninvasive method by: demonstrating fructose intolerance in patients with SSc; and identifying the group of SSc patients with fructose intolerance who may benefit from low-fructose diet. Interestingly, because the present series also shows that low-fructose diet resulted in a marked decrease of gastrointestinal clinical manifestations in SSc patients with fructose malabsorption, our findings underscore that fructose malabsorption may play a significant role in the onset of gastrointestinal symptoms in these patients. Finally, we suggest that fructose malabsorption may be due to reduced fructose absorption by enterocytes, impaired enteric microbiome, and decreased intestinal permeability.

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Section: Discussionmentioning

confidence: 97%

Fructose Malabsorption in Systemic Sclerosis

et al. 2015

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“…Our rationale for this time frame is that the peak of hormone release is found at about 10–15 minutes post ingestion and fructose is rapidly converted to glucose in the liver so that the time window for distinguishing fructose from glucose effects in the brain is very short [ 39 ]. More importantly, 75g of fructose is a very high load and can cause adverse events even in healthy subjects: 25g is the highest load of fructose absorbed by healthy volunteers and a fructose load of 50g induces unspecific results in 40–60% of individuals [ 43 , 44 ]. Therefore, we used 75g of glucose (as in a standard glucose tolerance test) and 25g of fructose (the highest absorbable load).…”

Section: Discussionmentioning

confidence: 99%

Dissociable Behavioral, Physiological and Neural Effects of Acute Glucose and Fructose Ingestion: A Pilot Study

et al. 2015

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Previous research has revealed that glucose and fructose ingestion differentially modulate release of satiation hormones. Recent studies have begun to elucidate brain-gut interactions with neuroimaging approaches such as magnetic resonance imaging (MRI), but the neural mechanism underlying different behavioral and physiological effects of glucose and fructose are unclear. In this paper, we have used resting state functional MRI to explore whether acute glucose and fructose ingestion also induced dissociable effects in the neural system. Using a cross-over, double-blind, placebo-controlled design, we compared resting state functional connectivity (rsFC) strengths within the basal ganglia/limbic network in 12 healthy lean males. Each subject was administered fructose, glucose and placebo on three separate occasions. Subsequent correlation analysis was used to examine relations between rsFC findings and plasma concentrations of satiation hormones and subjective feelings of appetite. Glucose ingestion induced significantly greater elevations in plasma glucose, insulin, GLP-1 and GIP, while feelings of fullness increased and prospective food consumption decreased relative to fructose. Furthermore, glucose increased rsFC of the left caudatus and putamen, precuneus and lingual gyrus more than fructose, whereas within the basal ganglia/limbic network, fructose increased rsFC of the left amygdala, left hippocampus, right parahippocampus, orbitofrontal cortex and precentral gyrus more than glucose. Moreover, compared to fructose, the increased rsFC after glucose positively correlated with the glucose-induced increase in insulin. Our findings suggest that glucose and fructose induce dissociable effects on rsFC within the basal ganglia/limbic network, which are probably mediated by different insulin levels. A larger study would be recommended in order to confirm these findings.

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“…13 The second major methodological point was the limitation of the fructose intake to 25 g. Indeed, several recent studies have highlighted that 25 g was the highest amount of fructose absorbed by healthy volunteers. 14,15 According to these studies, a fructose load of 50 g induces false positive results in 40-60% of cases. 14,15 The collection of breath samples was carried out according to previous methodological recommendations in order to ensure end-alveolar breath samples.…”

Section: Discussionmentioning

confidence: 99%