home Adviсe Fructose intolerance. Hereditary fructose intolerance (HFI). Fructose metabolism disorder (fructosuria) in children. Symptoms Diagnostics. Treatment

Fructose intolerance. Hereditary fructose intolerance (HFI). Fructose metabolism disorder (fructosuria) in children. Symptoms Diagnostics. Treatment

Hello, dear readers! In this article I propose to consider such a phenomenon as allergy to sweets, and also find out what it is allergy to sugar. Yes, yes, for dessert! Everyone's favorite sweet, without which childhood is unthinkable!

Let's look at what sweets and how an allergy can manifest itself, and what sweets can trigger it. And also why this happens and how you can help a person in such a situation.

In fact, the term “sugar allergy” does not exist, but there is food intolerance to certain foods, including sugars. However, this does not make it any easier for the person who is faced with this problem. He enters into the search engine those queries that most accurately describe his condition, and the first thing that comes to mind is allergies.

Briefly: If we're talking about about allergies— an inadequate immune response to the introduction of an allergen occurs.

At food intolerance, due to any reasons, the normal absorption of food is disrupted. In such cases, the body encounters substances that normally do not penetrate it, and perceives them as hostile agents or toxins.

When in the intestines lacks one or another enzymes to digest sugars or, When sugars are supplied in excess, food intolerance begins. It can also lead to food intolerance altered state(some hereditary disorders) digestive organs or pathological process in the gastrointestinal tract.

Northern peoples, for example, do not have the enzyme sucrase, and consuming sucrose will cause digestive problems in them.

Speaking of excess sweetness, we can recall how it sprinkles children after a whole bag of candy.

However, in addition to sugar, candies also contain various additives: flavors, dyes, preservatives...

These substances can also be poorly absorbed or, conversely, penetrate into the bloodstream, causing pathological symptoms: skin rash, itching, stool disorders.

Another example of excess sugar intake is limiting the duration of feeding infant or frequent change breasts This results in the baby sucking only " foremilk", rich in lactose, and "back" *, rich in fats and enzymes - it doesn’t have time. In such a situation, the baby develops symptoms similar to lactase deficiency. The child is healthy, but his nutrition is not balanced.

With a number of diseases of the stomach and intestines, sweets are limited in the diet - the body is simply not able to absorb it normally, since the pathological process has led to changes in the functioning of the organs.

If, after all, we are talking about allergies to sweets, pay attention to the composition of the sweets you consume. Almost all industrial and homemade sweets may contain allergens:

Now, let's look at which sugars most often cause food intolerance. ______________________________________________________________________________________________ *Separation breast milk into “front” and “back” is very arbitrary. And it is used in the article only to clearly illustrate the problem through traditional Internet terms.

2. Types and causes of intolerance to sweets

When we talk about sweets or sugars, we mean foods or substances that taste sweet. Mono- and disaccharides have a sweet taste:

The most common intolerances are lactose, fructose and sucrose.

Impaired absorption of lactose

Or milk sugar, may be primary, secondary or congenital.

For primary intolerance In humans, the ability to digest lactose is lost with age.

With secondary- develops as a result of damage to the mucous membrane of the small intestine (acute food poisoning, colitis, celiac disease, etc.).

Congenital intolerance lactose is genetic defect. In this case, the child is already unable to digest milk from birth. Very few such cases are known (a few). Until the 20th century, children with this diagnosis had no chance of survival. There is always profuse vomiting, diarrhea, sudden loss weight (less than birth weight), severe dehydration.

Symptoms that suggest lactose intolerance:

flatulence
bloating
diarrhea or chronic constipation
pain (cutting) in the abdomen
vomit
deterioration is always associated with consumption of milk and dairy products
the severity of symptoms depends on the amount of lactose consumed

Lactase deficiency is diagnosed by a hydrogen breath test, a blood sugar test under lactase load, and for children a stool acidity test is used.

