Fructose: role in the formation of intestinal symptoms

Authors

DOI:

https://doi.org/10.22141/2308-2097.56.1.2022.488

Keywords:

fructose, malabsorption, FODMAP, irritable bowel syndrome

Abstract

Fructose is a simple sugar that is present in fruit and honey, but is also a major component in the two most commonly used sweeteners, sucrose (table sugar), and high fructose corn syrup (HFCS). Intake of fructose has increased markedly over the last several hundred years, and currently the intake of added sugars approaches 15 percent of overall energy intake in the average western diet. The prevalence of fructose malabsorption is relatively high in healthy adults (~ 34 %) and is even greater in patients with functional gastrointestinal disorders. Symptoms following fructose ingestion, or fructose intolerance, are common in patients with irritable bowel syndrome (IBS). Due to the paucity of targeted therapy for IBS, many patients turn to dietary modifications for symptom management. In recent years the low-FODMAPs diet for treatment of IBS has gained increasing popularity. The acronym FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyol” and includes foods with fructose in excess of glucose, oligosaccharides including fructans, galacto-oligosaccharide and sugar polyols such as sorbitol and mannitol and lactose. The composition of FODMAPs diets and their mechanisms of action in IBS have been intensively studied in the past decade, but since this link is not specific to fructose. Dietary FODMAP might exacerbate intestinal symptoms by increasing small intestinal water volume, colonic gas production, and intestinal motility. Dietary FODMAPs restriction is associated with reduced fermentation and significant symptom improvement in some IBS patients.

Downloads

Download data is not yet available.

References

Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018 May;68(5):1063-1075. doi: 10.1016/j.jhep.2018.01.019.

Roeb E, Weiskirchen R. Fructose and Non-Alcoholic Steatohepatitis. Front Pharmacol. 2021 Feb 8;12:634344. doi: 10.3389/fphar.2021.634344.

Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol. 2020 Jul;73(1):202-209. doi: 10.1016/j.jhep.2020.03.039.

Miranda J, Vázquez-Polo M, Pérez-Junkera G, et al. FODMAP Intake in Spanish Population: Open Approach for Risk Assessment. Int J Environ Res Public Health. 2020 Aug 13;17(16):5882. doi: 10.3390/ijerph17165882.

Dornas WC, de Lima WG, Pedrosa ML, Silva ME. Health implications of high-fructose intake and current research. Adv Nutr. 2015 Nov 13;6(6):729-37. doi: 10.3945/an.114.008144.

Kolderup A, Svihus B. Fructose Metabolism and Relation to Atherosclerosis, Type 2 Diabetes, and Obesity. J Nutr Metab. 2015;2015:823081. doi: 10.1155/2015/823081.

Perederiy VG, Sizenko AK, Tkach SM. Modern approaches to the diagnosis and correction of fructose malabsorption. Modern gastroenterology. 2010;(53):113-120.

Council Directive 2001/110/EC of 20 December 2001 relating to honey. Off J Eur Commun. 2002;(10):47-52. Available from: https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex:32001L0110.

Bogdanov S, Jurendic T, Sieber R, Gallmann P. Honey for nutrition and health: a review. J Am Coll Nutr. 2008 Dec;27(6):677-89. doi: 10.1080/07315724.2008.10719745.

Nguyen HTL, Panyoyai N, Kasapis S, Pang E, Mantri N. Honey and Its Role in Relieving Multiple Facets of Atherosclerosis. Nutrients. 2019 Jan 14;11(1):167. doi: 10.3390/nu11010167.

Hengist A, Koumanov F, Gonzalez JT. Fructose and metabolic health: governed by hepatic glycogen status? J Physiol. 2019 Jul;597(14):3573-3585. doi: 10.1113/JP277767.

Hills SP, Mitchell P, Wells C, Russell M. Honey Supplementation and Exercise: A Systematic Review. Nutrients. 2019 Jul 12;11(7):1586. doi: 10.3390/nu11071586.

