Dietary fructose and gastrointestinal symptoms: a review

It has been proposed that fructose may cause or aggravate symptoms in patients with functional gastrointestinal disorders. Fructose is commonly used to sweeten processed foods, and the prevalence of incomplete fructose absorption (25 g, 10%) in healthy subjects is as high as 50%. The only controlled study that has been performed did not demonstrate a higher prevalence of fructose-induced gastrointestinal symptoms or incomplete fructose absorption in patients with functional gastrointestinal disorders. The amount and concentration of fructose used to evaluate absorption by breath testing has varied among studies. Moreover, dietary sources of fructose usually contain glucose, which increases fructose absorption in healthy subjects. Thus, breath testing with fructose alone may not reflect fructose ingestion under normal circumstances. Given these limitations, we suggest that a practical, empirical approach to testing in patients with suspected incomplete fructose absorption is to restrict fructose ingestion. Additional controlled studies are needed to clarify the relation between incomplete fructose absorption and symptoms, assess the effects of co-ingestion of other sugars on fructose absorption, and evaluate the effects of eliminating sugars from the diet on gastrointestinal symptoms.