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.

Symptoms

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:

Fruits

The following should be completely avoided:

  • Apple
  • Cherry
  • Guava
  • Grape
  • Honeydew
  • Lychee
  • Mango
  • Paw Paw
  • Persimmon
  • Pear
  • Quince
  • Watermelon

- 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:

  • Artichoke
  • Asparagus
  • Chickory
  • Leek
  • Onion
  • Radicchi
  • Shallot
  • Spring onion

- Tomato paste, chutney, barbecue sauce are high in fructose/fructans, as well.

Other Food Items

- Coconut milk and cream

- Honey

- 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

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)

 Low
Moderate 
High 
Cumquat
Avocado 
 Apple
Grapefruit 
Banana 
Cherry 
Lemon 
Blackberry 
Date 
Lime
Boysenberry
Fig
 
Blueberry
Grape
 
Cantaloupes
Guava
 
Cranberries
Honeydew melon
 
Passionfruit
Lychee
 
Pineapple
Mango
 
Rhubarb
Nashi Fruit
 
Strawberry
Papaya
 
Rasberry
Pear
 
Tamarillo
Persimmon
 
Tangelo
Plume
 
Apricot
Prune
 
Nectarine
Raisin
 
Peach (high in sorbitol)
Star Fruit
 
 
Sultana
 
 
Quince
Gluten-Free Cooking
Gluten-Free Cooking

Gluten-Free, Fructose Malabsorption Cookbook

by Sue Shepherd

 
Gluten-Free Kitchen
Gluten-Free Kitchen

Includes fructose friendly recipes!

 
Low FODMAP Diet
Low FODMAP Diet

Food Shopping Guide

Written by Dr Sue Shepherd

 
Fructose Malabsorption: The Survival Guide
Fructose Malabsorption: The Survival Guide

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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Replies 26 comments

Brent Watson 6 years ago

Great post! It's always interesting to hear about other peoples experience with FM. Thought I would mention a site that you can use to search for any food to see if it is OK to eat or not (and rate that food based on your own experience/tollerence level). Check it out: http://www.thefartingpear.com


infonolan profile image

infonolan 6 years ago from Australia Author

Thanks for commenting!

Keep improving your site, and it will be something we'll all look to, eventually. Thanks for the link!


watchinmywifesuffer 6 years ago

my wife started having gas and bloating in 1988 or 89. It took until this year to find out about FM. She now gets sick if she smells anything with fructose in it. She can't be near or use perfume due to the glycerin. That includes scented lotions and hair products. She had the H2 test which came back neg. She still follows the FM diet along with anti-fungal & anti-mold. It's crazy.but if she is super strict it helps. Our next step is a water fast using Calcium Bentonite Clay & maybe a green drink. The green drink will give her energy. We tried just water. It was to tough but if you try just water look up Dr. Joel Fuhrman. He wrote the book Fasting and eating for health. The clay does wonders when she gets exposed to anything. You can find it at Living Clay.com


carol 5 years ago

I have fm and find that citrus fruits, corn and carrots bother me the most yet everything i read now says they are low in fructose. Why is that??


infonolan profile image

infonolan 5 years ago from Australia Author

Thanks for your question, carol! There may be a salicylate sensitivity present, I know some have combined salicylate intolerances along with fructose malabsorption. That is the only other possibility I am currently aware of, though. That being said, fructose malabsorption remains a fairly unstudied topic at this point in time and (despite many of the websites and forums' opinions) I find brown rice to be perfectly fine. Dietician Sue Shepherd in Melbourne of http://shepherdworks.com.au/ has some good information.


Rouillie 5 years ago

Interesting article, much to be learned here and you very good about providing over and above useful information. Thanks!


Eliza 4 years ago

Fantastic post. It is very hard to find Australian info on FM on the net. I have been Fructose Free for 5 years and I am just starting to reintroduce small amounts of onion powder and wheat. Symptoms are no where near what they would have been a year or so ago. I'm not going to get too adventurous, but it's great to give it a go after this long :-)


Doreen 4 years ago

I am a diabetic - type 2 on Insulin injections (humalog 3 daily and Lantus 1 at night) as well as diabex Xt 4000 at night. I am also Fructose malabsorbant and lactose intolerant, and also I am on Warferen (limits dark green vegies) I stuggle with my eating plan. I am never sure what vegies and fruit I can have - but have made a list from this post of yours which should help me a bit. I have attended the gluten free shows several times and been to dieticians, and have received some assistance from these. But I still struggle

I am a mature aged pensioner(low income budget) on multiple medications due to the problems mentioned above as well as for high blood pressure, Meniere's, Chronic back pain, Neuropathy of the feet and (hands slightly)artrial fibrillation, vascu;lar disease, etc - just seem to take so many drugs, feel unwell most of the time and lethargic. Whenever I inquire about natural rememdies - am told because of one or the other of my medications - not suitable for me e.g. Raw honey and cinnamon, St John's Wort etc. etc.etc.I am currrently seeing an eye specialist re a problem with my eyes. (my maccular is OK tho') :-) But I find it extremely hard to read ingredients on packages because of the small writing and inappropriate colour of text and/or background. Yep! I'm a problem and I am a sweet tooth, low will-powered and hungry all the time person. That's my whinge (problems) Sometimes I give up trying - I am really desperately trying to get some help!!!

