Lactose and Fructose Intolerance

  • Eitan Amir
  • Peter J. Whorwell
Part of the Allergy Frontiers book series (ALLERGY, volume 3)


Intolerance of dietary carbohydrate and sugars can result from a variety of genetically determined enzyme and transporter deficiencies and is a common finding in both normal patients and those with bowel symptoms. In symptomatic patients, these conditions can give rise to bloating, flatulence, abdominal pain and diarrhoea. These non-specific symptoms overlap with other pathological processes and consequently, the diagnosis and management of carbohydrate intolerance can be challenging to clinicians. A number of dietary and pharmacological treatments have been postulated for these conditions and these are described in detail.


Irritable Bowel Syndrome Lactose Intolerance Fructose Absorption Breath Hydrogen Lactase Persistence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fernandez-Banares F, Esteve-Pardo M, de Leon R, Humbert P, Cabre E, Lovet JM, Gassullm A. Sugar malabsorption in functional bowel disease: clinical implications. Am J Gastroenterol 1993; 88: 2044–2050.PubMedGoogle Scholar
  2. 2.
    Scrimshaw NS, Murray EB. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Clin Nutr 1988; 48: 1083–1159.Google Scholar
  3. 3.
    Ravich WJ, Bayless TM, Thomas M. Fructose: incomplete intestinal absorption in humans. Gastroenterology 1983; 84: 26–29.PubMedGoogle Scholar
  4. 4.
    Truswell AS, Seach JM, Thorburn AW. Incomplete absorption of pure fructose in healthy subjects and the facilitating effect of glucose. Am J Clin Nutr 1988; 48: 1424–1430.PubMedGoogle Scholar
  5. 5.
    Nelis GF, Vermeeren MAP, Jansen W. Role of fructose– sorbitol malabsorption in the irritable bowel syndrome. Gastroenterology 1990; 99: 1016–1020.PubMedGoogle Scholar
  6. 6.
    Rumessen JJ, Gudmand-Hoyer E. Functional bowel disease: malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose-sorbitol mixtures. Gastroenterology 1988; 95: 694–700.PubMedGoogle Scholar
  7. 7.
    Shaw AD, Davies GJ. Lactose intolerance: problems in diagnosis and treatment. J Clin Gastroenterol 1999; 28: 208–216.PubMedCrossRefGoogle Scholar
  8. 8.
    Scrimshaw NS, Murray EB. Prevalence of lactose maldigestion. Am J Clin Nutr 1988; 48: 1086–1098.Google Scholar
  9. 9.
    Sahi T. Genetics and epidemiology of adult-type hypolactasia. Scand J Gastroenterol 1994; 29: 7–20.CrossRefGoogle Scholar
  10. 10.
    Rao DR, Bello H, Warren AP, Brown GE. Prevalence of lactose maldigestion: influence and interaction of age, race, and sex. Dig Dis Sci 1994; 39: 1519–1524.PubMedCrossRefGoogle Scholar
  11. 11.
    Szilagyi A, Salomon R, Martin M, Fokeeff K, Seidman E. Lactose handling by women with lactose malabsorption is improved during pregnancy. Clin Invest Med 1996; 19: 416.PubMedGoogle Scholar
  12. 12.
    Villar J, Kestler E, Castillo P, Juarez A, Menendez R, Solomons NW. Improved lactose digestion during pregnancy: a case of physiologic adaptation? Obstet Gynecol 1988; 71: 697.PubMedGoogle Scholar
  13. 13.
    Paige DM, Witter FR, Bronner YL, Kessler LA, Perman JA, Paige TR. Lactose intolerance in pregnant African-American women. J Am Coll Nutr 1997; 16: 488.Google Scholar
  14. 14.
    Launiala K. The effect of unabsorbed sucrose and mannitol on the small intestinal flow rate and mean transit time. Scand J Gastroenterol 1968; 3: 665–671.PubMedGoogle Scholar
  15. 15.
    Christopher NL, Bayless TM. Role of the small bowel and colon in lactose-induced diarrhea. Gastroenterology 1971; 60: 845–852.PubMedGoogle Scholar
  16. 16.
    Ladas S, Papanikos J, Arapakis G. Lactose malabsorption in Greek adults: correlation of small bowel transit time with the severity of lactose intolerance. Gut 1982; 23: 968–973.PubMedCrossRefGoogle Scholar
  17. 17.
