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Fructose Intolerance

Fructose Intolerance

What a minefield 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.

 

Article submitted by Kim Samsa Naturopath 2009

 

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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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“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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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 healthhype.com 

 

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