Fructose and sorbitol intolerance

  • Summary:

Fructose intolerance is a malabsorption caused by a deficiency of the transporter of this sugar from the cavity or lumen, of intestine to interior of intestinal cells.

This transporter is GLUT5, which also serves to transport sorbitol.

Fructose is passively transported across membranes by a facilitative glucose transporter (GLUT) protein, termed GLUT5.

Among the seven members capable of transporting fructose, the membrane protein, GLUT5 is the only specific transporter for fructose without the ability to transport glucose or galactose.

It should not be confused with fructosemia, a potentially serious hereditary disorder, in which there is a defect in the liver enzyme that breaks down fructose.

Fructosemia is an autosomal recessive disease caused by a genetic defect in fructose 1-phosphate aldolase (aldolase B) in the liver.

Symptoms of aldolase B deficiency begin when the baby is exposed to fructose. Aldolase B deficiency results in phosphate depletion and accumulation of fructose 1-phosphate in the liver.

  • Developing:

When eating a food that contains fructose or sorbitol, symptoms such as diarrhea, gas, flatulence, bloating and abdominal pain arise between 30 minutes and 2 hours after eating.

The intensity of the symptoms depends on the amount ingested and its concentration.

The human body absorbs sorbitol slowly, so the ingestion of large amounts can cause gastrointestinal problems, especially osmotic diarrhea and alter the intestinal flora.

Fructose is used to sweeten foods and is also present in fruits, sugar, and honey.

In general, foods with added fructose are low in nutrition and are best limited in our daily diet.

Whole fruits are healthier options than juices or fruit juices, and vegetables are preferable if fructose is not tolerated.

Fructans are fermentable carbohydrates that are made up of short chains of fructose with a single glucose unit attached.

Sorbitol is used as in dietetic foods. It is classified as a low-nutrition sweetener because each gram contains 2.4 calories, considerably less than the 4 of sucrose or starch and is 400 times more sweet than sucrose.

In addition to being produced synthetically, it is found naturally in is a polyol (sugar alcohol) that we find naturally in some foods.

Especially in fruits that have a stone inside, in their juices, in dehydrated fruit and in vegetables such as green peppers, cabbage and sweet corn.

It is the sweetener that «sugar-free» chewing gums generally contain, given that as it cannot be metabolized by the bacteria in the mouth and induce the appearance of cavities

Fructose can be found in three ways: As free fructose, for example in honey, bound to glucose to form table sugar, and as part of a fructan.

Fructans are multiple molecules of fructose linked to a molecule of glucose, they are found in: onions, artichokes, asparagus, leeks, garlic and lettuce, for example.

Fructose malabsorption can be diagnosed using a hydrogen breath test.

The hydrogen breath test measures the amount of hydrogen in our breath, this gold standard diagnostic test is tested for fructose intolerance.

  • Conclusions:

Foods Recommended in intolerance to fructose and sorbitol:

-Dairy: Milk, cheese, natural yogurt, butter.
– Meats: All without problems.
-Egg: No adverse effects.
-Vegetables: All except those prohibited.
Better to consume them fresh, frozen or canned. Homemade or commercial chips, carrots (no more than 1 small per day). Onion (no more than 1 teaspoon per day).
-Cereals: Oats, wheat, barley, rye, according to tolerance, rice, tapioca and products made from these.
White bread should be limited. Homemade cookies made with glucose instead of sucrose.
-Desserts: without fructose, sucrose or sorbitol.
– Sweeteners: Glucose, corn syrup. Artificial sweeteners yes
– Soups: Homemade using permitted foods. Meat extract, concentrated cubes.
-Condiments: Sauces, dressings, salads, commercial mayonnaise.
-Drinks:Infusions, cocoa (make sure they do not contain sorbitol as a sweetener.
-Condiments: aromatic herbs, spices, essences, Foods Recommended in intolerance to fructose and sorbitol:
-Dairy: Milk, cheese, natural yogurt, butter.
– Meats: All without problems.
-Egg: No adverse effects.
-Vegetables: All except those prohibited.
Better to consume them fresh, frozen or canned. Homemade or commercial chips, carrots (no more than 1 small per day). Onion (no more than 1 teaspoon per day).
-Cereals: Oats, wheat, barley, rye, according to tolerance, rice, tapioca and products made from these.
White bread should be limited. Homemade cookies made with glucose instead of sucrose.
-Desserts: without fructose, sucrose or sorbitol.
– Sweeteners: Glucose, corn syrup. Artificial sweeteners yes
– Soups: Homemade using permitted foods. Meat extract, concentrated cubes.
-Condiments: Sauces, dressings, salads, commercial mayonnaise.
-Drinks:Infusions, cocoa (make sure they do not contain sorbitol as a sweetener.
-Condiments: aromatic herbs, spices, essences.

Prohibited foods in intolerance to fructose and sorbitol:

-Dairy: Milk sweetened with fructose, commercial ice cream with fructose or sorbitol, yogurt with fruit.

– Meats: Sweet ham; stews with vegetables not allowed.
-Vegetables: Peas, lentils, chickpeas, navy beans, corn, root vegetables: turnips, beets, pickles, soybeans, cabbage, tomato.
– Fruits: All, natural or different preparations.
-Cereals: White bread, barley or rye bread is preferable only for toast at breakfast.
– soy flour, muesli, all kinds of cereals with sugar or honey.
-Desserts: Commercial ice cream, chocolate, pastries, commercial cookies, sweet pastries, especially those that are sugar-free, dietetic or for diabetics.
– Sweeteners: Table sugar, molasses, maple syrup, such as fructose or sorbitol, sucralose etc.
-Jams, sweets: dietary sweets, for diabetics, candies or sweets, nuts, chocolate, regular or sugar-free chewing gum.
– Beverages: All those flavored with milk, coffee with the addition of sucrose, shakes, juices, fruit and vegetable smoothies
dyes, salt, pepper, mustard, curry.
-Fats: Butter, margarine, oils.
-Fruits:
Foods with the highest fructose content that can cause intestinal problems are prunes and raisins, pears, cherries, peaches, apples, prunes, applesauce, apple juice, pear juice, apple cider, grapes and dates.
Easily digestible fruit that has minimal effect on the digestive tract is pineapple.
IMPORTANT: it should be borne in mind that both sucrose (common sugar) and sorbitol, a polyalcohol (artificial sweetener, are a source of fructose), if a sweetener is used, aspartame should be chosen, which is an amino acid with a sweet taste.

-References:

-Curr Gastroenterol Rep. Author manuscript; available in PMC 2015 Jan 1.Published in final edited form as:Curr Gastroenterol Rep. 2014 Jan; 16(1): 370.-doi: 10.1007/s11894-013-0370-0

-DOI: 10.1016/S1575-0922(09)71407-X-Food intoleranceAna Zugasti Murillo-Clinical Nutrition and Dietetics Unit. Hospital Virgen del Camino. Pamplona. Navarre. Spain.

-Keywords:

Fructose intolerance and sorbitol, fructose intolerance and chronic diarrhea, fructose intolerance and GLU5 transporter, fructose intolerance and bloating, fructose intolerance and flatulence, fructose intolerance and prohibited foods, fructose intolerance and allowed foods, fructose intolerance and fructosemia, fructose intolerance is not hereditary, fructosemia is hereditary, fructosa y fructanos.

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