Or more correctly, fructose malabsorption is a digestive disorder. In this case, the transport of fructose from the intestinal lumen into the blood is disrupted due to insufficiency of the transporter protein. Thus, fructose remains in the human intestine and is not absorbed.

Symptoms:

flatulence
bloating
diarrhea or chronic constipation
pain (cutting) in the abdomen
vomiting (if consumed in large doses)
early symptoms of mental depression
aversion to sweet taste
worsening is always associated with consumption of fructose, sucrose and sorbitol
the severity of symptoms depends on the amount of fructose consumed

These symptoms may appear in early childhood with the introduction of complementary foods containing fructose. And they can appear with age, especially often in older people.

When food intolerance is caused by any disease, the underlying disease is treated, and food intolerance will go away on its own as you recover.

In case of lactase deficiency, depending on the severity of symptoms, limit fresh milk or prescribe special enzymes. Please note that skim milk has a higher lactose content.

Often there is no reaction to dairy products that have been fermented (cottage cheese, cheese, yogurt, kefir) or sweetened (ice cream, condensed milk).

There are also products with reduced lactose content.

In case of intolerance to fructose or sucrose, a deeper review of the diet will be required, together with a nutritionist and, possibly, the prescription of specific enzyme preparations. Complete exclusion of certain foods from the diet can lead to a lack of any nutrients, which is extremely undesirable for health.

Conclusion

So we looked at cases when a so-called allergy to sweets can develop. If you arrange in order the reasons that cause it, you can get the following picture:

Excess sweets in the diet
Digestive diseases
True allergy to sweet components
Enzyme deficiency (develops with age)
Genetically determined sugar intolerance (extremely rare)

In any case, you need to review your diet and, if necessary, consult a doctor.

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In some cases, the body stops accepting some food. This may be caused congenital features or acquired problems. In addition, such a violation may be a symptom of some serious illnesses, requiring close attention and adequate correction. So a fairly common problem is lactose intolerance - milk protein, both newborn children and adult patients encounter it. But this violation is quite amenable to correction - you just need to choose proper diet. TO possible problems This type includes fructose intolerance in a child, the symptoms of which in adults will also be discussed in detail.

Fructose intolerance is also known as fructosemia or fructose malabsorption. This is a hereditary disease that is caused by a lack of fructose-1-phosphaldolase. Due to this deficiency, fructose that enters the body is deposited in the form of fructose-1-phosphate in the tissues of the liver, intestines and kidneys. The disease makes itself felt at an early age and cannot yet be cured.

Fructose intolerance - symptoms in adults and children

Manifestations of fructosemia may appear soon after the baby is born if he is given complementary foods containing fructose or sucrose. Most often, the first symptoms of this disorder become noticeable after introducing fruit purees, juices, etc. into the baby’s diet. Nowadays, such an expansion of the diet is practiced mainly after the baby reaches six months of age, so before this time, fructose intolerance is rarely diagnosed.

At an early age, the intake of sucrose or fructose in such children can cause vomiting, drowsiness and/or excitability. The baby's skin may become pale and the baby may look lethargic. Excessive sweating is often recorded. Fructose intolerance usually manifests as diarrhea, with loose stool has a fairly significant volume (more than a regular portion).

If doctors are unable to immediately determine the causes of such symptoms, and fructose and/or sucrose continue to enter the body, the patient loses body weight (which leads to the development of malnutrition), and the size of his liver may increase. Ascites is also quite often recorded - the accumulation of fluid inside abdominal cavity.

Sometimes patients with fructosemia develop jaundice - skin and the mucous membranes turn yellowish, and the sclera may also turn yellow.

If a significant amount of fructose enters the body at a time, then a patient with intolerance to this substance may develop acute hypoglycemia. At this state There is a significant decrease in the amount of glucose (sugar) in the blood. Such a violation makes itself felt by noticeable trembling of the limbs, general violation well-being. The patient may experience convulsions - paroxysmal involuntary muscle contractions, which are accompanied by extreme muscle tension. In some cases, loss of consciousness and even the development of coma are possible. In this case, the patient stops responding to any stimuli, which poses a serious threat to his life.
Hypoglycemia usually occurs not in infants, but in older children.

