Fructose Malabsorption

Fructose Malabsorption

Article
Allergy
Digestive Health
+3
Contributed byKrish Tangella MD, MBADec 09, 2019

What are the other Names for this Condition? (Also known as/Synonyms)

  • Abnormal Fructose Absorption
  • DFI (Dietary Fructose Intolerance)
  • Dietary Fructose Intolerance (DFI)

What is Fructose Malabsorption? (Definition/Background Information)

  • Fructose Malabsorption is a common digestive disorder that prevents an individual from being able to adequately absorb fructose (a type of sugar, commonly found in fruits and honey), in the intestines
  • Onset of this condition, which is also known as Dietary Fructose Intolerance (DFI), normally occurs when an individual develops intolerance to fructose absorption due to certain intestinal disorders (such as irritable bowel syndrome), or due to regular excess consumption of fructose
  • Intake of fructose leads to abdominal pain, nausea, vomiting, bloating of stomach, etc. Continuous or repeated intake can seriously damage the liver and intestines
  • There is no remedy for this condition; avoidance of foods containing fructose, or following a fructose-restricted diet, is the prescribed treatment technique

Who gets Fructose Malabsorption? (Age and Sex Distribution)

  • Fructose Malabsorption is a frequent metabolic disorder affecting both children and adults
  • There is no gender preference among the male and female sex population
  • Current research does not indicate any particular racial predominance for Fructose Malabsorption; however, it is common in Africa and some industrially-developed (western) countries

What are the Risk Factors for Fructose Malabsorption? (Predisposing Factors)

A few risk factors for Fructose Malabsorption are:

  • Regular intake of fructose-rich diet for prolonged periods
  • This disorder may run in the families; hence, individuals with a family history of the condition have a higher risk
  • Factors causing a reduction in capacity of the intestines to absorb fructose include: Chemotherapy, radiotherapy, trauma affecting the intestinal walls, problems with bowel movements (digestion-related) like frequent diarrhea, celiac disease, etc.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Fructose Malabsorption? (Etiology)

  • The main cause of Fructose Malabsorption is a high intake of fruit sugar (usually from a young age). Fructose is contained in large quantities in carbohydrate drinks, some fast foods, fruits & fruit juices, corn & corn products (fructose corn syrup), etc.
  • There is a certain limit to the amount of fructose the intestine can absorb in any given meal, at any single time. If an excess amount is consumed, then the body lacks the ability to process it. This surplus fructose gets metabolized by bacteria resulting in the production of carbon dioxide, hydrogen, and methane gases
  • This leads to the typical symptoms of abnormal absorption of fructose; with changes in the gastrointestinal system that include increased load (owing to the gases), changed bacterial profile, formation of mucus coating on walls of the intestine, and lower quantities of folic acid, zinc, and tryptophan (an essential amino acid), in blood
  • Sometimes certain underlying diseases, disorders, or other factors can decrease the absorption limit of fructose in the body. Also, some individuals have a lesser physiological capacity to absorb fructose in their body, than others

What are the Signs and Symptoms of Fructose Malabsorption?

Signs and symptoms of Fructose Malabsorption include the following:

  • Feeling of bloated abdomen (especially the intestines), passing gas regularly
  • Irregularly, stomach/abdominal pain with cramps. The cramps may be mild, or in some cases severe and painful
  • Vomiting, nausea
  • Constipation or diarrhea
  • Weight loss
  • Feeling depressed (common in women), anger issues, headaches
  • Skin rashes and eczema causing itchy sensations

How is Fructose Malabsorption Diagnosed?

Diagnostic tests performed for Fructose Malabsorption are:

  • Physical examination of the individual with evaluation of family medical history
  • Eliminating fructose completely from the diet for a few days, to help bring about a reduction in the symptoms. This is a clear indication of the disorder
  • Hydrogen breath test: It is the standard test to determine Fructose Malabsorption. The hydrogen breath test includes testing an individual’s breath for sugars such as glucose, lactose, fructose, and sucrose. This is a specific test that requires certain preparations prior to testing; such as consuming only certain particular foods/drinks for 24 hours before a breath analysis is performed.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Fructose Malabsorption?

Complications of Fructose Malabsorption are:

  • Irritable bowel syndrome
  • Celiac disease
  • Infantile colic
  • Liver damage, resulting in liver failure

How is Fructose Malabsorption Treated?

Treatment of Fructose Malabsorption essentially involves the dietary avoidance of fruits and foods containing fructose. The measures include:

  • Avoidance of fructose (in any form) from the diet; though small quantities of fructose sugar are tolerated by the body
  • Food to avoid include: High fructose foods and beverages like fruits & fruit juices (apple, watermelon, pear, papaya, cherries, pomegranate, mango), dry fruits (dates, figs, raisins, currant), sugar syrup/concentrates (honey, corn syrup), coconut, whole corn, wine
  • Foods that can be consumed include: Fruits (such as apricot, peach, plum, banana, jackfruit, pineapple), berries (blackberry, cranberry, strawberry, raspberry), citrus fruits (orange, lemon, lime, grapefruit), animal products (meat, eggs, milk & milk products), vegetables (leafy greens, potato, broccoli), rice, olive, and nuts
  • If serious liver damage has occurred from prolonged fructose exposure, then liver transplants may be performed. End-stage liver disease can be fatal without a liver transplant

How can Fructose Malabsorption be Prevented?

Fructose Malabsorption is preventable in some cases by controlling the consumption of fructose in high risk individuals. If there are underlying disorders or physiological abnormalities, then improper absorption of the sugar may occur in spite of fructose restriction. Under such circumstances, an individual may have to completely eliminate fructose from the diet.

Certain precautionary measures to be considered include:

  • Limiting the intake of fructose to tolerable levels by having a diet that is restricted in fructose content (avoiding foods that have high level)
  • Ensure that food consumed is favorable to your body condition; especially when traveling, eating out in a restaurant, partying, etc.
  • As far as possible, check ingredients of the food (from the food label tag, or from the menu, or by asking the waiter) before preparing/consuming
  • Substitute fructose with other sugars such as sucrose or glucose that are acceptable to your specific condition
  • If you consume small quantities of fructose-laden food, then include a larger measure of non-fructose foods at the same time. This helps in diluting the effects of fructose on the body
  • Always take the advice of a well-qualified nutritionist/dietitian, who will help setup a diet plan

What is the Prognosis of Fructose Malabsorption? (Outcomes/Resolutions)

  • Fructose Malabsorption is a common metabolic condition affecting many individuals who have regularly high fructose intake levels. A stoppage of fructose intake normally resolves the condition and provides relief from the symptoms. The outcome is usually good
  • In case other disorders or conditions are present, then treatment of the primary (underlying) complication may help restore the body function completely
  • Repeated intake of fructose inadvertently from any early period of life, combined with a late awareness/discovery of the condition may lead to liver problems. This can have a negative effect on the outcome, since end-stage liver failure can be fatal

Additional and Relevant Useful Information for Fructose Malabsorption:

Fructose Malabsorption is sometimes confused with a condition known as Hereditary Fructose Intolerance (HFI), which is a genetic developmental disorder that prevents an individual from being able to digest the sugar, fructose. HFI onset is during infancy; without suitable recognition and treatment of which, the condition may turn out to be fatal.

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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