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      Frequently Asked Questions About Celiac Disease   09/30/2015

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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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