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 FM, 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.

Table: Foods – safe, to try, and to avoid in fructose malabsorption

FOOD GROUP SAFE TO EAT TO TRY (IN MODERATION) TO AVOID
SUGARS AND SWEETENERS 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.
FRUITS 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.
VEGETABLES 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.
BREADS AND CEREALS Barley, breads and pasta without fructose or gluten-free, wheat-free rye bread, corn meal (degermed), cornflakes (non-flavored), 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).
PROTEINS (MEAT, FISH, EGGS, NUTS) 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);
Nuts
Meat, fish (if processed, sweetened, or commercially breaded); coconut milk/cream.
DAIRY Plain, unsweetened milk, yogurt, cheese. Sweetened milk products, ice cream
SAUCES AND SPICES 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 chili pepper, pumpkin pie seasoning.
DRINKS Water: tap water, non-flavored 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.
WHEAT (containing 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.
BEANS (containing raffinose, galactans) Individuals with FM who cannot safely eat beans may also have problems with other legumes (peas, soy, lentils), broccoli, Brussel’s 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.

NOTE: the above 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.

The following substances, listed on food (and supplements) nutrition facts labels, may be problematic in fructose malabsorption:

  • Arabitol
  • Corn syrup solids
  • Dulcitol
  • Fructose (fruit sugar)
  • Fructooligosaccharides (FOS)
  • Fructose-glucose syrup
  • Fruit juice concentrate
  • Galactooligosaccharides (GOS)
  • Glycerol
  • Glycol
  • High fructose corn syrup (HFCS)
  • Hydrogenated starch hydrolysates (HSH)
  • Iditol
  • Inulin
  • Invert sugar, saccharin, sucanat
  • Isomalt
  • Lactalol
  • Lactitol
  • Maltitol
  • Mannitol
  • Oligofructose
  • Polyglycitol
  • Polyols
  • Raffinose
  • Sorbitol
  • Sucanat
  • Sugar alcohols
  • Threitol
  • Trimoline
  • Xylitol

The list above is probably not complete (some polyols ending with -tol are missing), but the point is that not just any “food additive” or “sweetener” is problematic in FM.

The following substances, listed on nutrition fact labels should NOT be problematic in FM (and if they are, this is probably from other reasons than FM):

  • Agar
  • Acesulfam potassium
  • Artificial dyes
  • Carrageenan
  • Dextrin
  • Dextrose
  • Erythritol
  • Essential oils
  • Gelatin
  • Glucodin
  • Glucose
  • Gluten
  • Glycogen
  • Lactose
  • Lecithin
  • Maltodextrin
  • Modified starch
  • Moducal
  • Pectin
  • Protein hydrolisate
  • Salt
  • Sodium nitrite (and other nitrites and nitrates)
  • Sulfites
  • Trehalose
  • Vitamins

To understand fructose malabsorption better, you may read about mechanism, symptoms and diagnosis of fructose malabsorption, principles of low fructose diet, and check the list of foods high in fructose/sorbitol/fructans/FODMAPs .

Related Articles:

About Jan Modric (249 Articles)
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  • kat1

    i find things hard with food what to eat and when tring to lose weight /. what abouts salads i love them cant eat tomato ? lettuce? sweet cuccumber whats that?

  • Jan Modric

    Green salads like lettuce,spinach, etc are generally well tolerated in people with fructose malabsorption. It is iceberg lettuce that’s often not tolerated, also tomatoes.

    Sweet cucumbers are sweetened cucumbers (tinned). Cucumbers themselves are usually tolerated well.

  • ElizaD

    I was diagnosed FM just over 2 years ago, within the 3 months following that I entered an entirely dairy free, gluten free and fructose free diet. Since then I re-introduced Carrots, Iceberg Lettuce, Tomatos, Brown rice, Ketchup and a few other foods that never seemed to be a problem but kept out the major problem ones like apples, pears, beans, onions, cabbage – really the ones the doctors and most websites indicate are the big no-no’s. I also within the past 6 months have re-introduced small quantities of cheese (but not butter or milk as they still make me sick) and also some glutenous products like Rye (but not wheat).

    I really think you should not base your diet 100% on what websites say, but use them as a guide and see what works for you. For a lot of people I have spoken to with FM, they went Fructose Free for 1-2years then introduced a few things back. Elimination diets are very tough, but they help in learning what your body can and cannot tolerate on a personal level!

    Hope it helps

    Eliza J. (23yr Australian, sufferer of IBS, FM and DI)

  • Jan Modric

    Complete abstinence from irritating foods for some time (6-8 weeks), especially in fructose malabsorption, may help, since it’s possible that small intestine recovers to some extent, and is able to absorb certain (increased) amount of fructose after that.

    Eliza, I appreciate your post, it sheds some light on the nature of these “food intolerances” – they are always individual, at least in part.

  • Pingback: Fructose Malabsorption - Causes, Symptoms, and Diagnosis | Current Health Articles 2009()

  • Pingback: Foods, High in Fructose, Sorbitol, Fructans and FODMAPs | Current Health Articles 2009()

  • msrysns

    This is a really useful table, but I can’t see the final column of the table (foods to avoid) in any browser I try. Is there another way of getting this information?

  • Jan Modric

    To msrysns.

    We will solve the issue shortly. Check it after few hours or tomorrow…

  • Cavegirl

    I am so grateful to you for designing this table. It will certainly make it much easier to avoid fructose with this in hand. It is so easy to read and use. Thanks again.

  • Jan Modric

    To Cavegirl.

    I certainly wanted to be helpful with the table. Fructose, sorbitol, fructans, and lactose may be also problematic for individuals with fructose malabsorption, so you may want to check FODMAP diet also:
    http://www.healthhype.com/fodmap-diet-foods-to-avoid-in-ibs-bowel-disorders-with-bloating-and-gas.html

  • momofgirlswcurls

    Hi –
    Can you explain the difference between the shallots which are safe to eat and the green onions and spring onions that are to be tried in moderation and the regular onions. Thanks.

  • Jan Modric

    To momofgirlswcurls.

    Shallots are low in fructose and other substances that could be problematic in fructose malabsorption.

    Onions and green onions contain *fructans* that can trigger symptoms in *some* people with FM, so this is why they are in the “to try” column.

  • CJS

    Thank you for posting this chart. Just a few questions: 1) Escarole is considered to be one of the “chicories” – how does it fall into the “safe” category? 2) Why are other alcohols (i.e. dry red wine or vodka made from potatoes) not okay? 3)Is it really okay to use onion (garlic too??) in a broth or sauce and then remove the flesh? Wouldn’t most of the sugars be absorbed into the sauce or broth? 4) I think that some of the confusion about shallots might stem from the fact that many Americans think of shallots as being green onions French, or true, shallots are more similar to miniaturized red onions often with multiple cloves per bulb. Which type are considered safe?

  • Jan Modric

    CJS,

    I appreciate your comment that can help to solve some misunderstanding.

    Escarole is a type of endive (green salad). With chicory, chicory roots from which coffee substitutes are made are meant.

    Certain sweetened alcohols may contain more fructose than glucose (if fructose is added), besides that alcohol itself may irritate the bowel. All this should be understood in a practical way: fructose malabsorption is not an allergy, so reactions to certain foods may differ a lot from person to person.

    In onions, there are fructans (not fructose) that may be problematic for **some** people with FM. I believe, fructans stay in the onion flesh, so removing it may help to those who get irritate by it. Garlic should not be problematic for most persons with FM.

    Shallots are “small onions”, yes. I’ll check it and comment later.

