Reading Food Labels for Fructose Malabsorption

Reading Food Labels for Fructose Malabsorption

In the table below there are lists of foods safe to eat, and to avoid in fructose malabsorption (FM), according to several dietitians and fructose malabsorbers recommendations. The list may serve only as the orientation, since absorption of fructose and other nutrients may vary considerably among individuals with fructose malabsorption, so everyone should make lists of not/allowed foods and their tolerable amounts, according to personal experience. In small children, fructose absorption often improves with age.

NOTE: the list of safe foods is pretty strict. A person with mild fructose malabsorption will be probably able to safely eat most foods from to try list and even some foods from to avoid lists.

Individuals with fructose malabsorption often have lactose, glucose or gluten intolerance, so they might need an additional lactose-free, sugar-free, gluten-free or FODMAP diet.


Foods to Avoid

Foods Safe to Eat

Agave syrup (in Tex-Mex foods, tequila, margaritas, soft drinks), caramel, Chinese rock sugar, corn syrup solids, fructose, fruit juice concentrate, golden syrup (cane syrup), High Fructose Corn Syrup (HFCS), honey, invert sugar (treacle), licorice, molasses, raw sugar (Turbinado, Demerara, jaggery, palm sugar gur); sweets in excess (>50g), soft drinks with sucrose (>375 mL); Sugar substitutes: hydrogenated starch hydrolysates (HSH), sorbitol, stevia, sucralose.

Acesulfam potassium (Nutrinova, Sweet One, Sunnett, Ace-K, Acesulfame K), dextrin, erythritol, glucose (dextrose, glucodin), glycogen, maltodextrin (modified starch), moducal, trehalose.

Apples, cherries, dates, figs, grapes (black), guava, honeydew melon, lychee, mango, nashi fruit, papaya, pears, persimmon, plumes, prunes, raisins, star fruit, sultana, quince, watermelon. Dried fruits, fruit compotes and jams in general.

Cumquat, grapefruit, lemons, limes.

Artichoke, eggplant, green peppers, green cabbage, kale, leeks, lettuce (iceberg), pickles (e.g. sweet cucumbers), radishes, squash, tomatoes, turnips, watercress.

Bouillon, celery, escarole, hash browns, mustard greens, pea pods (immature), potatoes (white), pumpkin, shallots, spinach, Swiss chard.

Brown rice, sweetened breakfast cereals (or with raisins, honey).

Barley, breads and pasta without fructose or gluten-free, wheat-free rye bread, corn meal (degermed), cornflakes (non-flavoured), grits, grouts, oatmeal, porridge (cooked oatmeal), plain muffins, rice (white), rice or buckwheat noodles, rye flour, tortilla

Meat, fish (if processed, sweetened, or commercially breaded); coconut milk/cream.

Meat (fresh, not commercially breaded), fish (fresh or tinned without sauce), other seafood, eggs, grains, nuts, seeds: amaranth, flax seed, millet, poppy, pistachios, sesame, tahini, sunflower

Sweetened milk products, ice cream

Plain, unsweetened milk, yogurt, cheese.

Sauces: Barbeque, Sweet & Sour, Hot mustard, chutney, ketchup, relish, soy sauce, vinegar (apple cider, balsamic);

Spices: chervil, dill weed, ginger, hot chilli pepper, pumpkin pie seasoning.

Basil, bay, cinnamon, cumin, curry, marjoram, oregano, parsley, rosemary, thyme.

Fruit juices (apple, apricot, mango, orange, pear, peach, prune, sweat cherry), soft drinks with sorbitol or HFCS; alcohol (except dry white wine); powdered sweetened beverages, sweetened milk/vegetable/soy drinks, coffee substitutes with chicory.

Water: tap water, non-flavoured bottled water, mineral water, tea, coffee (not chicory based coffee substitutes).


Information sourced from

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What is Dietary Fructose Intolerance?

What is Dietary Fructose Intolerance?

Dietary Fructose Intolerance or DFI is a dietary disorder that occurs when the body’s digestive system is incapable of absorbing fructose properly.  For those who may not be familiar, fructose is a naturally occurring sugar found in fruits, honey and some vegetables. High concentrations in the form of corn syrup are also used to sweeten many processed foods and beverages.

When individuals who are intolerant to fructose consume these foods, they often experience uncomfortable symptoms, such as bloating, cramps, gas, diarrhea, fatigue and weight loss. These symptoms occur because the body cannot fully absorb the natural sugar in the small intestine during the digestive process.  As a result, in the large intestine naturally occurring bacteria break down undigested fructose into carbon dioxide and hydrogen gases, as well as short chain fatty acids.