Cataracts do not develop with this disease and are also not impaired. mental development kids.

As practice shows, in most cases, fructose intolerance occurs in mild form. Similar condition It is not always diagnosed on time, because the intake of a small amount of this substance does not worsen general health person. In both children and adults, this does not lead to the appearance of alarming symptoms. In this case, adult patients are sure that they simply do not like sweets in any of its forms.

If the disease is severe, then it is impossible not to notice it. Indeed, in this case, even a small intake of fructose from baby food is fraught with the development of life-critical conditions.

Most often, with age, the condition of patients with even severe fructose intolerance improves slightly; they can eat a small amount of foods containing it without deteriorating.

Is it possible to cope with fructosemia?

Unfortunately, it is impossible to eliminate fructose intolerance. To correct this disease, the patient must permanently stop consuming foods containing fructose. And, as you know, such fruit sugar found in all sweet fruits and berries. In addition, it is present in honey and even in some vegetables. Patients also have to exclude foods with sucrose (cane or beet sugar) from the diet. Sorbitol (glucite, a sugar substitute) is also prohibited. It should be noted that the listed components are often included in products containing complex composition, medicines etc.

Additional Information

Since patients with fructose intolerance cannot eat fruits and berries, they often suffer from a lack of some nutrients contained in these foods. They are often prescribed an additional multivitamin, and herbs may also help.

Such an excellent source of many vital important vitamins will be the next collection. To prepare it, combine linden inflorescences and St. John's wort herb (one hundred grams each), stinging nettle plant (leaf), yarrow and tartar herbs, dandelion root (fifty grams each), as well as calendula and echinacea flowers (twenty grams each). Grind and mix all these ingredients thoroughly. Brew a teaspoon of the prepared mixture with a glass of just boiled water. Infuse the product for half an hour under the lid, then strain. Take hot medicine twice or thrice a day, about half an hour before meals.

The feasibility of using funds traditional medicine should definitely be discussed with your doctor.

Vegetables and fruits have always been classified as healthy products and an integral part balanced nutrition. For example, the German Nutrition Society (DGE) recommends eating fruits and vegetables at least five times a day. But these recommendations are not true for everyone. The one who gets these after every apple or banana he eats. unpleasant symptoms, such as abdominal pain or bouts of diarrhea, most likely suffers from fructose intolerance.

This problem is caused by a defect in one of the proteins responsible for ensuring that fructose from food is absorbed into the body. small intestine and entered the blood. Due to impaired metabolism, there are typical symptoms: belching, diarrhea, nausea and vomiting, heaviness in the stomach. But do not despair - it is enough to reduce the amount of fructose consumed per day to the amount that the patient’s body can still absorb, as this will bring quick relief. At the same time, you should also pay attention to the sorbitol content in the food you consume, since this sugar alcohol additionally interferes with the absorption of fructose. Very often it is used as a sugar substitute in food products for patients. diabetes mellitus, dietary and “light” products, in various drinks and chewing gum.

After a doctor has diagnosed fructose intolerance, you must immediately change your diet. This is done in two stages. The first involves the complete exclusion from the menu of products containing fructose and sorbitol. The second stage comes down to the gradual inclusion of products containing fructose in the daily diet in order to determine its individual norm. daily amount, which the patient’s body can absorb. Then the norm of products containing sorbitol is determined in the same way.

Various vegetables and fresh fruits contain varying amounts of fructose. Vegetables containing low amounts of fructose include: eggplants, carrots, red beets, cauliflower, broccoli, chicory, peas, lettuce, asparagus, tomatoes, zucchini, radish, celery, spinach. Fruits such as pineapple, melon, tangerines, grapefruits, papaya, lemons and bananas can also be included in the diet. It is better to avoid vegetables and fruits such as artichokes, white and red cabbage, apricots, apples, pears, kiwis, mangoes, peaches, plums, watermelons and grapes.