Caravaggio F, Borlido C, Hahn M, et al. Reduced insulin sensitivity is related to less endogenous dopamine at D2/3 receptors in the ventral striatum of healthy nonobese humans. Int J Neuropsychopharmacol. 2015 Feb 25;18(7):pyv014. doi: 10.1093/ijnp/pyv014.

Federico A, Rosato V, Masarone M, et al. The Role of Fructose in Non-Alcoholic Steatohepatitis: Old Relationship and New Insights. Nutrients. 2021 Apr 16;13(4):1314. doi: 10.3390/nu13041314.

Pensabene L, Salvatore S, Turco R, et al. Low FODMAPs diet for functional abdominal pain disorders in children: critical review of current knowledge. J Pediatr (Rio J). 2019 Nov-Dec;95(6):642-656. doi: 10.1016/j.jped.2019.03.004.

Dusilová T, Kovář J, Drobný M, et al. Different acute effects of fructose and glucose administration on hepatic fat content. Am J Clin Nutr. 2019 Jun 1;109(6):1519-1526. doi: 10.1093/ajcn/nqy386.

Hengist A, Koumanov F, Gonzalez JT. Fructose and metabolic health: governed by hepatic glycogen status? J Physiol. 2019 Jul;597(14):3573-3585. doi: 10.1113/JP277767.

Perrar I, Buyken AE, Penczynski KJ, et al. Relevance of fructose intake in adolescence for fatty liver indices in young adulthood. Eur J Nutr. 2021 Sep;60(6):3029-3041. doi: 10.1007/s00394-020-02463-2.

Ferraris RP, Choe JY, Patel CR. Intestinal Absorption of Fructose. Annu Rev Nutr. 2018 Aug 21;38:41-67. doi: 10.1146/annurev-nutr-082117-051707.

Douard V, Ferraris RP. Regulation of the fructose transporter GLUT5 in health and disease. Am J Physiol Endocrinol Metab. 2008 Aug;295(2):E227-37. doi: 10.1152/ajpendo.90245.2008.

Fuchs CJ, Gonzalez JT, van Loon LJC. Fructose co-ingestion to increase carbohydrate availability in athletes. J Physiol. 2019 Jul;597(14):3549-3560. doi: 10.1113/JP277116.

Gomara RE, Halata MS, Newman LJ, et al. Fructose intolerance in children presenting with abdominal pain. J Pediatr Gastroenterol Nutr. 2008 Sep;47(3):303-8. doi: 10.1097/MPG.0b013e318166cbe4.

Jones HF, Burt E, Dowling K, Davidson G, Brooks DA, Butler RN. Effect of age on fructose malabsorption in children presenting with gastrointestinal symptoms. J Pediatr Gastroenterol Nutr. 2011 May;52(5):581-4. doi: 10.1097/MPG.0b013e3181fd1315.

Barrett JS, Irving PM, Shepherd SJ, Muir JG, Gibson PR. Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders. Aliment Pharmacol Ther. 2009 Jul 1;30(2):165-74. doi: 10.1111/j.1365-2036.2009.04018.x.

Wilder-Smith CH, Materna A, Wermelinger C, Schuler J. Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2013 Jun;37(11):1074-83. doi: 10.1111/apt.12306.

Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel Disorders. Gastroenterology. 2016 Feb 18;150(6):1393-1407. doi: 10.1053/j.gastro.2016.02.031.

Gibson PR, Shepherd SJ. Personal view: food for thought--western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis. Aliment Pharmacol Ther. 2005 Jun 15;21(12):1399-409. doi: 10.1111/j.1365-2036.2005.02506.x.

Miranda J, Vázquez-Polo M, Pérez-Junkera G, et al. FODMAP Intake in Spanish Population: Open Approach for Risk Assessment. Int J Environ Res Public Health. 2020 Aug 13;17(16):5882. doi: 10.3390/ijerph17165882.

Mitchell H, Porter J, Gibson PR, Barrett J, Garg M. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther. 2019 Jan;49(2):124-139. doi: 10.1111/apt.15079.

