Digestive Diseases and Sciences

, Volume 45, Issue 7, pp 1255–1259 | Cite as

Carbohydrate Malabsorption Syndromes and Early Signs of Mental Depression in Females

  • M. Ledochowski
  • B. Widner
  • B. Sperner-Unterweger
  • T. Propst
  • W. Vogel
  • D. Fuchs


Fructose and lactose malabsorption are characterized by impaired duodenal fructose transport or by the deficiency of mucosal lactase, respectively. As a consequence, the nonabsorbed saccharides reach the colon, where they are broken down by bacteria to short fatty acids, CO2, and H2. Bloating, cramps, osmotic diarrhea, and other symptoms of irritable bowel syndrome are the consequence and can be seen in about 50% of carbohydrate malabsorbers. We have previously shown that fructose as well as lactose malabsorption were associated with signs of mental depression. It was therefore of interest to investigate possible interactions between fructose and lactose malabsorption and their influence on the development of signs of depression. In all, 111 otherwise healthy volunteers (81 females and 30 males) with gastrointestinal complaints were analyzed by measuring breath H2 concentrations after an oral dose of 50 g lactose and of 50 g fructose one week apart. They were classified as normals, isolated fructose malabsorbers, isolated lactose malabsorbers, and combined fructose/lactose malabsorbers. All patients filled out a Beck’s depression inventory–questionnaire. Twenty-five individuals (22.5%) were neither fructose nor lactose malabsorbers (group 1), 69 (62.2%) were only fructose malabsorbers (group 2), 4 (3.6%) were only lactose malabsorbers (group 3), and 13 (11.7%) presented with fructose and lactose malabsorption together (group 4). Isolated fructose malabsorption and combined fructose/lactose malabsorption was significantly associated with a higher Beck’s depression score. Further analysis of the data show that this association was strong in females (P < 0.01), but there was no such association between carbohydrate malabsorption and early signs of depression in males. In conclusion, the data confirm that fructose malabsorption may play a role in the development of mental depression in females and additional lactose malabsorption seems to further increase the risk for development of mental depression.