    Gilat T, Russo S, Gelman-Malachi E, Aldor TA. Lactase in man: a nonadaptable enzyme. Gastroenterology 1972; 62: 1125–1127.PubMedGoogle Scholar
  18. 18.
    Vonk RJ, Priebe MG, Koetse HA. Lactose intolerance: analysis of underlying factors. Eur J Clin Invest 2003; 33: 70–75.PubMedCrossRefGoogle Scholar
  19. 19.
    Wang Y, Harvey CB, Hollox EJ, Phillips AD, Poulter M, Clay P, Walker-Smith JA, Swallow DM. The genetically programmed down-regulation of lactase in children. Gastroenterology 1998; 114: 1230–1236.PubMedCrossRefGoogle Scholar
  20. 20.
    Cuatrecasas P, Lockwood DH, Caldwell JR. Lactase deficiency in the adult: a common occurrence. Lancet I 1965: 14–18.Google Scholar
  21. 21.
    Enattah NS, Sahi T, Savilahti E, Terwilliger JD, Peltonen L, Jarvela I. Identification of a variant associated with adult-type hypolactasia. Nature Genet 2002; 30: 233–237.PubMedCrossRefGoogle Scholar
  22. 22.
    Rasinpera H, Savilahti E, Enattah NS, Kuokkanen M, Totterman N, Lindahl H, Jarvela I, Kolho KL. A genetic test which can be used to diagnose adult-type hypolactasia in children. Gut 2004; 53: 1571–1576.PubMedCrossRefGoogle Scholar
  23. 23.
    Olds LC, Sibley E. Lactase persistence DNA variant enhances lactase promoter activity in vitro: functional role as a cis regulatory element. Hum Mol Genet 2003; 12: 2333–2340.PubMedCrossRefGoogle Scholar
  24. 24.
    Parry SD, Barton JR, Welfare MR. Is lactose intolerance implicated in the development of post-infectious irritable bowel syndrome or functional diarrhoea in previously asymptomatic people? Eur J Gastroenterol Hepatol 2002; 14: 1225–1230.PubMedCrossRefGoogle Scholar
  25. 25.
    Langman JM, Rowland R. Activity of duodenal disaccharidases in relation to normal and abnormal mucosal morphology. J Clin Pathol 1990; 43: 537–540.PubMedCrossRefGoogle Scholar
  26. 26.
    Szajewska H, Kantecki M, Albrecht P, Antoniewicz J. Carbohydrate intolerance after acute gastroenteritis – a disappearing problem in Polish children. Acta Paediatr 1997; 86: 347–350.PubMedCrossRefGoogle Scholar
  27. 27.
    Bode S, Gudmand-Hoyer E. Incidence and clinical significance of lacose malabsorption in adult coeliac disease. Scand J Gastroenterol 1988; 32: 484–488.CrossRefGoogle Scholar
  28. 28.
    Mishkin B, Yalovsky M, Mishkin S. Increased prevalence of lactose malabsorption in Crohn's disease patients at low risk for lactose malabsorption based on ethnic origin. Am J Gastroenterol 1997; 92: 148–153.Google Scholar
  29. 29.
    Tursi A, Brandimarte G, Giorgetti GM, Elisei W. Transient lactose malabsorption in patients affected by symptomatic uncomplicated diverticular disease of the colon. 1: Dig Dis Sci 2006; 51: 461–465.PubMedCrossRefGoogle Scholar
  30. 30.
    Osterlund P, Ruotsalainen T, Peuhkuri K, Korpela R, Ollus A, Ikonen M, Joensuu H, Elomaa I. Lactose intolerance associated with adjuvant 5-fluorouracil-based chemotherapy for colorec-tal cancer. Clin Gastroenterol Hepatol 2004; 2: 696–703.PubMedCrossRefGoogle Scholar
  31. 31.
    Launiala K. The effect of unabsorbed sucrose and mannitol on the small intestinal flow rate and mean transit time. Scand J Gastroenterol 1968; 3: 665–671.PubMedGoogle Scholar
  32. 32.
    La Brooy SJ, Male PJ, Beavis AK, Misiewicz JJ. Assessment of the reproducibility of the lac-tulose H2 breath test as a measure of mouth to caecum transit time. Gut 1983; 24: 893–896.PubMedCrossRefGoogle Scholar
  33. 33.