Catassi G, Lionetti E, Gatti S, Catassi C. The Low FODMAP Diet: Many Question Marks for a Catchy Acronym. Nutrients. 2017 Mar 16;9(3):292. doi: 10.3390/nu9030292.

Turco R, Salvatore S, Miele E, Romano C, Marseglia GL, Staiano A. Does a low FODMAPs diet reduce symptoms of functional abdominal pain disorders? A systematic review in adult and paediatric population, on behalf of Italian Society of Pediatrics. Ital J Pediatr. 2018 May 15;44(1):53. doi: 10.1186/s13052-018-0495-8.

Fodor I, Man SC, Dumitrascu DL. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet in children. World J Clin Cases. 2019 Sep 26;7(18):2666-2674. doi: 10.12998/wjcc.v7.i18.2666.

Wang XJ, Camilleri M, Vanner S, Tuck C. Review article: biological mechanisms for symptom causation by individual FODMAP subgroups - the case for a more personalised approach to dietary restriction. Aliment Pharmacol Ther. 2019 Sep;50(5):517-529. doi: 10.1111/apt.15419.

Yamashita LM, Corona LP, Dantas da Silva E, et al. FODMAP project: Development, validation and reproducibility of a short food frequency questionnaire to estimate consumption of fermentable carbohydrates. Clin Nutr. 2021 May;40(5):3409-3420. doi: 10.1016/j.clnu.2020.11.021.

Acín Albiac M, Di Cagno R, Filannino P, Cantatore V, Gobbetti M. How fructophilic lactic acid bacteria may reduce the FODMAPs content in wheat-derived baked goods: a proof of concept. Microb Cell Fact. 2020 Sep 17;19(1):182. doi: 10.1186/s12934-020-01438-6.

DiNicolantonio JJ, Berger A. Added sugars drive nutrient and energy deficit in obesity: a new paradigm. Open Heart. 2016 Aug 2;3(2):e000469. doi: 10.1136/openhrt-2016-000469.

Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional Disorders: Children and Adolescents. Gastroenterology. 2016 Feb 15;150(6):1456-1468.e2. doi: 10.1053/j.gastro.2016.02.015.

Melchior C, Douard V, Coëffier M, Gourcerol G. Fructose and irritable bowel syndrome. Nutr Res Rev. 2020 Dec;33(2):235-243. doi: 10.1017/S0954422420000025.

Gomara RE, Halata MS, Newman LJ, et al. Fructose intolerance in children presenting with abdominal pain. J Pediatr Gastroenterol Nutr. 2008 Sep;47(3):303-8. doi: 10.1097/MPG.0b013e318166cbe4.

Hutson JM, Hynes MC, Kearsey I, et al. 'Rapid transit' constipation in children: a possible genesis for irritable bowel syndrome. Pediatr Surg Int. 2020 Jan;36(1):11-19. doi: 10.1007/s00383-019-04587-x.

Wilder-Smith C, Lee SH, Olesen SS, Low JY, Kioh DYQ, Ferraris R, Materna A, Chan ECY. Fructose intolerance is not associated with malabsorption in patients with functional gastrointestinal disorders. Neurogastroenterol Motil. 2021 Dec;33(12):e14150. doi: 10.1111/nmo.14150.

Chumpitazi BP, Weidler EM, Lu DY, Tsai CM, Shulman RJ. Self-Perceived Food Intolerances Are Common and Associated with Clinical Severity in Childhood Irritable Bowel Syndrome. J Acad Nutr Diet. 2016 Sep;116(9):1458-1464. doi: 10.1016/j.jand.2016.04.017.

Downloads

Published

2022-05-09

How to Cite

Silivontchik, N. (2022). Fructose: role in the formation of intestinal symptoms. GASTROENTEROLOGY, 56(1), 54–60. https://doi.org/10.22141/2308-2097.56.1.2022.488

Issue

Section

Reviews and Lections