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Fructose Intolerances -- What Does The Medical Literature Say?
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Kareng brought up a good point on a different post -- what exactly does the medical literature say about problems eating fructose for people diagnosed with celiac? Some of us have it, but most don't. Is it a leaky gut thing? Is it a different genetic condition? Is there even a third factor that I can't think of right now that might be causing it?

The question spurred me on to better PubMed keyword searching. I think I ID'd some of the key stuff. It's sparse, though, and a lot of it offers no evidence, but just states it as current medical doctrine. Perhaps I can't find better stuff because I don't have a PubMed subscription and lack basic literacy in reading medical studies? I knew I should have taken BioChem in college, but noooo, I wanted to learn Italian.

Anyway, if anyone thinks they may have a severe issue with fructose, please PM me and I can talk with you offline about the fructose stuff, which has a good body of research behind it and a nice group of folks online who can answer questions on it. There's dietary (DFI or fructose malabsorption) and HFI (the scary one that's genetic and causes liver damage). They're basically analgamous to gluten intolerance vs celiac -- both suck but one's proven to be genetic and is more restrictive.

Here's the stuff connecting them that I could find:

Etiology of nonresponsive celiac disease: results of a systematic approach.

"Additional diagnoses accounting for persistent symptoms included: pancreatic insufficiency, irritable bowel syndrome, bacterial overgrowth, lymphocytic colitis, collagenous colitis, ulcerative jejunitis, T-cell lymphoma, pancreatic cancer, fructose intolerance, protein losing enteropathy, cavitating lymphadenopathy syndrome, and tropical sprue."

(http://www.ncbi.nlm.nih.gov/pubmed/12190170)

The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet.

"The causes of diarrhea in 11 patients consenting to this study were microscopic colitis, steatorrhea secondary to exocrine pancreatic insufficiency, dietary lactose or fructose malabsorption, anal sphincter dysfunction causing fecal incontinence, and the irritable bowel syndrome."

via http://listserv.icors.org/scripts/wa-icors.exe?A2=ind0312C&L=CELIAC&F=&S=&P=66360

Celiac (NIH "Gene Review")

"Consultation with an expert dietician to analyze the diet for hidden sources of gluten and to evaluate for lactose or fructose intolerance, which can contribute to poor clinical response to a gluten-free diet...•Assessment for lactose or fructose intolerance is important because these conditions can be responsible for lack of response to the gluten-free diet [Green & Jabri 2003]."

http://www.ncbi.nlm.nih.gov/books/NBK1727/

The Green & Jabri reference is here, but the abstract doesn't help: 30.Green PH, Jabri B. Coeliac disease. Lancet. 2003;362:383–91. [PubMed: 12907013] (http://www.ncbi.nlm.nih.gov/pubmed/12907013)

And two interesting studies (one just a case study) on cooexisting celiac and hereditary fructose intolerance. Yikes! I had thought this was too crazy a hypothesis to be really that likely for me, but it's apparently within the realm of possibilities:

Non responsive celiac disease due to coexisting hereditary fructose intolerance

"An association between these two distinct genetic gastrointestinal disorders is important as treatment failure of celiac disease calls for careful evaluation for hereditary fructose intolerance"

(http://www.ncbi.nlm.nih.gov/pubmed/22461154)

And from the flip side --

Hereditary fructose intolerance and celiac disease: a novel genetic association

"The possibility of an association between these 2 gastrointestinal disorders is important, particularly in the management of HFI patients with persisting symptoms."

(http://www.ncbi.nlm.nih.gov/pubmed/16630753)

Anyone have better research on this than I could find?

