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      Frequently Asked Questions About Celiac Disease   09/30/2015

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Free_CountryGirl

Fructose Malabsorption?!?

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Hi everyone, my story in a nutshell is,in the past few years, particularly past 2 years, I have been getting sicker, having problems such as extreme weight gain even though I can hardly eat, feeling all over crappy 24/7, always very very tired, bloating, gas, constipation to the max, intense cravings, mild depression ONLY after I eat carb-loaded/gluten foods, and joint pain. After my doctor tested me for different thyings over and over again, she threw up her hands in despair. When I proposed that I may have a gluten intolerance/celiac, she promptly blew off the idea and I was never tested. So i went gluten-free myself exactly a month ago, and while I have had plenty of accident glutenings in the past month, I have been feeling considerabling better. No more depression, joint pain, crazy fatigue, no more weight gain. But, I have noticed a problem where I seem to get nauseous, bloated, and just... a slow, bleh feeling when I eat foods that contain a quality amount of sugar. For example, I had a peice of gluten free chocolate bark that i made, and I didnt have a huge amount, just a couple squares. Well within the hour I felt rather queasy, hot, tired, just not good. Then later I taste tested some peanut brittle (gluten free) and I had bloating, gas and stomach pains, hot, and just didn't feel well. I have had this problem before, when i ate honey on gluten-free bread. I did some research and came up with Fructose Malabsorption.

Can anyone please explain this in laymans terms to me, and what should I do? Do I have celiacs, or FM? or both?! and what foods can I not eat/ can eat with FM???

Please help! Thank you so much in advance

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It shouldn't be fructose malabsorption*. FM is common, and if your intestines are damaged due to celiac, it's even more likely, but small amounts of those foods shouldn't trigger it. (Fructose isn't an interchangeable word with sugar--it's just a type of sugar.)

People with Fructose Malabsorption need to avoid foods that are heavy on fructose in relation to another sugar, glucose. Table sugar (if that's what's in the chocolate and peanut brittle) is 50% fructose and 50% glucose, and the glucose helps your body digest the fructose, so it shouldn't be a problem. High fructose corn syrup is a much bigger concern, and honey IS heavier on fructose than glucose, though not by that much.

At any rate, you should still be able to tolerate small amounts of fructose, and you don't seem to be eating enough to trigger a problem. You said you've been glutened--it could be that you're having ongoing reactions from the gluten. Whenever I get glutened, I react badly to every meal for the next several days (and up to a week or two.) Doesn't matter what the food is, my intestines don't want to have anything to do with it. So you might consider that possibility.

*my knowledge of fructose malabsorption come from wikipedia and other less than expert-level sites

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Honestly, I'm not sure why a person would have fructose malabsorption. Fructose crosses to the bloodstream without the assistance of anything else (no transporters, no energy required). I don't know how you could have malabsorption of it. It diffuses by itself based on a concentration gradient (more fructose within the intestines than within the cells and blood, so the fructose travels).

I don't know how you COULD malabsorb it.

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Thank you :) Well the peanut brittle was made from regular sugar and High Fructose Corn syrup so that may have been why it caused a problem, if I have FM. It is just so difficult and confusing...I did some research on what someone with FM can or cannot eat, and the list for cannot is....terrifying. I think I might try going...what would you call it? Fructose-free?? Lol, you know what i mean. I know I am definitely cannot have gluten, so I guess I will see how I feel w.o certain high-fructose foods. I eat apples quite often though, and I don't think i have problem with them...although they are suppose to be problematic. Do you think it is possible for FM to be like Celiac, as in when you dont eat gluten for a while and then you eat it again your reaction is more severe, could FM be the same? If so it would make it easy to know if i have it...

anyways thank you :)

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I brought fructose malabsorption up with my daughter's GI. He asked me if she ate a lot of highly processed foods and I said no. He said that unless you're eating a lot of processed foods that contain high fructose corn syrup and things like that then it's not very likely to have fructose malabsorption.

But, if you do suspect it the test is a very simple breath test.

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Thank you Salexander! That helps. I don't really eat processed food very much, or sugary treats, but you know how it is around the hilodays. So I have been eating more sugary foods than usual. Hmm... or maybe I'm just getting sick? goodness who knows, it's so confusing!

