Fructose malabsorption
Fructose malabsorption (FM) is a digestive disorder characterized by impaired transport of fructose across the small intestine. This results in increased levels of undigested fructose in the gut, which in turn causes overgrowth of bacteria in the small intestine. Undigested fructose also reduces the absorption of water into the intestine.
The clinical effects of FM include: intestinal dysbiosis, changes in motility, promotion of mucosal biofilm, and decreased levels of tryptophan, folates and zinc in the blood. Symptoms produced include bloating, gas, pain, constipation or diarrhea, vomiting and fatigue (to name a few). Recent research has also
tied fructose malabsorption to depression.
Lest you think this isn’t a common problem, studies have shown that
up to 40% of people in Western countries suffer from fructose malabsorption.
Even in healthy people without fructose malabsorption, however, only about
20-25g of fructose can be properly absorbed at one sitting. Glucose assists in transport of fructose across the intestine, so in general foods with equal amounts of glucose and fructose will be better absorbed than foods with excess amounts of fructose (in relation to glucose).
While fructose malabsorption can cause symptoms in anyone, those with Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD) are particularly affected. While the prevalence of FM is the same in healthy populations and those with IBS & IBD, the
experience of FM appears to be more intense in the latter group. This is probably due to the increased visceral sensitivity common in IBS and IBD patients.
In fact, one of the most promising clinical approaches to treating IBS & IBD right now is something called the FODMAP diet. FODMAP stands for Fermentable Oligo-, Di- and Mono-saccharides And Polyols. These include:
- fructose (fruits, honey, HFCS)
- fructans (wheat, onions)
- lactose (milk sugar)
- polyols (sugar alcohols like sorbitol, xylitol & mannitol, along with fruits like apples, pears and plums)
- galactooligosaccharides (legumes & beans, brussel sprouts, onions)
- other sweeteners like polydextrose and isomalt
Studies have found that
restricting FODMAPs can significantly improve the symptoms associated with IBS, IBD and fructose malabsorption.
What does this have to do with coconut milk, you ask? According to Drs. Gibson & Barrett, experts in fructose malabsorption, coconut milk is is a FODMAP and should be avoided by people with digestive conditions like IBS & IBD.
According to NutritionData.com, coconut milk has very little sugar of any kind – including fructose. Nevertheless, I do have patients that cannot even tolerate homemade coconut milk (which has no guar gum in it), even though they are fine with coconut oil. I assume that they are reacting to the fructos
http://www.mecfs-vic.org.au/sites/www.mecfs-vic.org.au/files/Article-BarrettPractGastro.pdf
3 reasons why coconut milk may not be your friend
On a whim, I emailed Dr. Lustig thanking him for contributing, and I even praised him for his tenacity despite our disagreement. His initial response was cordial, but contentious. The last thing I want to do is spend my time in a private email debate with him. I let him know that the point of our discussion in the first place is to educate the public, so I invited him to re-engage with me over here, for the learning benefit of the readers. He refused.
