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.

 

RECOMMENDED SITES TO VISIT FOR MORE INFORMATION

http://web.archive.org/web/200502041627 … Basics.htm

http://www.coeliac.com.au/Fructose-Malabsorption-Guide.html

 

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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.

 

Fruits

 

 

 

*Apple

*Cherry

*Grape

*Guava

*Honeydew

*Lychee

*Mango

*Paw Paw

*Persimmon

*Pear

*Quince*

*Watermelon

 

 

 

*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)

 

 

 

*Artichoke

*Asparagus

*Chickory

*Leek

*Onion

*Radicchi

*Spring onion

 

 

 

 

 

*Tomato paste, chutney, barbeque sauce

 

 

*Coconut milk and cream

 

 

*Honey

 

 

 

*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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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 healthhype.com

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Foods High in Fructose, Sorbitol, Fructans and FODMAP

Foods High in Fructose, Sorbitol, Fructans and FODMAP

Amount of Fructose, Glucose, Sorbitol and Fructans in Foods

Foods, problematic in fructose malabsorption (FM) are:

  • High in fructose
  • High in sorbitol
  • Have high fructose-to-glucose ratio (>1)
  • High in fructans or other FODMAPs (problematic only for some persons with FM)

Table: Foods, high in fructose, glucose, sorbitol, fructans and other FODMAPs (N/A = data non applicable)

FOOD

Fructose (g/100g)

Glucose (g/100g)

Fructose-to-Glucose Ratio

Sorbitol and other polyols (g/100g); Fructans, FODMAPs (g/serving)

High Fructose Corn Syrup (HFCS55)

39,05

31,95

1,22

0

HONEY

38.38 (31-44)

30.31 (23-41)

1,23 (0,76-1,86)

3-4g oligo-saccharides (15)

"LOW CALORIE" FOODS and SOFT DRINKS

< 3

< 3

N/A*

Check labels for Sugar alcohols (Polyols)

"SUGAR FREE" CHEWING GUM

0

0

N/A

~1,3-2,2g of sorbitol or xylitol / stick

VITAMIN and MEDICATION SYRUPS (for children)

N/A

N/A

N/A

Milk of Magnesia: 6g / dose; theophylinne: 26g /dose

PRUNES

Up to 23

Up to 30

0,77

Up to 15

PRUNE JUICE

14,0

23,0

0,61

12,7

AGAVE SYRUP

42-70

6-33

> 1.5

N/A

APPLES, dried

28,60

10,12

2,83

2,56

CHERRIES (sweet)

Up to 7,2

4,7

1,53

12,6

PEAR JUICE

5-9

1-2

4,5-5

1,1-2,6

PEARS, raw

6,23

2,76

2,25

3,59 (8)

APPLE JUICE

6,40

2,40

2,67

0,56

APPLES, raw

5,74

2,03

2,83

0,51

DATES, medjool

31,95

33,68

0,95

1,5

PEACHES, dried

13,49

12,83

1,05

5,41

APRICOTS, dried

4,88

9,69

0,50

4,60

PEACHES, raw

1,23

1,03

1,19

0,89

RAISINS

31,6

31,20

1,01

0,85

PLUMS, raw

Up to 4,0

Up to 5,05

0,72

Up to 2,8

APRICOTS, raw

0,73

1,87

0,50

0,82

COMPOTES (canned fruits + syrup)

3-8

3-8

~ 1

N/A

KAKI

8

7

1,14

N/A

POMEGRANATE

7,90

7,20

1,10

N/A

WATERMELON

3,92

3,02

1,94

N/A

GRAPES

7,44

7,18

1,04

Traces of sorbitol

SWEET POTATO in skin, boiled

0,50

0,57

0,88

N/A

KIWI

4,60

4,32

1,06

N/A

MANGO

23,50

25,70

0,91

N/A

PAPAYA

17

17

1

27 g of sucrose, also contains xylitol

WHEAT (BREAD, PASTA, PASTRY)

N/A

N/A

N/A

1-2,5 g of fructans / serving

ONION, SPRING ONION

N/A

N/A

N/A

2g/s

LEEK

N/A

N/A

N/A

6g/s

ASPARAGUS

0,99

0,81

1,23

2,6g/s

JERUSALEM ARTICHOKES

1,73

0,76

2,28

15g/s

GLOBE ARTICHOKE

N/A

N/A

N/A

6g/s

DANDELION GREENS

N/A

N/A

N/A

3g/s

CHICORY ROOTS

N/A

N/A

N/A

30g/s

CHICORY (coffee substitutes)

N/A

N/A

N/A

3g/s

HONEY MELON

1,30

0,62

2,10

N/A

ORANGE JUICE

up to 5,3

2,4

2,20

0

RYE WHOLE MEAL BREAD

1,06

0,72

1,47

N/A

BLUEBERRIES

3,35

2,47

1,36

N/A

TOMATO

1,36

1,08

1,26

N/A

GREEN PEAS

1,31

0,96

1,36

N/A

LEGUMES (beans),BROCCOLI, BRUSSEL SPROUTS, CARROTS, CAULIFLOWER

< 1,3

< 1,3

N/A

Galactans, raffinose, cellulose

GRAPE (WHITE) JUICE

7,5

7,1

1,05

0

ORANGES, PINEAPPLE, BLACKBERRY, GOOSEBERRY, RASPBERRY, STRAWBERRY

2-4

2-3

0,7-1,10

Strawberries and raspberries contain xylitol (20)

WINE, sweet

0,41

0,38

1,08

N/A

ZUCCHINI

1,02

0,90

1,13

N/A

GREEN CABBAGE

0,90

0,81

1,11

N/A

CARAMEL

N/A

N/A

N/A

Various sugars, oils, proteins, milk

BARLEY MALT SYRUP

Traces

~1g

N/A

~1g sucrose, ~6g complex sugars, ~5-6g maltose / tbsp

BROWN RICE SYRUP

0

0,6-1,6g /tbsp

N/A

~6g complex sugars, ~6g maltose / tbsp

MAPLE SYRUP

Traces

Up to 2g / tbsp

N/A

~2g sucrose / tbsp

CORN SYRUP (GLUCOSE SYRUP)

Traces

Various amounts

N/A

Various amounts of sucrose, maltose, and oligosaccharides

CORN SYRUP SOLIDS (DRIED GLUCOSE)

0

Various amounts

N/A

N/A

BANANA

3,8

4,5

0,84

0

SUCROSE

50

50

1

Information sourced from healthhype.com 

 

 

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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

3g/serving

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

 

Honey

 

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 http://www.breathtest.com.au . 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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