  • Mel

    Our 12 mths old son was recently diagnosed with FM (after weeks of severe diarrhoea). He reacts strongly to any food with a high fructose content and it seems to get worse (ie. bananas were sort of fine a few weeks ago but no longer are). Wheat products seem okay but anything else isn’t (even those foods to try (in moderation)).
    I find this table extremely helpful but have a few questions: Yoghurt is listed as being safe to eat. Do you mean plain yoghurt or is vanilla yoghurt fine too? What about vanilla custard, kohlrabi, red peppers, corn, processed meat (ie. sausages, salami, ham, pate), chocolate, mayonnaise? I couldn’t find these in the table? Plain unsweetened milk is listed as being safe to consume? Do you mean “normal” cows milk?
    Is galactose safe to consume?

    We are very desperate as we don’t know what to feed him anymore (half of what he can have he doesn’t like) and we are happy about any further information you can give us.
    Finally, will he get over this or will it just slightly improve with time? Should we eliminate any foods high in fructose from our unborn son’s diet as well until he is 1 yr old to prevent him from getting FM as well?

    • Jan Modric

      Mel,

      your son’s intestine can be irritated from weeks of diarrhea, so decresed tolerance to bananas can be from general irritation and not from worsening of FM itself. As long as his diarhea lasts, he may be also sensitive to sweets, spices, legumes and oats – which produces gas, and not just high-fructose foods. But it also means he might be able to tolerate more fructose after some weeks of normal digestion. I also hope the diagnosis is correct and he does not have a hereditary fructose intolerance (HFI).

      A general rule in fructose malabsorption is to avoid fructose, HFCS, sorbitol and resembling artificial sweeteners ending with -tol : xylitol, maltitol…(commonly known as polyols or sugar alcohols). These *may* be found in souces (including mayonaise), infant formula, sweetened breads or meat breading or any other processed food… Amount of fructose and mentioned sweeteners allowed depends on fructose tolerance level, which may differ a lot, and can be found out from experience.

      Galactose and glucose are not problematic. Table sugar = sucrose (glucose + fructose) is well tolerated by many persons with FM, but not by all. Glucose helps in absorption of fructose, so when a food contains more glucose than fructose, it should be fine. Sucrose should be still offered in moderation. If he can’t tolerate sucrose, offer him glucose (commercially available as dextrose).

      Plain, unswetened dairy, eggs, meat and fish should be OK, since they do not contain any of mentioned substances. Most of vegetables and cereals should be also OK, but check that chart again. If he can tolerate wheat, he will probably tolerate legumes – but yielded gas may irritate him. Actually “only” fruits/products and sweeteners (especially in “sugar-free” products) need to be avoided.

      If vanilla yougurt is sweetened by glucose or sucrose, it will be probably OK, but not, if it contains abovementioned artificial sweeteners. Processed and canned food, vitamin supplements and syrups are often artificially sweetened…You will need to check labels of any commercial food product…

      The cause of fructose malabsorption is not known in most cases. More members of one family can have it, but it is not considered as a genetic disease; theoretically your other son is only at higher risk to develop fructose malabsorption. I can’t say if early introducing of fructose would increase this risk.

      Offer him low-fructose foods to stop diarrhea and maintain this regine for 6-8 weeks. Then you can try again with some “to try” foods.

  • M S Smith

    I really appreciate this list as it was just some two or three days ago that I discovered FM and started thinking I might have it and not (just) lactose intolerance…something I started thinking about after I cut out all dairy and still had the same symptoms, or else when eating dairy the Lactaid didn’t work.

    I’ve decreased fructose, primarily in the form of a mid-day Coca-Cola and some sweets and fruits, and have had significant improvement in both bloating and severe flatulence…as well as sleeping though the night without waking with a growling stomach, something that caused a great deal of stress and anxiety.

    I’ve had the same symptoms since fall of 2008 and I was overjoyed to see how simply avoiding my afternoon soda could offer so much relief. I still get a little bloating and gas after eating even a lactose/fructose-free lunch or dinner, but not to anywhere the same degree as before. I am curious how long it takes for the body to absorb fully all previously consumed fructose once one has fully stopped consuming them?

    I look forward to testing out whether or not I can start consuming dairy again, especially cheese, and am curious to what degree lactose intolerance and fructose malabsorption go hand in hand.

    I would very much like to see this list expanded to include many more food items and how they rate in regards to “safe” “try” and “avoid.” One thing that this whole matter has helped me with more than anything over the last year and a half is that I am eating better that I ever have before, not reaching for the quick snack, and cooking more from scratch (something my wife appreciates).

    On a final note, it looks like a co-worker also suffers from FM and she reports common vaginal yeast infections. How does FM play into gynecological complaints?

    Thanks a bunch!

    ~Michael~

    • Jan Modric

      Michael,

      “suspicious” foods for persons with FM include fruits, any sweet food, certain vegetables (wheat and onions only for some), and commercial foods containing: fructose, sorbitol and other “polyols” (xylitol, maltitol, erythritol, etc.), HFCS, and FOS (fructooligoscharrides). So, checking labels is essential; I can’t list all foods there…

      Unabsorbed fructose should clear in 4 days most. The problem is that your small intestine may be still irritated from ongoing bloating and diarrhea, so the full recovery may last for weeks. During this time you might have less tolerance for lactose and for random other foods. Some people have both lactose intolerance (of various degrees) and FM. Lactose is mostly in milk and added in several commercial foods. Another (hopefully transitional) consequence of FM can be small intestinal bacterial overgrowth (SIBO), since unabsorbed fructose (and lactose) is a good food for bacteria. You might read about low-FODMAP diet to get more info. After some weeks you will be probably able to absorb more fructose than now, since, like said, your intestine may recover a bit. Amount of “allowed” fructose completely depends on your fructose tolerance limit, which you have to find yourself by trying some low-fructose foods. This is why I can’t make a reliable safe/to avoid list, since fructose tolerance limits vary greatly (from 0 to about 50 g of fructose per serving) among people.

      Sugars (fructose, glucose, lactose, sucrose) are good food for yeasts, so vaginal yeast infection is no surprise in FM (like in untreated diabetes, where glucose is excreted in urine). Besides a low-fructose diet, your co-worker can use some OTC anti-fungal ointment. If not already, you can read the other articles about FM: FM explanation and low-fructose diet.

  • M S Smith

    Monday was the last day I had any HFCS or anything that might be suspicious for someone with FM and Saturday would have been the fifth full day taken with care. Saturday was the first day in a year and a half that I didn’t have the symptoms I had become so used to, particularly the bloating and extremely putrid flatulance. And not to be particularly vulgar, but Satuday also produced a series of healthy bowel movements that can only be described as cleansing. In addition, I also have urinary improvements. Jan, I can’t thank you enough, I feel like a completely new person.

    ~Michael~

  • Ellen

    Hi, I have been having bloating and gas and constipation for a year and have yet to feel better. It seems that everything I eat fills my stomach with gas! I have tried a very limited gluten-free diet, which helped with the bloating but there was still a lot of gas, and my constipation was really bad in that period. Now looking back, the one thing that I was eating a lot of was fruits and vegetables! During this time, I lost a lot of weight, which I figured was because of the lack of anything high in calories.

    Recently, I have been trying to gain it back and have been having difficulties. I gained 5 pounds when I was eating an incredible amount of food, since I was determined to gain weight. And then over the holidays, I ate a lot of sweets and I was so surprised – I gained nothing!

    I am trying the gluten-free thing again and I am taking a fructose malabsorption test soon, and have been trying to avoid fructose, but still am having gluten-free sweets with cane sugar in them.

    The thing is, I have lost a couple pounds, even though I try to eat high-calorie foods (although i do eat very small amounts every couple hours because normal-sized meals make it sooo much worse).

    So I was wondering, could my inability to gain weight be related to fructose malabsorption if it turns out I have that? Does the malabsorption mean that eating foods high in sugar content will prevent me from keeping the calories in those foods?

    And on an unrelated note, I have difficulties with foods with any sort of spice. Do you think that if eliminating sugar makes me feel better, that my sensitivity to these foods (and also fatty foods) with also decrease?