You need to be very careful when choosing the food products you purchase in the store. There are many designations indicating the fructose content of a particular product: fruit sugar, fruit syrup, invert sugar, corn syrup. You should carefully review the ingredients of a food product before adding it to your shopping cart. This also applies to dairy and sausage products, various drinks And confectionery products– make sure first that it does not contain fructose additives, and then you can buy.

Fruit sugar (fructose, F) is found in most fruits and vegetables and is one half of the disaccharide sucrose, which is known simply as "sugar". Fructose intolerance often appears in infancy or childhood. However, it is not uncommon that the disease is diagnosed only in adults.

Hereditary fructose intolerance (HFI) is associated with a deficiency of a key enzyme in its metabolic pathway (Fig. 1). F consumed in food is metabolized in the liver. The first reaction of phosphorus in cells is its conversion into fructose-1-phosphate (F1P). The enzyme aldolase B is responsible for the next step of F conversion. Aldolase B plays a central role in the metabolism of F. It is localized in the cells of the liver, kidneys and mucous membrane small intestine.

Aldolase B breaks down fructose-1-phosphate into glyceraldehyde and dihydroxyacetone phosphate. If this enzyme is absent or its activity is significantly reduced, then P1P accumulates in cells and inhibits the mobilization of glycogen, glucose synthesis in the liver (gluconeogenesis), which leads to hypoglycemia, and inhibits glycolysis. F1F provides toxic effect on liver cells and kidney tubules. If a food product (fructose) is harmful to health, then it is said to be intolerant to it (fructose).

Clinical symptoms of hereditary fructose intolerance

Thus, NNF is a disorder of P metabolism, which is accompanied by the accumulation of P1P, which is toxic to the liver and kidneys and causes life-threatening hypoglycemia.

Causes of hereditary fructose intolerance

NSF is caused by mutations in the aldolase B gene. Genetic variants in the aldolase B gene result in the synthesis of an enzyme with significantly reduced activity. The pathogenic mutations responsible for the aldolase B defect have been identified. In Europe, the three most common mutations are A149P, A174D and N334K. They are responsible for 90% of all patients with NSF. The remaining 10% are rarer mutations in the aldolase B gene. NNF is an autosomal recessive disease, with a frequency of about 1:20,000.

Diagnosis of NSF

Diagnosis of NSF is carried out using molecular genetics. Diagnostic value have the three most common mutations of the aldolase B gene. NSF is considered proven if at least 2 mutations are found. If none of these common mutations are found, the likelihood of NSF is very low.

Study material: 2 ml of EDTA stabilized blood (an alternative for children is a throat smear). Transportation to the laboratory is not time critical and can be done by mail or courier. Genetic testing requires written consent from the patient. The cost of the test is 233.13 €.

Differentiation between NSF and fructose malabsorption

In addition to metabolic disorders, fructose intolerance may be associated with problems with F absorption in the small intestine. This intolerance is known as fructose malabsorption, in which F is only partially absorbed. This malabsorption can develop after damage to the epithelium of the small intestine as a result of NSF, but can occur independently of NSF and is associated with a deficiency of the protein transporter F from the intestine to the cells of its mucosa - enterocytes (GLUT5).

Clinical manifestations of fructose malabsorption

Diagnosis of fructose malabsorption

Fructose, which is not absorbed in the small intestine, is fermented by bacteria in the large intestine. One of the products of fermentation is hydrogen, which is released by the lungs when exhaled. On this basis, fructose malabsorption is diagnosed using a breath test with a load F (determination of hydrogen in exhaled air). Before performing a P-load test, NSF should first be ruled out using a genetic test, since P-load can lead to a life-threatening metabolic crisis in those patients treated with P-exclusion from the diet. In case of infants and children toddlers up to 2-3 years, the diet must be strictly followed. In senior childhood Tolerance to fructose may increase slightly, which allows easy adaptation to F consumption on an individual basis. Systematic elimination of F when early diagnosis NNF leads to a reduction in the risk of fatty liver.

