ResearchPerspectives in PracticeFructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for Effective Dietary Management
Section snippets
Patient Selection
Sixty-two consecutive patients with IBS and proven fructose malabsorption were referred in a private practice setting by physicians for dietary management. Age range of subjects was 17 to 81 years (median, 50 years).
Fifteen were men (17 to 77 years, median 61 years) and 47 were women (23 to 81 years, median 46). Inclusion criteria comprised a diagnosis of IBS (made by the referring physician and fulfilling the Rome II criteria [26]). Patients with predominant diarrhea or constipation and those
Results
From tables of fructose, glucose, and fructan content of foods, detailed lists of problematic and favorable foods related to fructose and glucose were compiled and are shown in Figure 2. For fructans, published detailed data are more limited (12, 36, 37, 38, 39). Problematic foods have been grouped according to the likelihood of inducing symptoms and are outlined in the Table. The majority of fructan intake in a typical Western diet derives from wheat-based products (pasta, bread, breakfast
Discussion
The potential importance of malabsorbed fructose and fructans as a trigger for symptoms in patients with IBS has been generally underappreciated. The evidence that a fructose or fructan load can provoke acute gastrointestinal symptoms is substantial (3, 4, 5, 8, 13, 14, 19).
There is also support for the view that chronic symptoms of IBS can be effectively reduced in patients with fructose malabsorption by restricting dietary fructose ingestion (6, 7). During the last few decades, reports
S. J. Shepherd is an accredited practicing dietitian and P. R. Gibson is a professor and director of Medicine, Department of Gastroenterology and Monash University Department of Medicine, Box Hill Hospital, Box Hill, Victoria, Australia.
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S. J. Shepherd is an accredited practicing dietitian and P. R. Gibson is a professor and director of Medicine, Department of Gastroenterology and Monash University Department of Medicine, Box Hill Hospital, Box Hill, Victoria, Australia.
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Australian credentials for Master of Nutrition and Dietetics (M Nut Diet) and Accredited Practising Dietitian (APD).