Review article: fructose malabsorption and the bigger picture
Article first published online: 3 NOV 2006
Alimentary Pharmacology & Therapeutics
Volume 25, Issue 4, pages 349–363, February 2007
How to Cite
GIBSON, P. R., NEWNHAM, E., BARRETT, J. S., SHEPHERD, S. J. and MUIR, J. G. (2007), Review article: fructose malabsorption and the bigger picture. Alimentary Pharmacology & Therapeutics, 25: 349–363. doi: 10.1111/j.1365-2036.2006.03186.x
- Issue published online: 3 NOV 2006
- Article first published online: 3 NOV 2006
- Publication data Submitted 24 August 2006 First decision 11 September 2006 Resubmitted 30 September 2006 Accepted 23 October 2006
Fructose is found widely in the diet as a free hexose, as the disaccharide, sucrose and in a polymerized form (fructans). Free fructose has limited absorption in the small intestine, with up to one half of the population unable to completely absorb a load of 25 g. Average daily intake of fructose varies from 11 to 54 g around the world. Fructans are not hydrolysed or absorbed in the small intestine.
The physiological consequences of their malabsorption include increasing osmotic load, providing substrate for rapid bacterial fermentation, changing gastrointestinal motility, promoting mucosal biofilm and altering the profile of bacteria. These effects are additive with other short-chain poorly absorbed carbohydrates such as sorbitol.
The clinical significance of these events depends upon the response of the bowel to such changes; they have a higher chance of inducing symptoms in patients with functional gut disorders than asymptomatic subjects. Restricting dietary intake of free fructose and/or fructans may have durable symptomatic benefits in a high proportion of patients with functional gut disorders, but high quality evidence is lacking.
It is proposed that confusion over the clinical relevance of fructose malabsorption may be reduced by regarding it not as an abnormality but as a physiological process offering an opportunity to improve functional gastrointestinal symptoms by dietary change.