https://doi.org/10.1016/j.clnu.2021.01.026

https://pubmed.ncbi.nlm.nih.gov/33551217

Abstract

BACKGROUND and AIMS

Hyperuricemia is an independent risk factor for the metabolic syndrome and cardiovascular disease. We hypothesized that asymptomatic carriers for hereditary fructose intolerance (OMIM 22960) would have increased uric acid and altered component of the metabolic syndrome when exposed to fructose overfeeding.

METHODS

Six heterozygotes for HFI (hHFI) and 6 controls (Ctrl) were studied in a randomized, controlled, crossover trial. Participants ingested two identical test meals containing 0.7 g kg^(-1) glucose and 0.7 g kg^(-1) fructose according to a cross-over design, once after a 7-day on a low fructose diet (LoFruD, <10 g/d) and on another occasion after 7 days on a high fructose diet (HiFruD, 1.4 g kg^(-1)  day^(-1) fructose   0.1 g kg^(-1)  day^(-1) glucose). Uric acid, glucose, and insulin concentrations were monitored in fasting conditions and over 2 h postprandial, and insulin resistance indexes were calculated.

RESULTS

HiFruD increased fasting uric acid (p < 0.05) and reduced fasting insulin sensitivity estimated by the homeostasis model assessment (HOMA) for insulin resistance (p < 0.05), in both groups. Postprandial glucose concentrations were not different between hHFI and Ctrl. However HiFruD increased postprandial plasma uric acid, insulin and hepatic insulin resistance index (HIRI) in hHFI only (all p < 0.05).

CONCLUSIONS

Seven days of HiFruD increased fasting uric acid and slightly reduced fasting HOMA index in both groups. In contrast, HiFruD increased postprandial uric acid, insulin concentration and HIRI in hHFI only, suggesting that heterozygosity for pathogenic Aldolase B variants may confer an increased susceptibility to the effects of dietary fructose on uric acid and hepatic insulin sensitivity. This trial was registered at the U.S. Clinical Trials Registry as NCT03545581.

------------------------------------------ Info ------------------------------------------

Open Access: True

Authors: François-Guillaume Debray - Kevin Seyssel - Marjorie Fadeur - Luc Tappy - Nicolas Paquot - Christel Tran -

Additional links:

https://doi.org/10.1016/j.clnu.2021.01.026

Does anyone of you also have a so called 'hereditary fructose intolerance' (hif)? It's pretty rare - like 1:20000 or 1:150000 depending on the research. Would be lovely to find another beeing in this universe to share some personal experience about it. Have a nice day y'all!

Hi everyone, I have a question and I’m hoping someone knows the answer. Sometimes lactic acidosis is one of the side effects in hereditary fructose intolerance. But why is the lactate accumulating? I know that ATP and phosphate depletion are some of the side effects... is it because there isn’t enough NADH? And why isn’t it turning back into pyruvate? Hope someone can help me :)

I just re-ran my results after about 6 months and this showed up. (Ancestry test). Is this a mistake? Mag 5. https://www.snpedia.com/index.php/rs370793608

So, since I was a kid I never liked sweets. They made my stomach hurt and I’d end out vomiting a ton anytime I ate something sweet. If I only ate a little bit I’d end out shaky and exhibiting signs of low blood sugar. It didn’t really matter if it was candy, or fruit, or a goddamn sweet potato.

My parents never believed me that these foods made me feel ill, and growing up I was just labeled “really picky” and “weird” for preferring vegetables to fruits and salty snacks to sweets. As long as I wasn’t forced to eat something I didn’t like I felt fine. For the most part my parents didn’t give me a hard time, because well, a kid who asks for veggies instead of ice cream is odd, but it certainly makes some things easier.

Fast forward like 20 years and I’m getting genetic testing for a pregnancy done, and it bounces back that i am not just a carrier but “at risk for disease” on hereditary fructose intolerance. I look it up and OH MY GOD. Reactionary hypoglycemia, self selecting a nearly fructose free diet, no dental cavities as an adult... it all made perfect sense.

I still don’t know how to explain it to people... because there are sweet things I can eat fine because they’re sweetened with dextrose or maltose not sucrose or fructose so from the outside I’m fully aware of how it looks... But it’s nice to know I’m not “too picky” or “being difficult” when I say no thank you to foods that make me feel cruddy.

It’s not going to kill me, it would’ve done that when I was a baby if it was going to, but damn after 30 years of being told I was just too picky, it’s nice to know that my “pickiness” was saving my liver and kidneys, and I might be weird, but there’s a REASON.

