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Scientific information on fructose malabsorption & FRUCTOSiN®
Scientific information
Scientific information on fructose malabsorption & FRUCTOSiN®
Adverse reactions to food
Toxic (Food poisoning)
Non toxic
Non immune mediated (food intolerance)
Immune mediated (food allergy)
Resorption, e. g. fructose malabsorptionEnzymatic Undefined Non IgE mediatedIgE mediated
Classification of adverse reactions to food
Modified after recommendation of EAACI (European Academy of Allergy and Clinical Immunology
Allergy vs. Intolerance
Allergy Intolerance
first contact, allergization, IgE-Antibody production no allergization (symptom occurrence anytime)
little amounts of allergen sufficient dose–dependent symptoms
rapid development of symptoms often latency until symptom occurrence
typical clinical pathology allergy-like symptoms
diagnosis: detection of IgE-Antibodies (blood test, skin test) enzyme deficiency testing, often additives responsible
Scientific information on fructose malabsorption & FRUCTOSiN®
Indication Percentage of western population
lactose intolerance 10-30%
fructose malabsorption 5-7%
food allergy 3-5%
histamine intolerance 1-2%
celiac disease 0.5%
fructose intolerance (hereditary) <0.1%
Prevalence
Systematic classification
Enzyme deficiency caused intolerances Further intolerances
lactose intolerance (lactase) celiac disease
histamine intolerance (DAO) fructose malabsorption
hereditary fructose intolerance (Aldolase B)
Scientific information on fructose malabsorption & FRUCTOSiN®
Sugar Structure
O OH
OH
OH
OH
CH2OH
Glucose C6H12O6
O OH
OH
OH
OH
CH2OH
Galactose C6H12O6
O OH
OH
OH
CH2OH
O O
1
4
OH
OH
CH2OH
Lactose C12H22O11
bOH
Glucose: most common sugar, occurrence in almost every foodFructose: natural occurrence in fruits and vegetablesGalactose: part of lactose (Disaccharide composed of galactose and glucose)Sorbitol: used as artificial sweetener
OH
OH
OH
H
H
H
H
HO
CH2OH
CH2OHSorbitol
Fructose Malabsorption vs. Fructose Intolerance• Hereditary fructose intolerance is a very rare enzyme deficiency related to the liver enzyme Aldolase B.• Acquired fructose malabsorption in the small intestine due to reduced activity of the transport protein GLUT-5
O OH
CH2OH
HOH
HO
H
H
CH2OH
Fructose C6H12O6
Facts & Figures• Fructose malabsorption has a prevalence of 5-7% in western population.• Important is the differentiation to hereditary fructose intolerance, an enzyme deficiency which affects approximately
every 25,000 person in Europe. The symptoms are vomitus, hypoglycemia and hepatomegalia, among others.• The tolerated amount of fructose highly varies.• In the majority of cases fructose malabsorption is combined with depression. Maybe this is caused by a decrease of serotonin syntheses.• After consumption of fructose rich food some people have symptoms like flatulence, stomach ache, diarrhea, obstipation and nausea.• Not every person, who cannot absorb fructose, has symptoms.
Diagnosis
• Functional: H2-Breathing test after oral fructose provocation (25-50g fructose – exhalation measurement)
• 25-50g fructose oral: according to decreased fructose absorption in the small intestine, fermentation of the ingested fructose by large intestine bacteria; H2 resorption and exhalation
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Referenz 30 min 60 min 90 min 120 min
H2-breathing testfructose malabsorption
healthy gut fructose malabsorption
Scientific information on fructose malabsorption & FRUCTOSiN®
Occurrence of fructose
• As Monosaccharide in fruits and vegetables• In industrial produced fructose sirup• As Disaccharide in commercial sugar (saccharose)• In fructanes as indigestible oligosaccharide
Fructose absorption
• The Monosaccharide is absorbed in a passive way in the small intestine via GLUT-5 carrier.• GLUT-2 is also able to transport fructose in a passive way, but is normally only integrated in the BLM.
