# Fructose Question



## cynthia (May 9, 2006)

I know this subject has been discussed in various threads here but I'm still confused. Pimental says that fructose is to be avoided while Gottshall said it's fine. I'm trying to understand the reasoning for both. In looking up the SCD info, it explains that fructose is a monosaccharide which is the exact size for absorption in the small intestine. Pimental says to avoid fructose as much as possible, which includes fruits and honey. I'm really confused about this differecne between the two diets. Can anyone help me to understand?


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## Kathleen M. (Nov 16, 1999)

I think the difference is in whether you think fructose absorption problems might be common or rare in the patient population you are dealing with???They also have very different starting assumptions about how diet is a problem.Also SCD starts from the person has an inflammatory bowel disease and SIBO starts with no inflammatory bowel disease but IBS and SIBO assumptions and which disease you are looking at may effect what problems you see in the diet.Some people do not absorb fructose well. If they do not bacteria in the small intestine or colon use the unabsorbed fructose as food and can generate gas.I'm nor really sure how much hard data either person is using to base their opinions about fructose on.If a person absorbs fructose normally it should be something well absorbed. I think some people think fructose problems are more common in IBSers???Most diet information even if presented as a hard fast rule tends to be based more on assumptions than fact and even when there is data they may interpret it in very different ways. All of that adds up to a lot of confusion if you try to combine inflrmation from differnent sources.K.


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## cynthia (May 9, 2006)

Thanks Kathleeen. So, what you're saying is that SCD is focused more on inflammation in the bowel and that Pimental is looking at the bacteria. SCD is saying that fructose is not an issue for inflammatioin therefore it's okay whereas Pimental is saying that, if for some reason it doesn't get absorbed easily, it will feed the bacteria. Is that what you're saying?


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## Kathleen M. (Nov 16, 1999)

As best as I understand the logic behind the two diets that is what I'm thinking could explain the difference.


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## eric (Jul 8, 1999)

Just fyi"Dr. Drossman is a Co-director of the Center and Professor of Medicine and Psychiatry at UNC-CH. He established a program of research in functional gastrointestinal disorders at UNC more than 15 years ago and has published more than 250 books, articles, and abstracts relating to epidemiology, psychosocial and quality of life assessment, design of treatment trials, and outcomes research in gastrointestinal disorders. Dr Drossman's comments on foods for IBS Health.Shawn Eric,To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Futhermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). *The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse. *However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature. The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-gut axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.Doug http://www.ibshealth.com/ibs_foods_2.htm


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## cynthia (May 9, 2006)

Kathleen,Are you also saying that, according to Pimental's theory on the subject of fructose, if you had a problem with it before any SIBO issues, then you need to stay away from it now. Pre SIBO problems, if all was fine with fruits and honey, it's probably okay now. Is that your take on the Pimental view?Thanks, C


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## Kathleen M. (Nov 16, 1999)

I'm not sure I fully understand his view of it, but if you could absorb frutose fine before you may be fine with it now.However sometimes the sugar issue has always been there but only the sensitivity of IBS cause you to have symptoms from the excess gas from the sugar getting to the colon. It depends if the curing the SIBO really got rid of the IBS issues for you.I would add it back carefully and see what amount you could tolerate. If it doesn't bother you during IBS/SIBO then it shouldn't bother you afterward. Not all IBSers have issues with fructose.K.


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## eric (Jul 8, 1999)

This is new from Digestive Disease week 2007'Bacterial OvergrowthA number of studies presented during DDW 2007 examined the issue of small bowel bacterial overgrowth (SBBO) in patients with IBS. This area is controversial because dramatically different results have been reported by different laboratories, which likely reflects differences in the study populations and in the type of breath test performed.[22]Randall and colleagues[23] found that of 77 patients with IBS and diarrhea (additional patient demographics not provided) who had coexisting symptoms of gas and bloating, bacterial overgrowth (using a standard lactulose hydrogen breath test) was present in 40 (52%). In addition, another 20 patients (26%) had evidence of a disaccharidase deficiency. The latter finding supports previous studies that recommend that IBS patients with diarrhea should also be evaluated for coexisting lactase deficiency (at least 25% of IBS patients have this deficiency) and fructase deficiency (approximately 50% of IBS patient have this deficiency).Cabansag and colleagues[24] also reported on their findings using the lactulose breath test in 105 patients (27 men, 78 women; mean age = 46.8 years) with symptoms of abdominal pain, bloating, distention, diarrhea, constipation, and nausea. Analysis of breath samples was performed to identify both hydrogen and methane production. More than half of the patients were found to have bacterial overgrowth (52.4%), including 26 of 45 patients who met the Rome II criteria for IBS (58%). Subgroup analysis found that IBS patients with alternating symptoms (IBS-mixed) of constipation and diarrhea were more likely to have SBBO (77.8%) compared with patients with IBS with constipation (61.9%) and patients with IBS and diarrhea (40%; P values not provided). In contrast to previous studies, methane production was not found to be more common in patients with IBS with constipation compared with in patients with IBS with diarrhea. These findings highlight that using the lactulose breath test, bacterial overgrowth appears to be fairly common in patients with a variety of GI symptoms. Due to the low specificity of symptoms, the study authors recommend that empirically treating patients for bacterial overgrowth on the basis of symptoms is not warranted."http://www.medscape.com/viewarticle/558253?src=mp