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Emilushka, here is an explanation i found that answers your question about malabsorption: "Basically Fructose Malabsorption is a condition where fructose, a simple sugar molecule, is not absorbed properly in the small intestine. It moves through to the large intestine where bacteria munch away on it. When the bacteria digest fructose it produces the symptoms of malabsorption. The degree of malabsorption can vary from individual to individual. Some people are very sensitive."

there you have it :) It is absorbed, just not properly, causing negative side effects

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I know my daughter is really sensitive to even cross contamination, the smallest amount can make her react. She has not been diagnosed yet, we know she has one of the genes and we're now doing a gluten challenge so we can retest her. It took us going pretty basic to see 100% results with her. I would maybe suggest just eating meats, veggies, fruits, and rice and/or quinoa for a couple weeks and see if you have any improvements. If you do then maybe you can challenge certain things and see what you're reacting to. Hope you find some answers soon!

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Hi - I have FM and it is very common and the amount you can tolerate varies widely.

You should research the low FODMAP diet (Sue Shepperd and Monash University) There's a lot of misinformation out there so the booklet from Monash is the most accurate. It's based on a lot of research and it's been working for me so far.

Good luck!

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Thank you :) Well the peanut brittle was made from regular sugar and High Fructose Corn syrup so that may have been why it caused a problem, if I have FM. It is just so difficult and confusing...I did some research on what someone with FM can or cannot eat, and the list for cannot is....terrifying. I think I might try going...what would you call it? Fructose-free?? Lol, you know what i mean. I know I am definitely cannot have gluten, so I guess I will see how I feel w.o certain high-fructose foods. I eat apples quite often though, and I don't think i have problem with them...although they are suppose to be problematic. Do you think it is possible for FM to be like Celiac, as in when you dont eat gluten for a while and then you eat it again your reaction is more severe, could FM be the same? If so it would make it easy to know if i have it...

anyways thank you :)

Limiting the high fructose foods is definitely a good start. Like you discovered above, fm happens when your intestines can't absorb all of the fructose & some makes it to your large intestine. It's not like celiac. It won't matter if you're not eating it for a long time then do eat some--the reaction will be same as if you were eating it regularly. It just depends on how much you eat (enough to make it to the large intestine).

If you still think it might be a problem, just eat small amounts of foods with fructose, spaced throughout the day to give your intestines a break in trying to absorb them.

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country girl:

hi, the many foods you described in your first post do not involve FM- except for the honey. i have some FM- and i feel so much better since eliminating most of the foods. it's a relatively new concept- and if you google Fructose Malabsorption & the FODmap diet-> you're going to find several different variations of food lists. if Fructose or excess Fructose is one of your intolerances- then u may have to trial and error the hard way. (ie: i can handle some tomato... but dates, pears, etc FORGET IT).

i also think its possible that some of these things like FM and Lactose Intolerance, and even food allergies could be maybe temporary for some- many on here after healing can go back to milk, while others cannot.

if you read many posts here- you'll see it's fairly common for those with Celiac or Gluten Intolerance to have additional intolerances: like- other grains, sugar, nightshades, fructose, lactose, etc, etc...

you mentioned peanut brittle- i CANNOT do peanuts AT ALL- they wreck my insides... just like many legumes & beans.

you also mentioned chocolate. it's weird... sometimes i am completely ok with choco.. and sometimes i get nauseaus w/ acid reflux.

it can be quite complicated.. good luck

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I have noticed a problem where I seem to get nauseous, bloated, and just... a slow, bleh feeling when I eat foods that contain a quality amount of sugar. For example, I had a peice of gluten free chocolate bark that i made, and I didnt have a huge amount, just a couple squares. Well within the hour I felt rather queasy, hot, tired, just not good. Then later I taste tested some peanut brittle (gluten free) and I had bloating, gas and stomach pains, hot, and just didn't feel well. I have had this problem before, when i ate honey on gluten-free bread. I did some research and came up with Fructose Malabsorption.

Can anyone please explain this in laymans terms to me, and what should I do? Do I have celiacs, or FM? or both?! and what foods can I not eat/ can eat with FM???