    • Jan Modric

      Ellen,

      I suggest you to find out, which foods (nutrients) exactly you can’t tolerate.

      These are some possible causes you may suffer from:

      1. You have a severe fructose malabsorption, in which you can’t tolerate fructose, HFCS, sorbitol and other polyols (xylitol, erithrytol..), and fructans (in wheat, onions) and galactans (legumes, cauliflower, cabbage). In this case, gluten-free diet helps you, since you don’t eat wheat. I mean, wheat may irritate you because of their fructans content, not from gluten, and a strict low-fructose diet (+ avoiding wheat) would help you.
      2. You have celiac disease, so you can’t tolerate gluten foods, but in addition, gluten irritates your small bowel to the extent you have developed (in this case transitional) fructose malabsorption, so you also can’t tolerate abovementioned nutrients.

      So, you can have a 4 day diet trial:

      1. Strict low-fructose diet, and also avoiding wheat, onions, artichokes leeks (they contain fructans), and legumes (they contain galactans), OR
      2. Gluten-free diet + excluding foods, mentioned under 1.

      You can also check low-FODMAP diet,
      OR consider to lower amont of soluble fiber (which may yield a lot of gas) in your diet.

      Sweets usually contain sucrose, which contains fructose+glucose. If fructose is not absorbed, normal colonic bacteria break it down and yield gas. This would explain why you don’t gain weight after eating sweets. Anyway, your original problem can be celiac disease or fructose malabsorption plus it seems you can’t tolerate certain spices and maybe certain other foods.

  • antifructose

    On another site, “Nutrition Data” I have found that a stalk of celery (64g) has 326 mg of fructose, while a slice of onion (14g) has 181 mg of fructose.

    Here, celery is considered a food “safe to eat”. Everywhere, onions are a food to avoid.

    I guess I’m confused by that. Also not sure about corn and corn products… basically a lot of contradicting info on this subject between different sites. Reminds me of the contradictory info from my doctors.

    • Jan Modric

      To antifructose.

      Fructose malabsorption in most cases does not mean a complete intolerance to fructose. Most people with FM can eat some low-fructose foods without problems. 326 mg of fructose in 64 g of celery is really a small amount of fructose, so I believe most individuals with FM can tolerate it.

      Onions, besides fructose, contain fructans that trigger symptoms in many individuals with FM. Also, onion is a spice that can irritate the bowel. Tolerance of fructose-containing foods is increased by their glucose content. You might want to read more in the articles about fructose malabsorption and low-fructose diet. I’ve collected data from several “fructose- content” sites and also made several polls and asked people with FM about foods they can/not tolerate. So I believe the above table is a useful start point from where you can make your own safe/to avoid list of foods.

      Fructose malabsorption is not like a food allergy or celiac disease where you have to avoid even tinny amounts of certain subastances.

  • antifructose

    Thanks Jan, that is reassuring. It’s a hard diet for me, since I am lactose, and fructose, and I am not diagnosed with celiac but have some wheat symptoms. I’ll keep it very strict, and see what happens over the next weeks. No sugar, is difficult and fruit seems iffy overall.

    • Jan Modric

      Antifructose,

      low-fructose + lactose free diet are both included in low-FODMAP diet. If you have problems with wheat (but not barley and rye), you probably can’t tolerate fructans, which are in wheat, onions, artichokes and leeks. You might also have problem with galactans, which are in legumes and some oter foods – it’s all explained in the low-FODMAP diet article. Pure glucose (commercially ‘dextrose’) should not be problematic. Table sugar (sucrose = glucose + fructose) is well tolerated by many with FM, since glucose helps in absorbing fructose. Foods with G:F ratio > 1 are often well tolerated, but not by all…

  • Jc_Oz

    Jan,

    I must commend you on a wonderful job that you have done here. Not only in the chart but the time you have taken to answer each persons indivually. The world needs a few more people like you!

    Now, I don’t have FM but my friend has all sorts of digestion/allergy issues.
    He gets diarrhea if he consumes, lactose, corn (even corn on the cob)or chocolate among many things (fruit juices except grape juice also upsets his stomach).
    I have a feeling he is FM (not sure why he can tolerate grape juice) & lactose intolerant.

    The question I have is one about FIBRE & FRUCTOSE.
    I recently watched a video on YouTube called ” Sugar: The Bitter Truth”. In this video Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology explains with amazing clarity & supported with visual images of how fructose works BUT importantly how fibre also reduces the effect of fructose (he also explains why corporations are reducing fibre in fast foods etc).
    YouTube link is:http://www.youtube.com/watch?v=dBnniua6-oM

    Given that in this day and age, our food is lower in fibre & higher in fructose, I wonder how much relief could be gained by those suffering from FM by increasing their fibre intake?

    Just a thought and once again I commend you wholeheartedly for the work you have done.

    • Jan Modric

      To Jc_Oz.

      Food allergy typically (not always, though) apears with itchy lips, mouth, throat or skin, within few minutes or several hours after eating triggering foods. So, if your friend thinks he’s allergic to corn or other foods, he might want to have skin tests done (by an allergologist). There are usually lactose and fructose in chocolate, so it’s not necessary he’s allergic to chocolate.

      Grape juice has glucose:fructose ratio about 1:1 . One mollecule of glucose helps in absorption of one mollecule of fructose even in persons with FM. It means, when an amount of glucose in a food exceedes or is it the same as an amount of fructose, all fructose will likely be absorbed. This is why table sugar, composed by equal amounts of glucose and fructose is often well tolerated in FM. The same apply for grape juice (not all types..).

      Low-FODMAP diet is appropriate for persons with both lactose intolerance and FM. Eventual allergies or other intolerances (for other random foods) would require removing additional foods from the diet.

      One of main problems in fructose malabsorption and lactose intolerance is excessive gas, produced by normal colonic bacteria, after they break down unabsorbed lactose and fructose. Merely adding more fiber (especially soluble fiber, which is in legumes, oats..) would likely cause even more bloating and flatulence.

      So, limiting lactose and fructose to some extent (according to personal fructose and lactose tolerance limit – should be found out by trying) is the first thing to do. *After* that, your friend can experiment with fiber. Some people having IBS have reported how soluble fiber in the morning help them maintain regular bowel movements.

      A strict low-FODMAP diet for the start, and then, after let’s say 1 month, introducing some “safe” and “to try” foods” back into the diet can be a way to go for your friend.

  • M S Smith

    Jc_Oz, thank you for the video link! I watched the whole thing and am sharing it with others. I’ve now gone almost two weeks without my daily 12oz coke, though I might admit to having a coke produced in Mexico which is made with just plain sugar about every other day. I’m watching my diet and avoiding any appreciable amounts of HFCS and feel so much better…well beside the fact that I got a bad cold.

    ~Michael~

  • Bonnie

    This site is an absolute blessing! I have not been officially diagnosed with FM, but in December, I was getting major stomach pains until I took fructose out of my diet. Then my symptoms cleared up immediately. My FM is kind of weird because my stomach gets upset from just plain old corn, but I can still eat tomatoes, and a limited amount of grapes. So, I agree that this should be just a guideline, not set-in-stone rules.

    Thanks so much for this list!!

    • Jan Modric

      Bonnie,

      foods containing about the same amount of fructose and glucose (like grapes) (check foods, high in fructose and sorbitol) are often well tolerated by persons with FM. Tomato contains rather small amount of fructose, apparently lower than your individual fructose absorption threshold (that may vary from person to person a lot). You can read about fructose:glucose ratio and theory about FM.

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  • Shannon

    I am so appreciative of your posted suggested diet. Can you tell me where to buy any of the suggested sugars? can you bake with them? they are copied from the list as follows: Acesulfam pottasium (Nutrinova, Sweet One, Sunnett, Ace-K, Acesulfame K), dextrin, glucose (dextrose, glucodin), glycogen, maltodextrin (modified starch), moducal, trehalose.

