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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 


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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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Nutrition Guide For Fructose Malabsorption

Nutrition Guide For Fructose Malabsorption

In the table below there are lists of foods – safe to eat, to try, 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.

Food Group: Sugars & Sweeteners

Safe To Eat

Safe to Try in Moderation


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

Barley malt syrup, brown rice syrup, brown sugar, corn syrup (if no fructose is added), grape syrup, maple syrup, sorghum syrup, sucrose (table or cane sugar).  Sugar substitutes: dulcitol, isomalt, lactalol, lacticol, litesse, lycasin, maltitol, mannitol, saccharin (Sweet `n Low), sucanat, trimoline, xylitol.

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.


Food Group: Fruits

Safe To Eat

Safe to Try in Moderation


Cumquat, grapefruit, lemons, limes

Avocado, bananas, blackberries, boysenberries, blueberries, cantaloupes, cranberries, grapes (white), jack-fruit, kiwi, mandarins, oranges, passion fruit, pineapple, rhubarb, strawberries, raspberries, tamarillo, tangelo; Apricots, nectarines, peaches, (not for persons sensitive to sorbitol).

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.

Food Group: Vegetables

Safe To Eat

Safe to Try in Moderation


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

Asparagus, beets, carrots, dandelion greens, cauliflower, endive, legumes (beans, peas and lentils), lettuce, mushrooms, onions, green onions, soy, sweet potatoes, turnip greens, zucchini.

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

Food Group: Breads & Cereals

Safe To Eat

Safe to Try in Moderation


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

Wheat (including dinkle, kamut, sourdoughs, spelt, wholemeal and wheat products: biscuits, noodles, pasta, pastry).

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


Food Group: Protein (Meat, Fish, Eggs, Nuts)

Safe To Eat

Safe to Try in Moderation


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

Legumes: chick peas, lentils, lima, mung, soy (including tofu);



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


Food Group: Dairy

Safe To Eat

Safe to Try in Moderation


Plain, unsweetened milk, yogurt, cheese.


Sweetened milk products, ice cream


Food Grouop: Spices & Sauces

Safe To Eat

Safe to Try in Moderation


Basil, bay, cinnamon, cumin, curry, marjoram,

oregano, parsley, rosemary, thyme.


Distilled vinegar.

Coriander, garlic, onions, parsnip, spring onions.


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

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


Food Group: Drinks

Safe To Eat

Safe to Try in Moderation


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


Fruit juices: blackberry, cranberry, white grapes;

Alcohol: dry white or red wine (1 glass/serving).

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.


Food Group: Wheat (Contains Fructans)

Individuals with FM who cannot safely eat wheat (white bread, pasta, breakfast cereals etc) may also have problems with artichokes, asparagus, chicory roots, chicory greens (whitlof, Belgium endive), chicory based coffee substitutes, dandelion greens, leeks, onions (after cooking, throw onions away and enjoy the taste), radish, spring onions. Tiny amounts of wheat in wheat thickener, maltodextrin and dextrose are not problematic.

Food Group: beans (Containing raffinose, galactans)

Individuals with FM who cannot safely eat beans may also have problems with other legumes (peas, soy, lentils), broccoli, Brussel sprouts, cabbage, cauliflower, kale, turnip greens, and whole grains.

Additional Low Fructose Diet Tips

Cooked vegetables (like carrots) may have higher fructose content then raw ones. Whole-grain bread has more fructose than refined bread. Brown rice has more fructose than white rice. New potatoes have more fructose than old ones. Medications like antibiotics, vitamins and supplements, often contain fructose or sorbitol, so it is suggested to find their fructose/sorbitol free alternatives.

Information sourced from:

Article reviewed by Dr. Greg. Last updated on March 27, 2011 

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Foods that Contain Excess Fructose

Foods that Contain Excess Fructose




Corn Syrup

Fruit Juice Concentrate




Honeydew Melon









Fructan food sources:



Brussels Sprouts

Chicory Root

Dandelion tea






Onion Powder

Spring Onions






Sorbitol Food sources:








*Gums, mints, confectionery

(often contain sorbitol)



Raffinose Food sources:


Brussels Sprouts



Green & yellow beans






Lactose Food sources:


High in Lactose

Moderate in Lactose

Lactose Free

Evaporative Milk

Cottage Cheese

Tasty Cheese


Cream Cheese



Ricotta Cheese


Milk Powder

Sour Cream


Ice cream






Blue cheese










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