Lumen Enterocyte Blood
Brush-Border Membran (BBM) Basolaterale Membran (BLM)
ATP
GLUT2GLUT5
SGLT1
Fructose
Glucose & Galactose Glucose
Na+ Na+
K+ K+
Fructose
• Approximately 50% of the population show a positive H2 breathing test after oral provocation with 25g fructose• The average fructose consumption per person in America is around 54.7g/d with a maxi-
mum of 72.8g/d. The amount of fructose from natural sources is approximately 13g/d.• Sorbitol inhibits the fructose absorption• Glucose is able to increase the absorption capacity of fructose through induction of GLUT-2 in the BBM.
Facts & Figures
Scientific information on fructose malabsorption & FRUCTOSiN®
Fructose content of various foods
Food g Fructose/100g Serving size [g] Fructose/meal [g]
honey 37.5 25 9
grapes 7.6 150 11
apples 5.7 200 11
soft drinks 5 300 15
sweet pepper 3.7 75 3
bananas 3.6 150 5
pumpkin 1.6 250 4
tomatoes 1.3 125 2
onions 1.1 75 1
green cabbage 1 250 3
potatoes 0.15 250 0
Scientific information on fructose malabsorption & FRUCTOSiN®
small intestine
fructose
large intestine
GLUT-5
SGLT-1GLUT-2
small intestine
fructose
large intestine
GLUT-5
SGLT-1GLUT-2
malabsorption
CO2
H2
CH4
scfa*
symptoms
Normal fructose resorption
Defect fructose resorption (fructose malabsorption)
*scfa: short chain fat acids
bacteria
bacteria
Scientific information on fructose malabsorption & FRUCTOSiN®
Xylose isomerase
• Xylose isomerase (XI) EC 5.3.1.5• XI is a bacterial enzyme, which transforms xylose to xylulose and
therefore is helpful for the degradation of plant material.• The containing isoform of the enzyme in FRUCTOSiN® is obtained from the
bacterium Streptomyces rubiginosus and transforms fructose to glucose.• 2-valent ions as zinc or magnesium are necessary for the catalytic effect
• Low Fructose diet (symptoms depend on the ingested amount of fructose and glucose)
Preference of low fructose fruits (berries, grapefruits,) Avoidance of sugar substitutes (sorbitol, xylitol)• FRUCTOSiN® helps the body to absorb fructose the symptoms of fructose malabsorption can be decreased or even avoided worldwide unique – developed and produced in Austria patent pending
Possible solutions
O
OH OH
OH
HO
HO O
OHOH
OH
HO
HO
O
OHOHHO
CH2
HOO OH
CH2OH
OH
HO
CH2OH
O
OH
CH2OH
OH
HO
CH2OH
a-D-glucopyranose b-D-glucopyranose
b-D-fructofuranose b-D-fructopyranose
a-D-fructofuranose
Scientific information on fructose malabsorption & FRUCTOSiN®
Fructose malabsorption with FRUCTOSiN®
small intestine
fructose
large intestine
GLUT-5
GLUT-2
no symptoms
glucose
SGLT-1
(XI) bacteria
Scientific information on fructose malabsorption & FRUCTOSiN®
User infomation
What is fructose?
Fructose is a monosaccharide naturally present in fruits and vegetables as well as commercial sugar. Usually the con-sumption of fructose is unproblematic. It is transported from the small intesti-ne through the intestinal mucosa to the circulation system via transport protein GLUT 5. Reaching the liver, fructose can be used for the body’s energy generation..
What does fructose malabsorption mean?
Fructose malabsorption means that ingested fructose cannot be absorbed properly in the small intestine, according to a dysfunction of the transport protein GLUT 5. The surplus of fructose is transported to the large intestine where fermentation by bacteria can lead to discomfort in the gastrointestinal tract as well as a reduction of life quality. Fructose malabsorption can occur temporarily or per-manently. Nevertheless the differentiation to allergies or the irritable bowel syndrome is very important.
