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Fructose Malabsorption and Probiotics
Fructose malabsorption is a condition in which you are not able to absorb fructose, a sugar found in fruits and various sweeteners. Unabsorbed fructose is fermented in your intestines and result in bloating, abdominal pain, flatulence, diarrhea and constipation as well as fatigue. The only way to manage fructose malabsorption is by restricting sources of fructose in your diet 1. While many people take probiotics -- friendly bacteria that can improve the quality of your gut flora -- people with fructose malabsorption need to exercise caution in choosing and using any probiotics. Check with your doctor before adding probiotics to your diet.
Elimination Phase
After being diagnosed with fructose malabsorption, you are typically referred to a qualified registered dietitian to help you get started in changing the way you eat. An elimination diet of safe foods low in fructose will help you get rid of most of your symptoms. During the elimination phase, which typically lasts a few weeks, it is best to avoid changing other factor that may affect your symptoms. For this reason, you should not start, stop or change any of your supplements, such as probiotics, during this phase.
- After being diagnosed with fructose malabsorption, you are typically referred to a qualified registered dietitian to help you get started in changing the way you eat.
- During the elimination phase, which typically lasts a few weeks, it is best to avoid changing other factor that may affect your symptoms.
Excess Gas
Sorbitol & Fructose
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One of the potential problems with fructose malabsorption is the excess production of gas by the bacteria in the intestinal tract 1. This is why adding probiotics can sometimes exacerbate your symptoms if you have fructose malabsorption 2. If you decide to start, stop or change your probiotic for any reason, document how it makes you feel, and bring any concerns to your doctor or dietician.
Watch for Prebiotics
Some probiotic supplements can contain prebiotics. Prebiotics are food for the probiotic and healthy bacteria and help you to maintain a healthy and favorable gut flora. Some of the prebiotics that are most often used include inulin and fructooligosaccharides -- substances that may be difficult to digest for people with fructose malabsorption. Carefully check the ingredient list of any supplements, including probiotics, before buying to ensure they do not contain potentially problematic ingredients.
- Some probiotic supplements can contain prebiotics.
- Some of the prebiotics that are most often used include inulin and fructooligosaccharides -- substances that may be difficult to digest for people with fructose malabsorption.
Start Small
Do You Have to Take Probiotics on an Empty Stomach?
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Whenever introducing something new to your diet, it is always prudent to start small to test how your body reacts. With your doctor's or dietician's okay, you can start with a small dose for a week and then slowly work your way up to an amount that is comfortable for you. If you are critically ill or are immunocompromised or take immune-suppressing drugs, probiotics are not a good choice -- discuss this with your doctor.
Related Articles
References
- Alimentary Pharmacology and Therapeutics: Review Article: Fructose Malabsorption and the Bigger Picture
- Journal of the American Dietetic Association: Fructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for Effective Dietary Management
- Biesiekierski JR. Fructose-induced symptoms beyond malabsorption in FGID. United European Gastroenterol J. 2014;2(1):10-3. doi:10.1177/2050640613510905
- Fedewa A, Rao SS. Dietary fructose intolerance, fructan intolerance and FODMAPs. Curr Gastroenterol Rep. 2014;16(1):370. doi:10.1007/s11894-013-0370-0
- National Institutes of Health. Hereditary fructose intolerance. Updated February 11, 2020.
- Mann NS, Cheung EC. Fructose-induced breath hydrogen in patients with fruit intolerance. J Clin Gastroenterol. 2008;42(2):157-9. doi:10.1097/01.mcg.0000225667.53673.02
- Choi Y, Kraft N, Zimmerman B, Jackson M, Rao S. Fructose Intolerance in IBS and Utility of Fructose-Restricted Diet. J Clin Gastroenterol. 2008 Mar;42(3):233-8. doi:10.1097/MCG.0b013e31802cbc2f
- Ebert K, Witt H. Fructose malabsorption. Mol Cell Pediatr. 2016 Dec;3:10. doi: 10.1186/s40348-016-0035-9
- Yao CK, Tuck CJ. The clinical value of breath hydrogen testing. J Gastroenterol Hepatol. 2017;32 Suppl 1:20-22. doi:10.1111/jgh.13689
- Jung KW, Seo M, Cho YH, et al. Prevalence of fructose malabsorption in patients with irritable bowel syndrome after excluding small intestinal bacterial overgrowth. J Neurogastroenterol Motil. 2018;24(2):307-316. doi:10.5056/jnm17044
- Fedewa A, Rao SS. Dietary fructose intolerance, fructan intolerance and FODMAPs. Curr Gastroenterol Rep. 2014;16(1):370. doi:10.1007/s11894-013-0370-0
- Johns Hopkins Medicine. (n.d.). Gastroenterology and Hepatology: Breath Testing.
Resources
- "IBS--Free at Last!"; Patsy Catsos; 2009
Writer Bio
Aglaee Jacob is a registered dietitian. She has experience working with people who have diabetes, cardiovascular disease, hypertension and obesity issues. Jacob obtained a bachelor of science and a master of science, both in nutrition, from Laval University in Quebec City, Canada.