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Scientific information on fructose malabsorption & FRUCTOSiN®

Scientific information


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


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)


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

0

20

40

60

80

100

120

140

160

Referenz 30 min 60 min 90 min 120 min

H2-breathing testfructose malabsorption

healthy gut fructose malabsorption


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


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


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


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


Fructose malabsorption with FRUCTOSiN®

small intestine

fructose

large intestine

GLUT-5

GLUT-2

no symptoms

glucose

SGLT-1

(XI) bacteria


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.


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


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






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







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



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


SCIOTEC Diagnostic Technologies GmbHZiegelfeldstr. 3A-3430 Tulln an der DonauE-Mail: [email protected]: +43 (0) 22 72 - 62 777

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Scientific information - WordPress.com · histamine intolerance (DAO) ... Scientific information on fructose malabsorption & FRUCTOSiN ... Maltose Stabilizer 97.32 9.73 25.13