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    • gluten intolerance, dairy intolerance and fructose
      I've never gone fructose free so can't help much with that.  But any fruit is probably a problem.  If you are serious about avoiding fructose you could do a search and print out a list of foods to avoid. http://www.mayoclinic.org/fructose-intolerance/expert-answers/faq-20058097 Yes, it very possible to have multiple food intolerance issues.  Many people have multiple food intolerances.  It might help to avoid any foods that are sweet for now.  Meat and most veggies are probably the way to go.  You may want to get some jerky to eat for snacks.  Peanuts might be ok but you'll need to verify that.  Boiled eggs are probably ok.  Most soda would be a no-no.      
    • Help
      Hi Courtney, You asked about dairy, and RMJ got it right.  Celiac disease destroys the villi lining of the small intestine.  Those villi make the lactase enzyme we need to digest dairy. Sigmoid colon thickening could be related to diverticulitis.  Which according to Wiki is a fairly common condition but doesn't always cause symptoms.  Diverticulitis can cause a problem if there is an infection though.  The sigmoid colon is part of the large intestine.  Celiac disease affects the small intestine, so celiac isn't likely involved.  I am not sure why the resident suggested celiac, unless there were some other reason to do so.  Possibly the weight loss, which could be explained by celiac disease.  Thickening of the colon may happen with Crohn's disease also.  And I'm not sure about UCD (ulcerative colitis disease) but it might cause that also, not sure https://en.wikipedia.org/wiki/Diverticulosis https://en.wikipedia.org/wiki/Sigmoid_colon http://biology-pages.info/G/GITract.html#pancreas http://www.ccfa.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/
    • So I've been glutened....
      Hi JMG, Since it's easy, and always fun, I'd blame your sister. That's what I do.  But seriously, if it's an ongoing problem, rather than an isolated incident stick with your first guess.  Then test it.   So get rid of the oat bread or the sister (her food) or anything that is a consistent part of your diet and you suspect could be the problem.  Of course processed foods are the most likely issue always. It's easy enough to drop back to a very few foods for a few days and see if things improve.  Eating with celiac isn't about having the most exciting diet, it's about eating a medically safe diet.  So it can be boring sometimes.  That's ok, being in pain is exciting but not so fun.   Boring is fine. You might ask your sister what brands of flour she used, and other ingredients.  Then check on those products for possible gluten issues.  If they turn out to be possible problems, make a note of it so you can avoid them in the future. My own sister has been gluten-free for years but she has made me sick several times with her "creations".  It really is best to trust your own cooking and nobody else's for at least 6 months as you are getting used to the diet and healing.  Then slowly branch out and add things in maybe 1 new item in a week.  Slow and controlled diet changes are the way to go.  Boring but safe.  Happy but slow.    
    • So I've been glutened....
      Jmg I am sorry to hear you are unwell. You have been so kind and helpful to me on the boards here. You deserve the time to rant too.   Everyone's suggestion of probiotic is helpful. I have taken them since the 1990's in spurts as needed but was told by my DC after this March glutening I should take it daily "for life". My local store ran out, (I buy the type that must be refrigerated so the manufacturer does not ship direct to customer.) I was ok first day without it but by day 3 I knew I had to locate some for the probiotic/ enzyme blend was necessary for me. I have still not healed well enough yet to be without. As others said it could be cc from sis or the food  industry. Within the food industry even with parameters in place errors can be made- hopefully not too often.  Often rare though especially if not designated facility.  It is hard to know some days what it was. I do hope you get better soon. Yes I do think it can affect the brain/mood. Happens to me a large amount can be immediately,  but a smaller amount by day 2 after glutening. I want to ban gluten everywhere in my environments, unrealistic I know,  but have only been able to do that at home.  Be kind and patient with yourself at this time as you would tell me. ((((((Hug)))))
    • So I've been glutened....
      Yeah I did all the bone broths and sauerkraut after my challenge. Although I wasn't very good at making sauerkraut... Its summer here now so I've eased up on the bone boiling, plus my local butcher is struggling to obtain them. As you say healing to the point where microscopic cross contamination doesn't get you would be a big win.  I was ok with coffee until last few days. I drank decaff black and would have several cups a day without issue. I'll be gutted if I can't handle it any more. I hadn't realised you could get gluten-free miso soup. Will have to look for that    
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