My email: sherriffda@yahoo.com.au


infonolan profile image

infonolan 4 years ago from Australia Author

Thanks for commenting Doreen.

Here's a link to a post that may be of assistance: http://glutenfreesoyfree.wordpress.com/2012/03/05/...


Adele 4 years ago

I was diagnosed with fructose malabsorption about 3 months ago. If it hadn't been for the Internet, I'd be totally ingnorant about what I can or can't eat. I felt like I was 'thrown to the wolves' after I was diagnosed...I've lost about 14 lbs. and I am still confused about the diet. I read conflicting information about what to avoid and what is safe to eat. I live in America and the information here is very limited. Anyone have some good sources in the United States?


Lynne 4 years ago

Im about to bring out a range of muesli's for all types including coeliac & fructose intolerant people. I have found in my research a lot of coeiacs are fructose intolerant so looking at the fruits which I have dried myself, I know what to use and in a smaller quantity. I have a suspicion that a lot the commercial dried fruits contain sulphur which could also have some sort of bearing on the issue.

Currently looking to see who grows quinoa, amaranth and buckwheat in Australia

I have rheumatoid arthritis with vasculitis, and my nurse who comes to see me three times a week I think she maybe gluten & fructose intolerant, so to make something up for her, she will also be my guineapig, to test the waters, before I release it onto the market. If someone in Australia would like to be a part of this study I can be emailed at meetthemaker1@optunet.com.au.

I cant start this until maybe the middle of May a new kitchen is about a week away and Im not looking forward to the mess.


Michelle 4 years ago

Lynne, I have just tried emailing you as I have coeliacs (6 months) and fructose malabsorption (1 day!) and I'm feeling very disheartened and at a loss about the fact that nearly everything is poison to me! But your email address isn't working.


Pen 4 years ago

Michelle, try 'optusnet' instead of optunet.


wendy 4 years ago

Can anyone tall me if we can tolerate barley? I have diligently mad barley water - and as my memory is unreliable I cannot (for the life of me) remember if barley is on the 'no -no' list.


Wendy 4 years ago

Can anyone tall me if we can tolerate barley? I have diligently mad barley water - and as my memory is unreliable I cannot (for the life of me) remember if barley is on the 'no -no' list. PS Whoops - substitute 'mad' with 'made' and 'tall' with 'tell'.


infonolan profile image

infonolan 4 years ago from Australia Author

Barley should not cause any problems with fructose malabsorption. However, it MUST be avoided by coeliacs and gluten sensitive individuals.


sharon 4 years ago

just finished the breath test yesterday, you know the results or I wouldn't be here. Researching the web, confused, spend an hour and a half reading labels, fructose malabsorption symptoms for awhile and never knew it had a name.


Colleen 4 years ago

I'm hearing that if you have HFM, you need to avoid wheat as the first ingredient. We love whole wheat bread and have found one that states No High Fructose Corn Syrup but I'm still having stomach issues. Is there something about the wheat that should be avoided? Very discouraging when you think you're being careful . Your blogs are very helpful.


rmblair 4 years ago

Thanks so much for all the info... it has been invaluable!!


VJ 3 years ago

thank you for the great info. My FM and lactose intolerance seem to go hand-in-hand. When I have removed dairy completely from my diet, the FM is much less of a problem.


Simone 3 years ago

This is hands down the most helpful article I have read on this topic. Having a list like this is extremely useful!


Em 3 years ago

I have had type 1 diabetes for 27years, celiac for 17years and just recently have been diagnosed with lactose and fructose intolerance.... Help... Does anyone have any easy lunch and dinner recipes please?


Sandy 3 years ago

I have had Fructose Malabsorption for about three years. I have just been diagnosed with Hishimoto's Throyiditis and must eliminate Gluten. Any ideas on a Fructos Friendly/Gluten Free Diet?


Briggsparuso 2 years ago

I was diagnosed with Hereditary Fructose Intolerance 2 years ago. It took 2 1/2 years of suffering prior to finding the answer on my own...then requesting the proper test to support the diagnosis.

I have taken 3,000 pages of research and created a book to help others navigate through this illness. I had no idea what to eat and finely I created a food chart, sweeteners and alcohol chart. I have included all this in my book.

Are You Sure You Know What You're Eating? Non-specific Irritable Bowel Syndrome or Fructose Mystery the Ignored Diagnosis.

It was a long painful journey but I hope the information I share can assist you to getting a quick resolution of your issue.


Barbara 2 years ago

Are lentils ok


infonolan profile image

infonolan 2 years ago from Australia Author

For fructose malabsorption: YES

For raffinose intolerance: NO

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