Which food contains fructose?
An increasing amount of fructose can not only be found in fruits and vegetables, but
also in industrial processed food. Especially food containing more fructose than glucose should be avoided. Furthermore a lot of dia-betic products contain sorbitol, which inhibits fructose absorption. Attached please find a list of food containing fructose (e.g.):
Fruits (grapes, apples, pears,..)
Vegetables (sweet pepper, cabbage, beetroot, ...)
Dried fruit (raisins, dates, figs, …)
Honey, jam, compote and dairy products containing fruits
Fruit juice, fruit tea, fruit syrup and soft drinks
Vinegar, ketchup, mustard, mayonnaise, ready to use gravy
Low fat and diabetic products
Sweets and pastries (e.g. chocolate, cake, pie, ice cream)
Characteristics of FRUCTOSiN®?
FRUCTOSiN® is a worldwide unique food supplement containing the enzyme Xylose Isomerase. This enzyme is able to support the body with the digestion of the surplus of ingested fructose. The consumption of fructose containing food is facilitated naturally.
User information
Food supplement
Ingredients of FRUCTOSIN®
Stabilizer: Microcristalline Cellulose, Capsule: Gelatine, Enzyme, Stabilizer: Maltose, Enteric Coat: Shellac, Stabi-lizer: Hydroxypropycellulose, Sepe-rator: Talc, Thickener: Polyvinylpoly-pyrrolidone, Stabilizer: Hypromellose, Thickener: Acetylated starch, Thickener: Sodiumcarboxymethylcellulose, Moistu-rizer: Glycerol, Acidity regulator: Sodi-um carbonat, Colour: Titandioxide
How to use FRUCTOSiN®?
Take daily 2 capsules with liquid directly before meals. If you should have problems swallowing the whole capsule, you can open it and swallow the ingredients with liquid without chewing.
Important information
FRUCTOSiN® is a food supplement and is not a substitute for a varied and balanced diet or a healthy lifestyle. Not to be used by diabetics and people suffering from heredi-tary (inherited) fructose intolerance. Keep out of reach of children. Store in cool and dry place..
Nutritional information per 2 Capsules pro 100 g
Energy 3.6 kJ/0.9 kcal 692.8 kJ/165.5 kcal
Protein 180.7 mg 35.0 g
Carbohydrate 58.1 mg 11.2 g
Fat < 0.1 mg < 0.1 g
Producer
Sciotec Diagnostic Technologies GmbHA-3430 Tulln, www.sciotec.com
FRU-0110-D/A-PBStand: Januar 2010
FRUCTOSIN® is available in which packaging sizes?
FRUCTOSiN® is available in packages with 10 and 30 capsules.
Scientific information on fructose malabsorption & FRUCTOSiN®
Composition of FRUCTOSiN®
Description E-Nr. mg/g*) g/100g*) mg/Caps*)
Microcristalline Cellulose Stabilizer E460i 272.76 27.28 70.43
Gelatine Capsule 182.94 18.29 47.24
Enzyme Enzyme 167.01 16.70 43.12
Maltose Stabilizer 97.32 9.73 25.13
Shellac Enteric Coat E904 85.37 8.54 22.04
Hydroxypropycellulose Stabilizer E463 79.02 7.90 20.40
Talc Seperator E553b 28.52 2.85 7.36
