Fructose-Free Diet

Fructose is a naturally occurring simple sugar found in fruit, vegetables and honey. Fructose is used to sweeten foods like jellies, soft drinks, gelatin, ice cream, candy, and certain diet foods. Fructose also absorbs moisture so it helps keep baked goods from becoming stale. Fruits and fruit juices with high levels of fructose may cause gas, bloating, abdominal cramping, and diarrhea.

Sugar malabsorption is the inability of the small intestine to break down sugar like fructose for digestion. The sugar moves into the large intestine (colon) where bacteria break it down causing bloating, pain, diarrhea and gas (flatulence). The fructose molecule attracts fluids back into the colon making bowel movements loose and watery. Fructose Malabsorption is not only associated with gastro-intestinal distress but also the inability to absorb all kinds of nutrients which can lead to serious diseases like anemia and osteoporosis.

What is the difference between fructose intolerance and fructose malabsorption?

“Fructose intolerance” is a general term that describes two conditions:

Hereditary Fructose intolerance is a rare genetic condition that doesn’t produce an enzyme necessary to break down fructose. One in three people has some level of sugar sensitivity – most commonly to fructose, however around half of these people show no symptoms at all. With this intolerance it is vital to observe a strict fructose-free diet. Otherwise there is risk of serious disease including liver failure, which is sometimes fatal, and kidney damage.

Fructose Malabsorption, on the other hand, is more common and affects about 30% of people. This disorder does not result in kidney or liver damage but it can cause abdominal cramping, diarrhea, nausea, pain, and bloating. In addition, sorbitol — a sugar alcohol — is converted to fructose during normal digestion. People with fructose intolerance should avoid foods that contain fructose,sucrose, and sorbitol.

How is fructose malabsorption and fructose intolerance treated?

A fructose-free (low-sugar diet) is the best treatment. Many processed foods contain added fructose under names like “corn syrup” or “high-fructose corn syrup.”

When will I be cured from fructose malabsorption or fructose intolerance?

Hereditary Fructose Intolerance cannot be cured so a strict fructose-free diet must be followed.

Fructose Malabsorption is much easier to manage. Keeping a food diary/journal will help you decide which fructose-containing foods bother you the most. Some people can eventually tolerate small amounts of fructose in their diet.

High Fructose Corn Syrup (HFCS)

HFCS is made up of almost half glucose and half fructose and may be absorbed just as well as sucrose (regular table sugar). Items with HFCS such as soft drinks, may be tolerated well when limited to 12 oz. per day and with a meal. HFCS can also be found in canned, baked, or processed foods. In some patients, even a small amount of processed fruit juice or even foods with HFCS may cause as much malabsorption and/or intestinal discomfort as eating large quantities of fruit.

Sorbitol

Sorbitol or Sorbose is a sugar alcohol used as an artificial sweetener and found naturally in fruits and fruit juices. It can also be found in many “diet foods” such as diet soft drinks, sugarless gum, sugar-free jelly/jam, and liquid medications. Sorbitol often creates similar symptoms as fructose – especially when fructose and sorbitol are ingested together.

General Guidelines

  • Eliminate products with ingredients that list fructose, crystalline fructose (not HFCS), honey, and sorbitol on the label.
  • Avoid sugar alcohols, which include sorbitol, isomalt, lactitol, maltitol, mannitol, xylitol, erythrytol, and lactatol. These are often found in “diet or diabetic foods” such as diet drinks, ice cream, candy, processed goods, etc.
  • Limit drinks with HFCS; if used, drink less than the recommended serving size, e.g., less than 12 oz. soda (may help to drink with a meal).
  • Check medications for fructose and sorbitol. They are not always listed on the label, so check with your pharmacist or the manufacturer.
  • Keep in mind the amount of fructose found in 2 apples or 2 oz. of honey is the same fructose as one can of soda.
  • Follow guidelines below for fruits, vegetables, and other foods that are friendlier to your intestines.

Fruits:

  • Serving size is ½ cup – recommended 1 to 2 cups per day.
  • Fresh or frozen fruit may be better tolerated than canned fruit.
  • Keep in mind tolerance may depend on the amount you eat at one time.
  • The following recommended foods to avoid, should not be eaten because of their high fructose content. These are otherwise healthy foods.

Intestine Friendly Foods to Avoid Questionable Foods/Limit
Pineapples, strawberries, raspberries, blackberries, lemons, limes, avocado, bananas*, rhubarb, orange Prunes, pears, cherries, peaches, apples, plums, applesauce, apple juice, pear juice, apple cider, grapes, dates Other fruit/juices or drinks
Sugar-free jam/jelly
Dried fruit, canned fruit in heavy syrup
Other fruit

Vegetables:

  • Serving size is ½ cup, 1-cup leafy green vegetables – recommend 1 ½ to 3 cups per day.
  • Cooked vegetables may be tolerated best as cooking causes the loss of free sugars.
  • Keep in mind tolerance may depend on the amount you eat at one time.