    • Jan Modric

      Shannon,

      those are examples of sugars found in certain commercial foods and drinks. It means that they should not aggravate symptoms in persons with fructose malabsorption. Many people with fructose malabsorption can safely eat certain amount of table sugar (sucrose). Pure glucose (dextrose, glucodin) is available as tablets or powder in markets.

  • Sue

    There is not mention of red wine in your list? What alcohol is to be avoided please?

    • janmodric

      Sue,

      these types of alcohol can be problematic:

      – sweet wines, even some sweet dry wines. A glass of dry wine in FM is something to “try and see”.
      – any sweetened alcohol, like liquers, alcohols containing fruits, or cocconut (Malibu)

      Beer can irritate you because of gas. Alcohol as such can cause diarrhea in some individuals with FM.

  • gadgetguy

    Saccharin (Sweet ‘n Low) is listed in the Foods to try AND in the Foods to Avoid for Sugars and Sweeteners. Is there a reason for that?

    • Jan Modric

      gadgetguy,

      in the “safe to eat” column, there is “Sweet One”, which is acesulfam potassium and not saccharin, if this is what you’ve meant.

  • gadgetguy

    Thanks. I was referring to the “To Try” column and the “Avoid” columns in Sweeteners. Both columns had Saccharin listed and I was puzzled by that.

    • Jan Modric

      Yes, it was double entry, I’ve removed it now from the “avoid” column and it’s now only in the “to try” one.

      There were some tests done on rats that have shown saccharin can cause cancer in rats. From this reason, for some time, saccharin was considered as carcinogenous for human, but later tests have not proven this, and is now not considered carcinogenic for human. It was probably this why I’ve initially put it on the avoid list. Some people with FM have reported symptoms after taking saccharin and other substances not directly related with FM. In FM, the small bowel is constantly irritated, and can be sometimes sensitive to other nutrients not mentioned anywhere in above lists.

  • Anneke

    Why is iceberg lettuce on the red list? – it used to a lifesaver on rye sandwiches!

    • Jan Modric

      Anneke,

      iceberg lettuce contains enough fructose to cause problems in many individuals with fructose malabsorption. This does not mean it’s not healthy for others.

  • VeganGroomer

    Hello Jan!
    Thanks for all the great info you offer. I have been suffering from excessive stomach pain, bloating, burping, flatulence, diarrhea, fatigue and depression for 6 long years. I have been a vegan for the past 20 yrs, and that will never change. I’ve seen doctors, to no avail. My life is miserable. Had to drop of out school, lost jobs and I cannot do anything physical. Even sweeping my floor causes me pain-I am bloated so much of the time. I feel “full” after just a few bites.
    Yet I just discovered (6 years to the day!)that I suffer from SIBO-no doubt about it! Now I realize that it likely stems from FM. Please, please help me find a starting point. I am concerned about my intake of proteins on this diet, since most of my favorite foods may be causing me problems. I love to eat hummus, rice milk, quinoa, brown basmati rice, kale, leeks, asparagus, peas. I choose to delete wheat from diet a couple of years ago-I thought it might help me. I eat very little tofu, sometimes a little tempeh. Fruit definitely causes me pain, so I stopped eating fruit a couple yrs ago. Oil seemed to cause pain too, so I try to limit my oil intake(avocados, anything fried, etc,). I am someone who can restrict my diet without too much difficulty. Can you give me some food ideas for a vegan suffering from SIBO-who needs a low-fructose diet for a year or so to clean myself out? BTW, I was thinking about getting a colonic cleansing from a professional, do you recommend this? Since having this chronic stomach problem, I have not been able to get health insurance. Thanks for listening!
    Peace!

    • Jan Modric

      VeganGroomer,

      do you eat dairy, eggs, fish?

      Main causes of bloating (and burping):
      1. Dietary causes:
      – lactose (in lactose intolerance)
      – fructose, sorbitol, manitol, xylitol, fructans and galactans (in fructose malabsorption)
      soluble fiber List of food with soluble and insoluble fiber

      2. Diseases
      Fats by themselves should not cause bloating, but when fats are not absorbed properly, they reach the colon and are broken down by colonic bacteria, which yield gas. Causes of fat malabsorption:
      – celiac disease
      – smal intestinal diseases, like celiac disease or severe Crohn’s disease
      – gallstones or other causes of blockage of the bile duct (fats can’t be absorbed without bile)
      – liver disease, obstructing bile flow
      – pancreatic disease resulting in insufficient production of lipase that is necesarry for digestion of fats

      3. Infections:
      – H. pyori infection of the stomach.
      – SIBO
      – Intestinal parasites

      I do not recommend colon cleansing, which clears only the stool, but bacteria stay in the gut.

      You can try a strict low-fructose diet (as in above table). If your major problem is fructose malabsorption (FM), symptoms should lessen within a week (not a year). If you have FM + SIBO, you would additionally need to treat SIBO with antibiotics, but you would need to have a breath test for SIBO first.

      If you are sure oily/fatty foods aggravate your symptoms, I recommend you to have a stool test for fats (orderd by a gastroenterologist).

      If you eat dairy, your problems may be from lactose intolerance. Lactose can be added to many foods.

      So, where to start:
      1. Try low-fructose diet for 4 days and observe its effect. If it doesn’t help, additionally exlude lactose.
      2. Consider tests:
      – stool tests for fat, intestinal parasites
      – blood test or breath test for H. pylori (and later for celiac disease)
      – breath test for SIBO
      – ultrasound of the abdomen (gallbladder and pancreas)
      – blood test for iron and vitamin B12 (low levels can cause anemia and thus tiredness)

  • Anneke

    Thanks Jan! Would other kinds of lettuce be acceptable?

    I have read somewhere that mushrooms contain mannitol. Is it true?

    • Jan Modric

      Anneke,

      I’ve listed both lettuce and mushrooms into the “to try” column above. “Lettuce” or “green salad” includes several sorts of salad which may contain various amounts of fructose. Please note that small amounts of fructose are not necessary harmful – it depends on how much your bowel can tolerate it. So, lettuce is to try and see.

      Mushrooms contain mannitol, yes, but again, its amount may vary a lot from species to species. Also, not every person with FM is equaly intolerant to mannitol. Manittol is a “polyol” or “sugar alcohol”, and you can check their amount (in summary) on a food product labels. Can’t say what would be a lot of mannitol. A pack of chewing gum sweetened by sorbitol can trigger diarrhea, for example.

  • VeganGroomer

    Hello again!
    I have been a vegan for 20 years: No meat,eggs,dairy,honey or casein. Since I’ve had this stomach problem for 6 years my stomach is nearly always in pain or discomfort. That being the case, I cannot be sure that oil/fats are a definite cause. I am on day 2 of my “fructose detox” -it’s difficult task as a vegan. Is ok to drink green tea and/or peppermint tea? I could not find a B12 supplement without a sweetener, hopefully 1.5g of stevia will not cause me a problem.
    Thank you Jan!

    • Jan Modric

      VeganGrommer,

      if the fats (fat malabsorption) were the cause, you would have whitish, foamy, floating and stinky stools. During low-fructose diet it is important to exclude fructose, HFCS, sorbitol, xylitol, fructans and galactans. If you have FM, you should see effect within 4 days. You can eat corn products, rice, and potatoes and most vegetables in this time.

      Soluble fiber, SIBO, H. pylori are next possible causes.

  • VeganGroomer

    Jan,
    Vegans do not eat fish either.
    Thanks.

  • Anneke

    Your help is much appreciated: thank you very much.