I understand that it causes low blood sugar due to ATP depletion in hepatic cells and thus less ATP for gluconeogenesis, since there is less DHAP available for glycolysis, and glyceraldehyde can only contribute to glycolysis if phosphorylated with triose kinase, which is not highly expressed in the liver (anything else I'm missing here?)

But as for lactic acidosis, I am quite confused. I don't see how a build up of Fructose-1-Phosphate can result in excess lactic acid being formed. So there is a deficiency in Aldolase B, meaning you can't cleave the F-1-P into DHAP and glyceraldehyde. You're stuck with F-1-P, which I would assume just gets transported into urine but F-1-P can't leave cells unless dephosphorylated, and I am not sure if there is a phosphatase available for that reaction.

Anyway the only means by which lactic acid is formed that I am familiar with is anaerobic respiration (pyruvate -> lactic acid) but seriously I can't think of how a buildup of F-1-P results in lactic acidosis.

Dr Ryan implies in his video that there is the presence of Galactose in urine of patients with HFI. So I wonder is it actually what happens or is it a mistake?

I tht a decreased atp would stimulate glycogenolysis to make glucose for glycolysis?

I have always had a terrible stomach pain and bloating whenever I ate too much fruits since I was a kid. I didn't know that it was related to fructose and my GP even prescribed an EKG to rule out stomach ulcer. Until today I searched online and found out this gene that increases the risk of HFI, it turns out that I have the CC variation, which is the risk-associated allele. This is actually the first thing for me that paid off the cost of 23andme.

Do any of you know if there is any connection between fructose intolerance and h.pylori? (I had h.pylori several years ago and was just diagnosed with fructose malabsorption). Thank you

Has anyone tested positive for fructose intolerance/malabsorption? What were/are your symptoms? My nutritionist wants me to get tested for it because my biggest trigger foods are apples, honey, and brown sugar.

Hi, I've been trying to sort through a couple things.

1. I went gluten-free (not because I had symptoms but to accompany my son).
2. After gluten-free, I noticed better mood but a more sensitive gut (I had NO gut issue whatsoever before).
3. Particularly, after gluten-free, I found that fructose makes me intolerant to a lot of things. For example, milk and beans now give me loads of gas ONLY if I had eaten fructose before. If I don't eat any fructose/fruits, I handle milk and beans just fine.
4. To reiterate #3, I don't seem to have SIBO unless I begin to eat fructose. Also, to reiterate #1, I've had NO gut issue whatsoever before going gluten-free. All these reactions came after.

This is so mysterious I'm pulling my hair off trying to make sense of them. Why? Why? Why?

I wanted to share that I am fructose intolerant as well as SIBO. And I wonder how many of us are like this. I would try to do the elimination diet and it didn’t work and I had no idea that I was eating things that was triggered by the fructose intolerance.

Anyone else like this??

This is just a vent post to get it off of my chest.

I know that an intolerance isn't as severe as an allergy (and I'm so thankful - can't imagine what those of you who have legit anaphylaxis have to go through) but I'm so tired of not being able to eat what I want to eat. I'm tired of feeling like a burden any time people want to cook for me or treat me to a nice dinner out. I'm tired of people saying that a fructose intolerance sounds made up, or, better yet, "Don't you know that's in everything?" (Yes, thanks! I do!)

This whole vent has been triggered by the fact that I found a salsa awhile ago that is low-FODMAP. I ate that salsa for 3 years with ZERO issue, and then last Thanksgiving I started having reactions to jalapeño peppers, and now that salsa (it has jalapeño peppers) is off limits, and I forgot about the jalapeño peppers in it and ate it tonight and now I feel like crap.

My favorite is the restaurant manager one time who personally came out to tell me that if my mom had exposed me to all these foods as a child, I would've built up a tolerance for them... yeah, no thanks, that's what caused the SIBO that I needed a prescription for 3 separate times.

Thank you for listening. If you're a noob with fructose intolerance, feel free to DM me for advice.

I recently was diagnosed with fructose and sucrose intolerance. I have not received any information from my GI about this outside of a couple lists of foods to avoid. It seemed like keto might be the right type of diet to adapt to based off a lot of the foods I need to cut out of my diet. Sadly I’m struggling to find information out there with regards to having both types of intolerances.
I’m curious if anyone here has a similar problems and how they’ve adapted or know of any resources that could help me get a handle on the type of diet to adhere to. Thank you!