    He T, Priebe MG, Welling GW, Vonk RJ. Effect of lactose on oro-cecal transit in lactose digesters and maldigesters. Eur J Clin Invest 2006; 36: 737–742.PubMedCrossRefGoogle Scholar
  34. 34.
    Christopher NL, Bayless TM. Role of the small bowel and colon in lactose-induced diarrhoea. Gastroenterology 1971; 60: 845–852.PubMedGoogle Scholar
  35. 35.
    Argenyi EE, Soffer EE, Madsen MT, Berbaum KS, Walkner WO. Scintigraphic evaluation of small bowel transit in healthy subjects: inter- and intrasubject variability. Am J Gastroenterol 1995; 90: 938–942.PubMedGoogle Scholar
  36. 36.
    Degen LP, Phillips SF, Kost L, Thomforde G. Does the menstrual cycle really influence gastrointestinal transit? Gastroenterology 1994; 106: A484.Google Scholar
  37. 37.
    Read NW. Small bowel transit time of food in man: measurement, regulation and possible importance. Scand J Gastroenterol Suppl 1984; 96: 77–85.PubMedGoogle Scholar
  38. 38.
    Tursi A. Clinical implications of delayed orocecal transit time and bacterial overgrowth in adult patients with Crohn's disease. J Clin Gastroenterol 2001; 32: 274–275.PubMedCrossRefGoogle Scholar
  39. 39.
    Tursi A, Brandimarte G, Giorgetti GM, Nasi G. Assessment of orocecal transit time in different localisation of Crohn's disease and its possible influence on clinical response to therapy. Eur J Gastroenterol Hepatol 2003; 15: 69–74.PubMedCrossRefGoogle Scholar
  40. 40.
    Husebye E. Gastrointestinal motility disorders and bacterial overgrowth. J Intern Med 1995; 237: 419–427.PubMedCrossRefGoogle Scholar
  41. 41.
    Tursi A. Factors influencing lactose intolerance. Eur J Clin Invest 2004; 34: 314–315.PubMedCrossRefGoogle Scholar
  42. 42.
    Joseph F, Rosenberg AJ. Breath hydrogen testing: diseased versus normal patients. J Pediatr Gasterenterol Nutr 1988; 7: 787–791.CrossRefGoogle Scholar
  43. 43.
    Matthews SB, Waud JP, Roberts AG, Campbell AK. Systemic lactose intolerance: a new perspective on an old problem. Postgrad Med J 2005; 81: 167–173.PubMedCrossRefGoogle Scholar
  44. 44.
    Fauchi AS, Braunwald E, Isselbacher KJ. Disorders of the gastrointestinal system. In: Harrison's principles of internal medicine. 14th ed. New York: McGraw-Hill; 1998: 631 pp.Google Scholar
  45. 45.
    Shaw AD, Davies GJ. Lactose intolerance: problems in diagnosis and treatment. J Clin Gastroenterol 1999; 28: 208–216.PubMedCrossRefGoogle Scholar
  46. 46.
    Büning C, Genschel J, Jurga J, Fiedler T, Voderholzer W, Fiedler E-M, Worm M, Weltrich R, Lochs H, Schmidt H, Ockenga J. Introducing genetic testing for adult-type hypolactasia. Digestion 2005; 71: 245–250.PubMedCrossRefGoogle Scholar
  47. 47.
    Swallow DM. DNA test for hypolactasia premature. Gut 2006; 55: 131–132.PubMedGoogle Scholar
  48. 48.
    Swallow DM. Genetics of lactase persistence and lactose intolerance. Annu Rev Genet 2003; 37: 197–219.PubMedCrossRefGoogle Scholar
  49. 49.
    Troelsen JT, Olsen J, Moller J, Sjostrom H. An upstream polymorphism associated with lactase persistence has increased enhancer activity. Gastroenterology 2003; 125: 1686–1694.PubMedCrossRefGoogle Scholar
  50. 50.
    Suarez FL, Savaiano DA, Levitt MD. Review article: the treat- treatment of lactose intolerance. Aliment Pharmacol Ther 1995; 9: 589–597.PubMedGoogle Scholar
  51. 51.
