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The Fructose Malabsorption Diet

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What Is Fructose Malabsorption?

Dietary fructose intolerance occurs when the small intestine is not capable of processing fructose and fructans properly. This causes excess fructose in the intestinal tract and symptoms associated with irritable bowel syndrome.

What Is fructose?

Fructose is a dietary sugar that falls into the category of monosaccharides. It is a simple sugar, meaning that it is made up of a single sugar molecule. When digested, simple sugars absorb directly into the blood stream and are metabolized by the liver.

Commercially produced sources of fructose include white table sugar, high fructose corn syrup, and sucrose. Fructose naturally occurs in honey, fruits and some vegetables.

Do I Have to Give up Sugar Entirely?

Not exactly. You just can't eat as much of it as an average person. It is common for people with this disorder to be able to consume less than 25g of sugar in one sitting. Any more than this will lead to symptoms like bloating, flatulence, stomach pain, nausea, diarrhea and/or constipation; but a fructose-free diet is not usually necessary.

Experiment with a low fructose diet, as the right amount of fructose will vary from person to person. Beware the attitude of "I'd rather deal with the discomfort than give up my dessert," though; some other side effects of a fructose allergy are:

  • Deficiency in some rather important vitamins and amino acids
  • Anxiety, mood swings
  • Lethargy or fatigue
  • Depression

Problematic Foods for the Fructose Intolerant

Fruits:
Vegetables/Legumes:
Grains
Sweeteners
Apples, Boysenberry, Cherries, Dried fruit, Figs, Fruit juice, Grapes, Mango, Nectarine, Pears, Peaches, Watermelon
Artichoke, Asparagus, Baked beans, Cabbage, Cashews, Chickpeas, Dandelion greens, Edamame, Fennel, Garlic (in large amounts), Kale, Leeks, Lentils, Okra, Onion, Pistachios, Radicchio, Red kidney beans, Shallot, Sugar snap peas, Tomato sauces
Barley, Brown rice, Rye, Wheat
Agave nectar, Corn syrup solids, High fructose corn syrup, Honey, Molasses
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Foods to Avoid

Processed Foods and Drinks

  • Any sweetened drink, diet or not, should be avoided. This includes soda, sweet tea, flavored coffees and more. Technically, this rule is true for everyone, not just FructMal sufferers.
  • Artificially sugar products of any kind - sorbitol, xylitol, and others. It should be noted that chewing gum, and any product advertised as "zero calorie," is usually sweetened with one of these products.
  • Inulin (chicory root) - often added as a source of fiber to foods like yogurt, cereal and granola.
  • Pastries of any kind.

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More Easily Tolerated Sources of Fructose

It should be noted that consuming glucose with fructose can help with fructose absorption; therefore, foods that have fructose in equal or lesser amounts than glucose will be better tolerated.

Fruits
Vegetables
Sweeteners
Avocado, Banana, Blueberries, Cantaloupe, Clementine, Coconut, Cranberries, Grapefruit, Grapes, Honeydew melon, Kiwi, Lemon, Lime, Mulberries, Orange, Pineapple, Pomegranate, Raspberries, Rhubarb, Strawberries, Tangelos
Arugula, Bamboo shoots, Bean sprouts, Bok choy, Carrots, Celery, Chili pepper, Chives, Collard greens, Cucumber, Eggplant, Green beans, Leaf lettuce, Mustard greens, Parsnip, Potato (white), Pumpkin, Rutabaga, Scallions (green part), Seaweed, Spinach, Summer squash, Swiss chard, Turnips, Water chestnuts, Zucchini (peeled)
Dextrose (glucose), Glucose syrup, Rice malt syrup, Malt extract, Stevia (made from the leaf and without any added ingredients like inulin)

Other

  • Some people are okay with 100% maple syrup and small amounts of table sugar (sucrose), as well.
  • Wheat may or may not cause problems. It is best to stick to a low-wheat diet, although it is not necessary to be gluten-free.

Still Feeling Ill After Following a Low-Fructose Diet?

Consider taking the FODMAP diet for a test drive. The diet is also commonly referred to as "the IBS diet," and eliminates other troublesome items from wreaking havoc in your intestines.

Or, better yet, see a nutritionist to begin a protocol for healing leaky gut - this is probably the reason you are having these problems in the first place.

Have you been diagnosed with fructose malabsorption? What foods do you have the most trouble with? What foods don't bother you? Please, answer below in the comments.