Research studies show that dietary fructose intolerance is associated with several conditions, including an increase in plasma and liver triglyceride levels, a moderate elevation of amylase and lipase-enzymes in blood levels,  lower Vitamin E, Vitamin C and glutathione activities, the onset of mental depression and more.

Unfortunately, it is not clear exactly what causes DFI. However, some theories suggest that bacteria, health conditions such as celiac disease, intestinal injury and medical treatments such as chemotherapy and radiation may be involved.

Dietary fructose intolerance is a fairly common condition. In contrast, it is very different from hereditary fructose intolerance (HFI), which is a genetic disorder and can result in serious health complications, including liver disease and mental retardation if left untreated.


Diagnosing Dietary Fructose Intolerance

A series of noninvasive hydrogen breath tests can identify those who have DFI. A Fructose Intolerance Breath Test checks for the presence hydrogen. A high level of hydrogen indicates a positive finding.  Additional tests may be indicated including:

  • Lactose Breath Test

  • Glucose Breath Test

  • Sucrose Breath Test

  • 3C stable Radioisotope


Prior to taking the tests, specific instructions will be given on how to prepare, including what can and cannot be consumed during the 24 period before testing.  It is important that patients follow the instructions closely; otherwise, test results will not be accurate.


Treating DFI with Diet

To date researchers have not been able to discover an enzyme that would help break down fructose. Until then, fructose intolerance is treated or managed by restricting the amount of foods and beverages containing fructose in the diet. Additionally, a simple sugar, dextrose, may be used as a substitute.




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Fructose in Fruits

Fructose in Fruits

Information on Fructose Malabsorption

•Fructose is a type of sugar found in almost all fruits, honey, and in many vegetables.

•Some people face a problem called Fructose Malabsorption. It occurs if they aren’t able to absorb fructose in their small intestine properly.

•Some of the common symptoms include bloating, pain, nausea and diarrhea or watery stools.

•It can occur in healthy infants, children and adults, as well as those with functional bowel disease such as Irritable Bowel syndrome.

•Fructose tolerance depends on dose, small quantities may not cause symptoms.

•After an initial low fructose diet for 4-6 weeks, high fructose foods may be slowly re-introduced to find tolerance level.

•Fructose can take up to 3 days to pass through the digestive tract, start by trying a small amount every four days. If this is OK, try having it more frequently, build up the quantity. Cut back again if symptoms start to recur.


Hereditary Fructose Intolerance (HFI) is a rare genetic condition which causes severe toxic symptoms. It requires strict avoidance of fructose, and ongoing medical treatment. The advice in this pamphlet is not suitable for this condition.

Fructose is found in most fruits, honey and some vegetables, but not all foods that contain fructose need to be avoided. How well fructose is absorbed depends on the concentration of other kinds of sugars in the food, such as glucose, sucrose and sorbitol.

*Glucose and Dextrose can improve absorption, especially if there is more glucose than fructose (a high glucose to fructose ratio)

*Sucrose (cane sugar) is broken down during digestion into equal amounts of glucose and fructose, and may be tolerated in small amounts. However, large amounts of sucrose will release too high a total load of fructose.

*Sorbitol is a sugar alcohol found in some fruits, and is often used as a sweetener. Sorbitol will usually decrease fructose absorption, and worsen symptoms.

*Some people will also have a problem with fructans, which are fructose units linked in long chains. Wheat, in particular, has significant levels of fructans.


Dietary Treatment

•In some cases, simply cutting out fruit juice may be enough to alleviate symptoms. For infants, whole or mashed/pureed fruit is recommended instead of juice, Fruit juice intake should be no more than about half a cup per day.

•Some people will need to limit or avoid common problem foods to control symptoms

•Very sensitive people may require even greater restriction of fruit and vegetables, if symptoms persist.


Common Problem Foods

The following foods are either high in total fructose content, contain a higher ratio of fructose compared to glucose, or contain significant amounts of sorbitol or fructans.













