World Digestive Health Day WDHD – May 29, 2016 CARBOHYDRATE INTOLERANCE (LACTOSE, SUCROSE AND FRUCTOSE): IDENTIFICATION AND TREATMENT, continued The treatment of fructose malabsorption involves mainly the food items, which are rich in fructose. (See Table 4) Patients should be advised to adhere to a low fructose diet (< 10 gm/ day). Emphasis should be given on balanced intake of glucose and fructose. Supplementation of xylose isomerase, which converts fructose into glucose, can also be provided which decrease symptoms of fructose intolerance 15. Table 4: Food items, which are restricted and allowed in patients having fructose intolerance Food items, that which should be avoided Food items, which should be allowed All fruits Fructose, honey, high-fructose corn syrup, sorbitol, jams, gelatin desserts, candies, and all desserts sweetened with fructose Condiments such as barbeque sauce, ketchup, sweet and sour sauce, pancake syrup, and plum sauce Broccoli, carrots, cauliflower, green beans, green peppers, sweet potatoes, and tomatoes Beans and peas All cereals All meat, fish, and eggs All dairy All fats Sugar (sucrose), molasses, and saccharine Pumpkin, radish, scallions, spinach, spinach, white potatoes, shallots, cucumber, and lettuce CONCLUSIONS Amongst the carbohydrate intolerances, lactose intolerance is the most common. Because of overlapping symptoms with other small intestinal diseases, carbohydrate intolerance should be kept in mind and suspected clinically. The mainstay of treatment is avoidance of carbohydrate causing symptoms. REFERENCES 1 Lomer MC. Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther. 2015;41:262-75. 2 Berni Canani R, Pezzella V, Amoroso A. Diagnosing and treating intolerance to carbohydrates in children. Nutrients. 2016;8. 3 Lomer MC, Parkes GC, Sanderson JD. Review article: lactose intolerance in clinical practice--myths and realities. Aliment Pharmacol Ther. 2008;27:93-103. 4 Enattah NS, Sahi T, Savilahti E. Identification of a variant associated with adult-type hypolactasia. Nat Genet. 2002; 30: 233–7. 5 Hammer HF, Hammer J. Diarrhea caused by carbohydrate malabsorption. Gastroenterol Clin North Am. 2012;41:611-27. 6 Raithel M, Weidenhiller M, Hagel AF. The malabsorption of commonly occurring mono and disaccharides: levels of investigation and differential diagnoses. Dtsch Arztebl Int. 2013 ;110:775-82. 7 Di Rienzo T, D’Angelo G, D’Aversa F. Lactose intolerance: from diagnosis to correct management. Eur Rev Med Pharmacol Sci. 2013;17:18-25. 8 Usai-Satta P, Scarpa M, Oppia F. Lactose malabsorption and intolerance: What should be the best clinical management? World J Gastrointest Pharmacol Ther. 2012;3:29-33. 9 Ritz V, Alfalah M, Zimmer KP. Congenital sucrase-isomaltase deficiency because of an accumulation of the mutant enzyme in the endoplasmic reticulum. Gastroenterology. 2003 ;125:1678-85. 10 Bell RR, Draper HH, Bergan JG. Sucrose, lactose, and glucose tolerance in northern Alaskan Eskimos. Am J Clin Nutr. 1973;26:1185-90. 11 Ellestad-Sayed JJ, Haworth JC, Hildes JA. Disaccharide malabsorption and dietary patterns in two Canadian Eskimo communities. Am J Clin Nutr. 1978;31:1473-8. 12 Uhrich S, Wu Z, Huang JY. Four mutations in the SI gene are responsible for the majority of clinical symptoms of CSID. J Pediatr Gastroenterol Nutr. 2012;55:34–5. 13 Escobar MA Jr, Lustig D, Pflugeisen BM. Fructose intolerance/ malabsorption and recurrent abdominal pain in children. J Pediatr Gastroenterol Nutr. 2014;58:498-501. 14 Mishkin D, Sablauskas L, Yalovsky. Fructose and sorbitol malabsorption in ambulatory patients with functional dyspepsia: comparison with lactose maldigestion/malabsorption. Dig Dis Sci.1997;42:2591-8. 15 Komericki P, Akkilic-Materna M, Strimitzer T. Oral xylose isomerase decreases breath hydrogen excretion and improves gastrointestinal symptoms in fructose malabsorption - a double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2012;36:980-7. 24 WGO Handbook on DIET AND THE GUT World Digestive Health Day WDHD May 29, 2016
WGO Handbook on Diet and the Gut_2016_Final
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