Polyvinylpolypyrrolidone Thickener E1201 41.61 4.16 10.75
Hypromellose Stabilizer 8.39 0.84 2.17
Acetylated starch Thickener E1420 15.11 1.51 3.90
Sodiumcarboxyme-thylcellulose
Thickener E466 10.44 1.04 2.70
Glycerol Moisturizer E422 5.00 0.50 1.29
Sodium carbonat Acidity regulator 2.80 0.28 0.72
Titandioxide Colour E171 3.72 0.37 0.96
Total 1000.00 100.00 258.20
*) All weights and measures are within 10% production tolerance
Nutrition panel per 2 Caps per 100g
Proteins 180.71 mg 35.0 g
Carbohydrates 58.06 mg 11.2 g
Fat < 0.1 mg < 0.1 g
Calorific Value kJ/2Kaps kcal/2Kaps kJ/100g kcal/100g
3.57 0.85 690.4 164.9
Scientific information on fructose malabsorption & FRUCTOSiN®
Food Fructose content [g/100g]
Sorbitol content [g/100g]
Glucose content [g/100g]
Sucrose content [g/100g]
Apple 5.7 0.51 2.0 2.5
Apricot 0.86 0.80 1.7 5.1
Artichoke 1.5 0 0.53 0.61
Asparagus 1.2 0 0.57 0.31
Aubergine / Eggplant 1.1 0 1.1 0.13
Avocado 0.06 0 0.02 0.02
Banana 3.6 0 3.8 11.0
Bean broad 2.2 0 1.7 0.75
Bean green 0.56 0 0.43 0.20
Bean sprouts 1.1 0 1.1 2.4
Bilberry 4.1 0.01 3.0 0.29
Blackberry 1.3 0 1.30 0.07
Broccoli 0.90 0 1.0 0.48
Brussels sprouts 0.89 0 0.99 1.1
Butterhead lettuce 0.53 0 0.43 0.10
Cabbage turnip 1.1 0 1.3 1.1
Carrot 1.3 0 1.6 1.7
Cauliflower 0.91 0 1.0 0.19
Celery 0.61 0 0.61 0.57
Cep 0.03 0 0.06 0.02
Chard 0.64 0 1.5 0.29
Cherry 6.2 0 6.9 0.20
Chickpea 0.43 0 0.64 0.32
Chicory 0.73 0 1.4 0.19
Chinese Cabbage 0.43 0 0.42 0.30
Cucumber 0.88 0 0.79 0.09
Currant 3.8 0 3.0 0.43
Date 31.3 0 33.6 0.07
Sugar content of various foods
Scientific information on fructose malabsorption & FRUCTOSiN®
Food Fructose content [g/100g]
Sorbitol content [g/100g]
Glucose content [g/100g]
Sucrose content [g/100g]
Endive 0.05 0 0.02 0.22
Fennel 1.1 0 1.3 0.37
Gooseberry 4.0 0 3.6 0.86
Grape 7.6 0.20 7.3 0.44
Grapefruit 2.5 0 2.9 3.5
Honey 37.5 0 33.8 2.3
Honeydew melon 0.58 0 0.68 4.0
Iceberg lettuce 0.63 0 0.63 0.30
Kale / Borecole 0.73 0 0.61 0.67
Kiwi 4.4 0 4.7 1.3
Lamb’s lettuce 0.18 0 0.27 0.25
Leek 1.2 0 0.90 0.53
Lime 0.80 0 0.80 0.30
Nectarine 1.8 0.09 1.8 8.7
Onion 1.1 0 1.7 0.98
Orange 2.9 0 2.5 3.8
Papaya 0.34 0 1.0 1.0
Paprika green 1.2 0 1.5 0.12
Paprika red 3.7 0 2.3 0.06
Pea 0.25 0 0.37 4.9
Peach 1.2 0.89 1.0 5.7
Pear 6.7 2.2 1.7 1.8
Pineapple 2.6 0 2.3 8.3
Potato 0.14 0 0.21 0.28
Prune 2.0 3.4 1.4 3.4
Pumpkin 1.6 0 1.3 0.73
Radicchio 0.60 0 0.60 0.29
Radish 0.64 0 1.4 0.11
Sugar content of various foods
Scientific information on fructose malabsorption & FRUCTOSiN®
Food Fructose content [g/100g]
Sorbitol content [g/100g]
Glucose content [g/100g]
Sucrose content [g/100g]
Raisin 32.3 0 32.7 1.1
Raspberry 2.0 0.01 1.7 1.0
Red Cabbage 1.8 0 1.3 0.35
Sauerkraut 1.0 0.08 0.52 1.0
Savoy Cabbage 0.86 0 0.86 0.60
Sour Cherry 4.8 0 5.8 0.46
Spinach 0.11 0 0.14 0.22
Strawberry 2.3 0.03 2.2 1.0
Tangerine 1.3 0 1.7 7.1
Tomato 1.3 0 1.1 0.10
