Fructose malabsorption: causes, diagnosis and treatment

Br J Nutr. 2022 Feb 28;127(4):481-489. doi: 10.1017/S0007114521001215. Epub 2021 Apr 5.


This review intends to act as an overview of fructose malabsorption (FM) and its role in the aetiology of diseases including, but not limited to, irritable bowel syndrome (IBS) and infantile colic and the relationship between fructose absorption and the propagation of some cancers. IBS results in a variety of symptoms including stomach pains, cramps and bloating. Patients can be categorised into two groups, depending on whether the patients’ experiences either constipation (IBS-C) or diarrhoea (IBS-D). FM has been proposed as a potential cause of IBS-D and other diseases, such as infantile colic. However, our knowledge of FM is limited by our understanding of the biochemistry related to the absorption of fructose in the small intestine and FM’s relationship with small intestinal bacterial overgrowth. It is important to consider the dietary effects on FM and most importantly, the quantity of excess free fructose consumed. The diagnosis of FM is difficult and often requires indirect means that may result in false positives. Current treatments of FM include dietary intervention, such as low fermentable oligo-, di-, monosaccharides and polyols diets and enzymatic treatments, such as the use of xylose isomerase. More research is needed to accurately diagnose and effectively treat FM. This review is designed with the goal of providing a detailed outline of the issues regarding the causes, diagnosis and treatment of FM.

Keywords: Breath hydrogen testing; Diagnosis; Fructose malabsorption; Irritable bowel syndrome; Small intestines.

Publication types

  • Review

MeSH terms

  • Breath Tests
  • Colic* / complications
  • Fructose
  • Humans
  • Irritable Bowel Syndrome* / diagnosis
  • Irritable Bowel Syndrome* / etiology
  • Irritable Bowel Syndrome* / therapy
  • Malabsorption Syndromes* / diagnosis
  • Malabsorption Syndromes* / etiology
  • Malabsorption Syndromes* / therapy


  • Fructose