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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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Possible symptoms of Fructose  Malabsorption

Possible symptoms of Fructose Malabsorption

Excessive FODMAPs intake may cause: 

1. Diarrhea, since FODMAPs are osmotically active, so they drag water from the intestinal vessels into 
the intestine 
2. Bloating and flatulence, since FODMAPs are broken down (fermented) by intestinal bacteria to 
gases like hydrogen, carbon dioxide or methane 
3. Excessive belching (burping) 
4. Abdominal pain 
5. Unintentional weight loss 
6. Symptoms of vitamin and mineral deficiency, like paleness, tingling, tiredness, depression 
7. Headache 

FODMAPS may also aggravate symptoms of: 
Lactose intolerance 
Fructose malabsorption 
Small intestinal bacterial overgrowth (SIBO) 
Celiac disease 
Inflammatory bowel disease (Crohn's disease, ulcerative colitis) 
Dumping syndrome (rapid gastric emptying) 

Information sourced from 


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The difference between Fructose  Intolerance and Fructose  Malabsorption

The difference between Fructose Intolerance and Fructose Malabsorption

What a minefield the diet is. We think we are doing the right thing using fructose (fruit sugar) instead of other refined sugars. But are we?  

Sensitivity to sugars like lactose, fructose and sorbitol is largely undiagnosed, but responsible for stomach bloating and intestinal distress in millions. These substances are used extensively in manufactured foods due to sweetening power and low cost. The genetic pre-disposition plays a role and more so the quantities ingested in combination with other elements. 
The difference between Fructose intolerance and malabsorption is this: 
Hereditary Fructose intolerance (HFI) is a quite rare genetic condition where the enzyme for breaking down Fructose is not produced. With HFI it is vital to observe a strict Fructose-free diet. Otherwise there is risk of serious disease including liver failure (sometimes fatal). 
Fructose Malabsorption on the other hand is much more common and affects about 30% of people. Certain special cells (epithelial cells) on the surface of the intestine are not available to assist the digestive process. 
Did you know that in experiments they inserted a camera down someone`s esophagus at the same time as putting sugar down they`re to see what it would do? The result was inflammation. Imagine your mouth tissues are the same soft vulnerable tissue all the way through your digestive tract. Constant bombardment of sugars not in their natural context i.e. in fruit, vegetables. Not only does this cause some of the above mentioned symptoms but also can cause valuable nutrient absorption to be impaired.  When we get down to it, it is a matter of what form of sugar we are ingesting and how often. 

Source: Kim Sansa (Naturopath)


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What is DFI?

What is DFI?

Exploring the Symptoms, Diagnosis, Testing, Causes and Treatment of Fructose Intolerance 

What is DFI? 

Dietary Fructose Intolerance (DFI) 

DFI is the inability to absorb fructose efficiently. Fructose is broken down by bacteria into short chain fatty acids, carbon dioxide and hydrogen. Fructose is associated with low plasma folic acid concentrations, low serum tryptophan and zinc, moderately elevated serum amylase and lipase concentrations, elevated plasma and liver triglyceride, hepatic lipogenesis, fatty acid oxidation, mental depression, and lower Vitamin C, Vitamin E and glutathione activities. 

Hereditary Fructose Intolerance (HFI) should not be confused with Dietary Fructose Intolerance. HFI is a deficiency of a hepatic enzyme (fructose-1,6 diphosphatase) causing acute inhibition of hepatic glucose output when fructose is ingested. HFI leads to hypoglycemia, acidosis, accumulation of gluconeogenic precursors, and, if untreated, can lead to an enlarged liver and mental retardation. 

What are the symptoms of DFI? 

  • Bloating 
  • Abdominal pain 
  • Diarrhea 
  • Headache 
  • Weight loss 
  • Fatigue 

How is DFI diagnosed? 

DFI is diagnosed with hydrogen breath tests. Those include: 

  • Glucose Breath Test to rule out bacterial overgrowth. 
  • Lactose Breath Test to test for intolerance to milk and milk products. 
  • Fructose Breath Test to determine intolerance to fructose. 
  • Sucrose Breath Test if indicated from physical and oral history. 
  • 3C stable Radioisotope; Breath tests for children and pregnant women.

How are results of the tests interpreted? 

10 – 20 H2, ppm (depending on facility) above baseline indicates a positive result. 

How does someone prepare for the tests? 
Preparation is vital to the success of the tests. Indiscretions can result in either a false positive or false negative test. 
Do not smoke or perform physical exercise two hours before testing to avoid hyperventilation. 
Rinse mouth with antibacterial mouthwash before testing to prevent premature hydrogen or carbon dioxide production. 
Eat/drink only the following foods 24 hours before testing: 
White bread (limit to 6) 
White potato 
White rice 
Chicken breast 
Turkey breast 

What causes DFI? 
As yet there are only theories. Some of those are: 
Abnormalities in GLUTE5, a fructose transporter 
Celiac Disease (transitional) 
Chemotherapy (transitional) 
Familial predisposition 
Injury to the intestinal lining 
Overuse of High Fructose Corn Syrup (HFCS) 
Motility problems 
Rapid gastric emptying of liquids Rapid intestinal transit 

What is the treatment for DFI? 

There currently is no specific enzyme developed to break down fructose. Until an enzyme is developed the only treatment is to follow the diet and include dextrose (a simple sugar) with your food. 

Source: University of Iowa


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