Watermelon 3.9 0 2.0 2.4
White Cabbage 1.9 0 1.9 0.33
White Mushroom 0.03 0 0.07 0.02
Zucchini 0.70 0 0.60 0.33
Sugar content of various foods
Scientific information on fructose malabsorption & FRUCTOSiN®
Fructose malabsorption:Born P.: Carbohydrate malabsorption in patients with non-specific abdominal complaints; World J Gastroenterol (2007)Gibson P. R., Newnham E., Barrett J. S., Shepard S. J., Muir J.G.: Review article: fructose mal-absorption and the bigger picture; Aliment Pharmacol Ther (2006)Sheperd S. J., Gibson P. R.: Fructose Malabsorption and Symptoms of Irritable Bowel Syndro-me: Guidelines for Effective Dietary Management; J Am Diet Assoc (2006)Drozdowski L. A., Thomson A. B. R.: Intestinal Sugar Transport; World J Gastroenterol (2006)Skoog S. M., Bharucha A. E.: Dietary Fructose and Gastrointestinal Symptoms: A Review; Am J Gastroenterol (2004)Ledochowski M., Widner B., Fuchs D.: Fruktosemalabsorption; J Ernährungsmed (2000)
Histamine intolerance:Pfisterer M., Mayer I.: Histamin-Intoleranz – aktueller Stand der Technik von Diagnose und Therapie; EHK (2008)Maintz L., Novak N.: Histamine and histamine intolerance; AM J Clin Nutr (2007)Missbichler A., Pfister M.: Biogene Amine und Histamin – Genuss oder Verdruss?; Ernähr Aktuell (2007)Maintz L., Bieber T., Novak N.: Die verschiedenen Gesichter der Histamin-Intoleranz – Konsequenzen für die Praxis; Ärzteblatt (2006)Jarisch R.: Histamin-Intoleranz: Ein oft übersehenes Problem; Arzt & Praxis (2005)
Lactose intolerance:Bhatnagar S., Aggarwal R.: Lactose intolerance; BMJ (2007)Hryman M. B.: Lactose Intolerance in Infants, Children and Adolescents; Pediatrics (2006)Montalto M., Curigliano V., Santoro L., Vastola M., Cammarota G., Manna R., Gasbarrini A., Gasbarri-ni G.: Management and treatment of lactose malabsorption; World J Gastroenterol (2006)
Celiac disease:Dubois P. C., van Heel D. A.: Translational Mini-Review Series on the Immunogenetics of Gut Di-sease: Immunogenetics of coeliac disease; Clin Exp Immunol (2008)Kagnoff M.: Celiac disease: pathogenesis of a model immunogenetic disease; J Clin Invest (2007)Van Heel D. A., West J.: Recent advanced in coeliac disease; Gut (2006)Howdle P. D.: Gliadin, glutenen or both? The search for the Holy Grail in coeliac disease; Eur J Gastroenterol Hepatol (2006)Hischenhuber C., Crevel R., Jarry B., Mäkis M., Moneret-Vautrin D. A., Romano A., Troncone R., Ward R.: Review artic-le: safe amounts of gluten for patients with wheat allergy or coeliac disease; Aliment Pharmacol Ther (2005)
Recommended literature
Scientific information on fructose malabsorption & FRUCTOSiN®
SCIOTEC Diagnostic Technologies GmbHZiegelfeldstr. 3A-3430 Tulln an der DonauE-Mail: [email protected]: +43 (0) 22 72 - 62 777
LACTOSOLV® 30 Caps 9,90 €
60 Caps 17,90 €
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