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Coincidental Malabsorption of Lactose, Fructose, and Sorbitol Ingested at Low Doses Is Not Common in Normal Adults

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Abstract

Normal subjects may incompletely absorb either lactose, fructose, or sorbitol and may therefore have abdominal symptoms. The frequency of coincidental malabsorption of these sugars is not known. This is clinically important, since we often ingest them during the same day and malabsorption may cause abdominal symptoms. To shed light on this issue we studied 32 normal subjects. Volunteers drank in random order the following solutions: 20 g lactulose, 50 g sucrose, 50 and 25 g lactose, 50 and 25 g fructose, 20 and 10 g sorbitol. Semiquantitative carbohydrate malabsorption was estimated with lactulose standards. Frequency of 50-g lactose (69%), 50-g fructose (81%), and 20-g sorbitol (84%) malabsorption was not significantly different (P = 0.3). The estimated median fraction of the ingested high dose malabsorbed was 42, 19, and 68% for lactose, fructose, and sorbitol, respectively. At low challenging doses, 63% of the volunteers absorbed two of three or all three sugars, and 88% were asymptomatic to two or all three sugars. In conclusion, the frequency of coincidental malabsorption of lactose, fructose, and sorbitol and intolerance to these sugars is not common, when normal adults ingest them at low doses.

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REFERENCES

  1. Scrimshaw NS, Murray EB: The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Clin Nutr 48:1083-1159, 1988

    Google Scholar 

  2. Ravich WJ, Bayless T, Thomas M: Fructose: Incomplete intestinal absorption in humans. Gastroenterology 84:26-29, 1983

    Google Scholar 

  3. Truswell AS, Seach JM, Thorburn AW: Incomplete absorption of pure fructose in healthy subjects and the facilitating effect of glucose. Am J Clin Nutr 48:1424-1430, 1988

    Google Scholar 

  4. Nelis GF, Vermeeren MAP, Jansen W: Role of fructose-sorbitol malabsorption in the irritable bowel syndrome. Gastroenterology 99:1016-1020, 1990

    Google Scholar 

  5. Ladas S, Papanikos J, Arapakis G: Lactose malabsorption in Greek adults: Correlation of small bowel transit time with the severity of lactose intolerance. Gut 23:968-973, 1982

    Google Scholar 

  6. Hyams JS: Sorbitol intolerance: An unappreciated cause of functional gastrointestinal complaints. Gastroenterology 84:30-33, 1983

    Google Scholar 

  7. Rumessen JJ, Gudmand-Hoyer E: Functional bowel disease: Malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose-sorbitol mixtures. Gastroenterology 95:694-700, 1988

    Google Scholar 

  8. Sahi T: Genetics and epidemiology of adult-type hypolactasia. Scand J Gastroenterol 29:7-20, 1994

    Google Scholar 

  9. Mishkin D, Sablauskas L Yalovsky M, Mishkin S: Fructose and sorbitol malabsorption in ambulatory patients with functional dyspepsia: comparison with lactose maldigestion/malabsorption. Dig Dis Sci 42:2591-2598, 1997

    Google Scholar 

  10. Rumessen JJ, Gudmand-Hoyer E: Absorption capacity of fructose in healthy adults. Comparison with sucrose and its constituent monosaccharides. Gut 27:1161-1168, 1986

    Google Scholar 

  11. Crane RK: The physiology of the intestinal absorption of sugars. In Physiological Effects of Food Carbohydrates. A Jeans, J Hodge (eds). Washington, DC, American Chemical Society, 1975, pp 2-19

    Google Scholar 

  12. Langkilde AM, Andersson H, Schweizer TF, Wursch P: Digestion and absorption of sorbitol, maltitol and isomalt from the small bowel. A study in ileostomy subjects. Eur J Clin Nutr 48:768-775, 1994

    Google Scholar 

  13. Beaugerie L, Flourie B, Marteau P, Pellier P, Franchisseur C, Rambaud J-C: Digestion and absorption in the human intestine of three sugar alcohols. Gastoenterology 99:717-723, 1990