    Di Stefano M, Veneto G, Malservisi S, Cecchetti L, Minguzzi L, Strocchi A, Corazza GR. Lactose malabsorption and intolerance and peak bone mass. Gastroenterology 2002; 122: 1793–1799.PubMedCrossRefGoogle Scholar
  52. 52.
    Rask Pedersen E, Jensen BH, Jensen HJ, Keldsbo IL, Hylander Moller E, Norby Rasmussen S. Lactose malabsorption and tolerance of lactose-hydrolyzed milk. A double-blind controlled crossover study. Scand J Gastroenterol 1982; 17: 861–864.Google Scholar
  53. 53.
    Onwulata CI, Rao DR, Vankineni P. Relative efficiency of yogurt, sweet acidophilus milk, hydrolyzed-lactose milk, and a commercial lactase tablet in alleviating lactose maldigestion. Am J Clin Nutr 1989; 49: 1233–1237.PubMedGoogle Scholar
  54. 54.
    Reasoner J, Maculan TP, Rand AG, Thayer WR Jr. Clinical studies with low-lactose milk. Am J Clin Nutr 1981; 34: 54–60.PubMedGoogle Scholar
  55. 55.
    Nielsen OH, Schiotz PO, Rasmussen SN, Krasilnikoff PA. Calcium absorption and acceptance of low-lactose milk among children with primary lactase deficiency. J Pediatr Gastroenterol Nutr 1984; 3: 219–223.PubMedGoogle Scholar
  56. 56.
    Solomons NW, Guerrero AM, Torun B. Dietary manipulation of postprandial colonic lactose fermentation: II. Addition of exogenous, microbial beta-galactosidases at mealtime. Am J Clin Nutr 1985; 41: 209–221.Google Scholar
  57. 57.
    Barillas C, Solomons NW. Effective reduction of lactose maldigestion in preschool children by direct addition of betagalactosidases to milk at mealtime. Pediatrics 1987; 79: 766–772.PubMedGoogle Scholar
  58. 58.
    Lin MY, Dipalma JA, Martini MC, Gross CJ, Harlander SK, Savaiano DA. Comparative effects of exogenous lactase (betagalactosidase) preparations on in vivo lactose digestion. Dig Dis Sci 1993; 38: 2022–2027.PubMedCrossRefGoogle Scholar
  59. 59.
    Montalto M, Nucera G, Santoro L, Curigliano V, Vastola M, Covino M, Cuoco L, Manna R, Gasbarrini A, Gasbarrini G. Effect of exogenous beta-galactosidase in patients with lactose malabsorption and intolerance: a crossover double-blind placebo-controlled study. Eur J Clin Nutr 2005; 59: 489–493.PubMedCrossRefGoogle Scholar
  60. 60.
    Flood MT, Kondo M. Toxicity evaluation of a beta-galactosidase preparation produced by Penicillium multicolor. Regul Toxicol Pharmacol 2004; 40: 281–292.PubMedCrossRefGoogle Scholar
  61. 61.
    DiPalma JA, Collins MS. Enzyme replacement for lactose malabsorption using a beta-D-galactosidase. J Clin Gastroenterol 1989; 11: 290–293.PubMedCrossRefGoogle Scholar
  62. 62.
    Adolfsson O, Meydani SN, Russell RM. Yogurt and gut func- function. Am J Clin Nutr 2004; 80: 245–256.PubMedGoogle Scholar
  63. 63.
    Hove H, Norgaard H, Mortensen PB. Lactic acid bacteria and the human gastrointestinal tract. Eur J Clin Nutr 1999; 53: 339–350.PubMedCrossRefGoogle Scholar
  64. 64.
    Bourlioux P, Pochart P. Nutritional and health properties of yogurt. World Rev Nutr Diet 1988; 56: 217–258.PubMedGoogle Scholar
  65. 65.
    McDonough FE, Hitchins AD, Wong NP, Wells P, Bodwell CE. Modification of sweet acidophilus milk to improve utilization by lactose-intolerant persons. Am J Clin Nutr 1987; 45: 570–574.PubMedGoogle Scholar
  66. 66.
    Savaiano DA, AbouElAnouar A, Smith DE, Levitt MD. Lac- Lactose malabsorption from yogurt, pasteurized yogurt, sweet acidophilus milk, and cultured milk in lactase-deficient individuals. Am J Clin Nutr 1984; 40: 1219–1223.PubMedGoogle Scholar
  67. 67.