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## 20656 (Aug 30, 2006)

Hi the SCD diet was started up by elaine at the time when she was looking into cures for her daughter who had chrohns. The diet was orignally used much earlier in the century for these purposes IBD etc. However that is not to say that is what it is there for, when taken up it is now used for both IBS symptoms and IBD. i.e. Issues caused by bacteria/yeast/parasites quite often use undigested carbs for survival e.g large intestine, or some move into the small intestine and compete with the body for the food sources. Both will cause various issues, some fermentation/putrification by bacteria etc produce gases like hydrogen sulphide which is for example what can cause the imflamation etc. Some people have used the diet alone and 1-2 yrs later can resume a normal grain/sugar type diet. Others have tried other things like antibiotics, natural anti bacterials/fungals/virals and chelation to get betterHowever depending on what your issues there is a stricter version that is SCD + no fruit and no beans. Its pretty easy to go by symtoms, both emotions and physical. e.g. aggression or constipation. If you really want to confirm if you have issues with a few sugars you can do breath tests, these measure fermentation in both the small and large intestine, shown by gases over a few hrs. e.g Fructose, lastose, glucose. For grain issues you will just have to go by symptoms, bloating, gas, tired, fatigued, constipation, diarrhea etc. There is a yahoo group fructose malabsorbtion which has a file listing sugar content for all foods. You may be able to tolerate certain levels of fructose but its best to stick to foods with either more glucose that fructose or an even ratio. Glucose helps fructose to be absorbed. There are also various yahoo groups where you can ask some questions etc. http://www.breakingtheviciouscycle.info/support/support.htmalso another adult list http://www.healingcrow.com/Phil


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## cynthia (May 9, 2006)

Phil128 said:


> Glucose helps fructose to be absorbed. There are also various yahoo groups where you can ask some questions etc. http://www.breakingtheviciouscycle.info/support/support.htmalso another adult list http://www.healingcrow.com/Phil


If a food was higher in fructose than glucose, would it be reasonable to take glucose tablets with it? Also, what are the yahoo groups for these sorts of questions? Thanks


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## cynthia (May 9, 2006)

So sorry Phil. I think those links were the groups you were talking about. Not sure how I missed that!!C


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## 20656 (Aug 30, 2006)

Hi no problem, yes those links did contain further links to groups. With the glucose tablets I am not sure I don't think it would work but you could try it. I think there is a certain element of the body always being able to process natural foods better than processed and the way I understoon this to work is fructose getting a piggy back. But this is just me trying to understand the theory in simple terms I have never looked into detail and just avoid the foods with high fructose or a high ratio. Its not a good sugar any way from what I gatherPhil


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## cynthia (May 9, 2006)

Phil128 said:


> With the glucose tablets I am not sure I don't think it would work but you could try it. I think there is a certain element of the body always being able to process natural foods better than processed and the way I understoon this to work is fructose getting a piggy back. But this is just me trying to understand the theory in simple terms I have never looked into detail and just avoid the foods with high fructose or a high ratio. Its not a good sugar any way from what I gatherPhil


Why do you think it wouldn't work? I'm not sure if I would know if it was working or not. It actually seems reasonable to me. But I have such limited knowledge of this stuff. Fructose in fruits and honey are natural.


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## Kathleen M. (Nov 16, 1999)

When you body sees a glucose molecule it doesn't know if itis natural or processed.Usually the problem in processed foods the proportions of things are not normal (like more fructose than usual from high fructose corn syrup).Lots of totally natural compounds in their original form cause problems. In processed foods you can get these normal problem compounds in higher amounts (like sorbitol) but they cause as much problem in the foods they come from as they do from processed foods.Natural does not equal safe. Processed doesn't mean unsafe.After all getting Calcium Carbonate from oyster shells may seem more natural than from a lab th "natural" version also can be contaminated with whatever pollution the oyster was exposed to so the lab/man made stuff may be safer a lot of the time.K.


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## cynthia (May 9, 2006)

Kathleen M. said:


> Natural does not equal safe. Processed doesn't mean unsafe.K.


Kathleen, Yes I know. I was just responding to Phil's comment that the body was able to process natural foods better than processed.Do you have any thoughts on taking glucose tablets along with say honey since honey has a higher percentage of fructose than it does glucose?C


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## 20656 (Aug 30, 2006)

Hi I really don't know the answer to that regarding sugars its just a matter of trial and error. The one thing I do know is proteins and fats. When you do heat those or process them they do get damaged, fat can get turned into trans fats, proteins get denatured etc. For example you will probably know the best oil is extra virgin, cold processed, unfiltered etc. Proteins, - raw egg yolk, cold processed, UF/MF whey same thing, steak. The other thing you get with whole foods is the entire package of nutrients which help to digest the food like, the enzymes, vitamins and minerals. To digest anything you require these, without them you need to use your own reserves. e.g I also buy raw goats milk that works wonders for me when also fermented. When it comes down to specifically the absorbtion of sugars though, enzymes don't matter because they are both mono but I don't know exactly how the glucose/fructose thing works. The fructose thing is thought to be a transporter or receptor issue from what I gather. All I have seen reference wise is food based not sugars so I would just give both a go, would be interested how you get on. I can have fairly high sugar things like beets (sucrose -Glucose/fructose) or low sugar fruits with a good ratio and with fats to slow digestion but not apples high fructose


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