Skip to main content
SpringerLink
Log in

Fructose-sorbitol malabsorption

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Important dietary carbohydrates such as fructose and sorbitol are incompletely absorbed in the normal small intestine. This malabsorption is sometimes associated with abdominal complaints and diarrhea development, symptoms indistinguishable from those of functional bowel disease. Recently, polymerized forms of fructose (fructans) also were implicated in symptom production in patients with irritable bowel syndrome (IBS). Evidence from uncontrolled and controlled challenge studies suggests that malabsorbed sugars (fructose, sorbitol, lactose) and fructans may act as dietary triggers for clinical symptoms suggestive of IBS. Further placebo-controlled studies are needed to obtain definite conclusions about the role of dietary sugar malabsorption in functional bowel disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Sigman-Grant M, Morita J: Defining and interpreting intakes of sugars. Am J Clin Nutr 2003, 78(Suppl):815S–826S.

    PubMed  CAS  Google Scholar 

  2. Popkin BM, Nielsen SJ: The sweetening of the world’s diet. Obes Res 2003, 11:1325–1332.

    Article  PubMed  Google Scholar 

  3. Bleich SN, Wang YC, Wang Y, Gortmaker SL: Increasing consumption of sugar-sweetened beverages among US adults: 1988–1994 to 1999–2004. Am J Clin Nutr 2009, 89:372–381.

    Article  PubMed  CAS  Google Scholar 

  4. US Department of Health and Human Services and US Department of Agriculture: Dietary Guidelines for Americans, 2005, edn 6. Washington, DC: US Government Printing Office; 2005.

    Google Scholar 

  5. Hanover LM, White JS: Manufacturing, composition, and applications of fructose. Am J Clin Nutr 1993, 58(Suppl):724S–732S.

    PubMed  CAS  Google Scholar 

  6. Vos MB, Kimmons JE: Dietary fructose consumption among US children and adults: the third National Health and Nutrition Examination Survey. Medscape J Med 2008, 10:160.

    PubMed  Google Scholar 

  7. Park K, Yetley E: Intakes and food sources of fructose in the United States. Am J Clin Nutr 1993, 58(Suppl):737S–747S.

    PubMed  CAS  Google Scholar 

  8. Mitchell DO: Sugar policies: an opportunity for change. In Global Agricultural Trade and Developing Countries. Edited by Ataman Aksoy M, Beghin JC. Washington DC: The World Bank; 2005:146–153.

    Google Scholar 

  9. Montonen J, Järvinen R, Knekt P, et al.: Consumption of sweetened beverages and intakes of fructose and glucose predict type 2 diabetes occurrence. J Nutr 2007, 1447–1454.

  10. Foster-Powell K, Holt SH, Brand-Miller JC: International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr 2002, 76:5–56.

    PubMed  CAS  Google Scholar 

  11. Johnston KR, Govel LA, Andritz MH: Gastrointestinal effects of sorbitol as an additive in liquid medications. Am J Med 1994, 97:185–191.

    Article  PubMed  CAS  Google Scholar 

  12. Dills WL Jr: Sugar alcohols as bulk sweeteners. Ann Rev Nutr 1989, 9:161–186.

    Article  CAS  Google Scholar 

  13. Fernández-Bañares F, Rosinach M, Esteve M, et al.: Sugar malabsorption in functional abdominal bloating: a pilot study on the long-term effect of dietary treatment. Clin Nutr 2006, 25:824–831.

    Article  PubMed  CAS  Google Scholar 

  14. Waterhouse AL, Chatterton NJ: Glossary of fructans terms. In Science and Technology of Fructans. Edited by Suzuki M, Chatterton NJ. Boca Raton, FL: CRC Press; 1993:1–7.

    Google Scholar 

  15. Roberfroid MB: Introducing inulin-type fructans. Br J Nutr 2005, 93(Suppl 1):S13–S25.

    Article  PubMed  CAS  Google Scholar 

  16. Rumessen JJ: Fructose and related food carbohydrates. Sources, intake, absorption, and clinical implications. Scand J Gastroenterol 1992, 27:819–828.

    Article  PubMed  CAS  Google Scholar 

  17. Banguela A, Hernández L: Fructans: from natural sources to transgenic plants. Biotecnologóia Aplicada 2006, 23:202–210.

    Google Scholar 

  18. Green C: Fibre intake in the diet. In Fibre in Enteral Nutrition. Zoetermeer, The Netherlands: Nutritional Sciences, Nutricia Research Communications; 1997:23–27.

    Google Scholar 

  19. Gibson PR, Newnham E Barrett JS, et al.: Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther 2007, 25:349–363.

    Article  PubMed  CAS  Google Scholar 

  20. Drozdowski LA, Thomson ABR: Intestinal sugar transport. World J Gastroenterol 2006, 12:1657–1670.

    PubMed  CAS  Google Scholar 

  21. Kellet GL, Brot-Laroche E: Apical GLUT2. A major pathway of intestinal sugar absorption. Diabetes 2005, 54:3056–3062.

    Article  Google Scholar 

  22. Rumessen JJ, Gudmand-Hoyer E: Malabsorption of fructose-sorbitol mixtures. Interactions causing abdominal distress. Scand J Gastroenterol 1987, 22:431–436.

    Article  PubMed  CAS  Google Scholar 

  23. Wong JMW, Jenkins DJA: Carbohydrate digestibility and metabolic effects. J Nutr 2007, 137:2539S–2546S.

    PubMed  CAS  Google Scholar 

  24. Simrén M, Stotzer PO: Use and abuse of hydrogen breath tests. Gut 2006, 55:297–303.

    Article  PubMed  CAS  Google Scholar 

  25. Ravich WJ, Bayless TM, Thomas M: Fructose: incomplete intestinal absorption in humans. Gastroenterology 1983, 84:26–29.