*Paw Paw








*Large amounts of dried fruit or fruit juice

*Foods containing apple or pear concentrate

*Large amounts of stone fruit (sorbitol)

*Plum sauce, sweet and sour sauce


Vegetables     (fructans)










*Spring onion






*Tomato paste, chutney, barbeque sauce



*Coconut milk and cream







*Foods with a lot of High Fructose Corn Syrup, or corn syrup solids

*Large amounts of high sugar foods, such as soft drinks, cordials and confectionary

*Large amounts of wheat (fructans)


Reference: “Irresistibles for the Irritable”, Sue Shepherd, Dept. of Food and Nutrition Services, University of Iowa Allergy Advisor Digest


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Fructose Malabsorption and FODMAP’s.

Fructose Malabsorption and FODMAP’s.

The management of Irritable Bowel Syndrome by Julie Albrecht, A.P.D.

Irritable bowel syndrome (IBS) is a functional gut disorder, which affects up to 15 % of the community (1). IBS is a term which is used to define a variety of dysfunctions, which are characterised by chronic abdominal pain, bloating and alternation in bowel habits constipation / diarrhoea, in the absence of any organic cause. There may also be bowel urgency or the feeling of incomplete evacuation, gastro -oesophageal reflux, and depression. The exact cause of IBS is unknown. Theories highlight the interaction between the gastrointestinal tract and the brain, along with abnormalities in gut flora and or the immune system.

Fructose is a short chain carbohydrate found widely in our diet as a free hexose in fruits, disaccharide in sucrose and in a polymerized form frutans (1). In the free form, fructose has a limited absorption in the small intestine (1). The average daily intake of fructose ranges from 11 54 g, with up one half of the population being unable to completely absorb a 25g load (1). Fructans are not hydrolysed or absorbed in the small intestine. It is the malabsorption of free fructose and fructans that may induce gastrointestinal symptoms in individuals with a functional gut disorder (1).

The acronym FODMAPs – Fermentable Oligosaccharides, Disaccharides and Monosaccharides, is used to define an unrelated group of short chain carbohydrate and sugar alcohols. These include fructose, lactose, polyols sorbitol, xylitol and fructans and galactans (1). These all have a similar fate in the small bowel and colon (1). In the individual, fermentable short chain carbohydrates like fructose and lactose may be malabsorbed, polyols are generally poorly absorbed and fructans and galactans are always poorly absorbed in all individuals (1).

The physiological consequences of the malabsorption of FODMAP’s include an increased osmotic load, the provision of a substrate for rapid bacterial fermentation, changes in gastrointestinal motility, and the promotion of mucosal biofilm and the alteration of the bacterial profile (1).

The prevalence of fructose or fructose sorbitol malabsorption in the healthy population appears to be similar to that found in the populations with functional gut disorder (1). The difference between the two populations lies in the frequency of the induction of symptoms, highlighting the change in luminal conditions (induced by fructose) being the determinant rather than the malabsorption (1).

Research undertaking dietary intervention encompassing the exclusion of FODMAP’s, has been applied to patients with IBS (2). An evaluation of the outcome of this intervention revealed that 85 % of patients who adhered to the dietary intervention, had a marked and a sustained improvement in all abdominal symptoms (abdominal pain, gas, bloating, diarrhoea and constipation) (2). Of patients who adhered to the diet less than 50% of the time, 36% had a significant improvement in symptoms, particularly gas and abdominal pain (2).

This research reveals the potential the malabsorption of fructose and fructans act as contributing factors in the development of symptoms in patients with IBS. It highlights the opportunity to improve gastrointestinal symptoms and quality of life through dietary change.

Unfavourable Foods Fructose & Fructans

Excess Free Fructose

(fructose > glucose)


Fructose Load


Apple, pear, guava, 
honeydew melon, mango, 
nashi fruit, pawpaw/papaya, 
quince, star fruit, watermelon


Dried fruit apple, apricot, currant, date, fig, pear, prune, raisin, sultana


Fruit juice, canned packing fruit


Fruit pastes and sauce


Fruits with a high sugar content cherry, grape, persimmon, lychee, apple, pear, watermelon

More than one serve per sitting

Honey, High-fructose corn syrup, 
corn syrup solids, fructose, 
fruit juice concentrate


Coconut milk and cream


Dried fruit bars




Fortified wine


Sucrose sweetened soft drinks > 375 ml


Confectionary – Excessive intake 40g /50g


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Fructose Malabsorption Diagnosis

Fructose Malabsorption Diagnosis

Hyrdogen Breath Test – These tests are useful for detecting fructose malabsorption, lactose intolerance and other conditions including small bowel bacterial overgrowth. 

