Fructose Malabsorption and Foods To Avoid - Fructose Friendly Diet
Defining Fructose Malabsorption
Fructose Malabsorption is a food issue many of us have not heard of before. Even those with coeliac disease may have very little knowledge of fructose and foods it lies in. Symptoms of Fructose Malabsorption are similar to those of Lactose Intolerance, hence the -ose ending in the spelling of both these substances. Fructose malabsorption, similarly, tends to arise mainly in adulthood, often due to the fact that amounts of fructase receptors in one's body are slowly reduced by age hence the possibility of fructose malabsorption becomes more of a likelihood from year to year.
Edited to Add: Atlhough adults more commonly suffer from fructose malabsorption, many children are becoming affected by this condition as well.
Common symptoms caused by fructose malabsorption include symptoms of stomach bloating, wind, stomach pain, loose bowel motions and / or constipation. These are common symptoms that are often reflective of irritable bowel syndrome (IBS).
What is Fructose?
Fructose (as the name suggests) is a natural sugar found in a large variety of fruits and vegetables. It is a monosaccharide found in three main forms in the diet:
- free fructose (fruits and honey)
- constituent of the disaccharide sucrose
- fructans (present in certain vegetables and wheat) [NB: some individuals with fructose malabsorption can safely eat foods with fructans, while others need to avoid them altogether.]
Fruit juice concentrates are especially high in fructose, due to the loss of fibre during the juicing process. Like lactose intolerance, it is one possible cause of Irritable Bowel Syndrome (IBS). Individuals with fructose malabsorption lack various receptors to break down the sugars in fructose. Avoiding fructose can be VERY challenging as it is in many foods, including honey and wheat as well as many fruits and vegetables.
My fructose malabsorption condition is rather serious as I, myself, am especially low in the necessary agents in my body that are required to break down these natural molecules in my body. Exclusion of wheat (in large amounts (i.e. breads, crumbed foods, gravies, icing mixtures, etc.)) is as important as challenging to avoid as this is quite a major source of fructose in itself.
Fructose Malabsorption, Coeliac Disease, Lactose Intolerance
An ever-increasing number of Coeliac Disease patients now suffer from fructose malabsorption. Many recent studies show that fructose malabsorption can sometimes be a primary cause of Coeliac Disease. Other studies show that overexposure to fruit once on a gluten free diet (due to many processed foods containing gluten) may be the cause of fructose malabsorption. A small percentage of lactose intolerant individuals have also reported as 'fructase deficient'. Testing for fructose malabsorption is similar to that of lactose intolerance. The means is generally a hydrogen breath test and the process generally lasts a few hours. Many studies have shown that individuals deficient in one enzyme (e.g. lactase) are often deficient in other forms of sugar (e.g. fructase), hence the linkage between lactose intolerance and fructose malabsorption.
Malabsorption or Intolerance?
How the terms 'fructose malabsorption' and 'fructose intolerance' are defined remains a mystery at this stage. However, be aware that fructose malabsorption is different to hereditary fructose intolerance, so don't get the two confused.
Fructose Malabsorption (aka Dietary Fructose Intolerance (DFI)) is a digestive disorder in which fructose be properly absorbed, resulting in a greater concentration of fructose in the small and large intestine often causing discomfort for affected individuals. Approximately 30% of our current population are currently deficient (to some degree) in fructose receptors. This does not, however, mean you are likely to have known fructose malabsorption issues and irritable symptoms from smaller amounts in moderation (which is relatively standard in society, anyway). My fructose malabsorption condition is much more serious and it likely developed as a result of eating lots of fruit after going gluten free.
Fructose Intolerance (aka Hereditary Fructose Intolerance (HFI)/Hereditary Fructosemia) is a condition where there is too great a deficiency of liver enzymes to properly process and metabolise fructose. This condition can be harmful and potentially fatal to individuals who consume any fructose at all and is quite rare (i.e. 0.01% of population), in comparison to fructose malabsorption. It is more of an allergy to fructose than an intolerance, despite the 'illogical' terminology used.
