FOOD INTOLERANCE NETWORK
FACTSHEET
Fructose
Malabsorption
|
This factsheet is intended for people who are already
following a diet that is free of additives and low in salicylates, amines and
flavour enhancers (failsafe). |
Fructose malabsorption or too much fruit
syndrome
What is fructose?
What is Fructose Malabsorption?
Why does glucose help with FM?
Fructose in fruit and vegetables (for failsafers)
References and further reading
Fructose
malabsorption or too much fruit syndrome
When I was a kid and people still ate real foods instead of highly
processed products, everyone knew that if you ate too much fruit in a day –
often from your own fruit trees – you could get a stomach ache and maybe the
screaming runs for a day or two. The treatment was to eat less fruit.
What is fructose?
One of the components of fruit that can cause these symptoms is a
natural fruit sugar called fructose.
Over the last few decades, fructose intake – in fruits, juice, and high
fructose syrup - has increased in the Western diet to the point where the
amounts commonly consumed in a day may cause mild gastrointestinal distress in
normal people and severe symptoms in sensitive people. These days, such
symptoms are frequently diagnosed medically as fructose malabsorption.
What is Fructose
Malabsorption?
Previously known as fructose intolerance, fructose malabsorption (FM) is
a recently recognised condition that can cause gastrointestinal symptoms:
·
bloating
·
gas
·
diarrhoea and/or constipation
·
stomach pains and/or cramps
FM is not an abnormality, but a sign that a change of diet may be
necessary, according to recent medical thinking.
·
Fructose Malabsorption can be
diagnosed by a hydrogen breath test from a medical practitioner but the prevalence
of incomplete fructose absorption in healthy subjects was found to be as high
as 50% by Mayo Clinic researchers, who concluded that this test is not
particularly useful and instead recommended restricting fructose intake.
·
FM can co-exist with intolerance to
other food chemicals including additives, salicylates, amines, lactose or
gluten. We receive many queries from people who have tried restricting fructose
intake as recommended by their doctor and still have problems. In this case,
from our point of view, undertaking the RPA elimination diet and challenges
supervised by a dietitian is likely to resolve the confusion. For some people,
it is necessary to combine reduced fructose with failsafe eating.
·
If the only problem is FM, symptoms
can be controlled by restricting fructose in the diet
·
In some cases, taking glucose at the
same time as fructose may help
Why does glucose help with
FM?
Glucose enhances the absorption of fructose.
This means that:
·
foods with a fructose-to-glucose
ratio of less than 1 (like bananas) are better tolerated
·
foods with fructose-to-glucose ratio
of more than 1 (like apples and pears) can be a problem, regardless of actual
amount of fructose in the food
·
glucose supplements taken at the
same time as fructose-containing foods may reduce the symptoms. In a Thai
study, giving an equal quantity of glucose and fructose completely overcame the
fructose malabsorption.
·
Fruit and vegetables high in
fructose (many fruits, some vegetables)
·
Any fructose-containing food in
large amounts – including any fruit, fruit juice, dried fruit, tomato paste or
sauce
·
Foods with a high
fructose-to-glucose ratio, see above
·
HF Corn syrup: processed foods
containing high fructose corn syrup (HFCS)
·
Crystalline fructose (sold as
‘fructose sugar’) and any product containing it
·
Sorbitol: processed foods containing
sorbitol (420), Xylitol (967) and some other sugar-free sweeteners which are
converted to fructose during digestion
·
Inulin: a thickener made from
chicory, inulin contains fructose and is used some yoghurts, thickshakes and
other processed foods
·
Wheat: some people are also
sensitive to foods rich in fructans (chains of fructose molecules) in foods
such as wheat (this doesn’t affect all people with FM) - although people with
fructose malabsorption don't have to avoid gluten, gluten free breads are often
better tolerated by people with fructose malabsorption
Fructose in fruit and
vegetables (for failsafers)
Many fruits and vegetables have to be avoided by people with FM.
Failsafe foods (those low and moderate in salicylates) that contain fructose
and have to be avoided by people with fructose malabsorption include:
LOW
SALICYLATE
·
pears
·
green beans
·
shallots, leeks, garlic (and high
salicylate members of the onion family)
MODERATE
SALICYLATE
·
delicious apples (and high
salicylate apples)
·
mangoes
·
papaya
·
persimmons
·
asparagus
See others on Wikipedia
[550] IBS: ‘nice, big,
healthy bowel’ needed dietary modification (May 2007)
I have been aware of the RPAH diet for over 10 years and largely stuck
to it during that time to help with symptoms of MS (multiple sclerosis). I have
also suffered bowel issues for many years, predominately constipation but
sometimes diarrhoea. My symptoms primarily include bloating, constipation and
terrible pain. Initially, I thought it was the cause of my MS (bowel and
bladder disturbance can be a problem) so just figured I had to live with it.