Please help! Thank you so much in advance

Hi Country Girl until your post I knew nothing about Fructose Malabsorption. Your symptoms you described are similiar to mine. I have been on the Celiac diet for over a year now. The major change from following the Celiac diet, was my severe sleep apnea. It went from severe to readings within the normal range.

I have a "leaky gut", and Fructose a corn based sugar, causes me major distress. I am allergic to corn. If I have anything with Fructose, or corn product, my GERDs will act up. Corn, gluten, sulfites (severe allergy) and sulfates seems to be in everything. I don't eat any processed foods. As I have many allergies, my diet lately has become very problematic. I don't know what to eat anymore. Vegetables, fruit have a natural sulfur in them. This sulfur changes to sulfites in our body. I still eat them, but have an ongoing severe rash, constant itch. Sometimes I loose my breath, as if paralized, and have to force myself to think about how to take that breath. It's getting very scary.

The last paragraph is about me.

Look into an allergy to corn. I am going read up on Fructose Malabsorption. Hoping you feel good for the Christmas Holiday.

Merry Christmas and Happy New Years to everyone.

Hugs

Gerri

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Honestly, I'm not sure why a person would have fructose malabsorption. Fructose crosses to the bloodstream without the assistance of anything else (no transporters, no energy required). I don't know how you could have malabsorption of it. It diffuses by itself based on a concentration gradient (more fructose within the intestines than within the cells and blood, so the fructose travels).

I don't know how you COULD malabsorb it.

Fructose malabsorption is rather common. It does not diffuse freely, but rather crosses the intestine by active cotransport with glucose. (Think about cell membrane physiology for a second. There is no way a hydrophylic molecule like sugar could cross a lipid bliayer.) There is a lot of research coming out of Australia about FM. There are two kinds, a rare hereditary fructose intolerance (HFI) that makes people extremely sick from traces of fructose, and a milder form of fructose malabsorption that is common and suspected to be caused partly by a disturbance in intestinal microflora. HFI is usually diagnosed in early childhood, but FM is usually missed.

People with FM show similar signs to lactose intolerance. Bloating, pain, diarrhea, and cramping are the most common signs of it. There can also be some reflux. Usually fructose has to be avoided, or eaten with a little glucose for cotransport. The amount of fructose that's tolerated varies from person to person. Fructo-oligo-saccharides are a problem too, leading to intolerance of some surprising foods like onions, asparagus, brown rice, and wheat. Sucrose is less problematic as it's half fructose, half glucose but most people with FM can still tolerate only limited amounts. Glucose is tolerated well.

Here is an article on a low FODMAP diet.

http://health.glam.com/blogs/healthhypecom/low_fructose_diet_in_fructose_malabsorption/?cat=Health

And a very good website by one of the moderators of the Yahoo FM group.

http://hedra.pbworks.com/w/page/11325076/FrontPage

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country girl:

hi, the many foods you described in your first post do not involve FM- except for the honey. i have some FM- and i feel so much better since eliminating most of the foods. it's a relatively new concept- and if you google Fructose Malabsorption & the FODmap diet-> you're going to find several different variations of food lists. if Fructose or excess Fructose is one of your intolerances- then u may have to trial and error the hard way. (ie: i can handle some tomato... but dates, pears, etc FORGET IT).

i also think its possible that some of these things like FM and Lactose Intolerance, and even food allergies could be maybe temporary for some- many on here after healing can go back to milk, while others cannot.

if you read many posts here- you'll see it's fairly common for those with Celiac or Gluten Intolerance to have additional intolerances: like- other grains, sugar, nightshades, fructose, lactose, etc, etc...

you mentioned peanut brittle- i CANNOT do peanuts AT ALL- they wreck my insides... just like many legumes & beans.

you also mentioned chocolate. it's weird... sometimes i am completely ok with choco.. and sometimes i get nauseaus w/ acid reflux.

it can be quite complicated.. good luck

I was thinking the same thing here. The peanuts and chocolate are higher in lectin content as are legumes. Lectins are supposed to increase gut permeability which is also a problem for someone with a damaged gut. I have stayed away from peanuts and legumes. Makes sense. I used to love them but whenever I would eat any I knew I wouldn't be able to sing the rest of the day. As my gut gets healthier I am able to sing pretty much whenever.. almost makes me feel like an opera singer again.. no, really!

CS

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