Does anyone know where there would be good resources for a patient with fructose intolerance? I recently had a referral for a pt with this intolerance but have never worked with anyone with this condition before.

TIA!

Hi Low FODMAP fam.

I wanted to share news I've come across from Monash's IG account: Within the last month, they approved this Holland based company DISOLUT for manufacturing FODMAP friendly suppliments to help manage a variety of food sensitivities/intolerances. (They even have histamine intolerance suppliments, which I just learn was an issue some people experience.) Where I am in the US, we've have suppliments for lactose and GOS for a long time, but as someone with a fructan sensitivity, my nutritionist basically said "that's too bad because there's no supplement to help with that."

Now there is!

Their FODMAP suppliments come in a couple variations that I saw. There's a couple combination suppliments that target multiple FODMAPs, or you can get singular suppliments to target just one.

Because they're shipping internationally, it does take several weeks for orders to arrive. I purchased a 36 pack of their Fibractase suppliments, and it took about three weeks for them to arrive to me in the northeast US. They are a bit on the pricey side (IMO) as far as suppliments go (I paid about $30-35 for product and standard shipping), but I figure that I'll mainly be using these to help manage my dining options when I'm unable to cook meals for myself (e.i. during travel or social gatherings that include food made by other people). The packaging is rather compact: No individualized blister packaging; the suppliments I got came loose in a small metal tin much like a mini Altoids tin. The tin came shrink wrapped in plastic and stored in a little box. Instructions (not in English on the box, but the website has English translations for instructions) state to use 1-3 tablets at the start of a meal containing the trigger foods.

I haven't mustered the courage (or mental bandwidth) yet to test them out, so I can't report on effectiveness just yet. I plan to do a control test at home since I know the teaspoon amount of garlic I can tolerate before experiencing bloating/nausea symptoms, and then I'll test a challenge amount of garlic without the suppliments and then do another test with the suppliment to compare if it actually worked for me. If anyone is interested, I can make another post with my report.

Hope products like this will become more widely available, but this is a start!

Not as epic as most of the posts I’ve seen on this sub, but here’s my story: A few weeks ago I was offered a new position with a new company. Better pay, better hours, better people, all around better gig for me. I was so happy that I put my two weeks into my current job the next day. Since then I’ve been in consistent contact with my new employer’s HR manager, discussing and setting up everything that needed to be completed before my first day.

Then a few days ago the dreaded email came: criminal background check and DRUG TEST. This was the first time I’ve heard of them requiring a drug test, and my heart sank. I myself am an avid cannabis user, but mostly because it helps with my nonexistent appetite and keeps me from waking up 5+ times a night. I’d get a medical card, but I unfortunately live in a red state (USA) and my lovely governor shuts down the idea every time (He literally thinks marijuana kills babies).

I’ve never in my life gone to work or class stoned because to me that’s just silly. I can’t do it, morally or mentally. But I had 72 hours to complete this test, so I started researching online like a madwoman. I came across this drink called ReadyClean. Sick, I thought, I’ve seen that stuff at the shop where I buy my rolling papers. So I went and got two bottles, one for a mock trial and one for the day of the test. I got a few home drug tests from Walgreens and went home to try it out. I followed the directions PERFECTLY because that’s what all the reviews said to do. A couple hours go by and I’m ready to test it out. Both tests: failed. I was so frustrated that I decided I must not have followed the directions as well as I thought. I decided to try again and drink the second bottle in the morning, the day before the test, and I’ll just buy another bottle for the day of. Big mistake. The next day I tried again with the second bottle. Again, both tests failed. And when I thought things couldn’t get any worse, it all went downhill from there. I was in bed all day with massive stomach cramping, nausea, and occasional vomiting. My stomach hadn’t acted up this bad since before I was diagnosed with my fructose intolerance.. and then it hit me. I grabbed the bottle to scan the back for the ingredients. Guess what was listed as the second major ingredient. If you guessed fructose, you’re spot fucking on. So here I am, laying in bed with some of the worst stomach pain I’ve ever experienced. My test is in the morning.. we’ll see if I even make it. Wi

(This is a Google translation, sorry if some sentences are poorly expressed)

Hi all,

I allow myself to come to you to share my testimony.
I am French I have 36 years ago, 4 years ago just after an anguish crisis I fell in derealization for 2 months and became intolerant with fructose, lactose and galactose and acquired an IBS-D.
Before that I was feeding a lot of wheat, pizza and company. Many dairy products.