  • danni

    i was just diagnosed with fm today and i really need to know what meals i can consume. it’s ok to have the foods in the tables i understand that but propper meals can i eat? i have an appointment with a dietician in a few days but i need to eat something that will tied me over. i’m currently doing my last yr of high school and im desperate for a solution because i can’t starve myself because i need energy to study. also i am italian and pasta is a huge part of my diet and consumed alsmost every second day – i find that it has no effect on me if i have it for dinner – but i do get the diarrhea gurgling the next morning is this to do with this? also im 17 – is there any chance i will grow out of it?

    • Jan Modric

      danni,

      about pasta: the question is if you can tolerate wheat or not. They are fructans in wheat and they trigger symptoms in some individuals with FM. It could be a sauce used with pasta or some other food you have eaten that day that caused diarrhea…

      You should learn which foods and drinks contain fructose, HFCS (high fructose corn syrup) and polyols (sorbitol, xylitol..). From natural foods, these are mainly fruits and honey. Some (not all) individuals with FM can’t tolerate fructans, which are mostly in wheat and onions, and galactans, which are mainly in legumes.
      This list can help a bit.

      About commercial (packaged, canned, processed in any way..) foods – you should check nutrition facts labels for mentioned nutrients. It does not make sence if I try to make a list of these, it can be any food. Problematic foods are fruit juices and any fruit product, “diet” soda, “low-calorie” products, “sugar-free” chewing gum or candies (sweetened with sorbitol or xylitol…) and anything sweetened by sugar – sucrose, fructose or HFCS (glucose is ok).

      Not sure if you will grow out of FM..

  • danni

    thanks for your advice ur a legend – do you think that crackers would be ok? also lately ive been having really bad stomach pains before i go to bed and in the morning i get the gurgling – is this related to the foods i consume for dinner?

    • Jan Modric

      danni,

      the rough rule is this: you think what’s the main ingredient of the food. In crackers this is probably wheat. It is really convenient if you find out if you can tolerate wheat or not and which amount. Ask your dietitian how to perform “exclusion diet trials”. Next, check if the food is sweetened in any way. People with FM can tolerate glucose, many even sucrose – table sugar (despite it contains fructose), but not fructose alone or sorbitol. So, crackers can be (or not) problematic if they are from wheat and if they are sweetened.

      Stomach pains, gurgling, cramps, bloating, burping, excessive gas, diarrhea, nausea – all this may be symptoms of FM and they may, roughly said, appear from 2 hours to 2 days after a problematic meal.

      One simple way to find out what you can tolerate is this: you exclude everything what can theoretically cause symptoms: all fruit products, all wheat products, legumes and everything containing mentioned problematic nutrients for about a week. You can eat meat, dairy, eggs, potatoes, rice and most other vegetables in this week. Then you add other foods one by one every second day and see if symptoms appear.

  • danni

    i also get severe period pain can i take naprogesic? i know that i can’t take nurofen because of the sucrose coating but i don’t want to take the risk with naprogesic but i really need to use something and i find that panadol doesn’t help the pain at all

    • Jan Modric

      danni,

      sucrose, which is fructose + glucose can be often tolerated in FM, because one glucose mollecule helps in absorption of one fructose mollecule, and fructose:glucose ration in sugar is 1:1. If you can tolerate small amounts of table sugar, you can also tolerate the amount of sucrose in pills. Be sure if it is sucrose, though: pills are often covered with fructose or sorbitol, tham may be problematic.

  • Em

    Jan,

    Thanks for all of this helpful information. I was diagnosed FM almost 10 years ago and have avoided HFCS since then (a true challenge back then, but getting easier now) but your diet has really opened my eyes to other foods to avoid.

    A question about avoiding ice cream – is this due to HFCS/other “avoid” sweeteners typically being used? Here in the US Breyer’s all natural ice cream is sweetened with sugar (presumably, sucrose). Is there some kind of sugar-dairy interaction that makes ice cream something to avoid?

    Thanks.

    • Jan Modric

      Em,

      no real dairy/sugar interaction, but ice cream may contain artificial sweteners, often not tolerated by FM sufferers, or fructose or sorbitol in added fruits. Some FM sufferers also can not tolerate sucrose and other may have additional lactose intolerance. In summary, ice cream is quite risky to eat.

  • caryn

    I’ve had problems for years and just recently was diagnosed with fructose and lactose malabsorption/intolerance, in addition to the fact that I’m already allergic to shellfish. I’m on week seven of the no-fructose/lactose diet. At first, I felt great – all problems cleared up. But the last two weeks have been causing me some problems – foods I ate previously with no problems are now causing issues. Am I getting more sensitive to it rather than better? Is that possible?

    • Jan Modric

      caryn,

      saying elimination of which exact foods has helped, and which foods are causing problems could help to answer.

  • danni

    hi again
    can i have red wine? this also includes inside meals like chops which its marinate in

    • Jan Modric

      danni,

      unsweetened (dry) red wine contains almost no fructose and sorbitol. The problem may be alcohol itself and this may differ from person to person. In a full blown fructose malabsorption any alcohol may be irritant, since bacteria (which are usually overgrown in FM) break it down and produce gas. Red wine can be tried when you have no more symptoms from other foods. I’ll add red wine to the try list.

  • stilllearning

    I have been going without all sugar for about 8 months. It completely took away my terrible abdominal pain. But now I am getting some of the abdominal pain back and I noiced that iceburg lettuce is out, so that may be it. But I also noticed that Stevia is in the “avoid” list. I have depended on that for in my teas after meals. Why is that on the “bad” list?

    • Jan Modric

      stillearning,

      I’ve made one poll in one online group of fructose malabsorption sufferers and many of them have mentioned stevia and some other sweeteners as symptom triggers, so I’ve put them into avoid list. Also, I was thinking, when someone has so many problems with fructose, wouldn’t be just easier for him/her to not eat sugary food at all. I mean, when you do not eat any sugary food for a while, you may simply lose a strong desire to it.

  • danni

    ok i know this may seem like a stupid question but i was just wondering if it is possible to still use lipgloss and lipstick and not have any effects? can you please reply asap

    • Jan Modric

      danni,

      fructose malabsorption does not mean allergy to fructose. So, usually you do not need to avoid traces of fructose or sorbitol (I’m not sure if they appear in lipstick, anyway). But persons with celiac disease may need to avoid lipstick, since it may contain gluten.

  • danni

    yea but if it’s on your lips then you are slightly consuming it because part of it is being digested so does this pose a problem?

    • Jan Modric

      danni,

      eventual small amount of fructose or sorbitol in a lipstick could theoretically cause symptoms in a person with extreme fructose malabsorption (for example in those who cannot safely eat even one piece of orange, which is low in fructose). So, it completely depends how sensitive you are to fructose – this may vary considerably from person to person.

  • Charmaine

    Is Peanut Butter ok? I found it gave me problems.

    • Jan Modric

      Charmaine,

      if peanut butter gives you problems, it might not be OK for you.. Nuts, including peanuts often cause problems in fructose malabsorption. Eventual added sweeteners (fructose, HFCS, sorbitol or other polyols) on the exact product you were using can also be the cause.

  • lynn

    Hi Jan,

    I don’t remember a time when I was not bloated (though it seems I wasn’t always THIS bloated). I am 51 years old and was just diagnosed with gluten intolerance via a stool test in April of this year and diagnosed with fructose malabsorption two weeks ago. I am certain that I am lactose intolerant, too. Since April 7th, I have been on a strict gluten and lactose avoidance diet (though I have had feta cheese which is supposed to be extremely low in lactose). My symptoms of bloating still persist; it doesn’t seem to matter what I eat. Since being diagnosed with fructose malabsorption, I have cut back on some things, like not adding agave nectar to my gluten-free oats every morning, but still my bloating persists. I want to get to the point where I am symptom-free so that I can then add foods back to my diet to see what affects me, but I don’t know where to begin. Should I eliminate only fructose foods plus foods containing lactose and gluten or should I eliminate ALL fructans, galactose, etc, etc? The lists seem confusing to me. Maybe I should start off with a list of what I CAN eat. What do you suggest, including beverages, and please be as specific as you can. Thank you very, very much.