© 2013 Katie Hamre

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Comments 18 comments

findwholeness profile image

findwholeness 3 years ago from Midwest Author

Rants are okay! That is what this space is for. I totally understand where you are coming from. It's really hard to adjust to this new diet without strict yes and no foods. I eat tomatoes all the time with no trouble, but they cause you pain. It's just unfair, really, that even the advice we can give each other is so limited. A food and symptom journal helped me a lot in the beginning. My biggest trigger is chocolate (so sad). I'm reading a book now that just came out, so it's very current. I don't know if the link will work, but here is the title for you, so you can look it up: "The Complete Low-FODMAP Diet: A Revolutionary Plan for Managing IBS and Other Digestive Disorders" http://www.amazon.com/gp/product/1615190805/ref=as...


fructmaler13 3 years ago

I was diagnosed with fructose malabsorption (dietary fructose intolerance is what my doc called it, but it is the same thing) just over five years ago. My case is relatively mild, for which I am thankful. My three year old daughter also suffers from fructmal :(. Like others have posted, when pregnant with her, my symptoms actually improved, but got worse again once she was born. I am currently pregnant with baby number two, and sadly, have not experienced the relief from symptoms that I did the first time around. What I find frustrating is that all of the information out there about what is okay and what is not differs. The booklet I received with my diagnosis disagrees on many counts with what I'm reading on the internet now. Every case is so different...what works for one person may not work for another, etc. so it is so hard to know what is really acceptable and what is not. And the fact that a reaction may not occur until a few days after the problem food was eaten makes it really difficult to pinpoint exactly what causes a reaction. I find this especially frustrating because my daughter is still too young to really understand, or to explain how she is feeling. She tells me when her tummy hurts, but suffering myself I know that there are lots of different kinds of tummy discomfort. I have been able to narrow down certain problem foods. For example, tomatoes/tomato products in any amount are a BIG no-no for me. They cause PAIN. I've recently discovered that grapefruit, which I had thought was okay in small amounts, gives me diarrhea. And corn seems to be a source of severe bloating and all around "I don't feel good" symptoms. It is such a hard condition to explain to others, as most "healthy foods" (fruits, veggies, whole grains) are off the list for us. It isn't nearly as cut and dry as a lactose or gluten intolerance (lactose, avoid milk and milk products...gluten, avoid wheat and wheat products). Fructose/fructans occur naturally in so MANY things. Sorry, that was a bit of a rant. I appreciate your post, and hope to some day have a better handle on what really does and does not work for me/my system as well as for my daughter (because chances are her tolerance level will be different than my own).


findwholeness profile image

findwholeness 3 years ago from Midwest Author

You're welcome! Thank you for the nice comment. I have another hub that links to some FructMal resources that might be helpful to you.


Tan11538 3 years ago

Thank you so much for this article! I'm 24 and have been suffering from fructose malabsorption for at least the last 10years, however, until recently there wasn't very much information on it. Growing up I had no idea what was causing me hours of pain, and then my mom booked me in to see a stomach specialist and they determined it was lactose, but the breath test came out negative. After eliminating dairy from my diet(as best as possible), I still would have crazy stomach cramps and diareha. So I, with my mothers help, started eliminating foods from my diet and kept a journal of all the foods I ate in a day, and on which days I felt sick. After reading the ingridients on the foods, we both noticed the trend of fructose on the days I felt sick. I've never gone back to the doctors to do the breath test to determine for sure if it is indeed fructose malabsorption, all I know is that when I stay away from fructose and the fruits and vegtables that contain more fructose than glucose, I can get through a day without feeling sick. It is really nice to see that others are going through the same thing and you're not the only one. Thank you for the information on the site as well, learned some new foods I should stay away from that may be the casue of those "mystery" stomach pains!


findwholeness profile image

findwholeness 3 years ago from Midwest Author

Gina, actually the breath test isn't all that accurate. Yes, you can test negative and still have fructose malabsorption. And there are 2 breath tests - one is for lactose. Are you sure they tested you for fructose? Many people say their symptoms go away completely during pregnancy and then return after birth. I would suggest downloading the Monash University app on your iPhone and avoid the foods they suggest for awhile. If you feel lots better, you have your diagnosis.


Gina 3 years ago

This is so interesting and describes me to a tee. I've been having IBS issues since college and finally went to a gastro doc at age 22, who diagnosed gastroparesis through the stomach emptying scan. I'm pretty sure I had the breath test done too but that was normal. I was wondering if you have ever ears of false negatives on that test, or if people intolerant of fructose can get worse over time. Now age 27 and I really feel this is the true cause of my symptoms, and I feel it got worse after the birth of my twins. (I have read several other women's comments about worsening symptoms postpartum.)

I've also been dealing with depression, which I also read has recently been associated with fructose intolerance in women in a small Austrian study.

The past week I have been wheat free and feeling great. Last night I had some maple syrup with wheat free zucchini banana pancakes and some of my symptoms came rushing back. That's what made me start researching this.

Thank you for the information.


findwholeness profile image

findwholeness 3 years ago from Midwest Author

I'm glad it helped you!