Intestine Friendly Foods to Avoid Questionable Foods/Limit
Asparagus, cauliflower*, green peppers*, broccoli*, leafy greens, celery, mushrooms, white potatoes, shallots, spinach, pea pods, cucumber*, beans*, other root vegetables None Tomatoes, corn, carrot, sweet potatoes

Other:

Intestine Friendly Foods to Avoid Questionable Foods/Limit
  • All meats
  • All fats
  • All dairy
  • All eggs
  • All beans*
  • Aspartame (Equal and Nutrasweet), Saccharin (Sweet ‘n Low)
  • Sucrose (table sugar)
  • Honey
  • Flavorings with fructose or sorbitol
  • Desserts (ice cream, candy, cookies, bars) sweetened with fructose or sorbitol
  • Cereal or other processed foods with sorbitol or fructose on the label
  • Sugar-free gum and mints
  • Limit products with HFCS if symptoms still continue

*possible gas forming food – may need to be avoided.

Restaurant Survival

Eating away from home can be very challenging. Success includes choosing the right restaurant as well as enlisting the help from the employees in the restaurant.

The Chef

The chef is often in charge of the kitchen – to include ordering supplies, checking recipes and supervising the staff in the kitchen. Each cook has his/her own way of preparing foods even though the recipes should be standardized.

The wait-staff

Time your meals so that you do not go during peak times. This will allow your server the time needed to help with your selections as well as to discuss your diet with the chef. Be very clear and concise about your dietary needs. State:

  • “I need your help. I have a food intolerance where I must avoid fructose, a sugar found in processed foods, soda, fruits and vegetables. If I eat any foods containing fructose I will experience pain, bloating and diarrhea. I know the diet is complex, and I will try to order simple foods.
  • I cannot have foods containing fructose, high fructose corn syrup, Sorbitol, honey, molasses, maple syrup, or caramel.
  • I can use sugar substitutes with the exception of Splenda.
  • I cannot have carrots, tomatoes, beets, onions, peas or corn.
  • I can have plain green leafy vegetables, potatoes and rice.
  • I can have small amounts of asparagus, green beans, broccoli, cauliflower, leeks, cucumbers, lettuce, green pepper, and cabbage without added sugars or sauces.
  • I cannot have fruit or fruit juice, sweet wines or vegetable juices.
  • I can have unbreaded meat, chicken and fish (without added sweeteners), shellfish, crab, or crayfish.
  • I need to avoid spicy foods, since there are spices I cant tolerate.
  • I can have milk and milk products as long as there is no added sugar. Even small amounts of fructose in my food will cause symptoms.”

Consider these foods when eating out:

Salads

Small amounts of salad greens should not be a problem unless the greens have been treated to increase shelf life. If you have doubts, ask the chef, or bring a portion of salad greens from home.

Salad dressings

Commercial companies make most, if not all, salad dressing bases. Determine ingredients by reading the label on the original container. It may be safer to order a lemon wedge and oil on the side, or to bring a small container of dressing from home. House dressings are usually made from a commercial base with other ingredients added to make it unique to a particular restaurant. Read the label and talk to the person who made the dressing to determine if it is safe to eat.

Soup

Except for selected restaurants, most soups are canned. Read the label. If the soup is made at the restaurant it may contain ingredients not compatible with your diet. Obtain specific ingredient information from the person who made the soup.

Main courses

Prime Rib and other meats. Whether grilled or broiled, seasoning is routinely used in meat preparation. Specify no seasonings. Many establishments keep a pot of hot au jus in the kitchen for preparing prime rib. Au jus is a sauce used for flavor and appearance, and usually contains hydrolyzed vegetable protein, a soy product that may not be tolerated. Request no au jus on your meat. Additionally, meat and poultry is frequently marinated using untolerated ingredients. When making reservations, request no marinade. Emphasize the meat must be cooked on aluminum foil to avoid contamination from sauce used on other orders.

Sauces

In many fine restaurants, one person is in charge of all sauces. Often the sauce ingredients are a closely guarded secret. If the purpose of your inquiry is clear, the chef will help determine if the sauce has fructose containing ingredients. Canned sauces are also available in restaurants. Request to check the ingredient list. To avoid questionable sauces, bring your own.

French Fried Foods

In most restaurants, the same hot oil is used to cook breaded foods and french fries. The batter may contain an untolerated ingredient. There is a possibility of contaminating your french fries with small bits of batter from what has been in the fryer earlier. In large chains where french fries are cooked in separate fryers, there is less chance of contamination.

Hash browns

Few restaurants make fresh hash browns. Most hash browns are potatoes, dextrose and salt, but read the label to be certain. Ask the person cooking the hash browns what other ingredients have been added.

Non-Dairy products:

Non-dairy products are often used in restaurants, and may contain untolerated ingredients. Three frequently used non-dairy products are non-dairy creamer, non-dairy potato topping, and non-dairy whipped topping. Ask to read the label.

Fructose in Fast Food Restaurants: http://www.foodfacts.info/high-fructose-corn-syrup.shtml