    • Jan Modric

      lynn,

      yes, starting with what you can safely eat is a good idea. Also it is good to exclude anything what can theoretically cause bloating.

      I believe, the following prepared-at-home (I mean not packaged or processed) foods should not contain lactose, fructose, sorbitol (and other polyols), galactans and fructans:

      – white potatoes
      – white rice
      – fresh nonprocessed meat and fish
      – eggs
      – cornmeal (degermed)
      – vegetable and fish oils
      other:
      – gluten-free, non-sweetened pasta
      – Bouillon, celery, escarole, hash-browns, mustard greens, shallots, spinach, Swiss chard

      Try to stick with these for at least 4 days, and if you have no other digestive disorder, except gluten and lactose intolerance and fructose malabsorption, bloating should lessen considerably.

      It’s important you exclude:
      foods containing gluten. Gluten can be in many packaged foods, even in some sold as gluten-free. I don’t want to confuse you, only it’s good to avoid any commercial food during a diet trial.
      foods containing lactose. Many cheeses contain only trace amounts of lactose, but for the needs of the diet trial, I recommend you exclude all dairy products. Lactose can be added to many packaged non-dairy foods and drinks.
      It is good to know that foods high in *soluble* fiber, like oats, beans, oranges…(a list of soluble and insoluble fiber is here) can cause bloating, since intestinal bacteria can brek soluble fiber and yield gas.

      It seems that a low-FODMAP diet (+ gluten-free diet) is appropriate for you.

  • lynn

    Thank you for your advice. I am going to try it immediately. Only a few questions: how can I dress up these foods? I suppose I can add olive oil to the pastas and greens? What can I do with the degermed cornmeal? Also, can I use ghee to cook with since it doesn’t contain lactose or the casein protein?

    • Jan Modric

      lynn,

      in all disorders you’ve mentioned (gluten and lactose intolerance, and fructose malabsorption), only certain carbohydrates are problematic. Pure fats, like oils or ghee and foods that contain only fats and proteins: non-processed meats, fish and eggs should not be problematic. Degermed cornmeal should be fine, if it doesn’t contain traces of gluten (possible contamination during production). Cornmeal is low in soluble fiber, so it should not cause bloating from this reason. Oatmeal may be more bloating. Anyway, whatever you buy in the store, check lables for gluten, lactose, sugars, and “polyols” content. Glucose itself should not cause problems, but sucrose (table sugar) contains fructose and can cause symptoms. Rice milk, if produced from brown rice, can contain fructose, plus it can be sweetened. I would leave this for later, when you can add additional foods to initially strict diet. Unsweatened tea and coffee should not be problematic, again, check labels, since non-dairy products may have lactose added, and non-grain products may contain gluten…

  • lynn

    ALSO, what can I have to drink? May I have tea, herbal or caffeine? May I have rice milk? Can I mix it with the eggs, for instance, to make scrambled eggs? I really appreciate you taking the time to answer these questions.

  • AlysonAnn

    Hi, I have been suffering from foggy headedness, extreme fatigue, blurry vision, delayed response and overall sadness over the last month or so. I get waves of this feeling that come about 5-6 times a day. I originally thought I was gluten intolerant, however a diet that is gluten free has not helped. I am considering FM but I don’t have the most common symptoms of bloating, diarrhea, flatulence and so forth. It is all neurological. It is so hard to function day to day and I have always been an energetic happy person, so this is truly effecting me. I will try the diet for FM, but do you think that this could be anything else? Thank you.

    -Alyson

    • Jan Modric

      AlysonAnn,

      fructose malabsorption and other diet-related disorders usually causes some abdominal symptoms. One posibility are intestinal parasites, though, which may be present without any gastrointestinal symptoms.

      Hypoglycemia, anemia, low blood pressure or abnormal levels of potassium or other minerals, estrogen, thyroxin, cortisol, vitamin D…from various reasons including infection, inflammation within the body (sarcoidosis..), chronic poisoning or cancer could be a cause. Try to think if stress could be the cause. I recommend you to go through this personal medical history questionnaire to arrange all symptoms and eventual suspected causes in a time line.

  • amy

    thank you for your page. when trying to find info for my daughter, who is 10, and finding what she can and cannot eat, I get really frustrated. She got diagnosed a bit over a year ago and has still had two intestine infections and she is “puffing up again.” she has to take zantac for stomach acid as they did the endo and saw red flaming tissue. negative on all tests they took.

    I am finding this diet very frustrating and difficult – especially for her. I have a son diagnosed this year with Celiac and am finding more answers for him than for fructose issues.

    I just wanted to thank you for your page. I didn’t see cantaloup(sp?) listed – is it safe?

    • Jan Modric

      amy,

      it would be really good to know for you, if your daughter has only fructose malabsorption, or also any other disorder like celiac disease, lactose intolerance, chronic inflamation of the stomach caused by Helicobacter pylori, intestinal parasites.

      According to my research, there is about 1-2 g fructose and no (or at least not much) sorbitol in 100 g cantaloupe, so I’ve added it into “to try” column above in the article. They are fructose and sugar alcohols or polyols (sorbitol, xylitol, maltitol…added to several foods as artificial sweeteners) that are usually problematic in fm.
      Some (not all) individuals with fm can’t safely eat foods with fructans (in wheat, onions, artichokes) and galactans (in beans, cabbage, cauliflower), or can eat them only in small amounts. In this chart, there are foods high in fructose, sorbitol, fructans and galactans listed.

      So, try to find out, if she can eat wheat products.
      Legumes are gassy for many people even those without fm.
      Then you can try with oranges and other citruces, which are low in fructose and are well tolerated by many (not all) individuals with fm. Bananas and kiwi are also fairly low in fructose. If she can eat these, she can probaly eat cantaloupes.

  • amy

    Hi Jan,

    thanks for your response. she had the test with the biopsies for lactose, celiac and the pylori for sure. I may call and ask if they did for parasites too. all the tests came back negative, but she has acid and got gastitis from something.

    thank you! I have posted your nutritional info on my blog.

    • Jan Modric

      amy,

      parasites may casue inflammation of the stomach and intestine; you’ve also mentioned she has had “two infections” in the past. Diagnosis is made by stool test for parasites and stool culture for bacteria. Another possible cause of increased acid secretion is biliary reflux – the flow of the bile from the duodenum up into the stomach. In this case she might feel a bitter taste in the mouth. Not sure about the diagnostic method, but I guess, the presence of the bile in the stomach could be checked.

      Unabsorbed fructose can cause a small intestinal bacterial overgrowth (SIBO). As you might know, this is diagnosed by a breath test (much like for the fructose malabsorption or lactose intolerance). I want to say, fructose malabsorption alone, together with SIBO (or even without it) could cause gastritis because of backflow of certain substances into the stomach. A strict low-fructose diet could bring some relief in as few as 4 days, if fm was the cause.

  • lynn

    Jan,

    I just wanted to let people know on your website that you can have a blood test for celiac and it can come back negative, yet you can still be very gluten-sensitive. This is what happened to me. A negative blood test just means you haven’t developed full-blown celiac and the complete destruction of the villi (flattened villi). However, if you are gluten sensitive and still continue to ingest gluten, you may very well develop full-blown celiac. A more sensitive test to determine gluten sensitivity is a stool test. This test is relatively new. You can find more information at enterolab.com. I had the complete gene panel done there and was surprised to learn that I was gluten sensitive AND I had two genes predisposing me to celiac. I’ve since had my son tested and he is also gluten sensitive.