    Onwulata CI, Rao DR, Vankineni P. Relative efficiency of yogurt, sweet acidophilus milk, hydrolyzed-lactose milk, and a commercial lactase tablet in alleviating lactose maldigestion. Am J Clin Nutr 1989; 49: 1233–1237.PubMedGoogle Scholar
  68. 68.
    de Vrese M, Stegelmann A, Richter B, Fenselau S, Laue C, Schrezenmeir J. Probiotics – compensation for lactase insufficiency. Am J Clin Nutr 2001; 73: 421S–429S.PubMedGoogle Scholar
  69. 69.
    Lin MY, Yen CL, Chen SH. Management of lactose maldigestion by consuming milk containing lactobacilli. Dig Dis Sci 1998; 43: 133–137.PubMedCrossRefGoogle Scholar
  70. 70.
    Labayen I, Forga L, Gonzalez A, Lenoir-Wijnkoop I, Nutr R, Martinez JA. Relationship between lactose digestion, gastrointestinal transit time and symptoms in lactose malabsorbers after dairy consumption. Aliment Pharmacol Ther 2001; 15: 543–549.PubMedCrossRefGoogle Scholar
  71. 71.
    Peuhkuri K, Vapaatalo H, Nevala R, Korpela R. Influence of the pharmacological modification of gastric emptying on lactose digestion and gastrointestinal symptoms. Aliment Pharmacol Ther 1999; 13: 81–86.PubMedCrossRefGoogle Scholar
  72. 72.
    Szilagyi A, Salomon R, Seidman E. Influence of loperamide on lactose handling and oral-caecal transit time. Aliment Pharmacol Ther 1996; 10: 765–770.PubMedCrossRefGoogle Scholar
  73. 73.
    Leichter J. Comparison of whole milk and skim milk with aqueous lactose solution in lactose tolerance testing. Am J Clin Nutr 1973; 26: 393–396.PubMedGoogle Scholar
  74. 74.
    Vesa TH, Marteau PR, Briet FB, Boutron-Ruault MC, Rambaud JC. Raising milk energy content retards gastric emptying of lactose in lactose-intolerant humans with little effect on lactose digestion. J Nutr 1997; 127: 2316–2320.PubMedGoogle Scholar
  75. 75.
    Johnson AO, Semenya JG, Buchowski MS, Enwonwu CO, Scrimshaw NS. Adaptation of lactose maldigesters to contin- continued milk intakes. Am J Clin Nutr 1993; 58: 879–881.PubMedGoogle Scholar
  76. 76.
    Hertzler SR, Savaiano DA. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Am J Clin Nutr 1996; 64: 232–236.PubMedGoogle Scholar
  77. 77.
    Hertzler SR, Savaiano DA, Levitt MD. Fecal hydrogen pro- production and consumption measurements. Response to daily lactose ingestion by lactose maldigesters. Dig Dis Sci 1997; 42: 348–353.Google Scholar
  78. 78.
    Hill MJ. Bacterial adaptation to lactase deficiency. Delmont J, ed. Milk intolerances and rejection. Basel, Switzerland: Karger, 1983: pp. 22–26.Google Scholar
  79. 79.
    Perman JA, Modler S, Olson AC. Role of pH in production of hydrogen from carbohydrates by colonic bacterial flora. Studies in vivo and in vitro. J Clin Invest 1981; 67: 643–650.PubMedCrossRefGoogle Scholar
  80. 80.
    Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC. Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? Gut 1997; 41: 632–635.PubMedGoogle Scholar
  81. 81.
    Montalto M, Curigliano V, Santoro L, Vastola M, Cammarota G, Manna R Gasbarrini A and Gasbarrini G. Management and treatment of lactose malabsorption. World J Gastroenterol 2006; 12: 187–191.PubMedGoogle Scholar
  82. 82.
    Kibbe AH, ed. Handbook of pharmaceutical excipients: American Pharmaceutical Association. London: Washington and the Pharmaceutical Press; 2000: pp. 276–285.Google Scholar
  83. 83.
    Lieb J, Kazienko DJ. Lactose filler as a cause of 'drug-induced' diarrhea. N Engl J Med 1978; 299: 314.PubMedGoogle Scholar
  84. 84.