fructose malabsorption lactose malabsorption hydrogen breath test malabsorption syndrome depression 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Isselbacher KJ, Roger JM: Disorders of absorption. In Harrison's Principles of Internal Medicine, 14th ed. KJ Isselbacher (ed). New York, McGraw-Hill, 1997Google Scholar
  2. 2.
    Wasserman D, Hoekstra JH, Tolia V, et al: Molecular analysis of the fructose transporter gene (GLUT5) in isolated fructose malabsorption. J Clin Invest 98:2398–2402, 1996Google Scholar
  3. 3.
    Born P, Zech J, Stark M, Classen M, Lorenz R: Carbohydrate substitutes: Comparative study of intestinal absorption of fructose, sorbitol and xylitol. Med Klin 89:575–578, 1994Google Scholar
  4. 4.
    Born P, Zech J, Lehn H, Classen M, Lorenz R: Colonic bacterial activity determines the symptoms in people with fructose-malabsorption. Hepatogastroenterology 42:778–785, 1995Google Scholar
  5. 5.
    Fernandez-Banares F, Gassull MA: Accuracy of breath H2 criteria to detect carbohydrate malabsorption. Gastroenterology 107:323–324, 1994 (letter; comment)Google Scholar
  6. 6.
    Ledochowski M, Sperner-Unterweger B, Widner B, Fuchs D: Fructose malabsorption is associated with early signs of mental depression. Eur J Med Res 3:295–298, 1998Google Scholar
  7. 7.
    Ledochowski M, Sperner-Unterweger B, Fuchs D: Lactose malabsorption is associated with early signs of mental depression in females. A preliminary report. Dig Dis Sci 1998 (in press)Google Scholar
  8. 8.
    Hautzinger M, Bailer M, Keller F: Beck-Depressions-Inventar (BDI), AT Beck. Bern, Huber Verlag, 1992Google Scholar
  9. 9.
    Hautzinger M, CES-D Center for Epidemiological Studies Depressions-Skala Center for Epidemiological Studies Depression Scale (Radloff)-German version/author. Die CES D Skala 1988Google Scholar
  10. 10.
    Hautzinger M, Bailer M, Worall H, Keller F, BDI Beck-Depressions-Inventar Beck Depression Inventory-German version/author. 1994, Beck Depressions Inventar (BDI), Huber, 1994Google Scholar
  11. 11.
    Braden B, Braden CP, Klutz M, Lembeke B: Analysis of breath hydrogen (H2) in diagnosis of gastrointestinal function: validation of a pocket breath H2 test analyzer. Z Gastroenterology 31:242–245, 1993Google Scholar
  12. 12.
    Fleming SC: Evaluation of a hand-held hydrogen monitor in the diagnosis of intestinal lactase deficiency. Ann Clin Biochem 27:499–500, 1990Google Scholar
  13. 13.
    Duan LP, Braden B, Clement T, Caspary WF, Lembeke B: Clinical evaluation of a miniaturized desktop breath hydrogen analyzer. Z Gastroenterol 32:575–578, 1994Google Scholar
  14. 14.
    Rumessen JJ: Fructose and related food carbohydrates. Sources, intake, absorption, and clinical implications. Scand J Gastroenterol 27:819–828, 1992Google Scholar
  15. 15.
    Wildgrube HJ, Classen M: Wasserstoff (H2-)-Atemtests in der Diagnostik von Du¨nndarmerkrankungen. Z Gastroenterol 21:628–636, 1983Google Scholar
  16. 16.
    StatSoft I: Statistica for Windows. Tulsa, Oklahoma, StatSoft, Inc., 1995 (abstract)Google Scholar
  17. 17.
    Delgado PL, Price LH, Miller HL, et al.: Serotonin and the neurobiology of depression: Effects of tryptophan depletion in drug-free depressed patients. Arch Gen Psychiatry 51:865–874, 1994Google Scholar
  18. 18.
    Benkelfat C, Ellenbogen MA, Dean P, Palmour RM, Young SN: Mood-lowering effect of tryptophan depletion: Enhanced susceptibility in young men at genetic risk for major affective disorders. Arch Gen Psychiatry 51:687–697, 1994Google Scholar
  19. 19.
    Anderson IM, Parry-Billings M, Newsholme EA, Fairburn CG, Cowen PJ: Dieting reduces plasma tryptophan and alters brain 5-HT function in women. Psychol Med 20:785–791, 1990Google Scholar
  20. 20.
    Rapkin AJ: The role of serotonin in premenstrual syndrome. Clin Obstet Gynecol 35:629–636, 1992Google Scholar
  21. 21.
    Cater RE II: The clinical importance of hypochlorhydria (a consequence of chronic Helicobacter infection): its possible etiological role in mineral and amino acid malabsorption, depression, and other syndromes. Med Hypotheses 39:375–383, 1992Google Scholar
  22. 22.
    Ledochowski M, Widner B, Fuchs D: Fructose malabsorption and the decrease of serum tryptophan concentration. Adv Exp Med Biol 467:71–78, 1999Google Scholar
  23. 23.
    Ellenbogen MA, Young SN, Dean P, Palmour RM, Benkelfat C: Mood response to acute tryptophan depletion in healthy volunteers: sex differences and temporal stability. Neuropsychopharmacology 15:465–474, 1996Google Scholar
  24. 24.
    Menkes DB, Coates DC, Fawcett JP: Acute tryptophan depletion aggravates premenstrual syndrome. J Affect Disord 32:37–44, 1994Google Scholar
  25. 25.
    Salomon RM, Delgado PL, Licinio J, Krystal JH, Heninger GR, Charney DS: Effects of sleep deprivation on serotonin function in depression. Biol Psychiatry 36:840–846, 1994Google Scholar
  26. 26.
    Gasse T, Widner B, Baier-Bittelich G, et al: Abnormal tryptophan metabolism, neurologic/psychiatric disturbances and its relationship to immune activiation. In Neurochemical Markers of Degenerative Nervous Diseases & Drug Addiction. Progress in HPLC-HPCE: 7th ed. GA Quereshi (ed). The Netherlands: VSP Press, Zeist, 1997Google Scholar
  27. 27.
    Macdiarmid JI, Hetherington MM: Mood modulation by food: An explanation of affect and cravings in ‘chocolate addicts’. Br J Clin Psychol 34:129–138, 1995Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • M. Ledochowski
    • 1
  • B. Widner
    • 1
  • B. Sperner-Unterweger
    • 1
  • T. Propst
    • 1
  • W. Vogel
    • 1
  • D. Fuchs
    • 1
  1. 1.Department of Clinical Nutrition, Institute of Medical Chemistry and Biochemistry, Department of Psychiatry, and Department of GastroenterologyUniversity of InnsbruckInnsbruckAustria

Personalised recommendations