    Thank you Jan for having answered all my questions in the past. One more: is it okay to have tea from teabags that contain some of the offending spices or fruits? I was always told that ginger tea was good for digestion. Now I’m wondering if I should drink it. Also, some drinks will be raspberry flavored, for example, or contain orange peel. I do not add sugar or any kind of sweeteners to my tea. Okay or not?

    • Jan Modric

      lynn,

      during a strict low-fructose trial, I would avoid ginger tea, but you can try it later when you get your digestion under control. Tea bags and orange peel should not contain much (if any) fructose or polyols, so despite the fact that raspberries contain xylitol, raspbery flavored tea should not contain any considerable amount. If a nutrition facts label lists any amount of “sugars” or “polyols” or “sugar alcohols”, avoid the food during the diet trial. If you ask me, to make a low-fructose diet trial simple and reliable, it is good to avoid any commercial products completely, since they often contain several aditives, gluten and lactose, and it’s hard to have all under control.

      In the past, some stool tests for celiac disease checking for IgA antibodies came out non-reliable (false negative), but I do not want to judge Enterolab tests, since on a quick search I haven’t found any professional reviews of the test.

  • amy

    Hi again,

    yes, she has had the breath test for fructose, that is how we got a diagnosis after 1 1/2 to 2 years of misery. Someone mentioned Rice Dream ice cream. have you heard it or researched it?

    http://www.tastethedream.com/products/product/1483/204.php

    their ingredients for the vanilla are:
    Filtered water, natural sweetener mix (brown rice syrup, chicory syrup), rice mix (brown rice syrup solids, inulin, natural flavors, soy lecithin, salt), expeller pressed high oleic safflower oil, natural vanilla flavor, contains less than 2% tapioca starch, guar, locust bean, carrageenan and xanthan gums, natural flavor.

    AND, it toutes this on their main page:
    “These all natural treats contain no refined sweeteners, no cholesterol, are lactose free, and are available in a wide variety of dreamy flavors. With a taste this good, you won’t miss the dairy!”

    my daughter does okay with sucrose, but that is prob because it is 50/50. we mix dextrose in there too when we cook. I am wondering if I make homemade jam if it handles dextrose and sucrose mix okay so she can have jellies again (rasp and strawberry)

    I am just so unsure on this diet..the complexity and limitations are frustrating!

    thanks again!

    • Jan Modric

      amy,

      In fructose malabsorption, the following nutrients can trigger symptoms:
      Group A:
      fructose
      high fructose corn syrup (HFCS), which is added to certain drinks and commercial foods
      “polyols” or “sugar alcohols”, including sorbitol/xylitol/maltitol (in “sugar free gum” and certain “diet colas”, mannitol (these polyols are added to foods as artificial sweeteners, but not all artificial sweeteners are problematic; for example: Acesulfam pottasium (Nutrinova, Sweet One, Sunnett, Ace-K, Acesulfame K), dextrin, glucose (dextrose, glucodin), glycogen, maltodextrin (modified starch), moducal, trehalose, should not be problematic). Sorbitol is also naturally present in some fruits, like grapes and fruits with stones (peaches, prunes, cherries…). Xylitol is in some berries.
      – some people have symptoms after sugar (you say your daughter not).

      Group B:
      Some short-chain carbohydrates can trigger symptoms in some (not all!) people with fm:
      fructans (in wheat, onions and Jerusalem artichokes)
      galactans (in legumes, cauliflower, cabbage)
      inulin (also listed as oligofructose, or fructooiligosacchardises – FOS)
      Like said, only some people with fm are sensitive to group B nutrients, so it would be worth to try if your daughter can tolerate the foods listed in this group.

      Symptoms after either group A or group B nutrients depend on the amount of certain food eaten in one meal or one day. This means, some people with fm can safely eat, for example, 5 strawberries in a row, but not 15 strawberries. Or they can eat one slice of white bread, but not one pound of it.

      I think I’ve listed pretty much all nutrients that can trigger symptoms in fm (in bold), so just be aware where these nutrients appear. In that icecream, there is inulin that could be problematic, but if your daughter can safely eat wheat products, she should not have a problem with inulin, since both inulin and wheat are in group B. It depends on amount taken, though.

      Strawberies and raspberries contain some xylitol, so it depends how much of it your daughter can tolerate. Adding dextrose can help when it is added to foods with sucrose or fructose, since it promotes fructose absorption. Dextrose does not help in absorbing xylitol or sorbitol, though.

      If not already, I strongly recomend you to read other articles about fructose malabsorption:
      http://www.healthhype.com/fructose-malabsorption-cause-symptoms-and-diagnosis.html
      http://www.healthhype.com/low-fructose-diet-in-fructose-malabsorption.html

      Then you will see which exact foods are problematic and all theory behind it.

      Fructose malabsorption sometimes causes small intestinal bacterial overgrowth (SIBO) , with about the same symptoms as in fm. In this case even strict low-fructose diet alone does not help. SIBO is diagnosed with a breath test, and treated with antibiotics.

  • Sheila

    Is nutritional yeast safe for Fructmals?

    • Jan Modric

      Sheila,

      nutritional yeast can cause bloating in some people (even those without fructose malabsorption), which may improve with continious use… and depends on the amount taken.

  • Matthew

    I hate this diet.. i’m still sick trying to get this dumb diet down (can you tell i’m frustrated?)

    I’m so sensitive to fructose/fructans that my diet is eggs for breakfast..spinach and some white rice or potato for lunch..

    and chicken/spinach/lettuce for dinner..

    That’s basically it. 🙁 Can’t do dairy yet..and oats makes me really sick (not sure if gluten is a problem)

    The chart is pretty accurate..I have some issues with corn as well..which is sad because I thought corn chips were safe but they’re not. I’ve heard postatioes (nuts I can’t spell..) are pretty safe.. i’m looking to keep weight on since I’m so skinny so if anyone has any bright ideas and very safe veggies or other foods let me know! Thanks.

    • Jan Modric

      Matthew,

      oats is rich in soluble fiber, which causes bloating in pretty much everyone…Nuts, including pistachios, are often problematic, so this is something to try and wait…
      Have you tried:
      – plain cornmeal
      – non-wheat spagheti
      – white potatoes
      – barley
      – buckwheat
      – bouillon, celery, escarole, hash-browns, mushrooms, mustard greens, pea pods (immature), shallots, Swiss chard?

      Hard cheeses usually have almost no lactose…

  • Matthew

    Hey Jan,

    thanks for the response –

    Yeah celery seems ok, mushrooms I tried last night and seem ok..even canned (has citric acid but that seems ok..). Swiss Chard seems ok..

    Cornmeal .. not so sure, I bought some cereal that was just plain cornmeal and evaporated cane juice and that didn’t work so i’m trying to find just plain cornmeal.. do you just make cornbread out of it? Is that what you use?

    White potatoes seem find, I get headaches though (not diabetic but looks like i’m semi-hypoglycemic so I try to keep starches on the low side)

    So basically it’s spinach/frozen or baby.. and meats and eggs 🙁 Dairy still has issues so I’m waiting to heal before I re-introduce it but thanks for the suggestions (and sorry for the long response..just going stir fry crazy here with how limited my diet is. Not used to this)

    Thanks!

    • Jan Modric

      Matthew,

      I can buy cornmeal in a “corn grits” form (image), which takes about 10 minutes to be cooked in a boiled water, but the slightly processed form – “instant polenta” is cooked in 2 minutes. “Degermed” cornmeal also exists and it is this one you can try first. You may want to try pure cornmeal, maybe with spinach or something you know you can eat safely. Anything tinned sounds quite suspicious to me. Corn bread usually contains some additives, so you may want to try it, after you check if you can safely eat plain cornmeal.