I had a lot of digestive problems, lift acid, blood in the stool as well as liver pain, cardiac extrasysules. The worst of everything has sudden is the mental fog, which appears systematically after having consummate dairy products or just galactose hide in some foods.

In France we have bad attention on these problems, I saw several medicine and the only times I advance it is by finding information on the net. I tried fasting several times including one up to 6 days, the Keto regime, the carnivorous regime. In short, the one who goes best remains the lowcarb: some vegetables, a little rice or potatoes and meat.

I also try rifaximine without result. The essential oil of oregano works well, perfect stools and no more fog but hurts the liver quite quickly. This remains a summary of these last years, I also managed to spend several weeks without problems and that's what crosses me the most, have gone to a well being and not know why everything was fine at this moment and not now. What was the food that plunges me into this bad condition ?

What is it on research today, is it an infection has a germ, a fungus, some bacteria?
Is this the fault of an organ that works badly?

Today I do not know what to try, maybe probiotics?

In short, I read a lot on the net, your reddit site is a real mine of information, you are lucky the English-speakers :)

I recently had a colonoscapy and endocospy w/ biopsy and got diagnosed with Fructose Malabsorption & Lactose Intolerance. I couldn't see anything online about either of these being diagnosed through a colonoscapy/endoscopy or biopsies. I'm also wondering since I'm still usually constipated for 2 weeks at a time (6 weeks in a row I've been constipated for 2 weeks, if that makes sense)

EditNote: I was diagnosed through the biopsies while I had the colonoscapy. They had to analyze the biopsies before they diagnosed me. The regular colonoscapy itself results were normal except for irritation.

Hi all,

I’m an occasional Soylent user. I turned my sibling onto it but unfortunately it seems to be making them sick. They’re on a low-FODMAP diet but they’re especially sensitive to fructose, and in some people isomaltulose, the sweetener in Soylent, can metabolize to fructose and cause issues.

However, they liked the convenience and it was very helpful for their getting enough to eat. Does anyone know of any meal powders or RTD options that are, broadly, IBS friendly, or more specifically low-FODMAP and free from isomaltulose?

I do not have Fructose Malabsorption, but my 65 year old mother has had it her entire life. You can imagine the nightmare of restaurants when I was a kid! Here are a few things off the top of my head that I just walk around knowing, in the hope y'all are the people who can use them.

1. Sweet Tarts don't contain fructose. Almost all other sweets do.
2. Anything that can be cooked from scratch in less than 5 minutes is worth learning to do! Specifically, I always think of tomato sauce- a ton of pre-packaged things in the US have at least some added corn syrup for flavor, so learning some basic cooking can really help eliminating some hidden sugars.
3. Almost all bread in US stores is sweetened- unless it's in the actual bakery section of a proper store. A good rule of thumb is, if it was packaged onsite, it's less likely to have sugar in it.
4. Disney is incredible with dietary restrictions- the one place we've never had to send anything back.
5. If you have a favorite food, learn the actual names of the ingredients so you can more easily ask for modifications. For example, if you like Korean food, you may run into issues asking the kitchen about fructose because "sugar and fruit" often is confusing for people. If you really like a particular cuisine, learn the names of the most commonly used sugar products in the cooking and you'll get a better chance of success.

2001 Apr; Fructose malabsorption is associated with decreased plasma tryptophan

1998 Jun 17;3(6):295-8. Fructose malabsorption is associated with early signs of mental depression

I (f27) got diagnosed with Hashimoto’s a month ago, I already have epilepsy, IBS, and depression and after reading a lot of testimonies about people trying AIP and their results I thought I’d give it a try. I’ve only been on it a few days and I’m doing horrible. My digestion is worse, I feel like I’m about to get sick/ vomit a lot, I’ve had more panic attacks than in months, I’m afraid to eat and I’m loosing weight.

How long did it take for you guys to feel better? Was it worth feeling so bad in the beginning or was it so bad in the beginning in general?

Thanks everyone! If I don’t get better I will talk to a dietitian, but I’d love to hear about your stories anyway.

Hello! Just a quick question. When I eat grapes, apples and watermelon I feel very nauseous, even with small amounts. Is this fructose intolerance or something else? Thanks!

My 8yo fairly regularly gets an upset (queasy feeling) stomach immediately after eating, and it subsides within about 10 minutes. After ruling common culprits out (dairy, gluten) and keeping a log, it seems it's always after eating fruit of all things! This morning it was a banana, watermelon before that, cantaloupe before that, apples regularly.