    Google Scholar 

  14. Bond JH, Levitt MD: Quantitative measurement of lactose absorption. Gastroenterology 70:1058-1062, 1976

    Google Scholar 

  15. Ladas SD, Haritos D, Raptis SA: Honey: A readily absorbed nutrient or a mild laxative? Am J Clin Nutr 62:1212-1215, 1995

    Google Scholar 

  16. Levitt MD, Hirsh P, Fetzer CA, Sheahan M, Levine AS. H2 excretion after ingestion of complex carbohydrates. Gastroenterology 92:383-389, 1987

    Google Scholar 

  17. Bond JH, Levitt MD: Use of pulmonary hydrogen (H2) measurement to quantitate carbohydrate absorption. J Clin Invest 51:1219-1225, 1972

    Google Scholar 

  18. Welsh JD, Payne DL, Manion C, Morrison RD, Nichols MA: Interval sampling of breath hydrogen (H2) as an index of lactose malabsorption in lactose-deficient subjects. Dig Dis Sci 26:681-685, 1981

    Google Scholar 

  19. Rumessen JJ, Hamberg O, Gudmand-Hoyer E: Interval sampling of end-expiratory hydrogen (H2) concentrations to quantify carbohydrate malabsorption by means of lactulose standards. Gut 31:37-42, 1990

    Google Scholar 

  20. Fernandez-Banares F, Esteve-Pardo M, de Leon R, Humbert P, Cabre E, Llovet JM, Gassull MA: Sugar malabsorption in functional bowel disease: Clinical implications. Am J Gastroenterol 88:2044-2050, 1993

    Google Scholar 

  21. Ladas SD, Katsiyannaki-Latoufi E, Raptis SA: Lactose maldigestion and milk intolerance in healthy Greek schoolchildren. Am J Clin Nutr 53:670-680, 1991

    Google Scholar 

  22. Beaugerie L, Flourie B, Lemann M, Achour L, Franchisseur C, Rambaud J-C: Sorbitol absorption in the healthy human small intestine is increased by the concomitant ingestion of glucose or lipids. Eur J Gastroenterol Hepatol 7:125-128, 1995

    Google Scholar 

  23. Newcomer AD, McGill DB, Thomas PJ, Hoffmann AF: Prospective comparison of indirect methods for detecting lactase deficiency. N Engl J Med 193:1232-1235, 1975

    Google Scholar 

  24. Metz G, Jenkins DJA, Peters TJ, Newman A Blendis CM: Breath hydrogen as a diagnostic method for hypolactasia. Lancet 2:1155-1157, 1975

    Google Scholar 

  25. Kneepkens CMF: What happens to fructose in the gut? Scand J Gastroenterol 24:1-8, 1989

    Google Scholar 

  26. Coyne MJ, Rodriquez H: Carbohydrate malabsorption in black and Hispanic dialysis patients. Am J Gastroenterol 81:662-665, 1986

    Google Scholar 

  27. Bayless TM, Rothfeld B, Massa C, Wise L, Paige D, Bedine MS: Lactose and milk intolerance: clinical implications. N Engl J Med 292:1156-1159, 1975

    Google Scholar 

  28. Johnson AO, Semenya JG, Buchowski MS, Enwonwu CO, Scrimshaw NS: Correlation of lactose maldigestion, lactose intolerance, and milk intolerance. Am J Clin Nutr 57:399-401, 1993

    Google Scholar 

  29. Lisker R, Aguilar L: Double blind study of milk lactose intolerance. Gastroenterology 74:1283-1285, 1978

    Google Scholar 

  30. Suarez FL, Saviano DA, Levitt MD: A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 333:1-4, 1995

    Google Scholar 

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Ladas, S.D., Grammenos, I., Tassios, P.S. et al. Coincidental Malabsorption of Lactose, Fructose, and Sorbitol Ingested at Low Doses Is Not Common in Normal Adults. Dig Dis Sci 45, 2357–2362 (2000). https://doi.org/10.1023/A:1005634824020

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