    Brandstetter RD, Conetta R, Glazer B. Lactose intolerance associated with Intal capsules. N Eng J Med 1986; 315: 1613–1614.CrossRefGoogle Scholar
  85. 85.
    Malen DG. Parnate formulation change. J Clin Psychiatry 1992; 53: 328–329.PubMedGoogle Scholar
  86. 86.
    Petrini L, Usai P, Caradonna A, Cabula R, Mariotti S. Lactose intolerance following antithy-roid drug medications. J Endocrinol Invest 1997; 20: 569–570.PubMedGoogle Scholar
  87. 87.
    Honkanen R, Pulkkinen P, Jarvinen R, Kroger H, Lindstedt K, Tuppurainen M, Uusitupa M. Does lactose intolerance predispose to low bone density? A population based study of peri-menopausal Finnish women. Bone 1996; 19: 23–28.PubMedCrossRefGoogle Scholar
  88. 88.
    Slemenda C, Christian J, Hui S, Fitzgerald J, Johnston C. No evidence for an effect of lactase deficiency on bone mass in pre-or postmenopausal women. J Bone Miner Res 1991; 6: 1367–1371.PubMedCrossRefGoogle Scholar
  89. 89.
    Kudlacek S, Freudenthaler O, Weissboeck H, Schneider B, Willvonseder R. Lactose intolerance: a risk factor for reduced bone mineral density and vertebral fractures? J Gastroenterol 2002; 37: 1014–1019.PubMedCrossRefGoogle Scholar
  90. 90.
    Rumessen JJ. Fructose and food related carbohydrates. Sources, intake, absorption, and clinical implications. Scand J Gastroenterol 1992; 27: 819–828.PubMedCrossRefGoogle Scholar
  91. 91.
    Rumessen JJ, Gudmand-Hoyer E. Absorption capacity of fructose in healthy adults. Comparison with sucrose and its constituent monosaccharides. Gut 1986; 27: 1161–1168.Google Scholar
  92. 92.
    Mishkin D, Sablauskas L, Yalovsky M, Mishkin S. Fructose and sorbitol malabsorption in ambulatory patients with functional dyspepsia. Comparison with lactose maldigestion/ malabsorption. Dig Dis Sci 1997; 42: 2591–2598.Google Scholar
  93. 93.
    Choi YK, Johlin FC Jr, Summers RW, Jackson M, Rao SS. Fructose intolerance: an under-recognized problem. Am J Gastroenterol 2003; 98: 1348–1353.PubMedCrossRefGoogle Scholar
  94. 94.
    Truswell AS, Seach JM, Thorburn AW. Incomplete absorption of pure fructose in healthy subjects and the facilitating effect of glucose. Am J Clin Nutr 1988; 48: 1424–1430.PubMedGoogle Scholar
  95. 95.
    Fernandez-Banares F, Esteve-Pardo M, de Leon R, Humbert P, Cabre E, Llovet JM, Gassull MA. Sugar malabsorption in functional bowel disease: clinical implications. Am J Gastroenterol 1993; 88: 2044–2050.PubMedGoogle Scholar
  96. 96.
    Bueno L, de Ponti F, Fried M, Kullak-Ublick GA, Kwiatek MA, Pohl D, Quigley EM, Tack J, Talley NJ. Serotonergic and non-serotonergic targets in the pharmacotherapy of visceral hypersensitivity. Neurogastroenterol Motil 2007; 19: 89–119.PubMedCrossRefGoogle Scholar
  97. 97.
    Wasserman D, Hoekstra JH, Tolia V, Taylor CJ, Kirschner BS, Takeda J, Bell GI, Taub R, Rand EB. Molecular analysis of the fructose transporter gene (GLUT5) in isolated fructose malabsorption. J Clin Invest 1996; 98: 2398–2402.PubMedCrossRefGoogle Scholar
  98. 98.
    Burant CF, Saxena M. Rapid reversible substrate regulation of fructose transporter expression in rat small intestine and kidney. Am J Physiol 1994; 267: G71–G79.PubMedGoogle Scholar
  99. 99.
    Mesonero J, Matosin M, Cambier D, Rodriguez-Yoldi MJ, Brot-Laroche E. Sugar-dependent expression of the fructose transporter GLUT5 in Caco-2 cells. Biochem J 1995; 312: 757–762.PubMedGoogle Scholar
  100. 100.