Dr. Google mentions a fructose intolerance. Has anyone experienced this before? She loves fruit so I never imagined it could be the culprit, but it's the only common denominator when the upset occurs.

It took me awhile to narrow it to fruit because she's often eaten multiple things when it occurs, plus it's fruit which I never imagined could be the problem! Other sweet treats containing processed sugar don't seem to affect her which seems odd to me.

Hi all!

I was just diagnosed with rosacea and have been spending the past few weeks massively overhauling my skincare regimen, but am still getting awful flushing episodes after eating. I'm lactose and fructose intolerant, and eliminated lactose several weeks ago. Fructose, on the other hand, is tough for this fruit bat 😁 I have a hard time eliminating food that's supposed to be healthy for you. My question is, does anyone else have an intolerance to fructose and have you experienced a relief in symptoms after eliminating/reducing it from your diet? I just had a terrible flush, for example, brought on by a handful of blueberries 😦

Thanks in advance for any insights!

Kelly

(Brief context, can skip this part): My old doc would just put me off when asking her to add Neomycin or an alternative to the Rifaximin she was always prescribing me (and which wouldn't make me feel better after many rounds), having positive for methane and with high E.coli on my stool tests which is a methane generating bacteria. So I'm trying a new doc.

Before giving me antibiotics, this new doc asking me for an intestinal echography (I don't think that will be useful after comming clean from an endoscopy but I'll do it) and the fructose, lactose and sorbitol breathe tests which measure Hydrogen expired. I already did an Hydrogen+Methane breathe test for SIBO and it came over the top (+80ppm min 30, +140ppm min 60, +200ppm at min 90), but he's dismissing those results saying those tests have nothing to do with a frutose intolerance test.

Afaik, fructose is a monosacharide, lactose is a disacharide and sorbitol is a polyol, and those are feed bacteria that will generate hydrogen (and methane from that hydrogen if also SIBO-C/Archaea). Basically it's the first stuff they forbid you to avoid symptoms, a plain FODMAP diet. So if having SIBO the results of the intolerance tests will be just skewed and give positive.

I just don't wanna lose my time (4h each test, done in 3 different days) and feel miserable all those hours just for having skewed/useless results that prove something else I was already tested for. So my question is: Am I losing my time with this doc and should get another one, or am I just making a flawed logic about the mono/disacharides and polyol, and should just do the tests?

I just learned that I tested positive for lactose and fructose intolerance, and the doctor recommends a low-FODMAP diet for 4-6 weeks. I don’t eat much fructose anyway on keto, but I did eat a lot of dairy. There are good posts in the main keto subreddit about adapting keto for low lactose periods, but I haven’t found anything on how to train while removing those from my diet. My powerlifting club maxed while I tried to go dairy-free last month, and I came up 20# below my previous deadlift max, even on bench and squat, and was very faint by the end of the session. I wasn’t sure what I could eat mid-session for fuel, water wasn’t cutting it ;)

I’m registered for a powerlifting competition in mid-January—I saw it as a motivator to keep up my gym habit over the holidays. I’ve done competitions before on keto, but any type of carb or sugar snacks for energy during that day would be less than ideal now. (I didn’t have these symptoms at my previous competition.)

If anyone has experience lifting while adapting for food intolerance, I’d love to hear how you did it. Thanks!

EDIT: so much valuable feedback; thank you! I should have also noted I’ve been keto since October 2017; these issues only surfaced suddenly in July 2018.

Hi all,

My gf has developed a fructose malabsorption (even before turning vegan) and that's probably what's causing her stomach pain every single day. We already try to eat very little sugar, no fruits etc. but it doesn't help because fructose is everywhere...

According to the doctor she should live completely fructose-free for 1 month and after that slowly start to increase fructose intake over time.

But living fructose-free as a vegan is really hard. "Normal" people could just rely on meat and dairy products but that's not an option, of course. There really aren't many options left after rice and potatoes... Does anyone here have some experience with fructose intolerance as a vegan? Some resources, recipes? Thank you!!

Hi all, my partner just added a next level challenge to cooking.
Besides her celiacs she now also has developed Fructose intolerance and I am really running out of ideas on what to cook.
Any ideas?
Anyone experience with that?
(additional challenge, has to be reheatable and extremely nutricious since she is working as an MD-resident and has not really time for slow eating during the 14 hour workday.)

I just re-ran my results after about 6 months and this showed up. (Ancestry test). Is this a mistake? Mag 5. https://www.snpedia.com/index.php/rs370793608