IBS: Fructose Alert

And other dietary sugars that may explain the cause for millions of people who are suffering from IBS symptoms (including dyspepsia)

Intro / Fructose and Its Impact on Our Bodies / Management of IBS Symptoms (Fructose Testing & Diet control) / Impact of Other Dietary Sugars / Small Bowel Bacterial Overgrowth & IBS / References

Introduction:
GPDA's organized patient information forum on October 3, 2009 was well attended by many from across western Canada. Our audience had a chance to listen to Dr. Satish Rao, a world - leading expert on bowel problems.

One topic Dr. Rao touched upon was the association between fructose (fruit sugar) malabsorption and IBS symptoms. Dr. Rao is a pioneer in this research area and he has been hard at work educating his fellow GI specialists to test and treat this ubiquitous problem.

Since IBS causes non-specific symptoms of abdominal bloating, discomfort/pain, constipation, diarrhea, and gas, it is important for IBS problems to be fully evaluated - and this should include testing for poor digestion of dietary sugars like fructose, as well as for excess gut bacteria - more on that later.

Dietary Fructose and IBS
Dr. Rao's research team has shown that of the patients who have come to their clinic at the University of Iowa Health Care suffering from IBS symptoms (gas, bloating, belching, nausea, indigestion, diarrhea, abdominal discomfort/pain) over one third were found to have a fructose intolerance problem (malabsorption). Further, they found there was a direct relationship between escalating digestive symptoms and increasing the test dose of fructose.

Approximately 15% of North Americans suffer from IBS, so the connection between IBS and fructose malabsorption means many sufferers may be able to put down their medications and pick up dietary guidelines instead. Fructose intolerance can be effectively managed through dietary modification and lifestyle changes. So this is very good news for millions of people!

Dr. Rao recommends testing for fructose malabsorption for anyone suffering lower-bowel digestive symptoms and for those who have already been diagnosed with IBS. One note, there is an important distinction to make between fructose malabsorption - which is proving to be common and non-life-threatening - and a similarly named, much rarer condition found in childhood called hereditary fructose intolerance. In the latter condition, children are born lacking a specific liver enzyme needed for metabolizing the breakdown of fructose. Accumulation of toxic bi-products from failed fructose metabolism can seriously damage the liver and kidneys.

Understanding Fructose and Learning - it is a Bigger Problem than Just Bowel Symptoms!

But People Have Always Eaten Fructose. Why is This a Problem Now?
People have been consuming fructose forever in the form of fruits, root vegetables and honey - this is nothing new! Historically, we have consumed about 16 - 24 grams of fructose each day. What is new is the chemically reformulated fructose - that being, crystalline fructose and high- fructose corn syrup (HFCS) and their ubiquitous use as an additive sweeter in manufactured foods.

Crystalline fructose (a white powder) is derived from corn and enriched with fructose. The powder is 98% pure fructose. High-fructose corn syrup is a mixture of an enzymatically derived conversion of corn glucose to fructose with added corn syrup (100% glucose). The ratio of fructose to glucose can be manipulated to vary the sweetness of the HFCS for different applications of food processing.

Fructose is the sweetest of all natural sugars so it is easy to see why it has been chosen as a favourite sweetener by the food-manufacturing industry. Further, it does not spike blood sugar, so it has been considered a safer alternative to glucose - but, you will learn, this is not the case at all!

Modern food processing has put corn syrup, crystalline fructose or HFCS into just about everything we eat or drink from tomato soup, ketchup, salad dressings, yogurts, cookies, barbecue sauces, cakes, breads, soft drinks, sports drinks and fruit juices, to an endless list of manufacture snacks designed for children and adults.

The problem is not so much fructose but the amounts now consumed by modern society as well as the ratio of glucose to fructose consumed - we will discuss this in a moment.

Dr. Rao's research has demonstrated that the human gut can handle up to about 20 to 25 grams of fructose. Above this level, many people will begin to run into problems and develop lower-bowel symptoms of gas, belching, nausea, indigestion, bloating, and abdominal pain/discomfort as well as either diarrhea or constipation less so.

Our grandparents and their forebears were able to eat a variety of fruits and vegetables freely and rarely surpass their threshold for fructose tolerance. But since the technical development in 1957 of chemical (enzymatic) conversion of corn glucose to fructose, the end product, HFCS, has supplanted sucrose (table sugar), our previous food-sweetening champion.

There has been a steady rise, year after year, in the manufacturing and consumption of HFCS. Today, in the United States, the average consumption of fructose is approximately 80 grams a day, most of this from refined or processed foods/beverages. This adds up to between 17 and 20% of the average American's daily caloric intake being derived from fructose. The USDA reports that the average American is now consuming each year 156 pounds of sugar (all forms of sugar, including fructose). Since 1970, the consumption of HFCS has increased over 10 fold, from 5% to 55% as of only 2001.

Now, do we have your attention?