    PubMed  CAS  Google Scholar 

  26. Corazza GR, Strocchi A, Rossi R, et al.: Sorbitol malabsorption in normal volunteers and in patients with celiac disease. Gut 1998, 29:44–48.

    Article  Google Scholar 

  27. Mishkin D, Sablauskas L, Yalovsky M, Mishkin S: Fructose and sorbitol malabsorption in ambulatory patients with functional dyspepsia-comparison with lactose maldigestion/malabsorption. Dig Dis Sci 1997, 42:2591–2598.

    Article  PubMed  CAS  Google Scholar 

  28. Rumessen JJ, Gudmand-Hoyer E: Functional bowel disease: malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose-sorbitol mixtures. Gastroenterology 1988, 95:694–700.

    PubMed  CAS  Google Scholar 

  29. Nelis GF, Vermeeran MAP, Jansen W: Role of fructose-sorbitol mixtures in the symptoms of the irritable bowel. Gastroenterology 1990, 99:1016–1020.

    PubMed  CAS  Google Scholar 

  30. Fernández-Bañares F, Esteve-Pardo M, de Leon R, et al.: Sugar malabsorption in functional bowel disease: clinical implications. Am J Gastroenterol 1993, 88:2044–2050.

    PubMed  Google Scholar 

  31. Symons P, Jones MP, Kellow JE: Symptom provocation in irritable bowel syndrome. Effects of differing doses of fructose-sorbitol. Scand J Gastroenterol 1992, 27:940–944.

    Article  PubMed  CAS  Google Scholar 

  32. Caspary WF: Diarrhoea associated with carbohydrate malabsorption. Clin Gastroenterol 1986, 15:631–655.

    PubMed  CAS  Google Scholar 

  33. Grabitske HA, Slavin JL: Gastrointestinal effects of low-digestible carbohydrates. Crit Rev Food Sci Nutr 2009, 49:327–360.

    Article  PubMed  CAS  Google Scholar 

  34. Vesa TH, Seppo LM, Marteau T, et al.: Role of irritable bowel syndrome in subjective lactose intolerance. Am J Clin Nutr 1998, 67:710–715.

    PubMed  CAS  Google Scholar 

  35. Goldstein R, Braverman D, Stankiewicz H: Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. Isr Med Assoc J 2000, 2:583–587.

    PubMed  CAS  Google Scholar 

  36. Johlin FC, Panther M, Kraft N: Dietary fructose intolerance: diet modification can impact self-rated health and symptom control. Nutr Clin Care 2004, 7:92–94.

    PubMed  Google Scholar 

  37. Choi YK, Kraft N, Zimmerman B, et al.: Fructose intolerance in IBS and utility of fructose-restricted diet. J Clin Gastroenterol 2008, 42:233–238.

    Article  PubMed  CAS  Google Scholar 

  38. Born P, Sekatcheva M, Rösch T, Classen M: Carbohydrate malabsorption in clinical routine: a prospective observational study. Hepatogastroenterol 2006, 53:673–677.

    Google Scholar 

  39. Fernández-Bañares F, Esteve M, Salas A, et al.: Systematic evaluation of the causes of chronic watery diarrhea with functional characteristics. Am J Gastroenterol 2007, 102:2520–2528.

    Article  PubMed  Google Scholar 

  40. Velhuyzen van Zanten SJO, Talley NJ, Bytzer P, et al.: Design of treatment trials for the functional gastrointestinal disorders. In The Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology, and Treatment. A Multinational Consensus. Edited by Drossman DA, Corazziari E, Talley NJ, et al.: McLean, VA: Degnon Associates; 2000:577–622.

    Google Scholar 

  41. Ledochowski M, Widner B, Bair H, et al.: Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers. Scand J Gastroenterol 2000, 35:1048–1052.

    Article  PubMed  CAS  Google Scholar 

  42. Shepherd SJ, Gibson PR: Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc 2006, 106:1631–1639.

    Article  PubMed  Google Scholar 

  43. Shepherd SJ, Parker FC, Muir JG, Gibson PR: Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008, 6:765–771.

    Article  PubMed  CAS  Google Scholar 

  44. Shepherd SJ, Willet I, Fone D, et al.: The value of the ‘fructose malabsorption’ diet and the fructose breath hydrogen test in patients with irritable bowel syndrome. J Gastroenterol Hepatol 2003, 18(Suppl):B126.

    Google Scholar 

  45. Nucera G, Gabrielli M, Lupascu A, et al.: Abnormal breath tests to lactose, fructose and sorbitol in irritable bowel syndrome may be explained by small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2005, 21:1391–1395.

    Article  PubMed  CAS  Google Scholar 

  46. Pimentel M, Chow EJ, Lin HC: Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. A double blind, randomized, placebo- controlled study. Am J Gastroenterol 2003, 98:412–419.

    PubMed  Google Scholar 

  47. Dear KL, Elia M, Hunter KO: Do interventions which reduce colonic bacterial fermentation improve symptoms of irritable bowel syndrome? Dig Dis Sci 2005, 50:758–766.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Plaza Dr Robert 5, 08221, Terrassa, Barcelona, Spain

    Fernando Fernández-Bañares

Authors
  1. Fernando Fernández-Bañares
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Esteve
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Josep M. Viver
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando Fernández-Bañares.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fernández-Bañares, F., Esteve, M. & Viver, J.M. Fructose-sorbitol malabsorption. Curr Gastroenterol Rep 11, 368–374 (2009). https://doi.org/10.1007/s11894-009-0056-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-009-0056-9

Keywords

Search

Navigation