Treatment of NSF and fructose malabsorption

Differentiation between NSF and fructose malabsorption is very important to determine treatment options. The diet of patients with NSF should be practically free of P throughout their lives, while for patients with P malabsorption such a diet leads to long term to deterioration of carbohydrate absorption. For fructose malabsorption, a diet with increased fat and protein content is prescribed. This diet increases the absorption of phosphorus in the small intestine.

If you are intolerant to F, you should also remember that many diabetic foods food additives and low-calorie foods contain sorbitol. Since sorbitol is metabolized to produce phosphorus, consuming such foods worsens the symptoms of NSF.

Fructose intolerance is uncommon, but if diagnosed, significant dietary changes must be made. There is a lot of this substance in the most necessary products, the refusal of which leads to a deficiency of components important for the body. Therefore, you need to contact a specialist to create the right diet.

Intolerance and allergies

If the body reacts negatively to any foods or drinks as a result of digestive problems, then a food intolerance is diagnosed. Many people consider this condition an allergy, but these are two different concepts.

In case of an allergic reaction, rashes, swelling, and malfunctions appear digestive system and other organs. Food intolerance accompanied by fullness and weakness, urolithiasis, fatigue. Sometimes it has no symptoms and only causes you to feel unwell. Therefore, it is difficult to determine the problem.

Causes of dangerous conditions

Fructose intolerance in adults and children has its own reasons. Typically, pathology develops when there is not enough enzyme that breaks down fruit sugar.

The situation is aggravated by weakness or immaturity immune system. If there is not enough fructose-1-phosphate aldolase, then food is not completely digested, its remains accumulate and begin to rot. Wherein useful material are not absorbed, fructose accumulates in the intestines and liver.

This can cause cirrhosis and other dangerous diseases.

Due to the excessive content of toxic substances, protective forces are activated. The immune system tries to neutralize allergens, which is accompanied by various reactions from organs and systems. The likelihood of an allergic reaction under the influence of fruit sugar increases:

if a person often overeats, consumes a lot of sweets, fruits, honey;
when wrong and too early introduction complementary foods;
with a genetic predisposition to the problem;
if during pregnancy or breastfeeding the woman did not eat properly;
at pathological processes in the pancreas;
due to the hypersensitivity of the body.

Signs

Fructose allergy has different symptoms in adults. The severity of reactions depends on age, the amount of fruit sugar in the body, and the state of the digestive system.

If high level fructose is associated with overeating, then:

appear small rashes or large blisters on the surface of the skin;
the epidermis turns red, itching appears;
there are attacks of sneezing and coughing, runny nose, increased lacrimation;
the stomach swells and appears painful sensations, upset stool, nausea with vomiting.

An allergy to fructose in an infant occurs if the child was born with intolerance to this substance. If the baby does not have enough enzyme to break down fructose, then he cannot eat fruits and the body suffers from a lack of vitamins. This has a bad effect on the entire body.

In this situation, it is difficult for a child to gain weight, he becomes capricious due to intestinal colic, sleeps poorly. Allergic reactions can also occur in children:

If during pregnancy or breastfeeding a woman abused vegetables, honey, sweet syrups, sugar.
During the development of the pancreas.
With an incorrectly composed diet. Use large quantity fruits are as harmful as their lack.
If your child constantly overeats. In this case, the food does not have time to be digested, accumulates in the intestines, rots and poisons the body. This helps to reduce local immunity.

Many babies experience fructose intolerance when introducing complementary foods. Most parents think that this substance is found only in fruits, sweets, and honey.

