To your good health — Fructose intolerance is, unfortunately, rarely diagnosed

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By Keith Roach, M.D.

Signal Contributing Writer

Dear Dr. Roach hat can you tell me about fructose intolerance and/or malabsorption? Is there a genetic predisposition to this? Can it develop later in life? What are the symptoms, and how is it diagnosed? What type of doctor can best make a diagnosis?

My father was diagnosed with some sort of fructose problem years ago. I have no other information about his condition as he has passed away.

I have developed some intestinal issues over the past year and have noticed I frequently experience stomach cramps after eating grapes and green apples, specifically. I am a vegetarian, and my diet consists of lots of fruits and vegetables. I’m wondering if I may have an issue with fructose. I hope not! What are your thoughts?

— D.K.

Answer: ructose intolerance is common, but it is seldom diagnosed. One cause, hereditary fructose intolerance, is a genetic disorder that can cause serious symptoms in infants and children, but it is usually mild in adults.

The symptoms of fructose intolerance are very similar to another sugar intolerance — lactose, the sugar in milk. Many people cannot tolerate lactose and if they eat too much of it will have cramping and diarrhea.

Unlike lactose intolerance, which has a simple diagnostic breath test, there is no commonly available test for fructose intolerance.

Fructose is a simple sugar, called a monosaccharide, and is found in many fruits, especially apples, pears, cherries and dates. Fructose is also found in honey and is part of the disaccharide sucrose (table sugar), where it is combined with glucose. What is fascinating yet poorly understood is that when fructose is consumed with glucose, it is absorbed better by people with fructose intolerance.

Therefore, the goal in someone with inability to absorb fructose is to reduce or avoid fructose by itself. That means reducing foods and beverages sweetened with high-fructose corn syrup, which is present in many products; eating high-fructose fruits only with meals; and reducing honey intake.

Sorbitol, a sugar alcohol used as a sweetener in “diet” or “sugarless” foods, tends to worsen fructose intolerance and should be avoided.

A vegetarian diet is very healthy for most people, and you shouldn’t have to give up your fruits. Just following some simple rules should reduce or eliminate your symptoms.

Dear Dr. Roach ou have mentioned diseases of the blood marrow before, but what does the bone marrow actually do?

— T.S.B.

Answer he main job of the bone marrow is to produce the different blood cells: red blood cells to carry oxygen, white blood cells to fight infection and cancers, and platelets to stop bleeding. Diseases of the bone marrow can cause problems by making something abnormal (such as leukemia cells), but also by failing at its job and not making what it is supposed to. Low red cell counts lead to anemia; low white cell counts increase risk of infection; and low platelet counts contribute to abnormal bleeding. Bone marrow diseases sometimes can be treated directly, but often treatment involves replacing blood products, and possibly using growth factors to make the bone marrow work better. 

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].

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