Disaccharide malabsorption/Reseach papers 3

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These research papers papers discuss how sugars can cause GI problems.

Many of these articles mention problems with fructose. Fructose is now

being manufactured from corn and this might account for the problems

with the absorption of fructose since it is no longer pure.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\

ct&list_uids=8249972&query_hl=8

1: Am J Gastroenterol. 1993 Dec;88(12):2044-50. Related

Articles, Links

Sugar malabsorption in functional bowel disease: clinical

implications.

Fernandez-Banares F, Esteve-Pardo M, de Leon R, Humbert P, Cabre E,

Llovet JM, Gassull MA.

Department of Gastroenterology, Hospital Universitari Germans Trias

i Pujol, Badalona, Spain.

OBJECTIVE: To investigate the relationship of sugar malabsorption to

the development of clinical symptoms in functional bowel disease.

METHODS: Twenty-five consecutive outpatients [five men, 20 women;

mean age 38.7 +/- 2.6 (SEM) yr] with functional bowel disease and

symptoms suggestive of carbohydrate malabsorption were studied.

Twelve healthy subjects [six men, six women; mean age 35.7 +/- 3.7

(SEM) yr] acted as the control group. Sugar malabsorption was

assessed by breath-hydrogen test after an oral load of various

solutions containing lactose (50 g), fructose (25 g), sorbitol (5

g), fructose plus sorbitol (25 + 5 g), and sucrose (50 g). The

severity of symptoms developing after sugar challenge was studied.

In addition, the effect on clinical symptoms of a diet free of the

offending sugars, compared to a low-fat diet, was assessed. RESULTS:

Frequency of sugar malabsorption was high in both patients and

controls, with malabsorption of at least one sugar in more than 90%

of the subjects. Median symptom scores after both lactose [median 6;

interquartile (IQ) range 3-7] and fructose plus sorbitol (median 2;

IQ range 0-4) malabsorption were significantly higher than after

sucrose load (median 1; IQ range 0-1.5) in functional bowel disease

patients (p = 0.001 and p = 0.007, respectively). However, there

were no differences in healthy controls. In addition, symptoms score

after both lactose and fructose plus sorbitol malabsorption was

significantly higher in patients than in control subjects (p = 0.02

and p = 0.008, respectively). On the other hand, H2 production

capacity, as measured following lactulose load, was significantly

higher in patients than in controls. The clinical symptoms improved

in 40% of the evaluated patients after restriction of the offending

sugars. CONCLUSIONS: These results suggest that sugar malabsorption

may be implicated in the development of abdominal distress in at

least a subset of patients with functional bowel disease.

PMID: 8249972 [PubMed - indexed for MEDLINE

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1: Isr Med Assoc J. 2000 Aug;2(8):583-7. Related Articles, Links

Carbohydrate malabsorption and the effect of dietary restriction on

symptoms of irritable bowel syndrome and functional bowel

complaints.

Goldstein R, Braverman D, Stankiewicz H.

Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem,

Israel.

BACKGROUND: Carbohydrate malabsorption of lactose, fructose and

sorbitol has already been described in normal volunteers and in

patients with functional bowel complaints including irritable bowel

syndrome. Elimination of the offending sugar(s) should result in

clinical improvement. OBJECTIVE: To examine the importance of

carbohydrate malabsorption in outpatients previously diagnosed as

having functional bowel disorders, and to estimate the degree of

clinical improvement following dietary restriction of the

malabsorbed sugar(s). METHODS: A cohort of 239 patients defined as

functional bowel complaints was divided into a group of 94 patients

who met the Rome criteria for irritable bowel syndrome and a second

group of 145 patients who did not fulfill these criteria and were

defined as functional complaints. Lactose (18 g), fructose (25 g)

