Abdominal Pain in Children May be Linked to Fructose Intake

It’s a pretty common complaint heard in households around the country: “My tummy hurts.” Parents and teachers have been battling this complaint for decades, with children insisting that they are in pain and having no explanation why.

But a recent study highlighted at the American College of Gastroenterology meeting sheds some new light on the age-old dilemma. The cause could be fructose intolerance, and the unexplained abdominal pain may resolve with a low-fructose diet.

Breath hydrogen tests after fructose dosing revealed that 132 of 245 patients were intolerant to the sugar, but adherence to a low-fructose diet helped to clear up abdominal pain in 88 (67.7%) of the 132 patients. “The abdominal pain and other symptoms resolved very quickly in many cases after children started consuming a low-fructose diet,” said Bisher Abdullah, MD, of Mary Bridge Children’s Hospital in Tacoma, Washington.

The children ranged in age from two to 18 years (median age 11); more than 60% were girls. Symptoms reported by the children included abdominal pain, gas, bloating, constipation, and diarrhea.

The patients consumed a 1 g/kg dose of fructose up to a maximum of 25 g, followed by a breath hydrogen test for fructose. Results showed that 53.9% of the children tested positive (≥20 ppm) for fructose intolerance/malabsorption. Patients who tested positive were referred to nutritionists to develop a low-fructose diet. The dietary intervention resolved the unexplained abdominal symptoms almost immediately in the subjects observed.

“The principal culprit in many cases was fructose-sweetened soft drinks,” remarked Abdullah. “The human body was not designed to handle that much fructose. I often tell my patients and parents that cave men didn’t have Coke or Pepsi.”

Although sweetened soft drinks are a major source of fructose, avoiding fructose is not as simple as reading labels on food packages, Abdullah continued. Fructose occurs naturally in many foods, including tree fruits (like apples), berries, melons, certain root vegetables, and honey.

In addition, most of the children studied were overweight or obese. They lost weight after being placed on their new diet, a significant finding both to this study and to the study of obesity in children, which often is a precursor to diabetes. “Ideally, we would like to study this issue in a controlled trial to see whether a low-fructose diet might be useful as an intervention to help children with a higher body mass index lose weight,” Abdullah said.

Ultimately, two-thirds of the patients had complete resolution of symptoms. Improvement was closely associated with adherence to the low-fructose diet. It is important to note, however, that symptoms resolved in almost 50% of the children in whom the breath test for fructose intolerance was negative. These patients were not placed on a low-fructose diet, so more testing in a controlled trial will need to be done to find the real link between fructose and abdominal pain in children.

“These findings demonstrate how a simple diagnostic test and a simple dietary intervention can have a big impact on a common clinical problem,” Abdullah noted.

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