Investigation of Alanine in Fructose Intolerance: A Dose Ranging Study

Study Overview
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Brief Summary
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Background: Over the past few decades, fructose is increasingly being used as a sweetener/ additive in a variety of foods. Incomplete absorption of fructose has been implicated as a cause of gastrointestinal symptoms. In tertiary care centers, the prevalence of fructose malabsorption in subjects with unexplained GI symptoms is thought to be between 11-50%, when assessed with breath tests following administration of 25 grams of fructose in a 10% solution. Restriction of dietary fructose has been shown to improve symptoms in these patients to an extent. Currently, there are no therapeutic agents that improve intestinal fructose absorption and thereby decrease symptoms. Studies in the pediatric population have shown that fructose absorption in the small intestine is increased in the presence of glucose or amino acids, especially alanine. Objective: The investigators' objective is to assess whether co-administration of an oral solution of L-alanine facilitates fructose absorption and decreases gastrointestinal (GI) symptoms associated with fructose malabsorption in subjects undergoing standard fructose breath test when compared to placebo. Methods and analysis: The investigators propose a randomized, double-blind study in 40 subjects with known fructose intolerance. After an overnight fast, each subject will receive an oral solution of 12.5 grams of alanine in 125cc of water or placebo. Next, the subject will receive an oral solution of 25 grams of fructose in a 10% solution. Serum, urine and breath samples will be collected at baseline and at 30-minute intervals for 4 hours. GI symptoms will also be assessed and recorded at 30 minute intervals using a standard questionnaire. Repeated measures ANOVA will be used to compare the data obtained during the study protocol with the baseline (pre-study) data. Expected outcomes: Co-administration of alanine with fructose may improve fructose absorption and decrease symptoms in subjects with fructose intolerance. Hypothesis: Ingestion of alanine along with fructose, will facilitate intestinal absorption of fructose in subjects with fructose malabsorption. Aim: To investigate the effects of co-administration of equi-molar doses of alanine on a) the absorption of fructose and b) the occurrence of GI symptoms in subjects with fructose malabsorption.

Official Title
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Investigation of Alanine in Fructose Intolerance: A Randomized, Double Blind, Dose Ranging, Placebo Controlled Study

Conditions
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Fructose Intolerance

Intervention / Treatment
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* Dietary Supplement: Placebo
* Dietary Supplement: Alanine
* Dietary Supplement: Alanine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 18-70 years Diagnosis of fructose malabsorption (positive breath test after ingestion of 25 grams of fructose defined as either (a) ≥ 20 ppm rise of breath H2/CH4/both over baseline values or a successive rise of ≥ 5 ppm over baseline and in 3 consecutive breath samples) Exclusion Criteria: Cognitive impairment or any other inability to provide informed consent Prisoners GI surgery except appendectomy, cholecystectomy, caesarean section, hysterectomy Antibiotics in the previous 3 months Bacterial overgrowth or lactose intolerance Major co-morbid illnesses, including chronic pancreatitis, celiac disease, inflammatory bowel disease, diabetes, scleroderma, pseudo-obstruction syndromes etc. Known food allergies Medication use: opioids, Tegaserod, laxatives, enemas Diabetes

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Placebo<br>Subjects will receive placebo (mix of sugar and salt). | Dietary Supplement: Placebo<br>* Subjects will receive placebo (mix of sugar and salt) 20 minutes before consuming fructose.<br>|
| Experimental: Alanine - 12.5<br>Subjects will receive 12.5 grams of alanine | Dietary Supplement: Alanine<br>* Subjects will receive 12.5 grams of alanine 20 minutes before consuming fructose.<br>|
| Experimental: Alanine - 25<br>Subjects will receive 25 grams of alanine. | Dietary Supplement: Alanine<br>* Subjects will receive 25 grams of alanine 20 minutes before consuming fructose.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Decrease breath Hydrogen and/or Methane production |  | less than 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence or severity of GI symptoms during the test |  | less than 6 months |