    Gouyon F, Caillaud L, Carriere V, Klein C, Dalet V, Citadelle D, Kellett GL, Thorens B, Leturque A, Brot-Laroche E. Simple-sugar meals target GLUT2 at enterocyte apical membranes to improve sugar absorption: a study in GLUT2-null mice. J Physiol 2003; 552: 823–832.PubMedCrossRefGoogle Scholar
  101. 101.
    Corpe CP, Bovelander FJ, Munoz CM, Hoekstra JH, Simpson IA, Kwon O, Levine M, Burant CF. Cloning and functional characterization of the mouse fructose transporter, GLUT5. Biochim Biophys Acta 2002; 1576: 191–197.PubMedGoogle Scholar
  102. 102.
    Hoekstra JH, van den Aker JH. Facilitating effect of amino acids on fructose and sorbitol absorption in children. J Pediatr Gastroenterol Nutr 1996; 23: 118–124.PubMedCrossRefGoogle Scholar
  103. 103.
    Rumessen JJ, Gudmand-Hoyer E. Malabsorption of fructose-sorbitol mixtures. Interactions causing abdominal distress. Scand J Gastroenterol 1987; 22: 431–436.Google Scholar
  104. 104.
    Riby JE, Fujisawa T, Kretchmer N. Fructose absorption. Am J Clin Nutr 1993; 58: 748S–753S.PubMedGoogle Scholar
  105. 105.
    Shi X, Schedl HP, Summers RM, Lambert GP, Chang RT, Xia T, Gisolfi CV. Fructose transport mechanisms in humans. Gastroenterology 1997; 113: 1171–1179.PubMedCrossRefGoogle Scholar
  106. 106.
    Fine KD, Santa Ana CA, Porter JL, Fordtran JS. Mechanism by which glucose stimulates the passive absorption of small solutes by the human jejunum in vivo. Gastroenterology 1994; 107: 389–395.PubMedGoogle Scholar
  107. 107.
    Elias E, Gibson GJ, Greenwood LF, Hunt JN, Tripp JH. The slowing of gastric emptying by monosaccharides and disaccharides in test meals. J Physiol 1968; 194: 317–326.PubMedGoogle Scholar
  108. 108.
    Hyams JS. Sorbitol intolerance: an unappreciated cause of functional gastrointestinal complaints. Gastroenterology 1983; 84: 30–33.PubMedGoogle Scholar
  109. 109.
    Summers RW, Johlin FC. Fructose intolerance is due to rapid orocecal transit and not small bowel bacterial overgrowth. Gastroenterology 2001; 120: A1369.Google Scholar
  110. 110.
    Romagnuolo J, Schiller D, Bailey RJ. Using breath tests wisely in a gastroenterology practice: an evidence-based review of indications and pitfalls in interpretation. Am J Gastroenterol 2002; 97: 1113–1126.PubMedCrossRefGoogle Scholar
  111. 111.
    Doma S, Gaddipati K, Fernandez A, Friedenberg F, Bromer M, Parkman H. Results of the fructose breath test in healthy controls using different doses of fructose: which dose is best? Am J Gastroenterol 2003; 98: S265.CrossRefGoogle Scholar
  112. 112.
    Skoog SM, Bharucha AE. Dietary fructose and gastrointestinal symptoms: a review. Am J Gastroenterol 2004; 99: 2046–2050.PubMedCrossRefGoogle Scholar
  113. 113.
    Strocchi A, Levitt MD. Factors affecting hydrogen production and consumption by human fecal flora. The critical roles of hydrogen tension and methanogenesis. J Clin Invest 1992; 89: 1304–1311.Google Scholar
  114. 114.
    Shepherd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc 2006; 106: 1631–1639.PubMedCrossRefGoogle Scholar
  115. 115.
    Moshfegh AJ, Friday JE, Goldman JK, Ahuja JP. Presence of inulin and oligofructose in the diets of Americans. J Nutr 1999; 129: S1407–S1411.Google Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Eitan Amir
    • 1
  • Peter J. Whorwell
    • 2
  1. 1.Department of Medical OncologyChristie Hospital NHS TrustManchester
  2. 2.Education and Research Centre, Wythenshawe HospitalUniversity Hospitals of South ManchesterWythenshaweUK

Personalised recommendations