Common Sources of Fructose
It is important for one with fructose malabsorption to limit the amounts of fruit he or she consumes at once. While some fruits are ok in moderation, others must be avoided completely. Apples and pears are particularly bad for this.
The following list shows items particularly high in fructose or fructans:
The following should be completely avoided:
- Paw Paw
- Large amounts of dried fruit or fruit juice (all fruits)
- Foods containing apple or pear concentrate should be avoided completely
- Large amounts of stone fruit (sorbitol)
- Plum sauce, sweet and sour sauce.
Vegetables (Fructans) (may be tolerated by some individuals with fructose malabsorption)
The following should be completely avoided:
- Spring onion
- Tomato paste, chutney, barbecue sauce are high in fructose/fructans, as well.
Other Food Items
- Coconut milk and cream
- High Fructose Corn Syrup/Corn Syrup Solids
- Soft drink, cordial and confectionary (all in large amounts only)
- Wheat in large amounts (NB: unlike wheat, rye, barley, oats, corn, rice, etc. are mostly low in fructose. Rye bread (low in wheat) may work well as an alternative.)
For some, simply eliminating fruit juice may be sufficient to alleviate symptoms. Pureed fruit is a good alternative to juice if tolerated. Individuals, like myself, who are more sensitive need to avoid many of the above food items as well as other food items.
Fruits with a high fructose content can be rendered safe for people with fructose malabsorption by cooking the fruit with dextrose. Dextrose acts as a counteracting agent for fructose. I would recommend dextrose supplements for all individuals suffering from fructose malabsorption, just incase you end up eating some fruit and vegies outside of your normal diet. During the cooking process the excess fructose in the fruit bonds with the dextrose monohydrate, creating a sugar molecule (sucrose) which still tastes sweet but which will not provoke symptoms in an individual who suffers from a fructose malabsorption.
Avoiding fructose is no easy task, as the sugar type is present in many different forms in a variety of different foods. Interpreting ingredient statements is essential for success with a fructose-friendly diet. There are many fruits and vegetables that are often safe for individuals with fructose malabsorption, including pineapple, blueberry, raspberry, strawberry, tomato, corn, potato (plain), chilli (in moderation), celery, iceberg lettuce, and many others.
Fruit Fructose Categories (contributed by Jan Modric)
Peach (high in sorbitol)
Gluten-Free, Fructose Malabsorption Cookbook
by Sue Shepherd
Includes fructose friendly recipes!
Food Shopping Guide
Written by Dr Sue Shepherd
Debra Ledford (Author), Bob Ledford (Author)
Be careful with specific 'dairy-free' products, especially dairy-free chocolates. Inulin is almost always used to sweeten this type of chocolate when made from soybeans. As inulin is high in fructose, it is not suitable for sensitive individuals. This includes many gluten and dairy-free cookies manufactured by brands like Woolworths Freefrom. Milk chocolate (if tolerated) or normal Extra Dark varieties are generally safe alternatives and are available just about everywhere you look.
There are many low-fructose products out there and, even if gluten free, there is great selection to choose from. I would recommend that anyone with any concerns about this should enquire with a Sue Shepherd Dietitian, if and when possible. You could also request resources from http://shepherdworks.com.au/ This website includes various publications from the 'well respected' Sue Shepherd (highly experienced in IBS matters, fructose malabsorption and Coeliac Disease) including cookbooks, recipe suggestions and more!
There is great support around for individuals with such dietary requirements and I'm sure it is possible that you may be able to get assistance if you feel it necessary wherever you are. After all, it's becoming more of an issue all the time!
Happy fructose friendly Living!
Thanks to Jan Modric for contributing to this page. Information can be found at http://www.healthhype.com/nutrition-guide-for-fructose-malabsorption.html
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