When my lower bowel pain became quite severe - particularly after eating wheat
and despite being failsafe - I decided to consult my GP again. She referred me
to a gastroenterologist who proceeded to do a colonoscopy to see if some
inflammatory bowel disease was present and an endoscopy so she could take a
biopsy and take a definite diagnosis on whether I had Coeliac disease or not.
Fortunately, all my results came back clear and the gastro told me that
after examination she concluded that I had a 'nice big healthy bowel' (I guess
that's a compliment to the gastro fraternity!) As she had eliminated all other
possible diseases, she further concluded that I simply had IBS which has no
real treatment. She said that dietary modification could help however, and
referred me to a bowel dietician.
The dietician explained to me about fructans (a natural sugar) found in
the onion family, wheat, chicory and asparagus. Having been failsafe, I knew
about the amine and salicylate intolerance I have but thought that eliminating
fructans could help considering I found leeks, spring onions and wheat appeared
to affect me despite them all being failsafe and despite my not having
Coeliacs. This all really helped so now I have refined my diet again and have
eliminated all the trigger food chemicals (MSG, salicylates, amines) as well as
fructans (leeks, spring onions, wheat, asparagus). This has helped my IBS
greatly. I am now just trying to give up percolated coffee [moderate in
salicylates] every morning as that appears to trigger IBS symptoms. This fructans
information may just be another piece of the puzzle for some people who suffer
IBS. by email.
[728] Needed to be failsafe and reduced fructose
for full results (June 2009)
I am still
struggling a bit here trying to deal with fructose malabsorption and failsafe,
plus other malabsorptions (raffinose and sorbitol) that mean I don't tolerate
well any fruit, veges or legumes except for potato, celery and lettuce. If I
increase my salicylates then I get anxiety and other symptoms. Basically pears,
onions of any sort and leeks are on the banned list (as well as other veges and
fruit) - which I have been eating a lot of ! This explains why I wasn't getting
full results on failsafe eating. Jane, VIC
[727] IBS from fructose malabsorption plus
defiance from salicylates and amines (June 2009)
I have 2 kids
(2 and 4 yrs) with fructose malabsorption and my daughter has irritable
behaviour and defiance from salicylates and amines so we are looking at a
combination of low fructose and failsafe eating. – by email, VIC
[726] Fructose intolerance diagnosis not the
whole answer (June 2009)
My
eight-year-old daughter has been diagnosed with fructose intolerance and while
we have seen a dietitian it seems that we have recently hit a brick wall and
she is constantly getting tummy aches. I am exploring other causes at the
moment but was wondering if you could give me any information about
preservatives and spices (which I am suspicious of) that could help me manage
her better. The attitude I have had from
doctors is here is the diagnosis good luck and seeya later, I really wonder how
much they really know. I am literally
alone doing my own research and homework …
Three years on:
Together with your help, our dietitian and the web, our daughter is growing, is
a lot happier and not as sick as often. As well as fructose, we avoid flavour
enhancers (MSG 621 and others) and suspect sulphites (220-228), salicylates and
cheese are an issue for our daughter too. All in all we as a family are a lot
happier, family and friends are now more understanding and accepting of our
daughter and her food issues and we are constantly learning. We have also learnt that the key is “listen
to your body”. by email, SA.
References and
further reading
Wikipedia http://en.wikipedia.org/wiki/Fructose_malabsorption
Shepherd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable
bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc. 2006;106(10):1631-9.
This article describes a
Gibson PR et al, Review article: fructose malabsorption and the bigger
picture. Aliment Pharmacol Ther. 2007 15;25(4):349-63. According to these
researchers, FM is ‘not a an abnormality but a physiological process offering
an opportunity to improve functional gastrointestinal symptoms by dietary
change’.
Densupsoontorn N et al. Fructose malabsorption in Thai adult.
Beyer PL et al. Fructose intake at current levels in the
Skoog SM, Bharucha AE. Dietary fructose and gastrointestinal symptoms: a
review. Am J Gastroenterol. 2004 ;99(10):2046-50. This review from Mayo Clinic
researchers suggests that breath testing with fructose alone may not reflect
fructose ingestion under normal circumstances and instead recommends that
restricting fructose ingestion is a practical approach to testing in patients
with suspected incomplete fructose absorption. In the light on Dr Shepherd’s
later research (above) the recommendations from the Mayo Clinic about a low
fructose diet may appear overly restrictive: http://www.mayoclinic.com/health/fructose-intolerance/AN01574.
The
information given is not intended as medical advice. Always consult with your
doctor for underlying illness. Before beginning dietary investigation, consult
a dietician with an interest in food intolerance. You can find a supportive dietitian
through the Dietitians Association of
© Sue Dengate June 2009