This is a mistake because useful component a lot in berries, vegetables and legumes. It is even found in potatoes and cucumbers.

How to replace fructose

An allergy to fructose causes difficulties in creating a diet, since many products are prohibited. To replace fructose, doctors prescribe medications and foods that contain glucose and lactose.

If an allergy develops, you need to give different foods in small quantities, observing the condition of the skin and digestive system.

How to eat when sick

If fruit sugar continues to enter the body despite an allergic reaction, this will lead to various problems in organism. Therefore on initial stages For the development of the disease, doctors recommend completely eliminating all items that contain fructose.

After the manifestations of hypersensitivity are stopped, you need to gradually introduce foods into the diet, controlling the body’s reaction. The patient should eat this way for several weeks. After this, the doctor determines which foods are most suitable for the patient’s body and creates a safe diet. It usually includes foods with minimal glucose content. The patient is allowed to eat some zucchini, eggplant, spinach, potatoes, and cauliflower. Apples, pears, honey, and chocolate bars are prohibited.

It is also very important to know that this component is included in some medications. It is added to the shell of tablets and medicinal syrups.

When purchasing products, the patient should study the composition of the products and check whether they contain fruit sugar.

Treatment options available

Symptoms of fructose intolerance in adults require a thorough examination. After confirming the diagnosis, treatment is prescribed.

To avoid disorders in the digestive system, if there is not enough enzyme that breaks down fructose, diet alone will not work. Eliminating the irritant from your diet is very important, but it is not the only thing that needs to be done.

In this situation, antihistamines are needed. Thanks to their influence, the production of serotonin, histamine and other components that provoke inflammatory processes allergic type.

To get rid of the symptoms of intoxication of the body, it is necessary to use sorbents. Also prescribed local remedies to eliminate allergic rashes.

Usually, the disease is treated with syrups, tablets, drops. If the symptoms of the disease are pronounced, the face, eyelids, and ulcers swell, the use of Suprastin, Diazolin, and Diphenhydramine is required.

Moderate and mild course an allergic reaction is treated with antihistamines new generation. They are allowed to be taken for a long time.

Expert opinion

Allergist Dmitriev Mikhail Lvovich

Education: First Moscow State University medical University named after I.M. Sechenov, 1997

Ask a question to an expert

Reducing the likelihood of relapses is achieved with the help of calcium gluconate. Thanks to this, it is possible to normalize the condition of blood vessels, strengthen the functioning of the immune system, and improve metabolic processes in organism. Therefore, the drug is always prescribed

Preventive measures

Allergy to fructose in children and adults can subside and recur. To avoid repeated exacerbations, you must follow all the recommendations of specialists:

If you tend to have a negative reaction to fructose, you should have a chart at home that shows how much fruit sugar is in certain foods.
In the process of creating a diet, you need to select foods that contain fructose in small quantities.
Avoid overeating. Fruits, berries, vegetables and juices should be taken in small doses.
Take a course of calcium gluconate.
Avoid syrups containing synthetic fillers.
Monitor the condition of the digestive system, get rid of diseases of the intestines, liver and stomach in a timely manner.
Pay more attention to the composition of products, medicines, drinks, before consumption. Very often fructose is added, but this is not written about in the composition.

Parents who are suffering allergic reactions, wondering whether the baby may be allergic to fructose or not. Probability of problem when hereditary predisposition 25% higher than everyone else.

If the child has increased sensitivity to fructose, he is recommended to follow the diet until the age of six.

Poor reaction of the body to fruit sugar, development immune reactions when there is insufficient amount of enzyme in the body to break down fructose, they are complex processes. Therefore, the patient should pay a lot of attention to his own diet.

Treatment of the disease must continue with early age. If you follow all the rules, then most patients manage to outgrow the disease, but this only works in the case of acquired intolerance.

If a child was born with the disease, he will have to monitor the amount of fructose in foods throughout his life. But the right approach will help to avoid feeling unwell and all allergy symptoms.