Abstract
Background
Diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols
(FODMAPS) are used to manage symptoms in individuals with irritable bowel syndrome.
Although effective at reducing symptoms, the diet can be complex and restrictive.
In addition, there are still large gaps in the literature and many foods with unclear
effects in the gastrointestinal (GI) tract, like fruit juice. Although many fruits
are allowable on a low-FODMAP diet, consumption of all fruit juice is generally cautioned
due to the large fructose load contained in juice, regardless of the glucose concentration.
Very little research exists regarding the importance of limiting fructose load during
a low-FODMAP diet; therefore, individuals following a low-FODMAP diet may be unnecessarily
restricting their diets.
Objective
To determine whether there is a difference in GI tolerance between juice from a high-FODMAP
fruit (apple juice) and juice from a low-FODMAP fruit (white grape juice) in healthy
human subjects. The goal is to provide insight into the role of juice in a low-FODMAP
diet.
Methods
A double-blind, randomized, controlled crossover study was conducted with 40 healthy
adults. Fasted subjects consumed 12 oz of either apple juice or white grape juice.
Breath hydrogen measures were taken at baseline, 1, 2, and 3 hours. Subjective GI
tolerance surveys were completed at the same time intervals and at 12 and 24 hours.
Breath hydrogen and GI symptoms were assessed with area under the curve analysis.
Significance was determined with a two-sided t test with a P value <0.05.
Results
Consumption of apple juice resulted in a greater mean breath hydrogen area under the
curve at 23.3 ppm/hour (95% CI 13.0 to 33.6) compared with white grape juice at 5.8
ppm/hour (95% CI –4.6 to 16.1) (P<0.001). No differences in reported GI symptoms were seen between treatments.
Conclusions
Both juices were well tolerated and neither produced any severe symptoms in healthy
adults. White grape juice consumption resulted in only a small rise in breath hydrogen,
which may suggest excluding foods only because of the high fructose load could be
unnecessarily restrictive. The results of this study suggest that the fructose-to-glucose
ratio is likely more important than the total fructose load of the food when considering
the acceptability of a food on a low-FODMAP diet. More research is needed in individuals
with irritable bowel syndrome to determine whether white grape juice and other juices
from low-FODMAP fruits could be additional beverage options for individuals following
a low-FODMAP diet.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Academy of Nutrition and DieteticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach.J Gastroenterol Hepatol. 2010; 25: 252-258
- Fructose malabsorption and symptoms of irritable bowel syndrome: Guidelines for effective dietary management.J Am Diet Assoc. 2006; 106: 1631-1639
- Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome.J Hum Nutr Diet. 2011; 24: 487-495
- A diet low in FODMAPs reduces symptoms of irritable bowel syndrome.Gastroenterology. 2014; 146: 67-75.e5
- Intestinal fructose absorption: Clinical and molecular aspects.J Pediatr Gastroenterol Nutr. 1999; 28: 364-374
- Incomplete absorption of pure fructose in healthy subjects and the facilitating effect of glucose.Am J Clin Nutr. 1988; 48: 1424-1430
- Squeezing fact from fiction about 100% fruit juice.Adv Nutr An Int Rev J. 2015; 6: 236S-243S
- How to interpret hydrogen breath tests.J Neurogastroenterol Motil. 2011; 17: 312-317
- Use and abuse of hydrogen breath tests.Gut. 2006; 55: 297-303
- Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome.J Gastroenterol Hepatol. 2010; 25: 1366-1373
- Evaluation of a gastrointestinal symptoms questionnaire.Dig Dis Sci. 2006; 51: 1509-1515
- Dietary fructose and gastrointestinal symptoms: A review.Am J Gastroenterol. 2004; 99: 2046-2050
- Absorption capacity of fructose in healthy adults. Comparison with sucrose and its constituent monosaccharides.Gut. 1986; 27: 1161-1168
- Incomplete intestinal absorption of fructose.Arch Dis Child. 1984; 59: 735-738
- Intestinal fructose transport and malabsorption in humans.Am J Physiol Gastrointest Liver Physiol. 2011; 300: G202-G206
- Stimulation of fructose transport across the intestinal brush-border membrane by PMA is mediated by GLUT2 and dynamically regulated by protein kinase C.Biochem J. 2000; 350: 149-154
- Simple-sugar meals target GLUT2 at enterocyte apical membranes to improve sugar absorption: A study in GLUT2-null mice.J Physiol. 2003; 552: 823-832
- Translocation of transfected GLUT2 to the apical membrane in rat intestinal IEC-6 cells.Dig Dis Sci. 2012; 57: 1203-1212
- Evaluation of 13CO2 breath tests for the detection of fructose malabsorption.J Lab Clin Med. 1996; 127: 303-309
- Intestinal fructose absorption: Clinical and molecular aspects.J Pediatr Gastroenterol Nutr. 1999; 28: 364-374
- Diet quality is positively associated with 100% fruit juice consumption in children and adults in the United States: NHANES 2003-2006.Nutr J. 2011; 10: 17
- Fructose content in popular beverages made with and without high-fructose corn syrup.Nutrition. 2014; 30: 928-935
Biography
J. Erickson is a research assistant, Department of Food Science and Nutrition, University of Minnesota, Minneapolis/St Paul.
Biography
J. Slavin is a professor, Department of Food Science and Nutrition, University of Minnesota, Minneapolis/St Paul.
Biography
Q. Wang is a biostatistician, Clinical and Translational Science Institute, University of Minnesota, Minneapolis/St Paul.
Article info
Publication history
Published online: March 22, 2017
Accepted:
January 19,
2017
Received:
September 2,
2016
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was funded by Welch Foods Inc. The funder had no role in the design and conduct of the study.
Clinical Trials ID: NCT02565472.
Identification
Copyright
© 2017 by the Academy of Nutrition and Dietetics.
