Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management

J Am Diet Assoc. 2006 Oct;106(10):1631-9. doi: 10.1016/j.jada.2006.07.010.


Dietary fructose induces abdominal symptoms in patients with fructose malabsorption, but there are no published guidelines on its dietary management. The objective was to retrospectively evaluate a potentially successful diet therapy in patients with irritable bowel syndrome and fructose malabsorption. Tables detailing the content of fructose and fructans in foods were constructed. A dietary strategy comprising avoidance of foods containing substantial free fructose and short-chain fructans, limitation of the total dietary fructose load, encouragement of foods in which glucose was balanced with fructose, and co-ingestion of free glucose to balance excess free fructose was devised. Sixty-two consecutively referred patients with irritable bowel syndrome and fructose malabsorption on breath hydrogen testing underwent dietary instruction. Dietary adherence and effect on abdominal symptoms were evaluated via telephone interview 2 to 40 months (median 14 months) later. Response to the diet was defined as improvement of all symptoms by at least 5 points on a -10- to 10-point scale. Forty-eight patients (77%) adhered to the diet always or frequently. Forty-six (74%) of all patients responded positively in all abdominal symptoms. Positive response overall was significantly better in those adherent than nonadherent (85% vs 36%; P<0.01), as was improvement in individual symptoms (P<0.01 for all symptoms). This comprehensive fructose malabsorption dietary therapy achieves a high level of sustained adherence and good symptomatic response.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Australia
  • Breath Tests
  • Dietetics / standards
  • Female
  • Fructose / administration & dosage*
  • Fructose / adverse effects
  • Fructose / pharmacokinetics*
  • Humans
  • Intestinal Absorption
  • Irritable Bowel Syndrome / diet therapy*
  • Irritable Bowel Syndrome / etiology*
  • Irritable Bowel Syndrome / pathology
  • Irritable Bowel Syndrome / prevention & control
  • Malabsorption Syndromes / complications*
  • Malabsorption Syndromes / diet therapy
  • Male
  • Middle Aged
  • Patient Compliance
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Treatment Outcome


  • Fructose