Undigested carbohydrate (eg: fructose, lactose) can lead to the formation of various gases, including hydrogen (and/or methane for some people), by the bacteria in the large bowl. This hydrogen (or methane) gas is absorbed across the lining of the large bowel into the blood stream, where it is carried to the lungs and exhaled. The exhaled gas can be detected and measured by a breath hydrogen (or methane) detector. If there is a significant rise above the starting value, it can indicate the presence of fructose intolerance or lactose malabsorption. 

These tests are not available in every state of Australia. A list of testing centres is available from . Bad breath testing procedures may vary form centre to centre. The centre will provide you with information about a special diet that will need to be followed the day before the tests. Theis pre-test diet is, in essence, a low FODMAP diet. 

The tests are useful for diagnosing conditions such as fructose malabsorption and lactose intolerance, however they require specialist interpretation. The tests are not essential to confirm the Low FODMAP diet works for you – your symptom improvement can often be the most useful guide. 
Information sourced from Low FODMAP Diet by Dr Sue Shepherd 


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“Fructose Malabsorption,  Intolerances, and Allergies- Now  what do I cook?”

“Fructose Malabsorption, Intolerances, and Allergies- Now what do I cook?”

Wouldn`t it be lovely to know the exact cause of your fructose malabsorption. One theory is that a good dose of strong anti-biotics will do it for you. This was a BIG coincidence for me. But if I didn`t have the anti-biotics, then would I havea kidney infection today? All of us with it would love an answer to: When? How? Would it make a difference to lifenow? No, probably not. So after the initial, "why me?" questions and the grieving over past love affairs with sexy apples and pears, you will stop moping and take on a more, "What Can I Eat", attitude rather than cry over what you can`t! After having a diagnosis confirmed by your medical professional, an elimination diet is usually suggested. Then comes the nervous reintroduction of one food/ingredient at a time, to see how you react. This can be painful, stressful and downright exhausting on the body. 

One thing I know for sure is that everybody is different! No two Fruc-Mals (for lack of a better word) are alike. If you read everything on the net about what not to eat, then there wouldn`t be anything left and life would be depressing as you snack on cardboard and salt! After my diagnosis, I was pretty down in the dumps. I lived a wonderfully healthy life before, was kind to my body, and didn`t eat lollies or anything with colours or preservatives (even craved fruit and vegetables when I was pregnant). After receiving Dr Sue Shepherd`s "Fructose Malabsorption Food Shopping Guide", in the mail, my sanity was restored. I found out that there were way more things that I could eat because the offending ingredients were so low in some products, and that many of the dietary restrictions were not necessary for me (I also have lactose intolerance and was told to stay off all dairy – not true for me). 

Grains containing gluten are not suggested for `us`, but I make my own white sourdough bread and eat pasta twice a week! Most of `us` can tolerate garlic, but it hates my body with a passion! Does it come down to a number of variable things- size, weight, other existing health issues, general health and fitness levels? No one has a clear definitive answer. Is it just that your tolerance levels are higher or lower than mine? So there doesn`t seem to be `one fits all menu`, when it comes to a Fruc-Mal diet. Listen to your body. If you feel you are reacting to a food which was recommended to you, then don`t eat it. Continued research by people like Dr Sue Shepherd, is encouraging. And I`m determined to be the first person cured! 

Friends often say to me, "it couldn`t have happened to a better person, because you can cook anything." What!? That`s not fair! I can remember screaming at my poor husband when I was first dealing with my new diagnosis, that I thought God had done this to me on purpose so I could now not only empathise with people with allergies (because both of my children have anaphylaxis to nuts/eggs), but now have to develop recipes for people with fruc-mal and lactose intolerance as well! Crazy I know, but I`m certain that being `crazy for a day`, is one of the steps to acceptance. Rant- Big breath- Smile… 

One method I now use to satisfy my cravings is to have a good variety all at one time, but I`m careful to look at my whole day`s food plan to create balance. Instead of a LARGE serving of tomatoes in a salad, I will now have acomplex salad, with a tiny amount of tomato, cucumber, feta, olives, and then lots of celery, carrots and lettuce. Cravings-over! So now a lot of my recipes have become more complex, but this is to achieve the desired strength of flavour, texture and nutrition that *my* body needs. 

I now share some with you. Please feel free to copy them down, take them to your health professional/nutritionist before you try them, or delete any ingredients that you know are not good for you!

Health to you and good luck in your search for Health, Happiness and Yummy Food. Take Charge and become a `Cook in Control`! 


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