and a mixture of fructose (25 g) plus sorbitol (5 g) solutions were

administered at weekly intervals. End-expiratory hydrogen and

methane breath samples were collected at 30 minute intervals for 4

hours. Incomplete absorption was defined as an increment in breath

hydrogen of at least 20 ppm, or its equivalent in methane of at

least 5 ppm. All patients received a diet without the offending

sugar(s) for one month. RESULTS: Only 7% of patients with IBS and 8%

of patients with FC absorbed all three sugars normally. The

frequency of isolated lactose malabsorption was 16% and 12%

respectively. The association of lactose and fructose-sorbitol

malabsorption occurred in 61% of both patient groups. The frequency

of sugar malabsorption among patients in both groups was 78% for

lactose malabsorption (IBS 82%, FC 75%), 44% for fructose

malabsorption and 73% for fructose-sorbitol malabsorption (IBS 70%,

FC 75%). A marked improvement occurred in 56% of IBS and 60% of FC

patients following dietary restriction. The number of symptoms

decreased significantly in both groups (P < 0.01) and correlated

with the improvement index (IBS P < 0.05, FC P < 0.025).

CONCLUSIONS: Combined sugar malabsorption patterns are common in

functional bowel disorders and may contribute to symptomatology in

most patients. Dietary restriction of the offending sugar(s) should

be implemented before the institution of drug therapy.

PMID: 10979349 [PubMed - indexed for MEDLINE]

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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\

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1: Rev Prat. 2001 May 15;51(9):969-72. Related Articles, Links

[specific carbohydrate malabsorption]

[Article in French]

Nancey S, Flourie B.

Service d'hepato-gastro-enterologie Centre hospitalier Lyon-Sud

69495 Pierre-Benite.

Specific malabsorption of carbohydrate is related to the lack or

decrease in enzymatic activity needed for its hydrolysis; seldom, it

is related to the lack or overloading in transport mechanism of

monosaccharide. Ingestion of unabsorbed carbohydrate may induce

digestive symptoms due to its colonic fermentation (borborygmus,

bloating, pain, and flatus) or its osmotic activity (diarrhoea). In

a patient consuming at least a bowl of milk per day and suffering of

functional digestive symptoms, intolerance to lactose must be ruled

out because its treatment is easy and efficient, i.e. to put

fermented dairy products in place of milk.

Publication Types:

* Review

* Review, Tutorial

PMID: 11458611 [PubMed - indexed for MEDLINE]

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1: Am J Clin Nutr. 1985 Feb;41(2):228-34.

Related Articles, Links

Tolerance to glucose polymers in malnourished infants with diarrhea and

disaccharide intolerance.

Fagundes-Neto U, Viaro T, Lifshitz F.

The response of infants with diarrhea and lactose intolerance to

feedings containing soy protein and sucrose (Sobee), and/or to a

carbohydrate free formula (RCF), to which glucose polymers (GP) were

added, was assessed in twenty patients. They all were less than ten

months of age and had varying degrees of malnutrition. Eleven had acute

diarrhea and nine had chronic diarrhea. None of them had classical

enteropathogenic strains and parasites in the stools. All had lactose

intolerance when feedings were begun with cow's milk formula and some

also had sucrose intolerance when fed sucrose containing soy formulas.

They had persistent loose stools and excreted feces with an acid pH and

with carbohydrates, thus they were given dietary treatment with RCF with

GP. There were 9 patients with acute diarrhea and lactose intolerance (1

of them also had sucrose intolerance), who improved on RCF with GP

feedings; but 2 patients (lactose and sucrose intolerant) failed to

respond to this diet. There were six patients with chronic diarrhea and

lactose intolerance (four of them also had sucrose intolerance), who

improved on RCF with GP formula, but there were three patients who

failed on this treatment. These data show that some infants with

diarrhea, malnutrition, and lactose-sucrose intolerance may also develop

intolerance to GP and require further dietary management with glucose as

the source of carbohydrate in the diet.

PMID: 3969931 [PubMed - indexed for MEDLINE]

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