Sarah 3 years ago

Thanks for the article, after 3 years of gastro issues and bacteria many tests and misdiagnosis, I was advised I had IBS. Through a nutritionist I learnt garlic and onion as well apple were big triggers which set my tummy off. After still having a lot of my symptoms today, I have been searching for more answers. Have just booked in to get tested for fructose malabsorption! Again thanks for the article.


findwholeness profile image

findwholeness 3 years ago from Midwest Author

Rachael,

Which probiotics have you tried? Some probiotics can make IBS symptoms worse, and FM is a form of IBS. I have written another hub on the right kind of probiotics to take for IBS, and I have definitely noticed a difference - I am much more regular on them (I'd link to it, but HubPages doesn't allow it. Just click on "findwholeness" next to my photo at the top to find it). As for diet...I think it's very important to use the low fodmap diet as your baseline. It's the best way to find out for sure which foods trigger symptoms. But keep in mind that your average low fodmap diet guidelines do not take FM into account. You will have to remove high fructose and fructan foods from the "safe" list and put them on the "unsafe" list yourself. The best source of information for you would be 1) Monash University in Australia. They have a pamphlet you can order and an iPhone app with the most current FM diet info. And 2) The Facebook group called "Fructose Malabsorption Support Group - Victoria". Any questions you have can usually be answered by people in the group.


Rachael 3 years ago

My daughter has had 'gut' issues since she was born, with chronic gastric reflux for the first 6 years of life. She is Gluten Intolerant with the Coeliac gene in the family. I have tried many many many things to help her (13 years), including elimination diets (FAILSAFE & SCD as well as GF, Dairy and Soy). I have recently been told of the FODMAP diet as she still has discomfort and pain in her 'tummy' day and night. Interestingly her difficult birth ended in her having 6 days of IV antibiotics and I always wondered if this started all of her problems, she has been unable to tolerate probiotics, although I have tried many times. Her diet is self limited, she is also on the Autistic spectrum (Mild)and I heard that this is pretty normal. Her brother has similar issues and tests diagnosed a lack of Fructase in his gut. I am loathe to start a new diet, because nothing has helped to date... any thoughts or comments would be welcomed.


findwholeness profile image

findwholeness 3 years ago from Midwest Author

Rachel, to stay the most current on safe and unsafe foods, download the Monash University app on your iPhone: http://med.monash.edu.au/cecs/gastro/fodmap/iphone...


rachel 3 years ago

I've been going to the doctors for over a year trying to figure out what my symptoms were from. Got a scope down into my stomach to see if it was an ulcer, had many ultra sounds, blood tests and was sick once a week vomiting and diarhea for over 7 monthes, they still haven't figured it out. But my friend showed me an article recently about this and its 100% my case like ah. Its also common to be lactose intolerant to (which i am) and I plan to use the food guide above to try to help my body not die from food on a daily basis. Thank you!


findwholeness profile image

findwholeness 3 years ago from Midwest Author

@gemgoddis, sometimes you need to go back on an elimination diet for awhile to "reset" your system. You may also have "leaky gut." There are ways to fix that...just google it.


gemgoddis 3 years ago

I was diagnosed with FructMal 5 years ago after my son was born. I spent 4 long months on an elimination diet and then took 8 months of re-introduction to figure out what I could tolerate. I had a fairly mild case and was able to still eat most wheat products, tomatoes and corn without any trouble. Unfortunately after having my daughter a year ago, my FructMal has gotten worse and things I could tolerate before now make me miserable. I can no longer eat roasted nuts, syrup of any kind or too much tomato, corn or wheat without stomach cramps, gas, diarrhea and a headache to follow. I consume very little sugar because large amounts cause me severe vomiting and diarrhea. HFCS in any amount causes me to be extremely irritable, tired and depressed so I avoid it completely.


findwholeness profile image

findwholeness 3 years ago from Midwest Author

Oh my gosh, that sounds terrible. Have you tried the FODMAP diet? I talk about it in the last paragraph above. That would eliminate all those things you can't have. And maybe open up a few more options for you. Good luck, Bri!


Bri 3 years ago

I've been recently diagnosed with being fructose intolerant, and mine is an extremely bad case. For myself, I have to strictly stay gluten free as well as fructose, glucose, sucrose, dextrose etc. free. The only foods I can really eat are meat, peanut butter/nut butter, Greek yogurt, and some vegetables. My doctor has me on an antibiotic and also acid medication (for my reflux) as well as stool softeners and ducal ax (IBS/gastritis). I also take a multivitamin called ALIVE!


vibesites profile image

vibesites 3 years ago from United States

I've never heard of that condition before -- I thought everyone eats anything with sugar, fructose in particular -- so it's quite new to me. I've learned something new. Thanks for posting. Up and useful. :)


sarifearnbd profile image

sarifearnbd 3 years ago from Bangladesh

Wow, awesome. This is a great, interesting hub.

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