Z Gastroenterol 2014; 52 - KG203
DOI: 10.1055/s-0034-1386225

Tailored dietary re-education program leads to a significant improvement of fructose intolerance in adults

N Bonfrate 1, M Krawczyk 2, I Grattagliano 3, V Ruggiero 1, G Palasciano 1, F Lammert 2, P Portincasa 1
  • 1Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical Faculty, Bari, Italy
  • 2Saarland University Hospital, Department of Medicine II, Homburg, Germany
  • 3Italian College of General Practitioners, Florence, Italy

Background: Fructose, a hexose sugar consumed either naturally or as a sweetening additive, is absorbed by GLUT transporters in the small intestine. If this process fails, abdominal symptoms due to fructose intolerance (FI) may arise. Since the short-chain carbohydrates (FODMAP) low diet may improve functional gut symptoms, the effect of a personal alimentary program on gastrointestinal (GI) complaints was assessed in FI subjects.

Methods: In total 679 subjects with a suggestive history of lactose/fructose intolerance and without evidence of other organic/functional diseases underwent H2-breath tests (Lactofan®) to detect FI (50 g fructose) and lactose intolerance (LI, 25 g lactose). Abdominal pain, bloating (0 – 100 mm Visual Analogue Scale) and bowel habits (Bristol Stool Scale, BSS, score 1 – 7) were measured. Out of 107 patients with FI, 60% had concomitant LI. The study comprised a 6 mo. of unrestricted diet (self-dietary changes assessed by a custom-designed questionnaire, MEDSTYLE), a 1 mo. fixing the threshold values of fructose intake (daily diary for GI symptoms) and a 3 mo. on a fructose-controlled personalized diet (Winfood®).

Results: At baseline, fructose intake (g/day) positively correlated with BMI in women (r = 0.35, P = 0.0014, N = 79). The most frequent symptomatic pattern comprised the combination of abdominal pain, bloating, and diarrhea, and symptoms were invariably more severe with FI+LI than FI alone. During the unrestricted-diet period, subjects either abolished (48%) or reduced (52%) fructose-containing foods. Threshold value of fructose was 8.1 ± 0.2 g/day (range 4.2 – 14.0 g). During fructose-controlled personalized diet, subjects reported complete (12%) or improved (78%) symptoms, or no change (10%). A consistent decrease was observed for abdominal pain (-69.0 ± 2.3%), bloating (-70.0 ± 2.3%), number of daily evacuations (-47.0 ± 3.6%), and Bristol score (-25.7 ± 2.4%).

Conclusions: Fructose intolerance represents a common cause of gastrointestinal symptoms that requires careful diagnostic workup. A personalized dietary program effectively improves gastrointestinal symptoms. This approach makes deprivation of fructose unnecessary, avoids loss of valuable nutrients, and improves quality of life.