      Potatoe chips may contain: potatoes, (salt), hydrogenated oils, stabilizers, dyes and other additives – it kinda does not sound to be a first choise when your bowel is still upset.

      Yes, I made the chart, and I update it.

  • Matthew

    btw- thanks for putting this chart up (if you’re the one that did it) you’ve saved me a TON OF TIME 🙂

  • Matthew

    sorry last comment.. are potatoe chips generally safe? I would think so right?

  • Matthew

    ok really last comment..

    I’ll try barley and the others you listed. Thanks for those suggestions!

  • Matthew

    ok thanks for the info Jan, I’ll give those a try. I got some bob’s red mill cornmeal with nothing in it and i’ll try that out. Good point about the potato chips, I’m just trying to find a snack to get me through the day at a job :S *ugh starving mode*

    Yeah even the canned mushrooms make me a little worried with citric acid for example..I’m desperately trying anything to get better so thank you for all the information (and this chart! My doctor/s were clueless about fructose issues)

    Thank you!

    • Jan Modric

      Matthew,

      before choosing snacks it is good to know, can you tolerate sugar (sucrose). If not, you can choose snacks with glucose or dextrose and without fructose, sorbitol, xylitol, maltitol or other “polyols” or “sugar alcohols”. One polyol that should be ok, is erythritol. You can search online for “snacks glucose fructose” or “snacks dextrose fructose”, where these ingredients are explicitly mentioned. You may also find some specific foods on the gluten-free (no wheat) shelves in stores. “For diabetics” shelves have low-sugar foods…Snacks from white rice are available.

      Fructose malabsorption is not known for a long time, so some people may still get a diagnosis of IBS, instead of FM.

  • CJS

    Sorry to butt in here but, Matthew, there is a big difference between cornmeal and grits/polenta. Meal will be a finer flour-like powder, good for baking or for making crusts for breading chicken, etc. Grits and polenta are made with a much more coarse grind.

    Bob’s Redmill actually make a terrific grits/polenta product. This is made from yellow corn and is more of a traditional Italian style polenta.

    Another great brand to try is Alber’s Quick Grits. These are southern style grits made from hominy.

    I use either brand as a side dish and for breakfast almost every day. Try cheese, olive oil, and/or homemade fructose free broth as savory flavorings. The hominy grits can alternatively be flavored with some butter, cinnamon and, if necessary for your palate, a “safe” sweetener.

    As for potato chips, take a look at Kettle brand’s Sea Salt flavor. No unsafe ingredients. Admittedly, chips are not the most healthy food but, given the difficulties of this diet, it is sometimes good to be able to grab some quick energy.

    Good luck!

  • .

    Dear Jan,
    You made my day.
    I found your explanations extremely useful and using all advices and following the diet strictly. The info provided is precious and I would like to share this information translating to my language with ref to this site. Would you mind if more people who can not understand English refer this info under my blog ?
    Brgds.

    • Jan Modric

      Dear “.” 🙂 ,

      you can use these data in your blog and I would appreciate a link to my article, yes. Please, note that this is not an “exact” or “complete” list. For more indepth information about fructose malabsorption you can read other three articles – links are below the chart in the article above.

  • Matthew

    Thanks CJS! Yeah I generally have lay’s because it’s gluten/casein free (since i’m not sure about both) or kettle chips (the ones you listed I’ve eaten those..)

    Both of those work so far *crosses fingers*

    Thanks both of you! Hope I feel better soon – it’s fructose/fructans for sure just been a difficult recovery

  • Matthew

    just an update.. (no need to reply) that cornbread seems to work great! I haven’t tried it with dextrose sugar or dairy yet but …finally I can eat something other than white rice!

    I guess it’s corn items..toothpaste and others that are holding me back…ugh I’m so close to feeling 100%… 🙂 thanks for the advice!

    • Jan Modric

      Matthew,

      dextrose is glucose and could cause a problem if you have small intestinal bacterial overgrowth (SIBO), but otherwise, dextrose should not be problematic in fm. Toothpaste – what with it?

  • Matthew

    Hey Jan,

    well I’m learning that sorbitol and xylitol both give me some serious problems and they are in toothpaste so.. I know tom’s of maine has 2 kids toothpaste that is corn free even though they use fruit extract (a tiny amount shouldn’t bother me)

    *another weird thing with me; maltodextrin bothers me.. I don’t get it.

    • Jan Modric

      Matthew,

      sorbitol or xylitol in toothpaste bothering you would speak for quite severe fructose malabsorption, since you actually have to swallow some to have symptoms…Pure maltodextrin as such should not be problematic even in hereditary fructose intolerance (HFI). Also, maltodextrin products should be gluten-free…

  • HRW

    I am diabetic and am looking for a reason for my chronic diarrhea other than the side effects of ALL the drugs I have to take. Based on your list I searched for a sweetener other than Splenda and bought Truvia. At home I noticed that Truvia had Rebiana as an ingredient. I looked it up since I had never heard of it and was shocked at the bad press. Do you agree that this sweetener is as bad as they say and should be discarded?

    • Jan Modric

      HRW,

      there is some conflicting information about rebiana on the internet, so I don’t want to judge. Erythritol is a sweetener that, unlike other polyols, does not have a laxative and bloating effect and has no calories, but is sweet, and if you go on some diabetic forum, you can see many use it without a problem.

  • unsure.

    hello.

    im 17 years old and today tested and positive for FM using a breath test i was 40 over my starting test does that mean im highly intoleret since you only need 20 over to be diagnosed ?

    my mum and i and unsure what to look for on packaging will it just say containing fructose? or do i have to look out for others.

    also its my 18th birthday soon, alcohol wise is it just red wine okay?
    or sugar free okay too?
    or straight?
    i understand that it alcohol might irritate my stomach anyway.

    im seeing a dietian soon so hopefully that will help too.

    • Jan Modric

      unsure.,

      this is to check on nutrition labels and avoid: fructose, polyols (sorbitol, xylitol, mannitol, maltitol, isomalt…), inulin, oligofructose, FOS. Some individuals tolerate moderate amounts of table sugar or saccharose (which is fructose + glucose), others not. You will probaby need to avoid most fruits and fruit products, honey, foods sweetend with HFCS. “Sugar-free” foods are often sweetened with sorbitol that may cause worse symptoms than sugar. So, when deciding between sugar/free and straight, you should check ingredients and avoid the mentioned ones. It also depends if you can tolerate sugar or not. Red or white dry (non/sweetened) wine may be ok / this is something to try, when you won-t have symptoms from otherv irritating foods any more.

      You may carefully read other articles about fructose malabsorption (links are on the bottom of the article above) to understant fructose malabsorption better.

      You don’t say what is your main symptom (diarrhea or constipation). Metamucil or benefiber may help in constipation, and can aggravate diarrhea. You can get enough fiber from vegetables and grains, so there’s usually no need for additional fiber from supplements.

  • unsure.

    also will benefiber or metamucil help?

  • unsure.

    thank you.
    also do you know any good fructose free recipies or any good sites, im struggling to find any.

    • Jan Modric

      unsure.,

      low-fructose diet is not so complicated as it may appear on the beginning…It is important to know which *nutrients* to avoid (mentioned in my previous comment), and then, by your experience, which foods to avoid. On the beginning try to find out if you can tolerate small amount of table sugar, and foods that contain fructans (wheat products, onions) and galactans (in legumes, cabbage, cauliflower). On basis of that you will know, if you can/not eat foods with these nutrients. Other than that, you can search online for “low-fructose recipes”. There is also one Yahoo group where people discuss about everything related to fm.

  • Chris

    This list has been a big help in self-diagnosing my possible FM. I don’t have very serious symptoms after consuming the “to be avoided” foods, just rather large abdominal distention.

    I do have one question, however. I am not a soda drinker but yesterday I took a sip of diet pepsi and within minutes had the same type of abdominal distention that I would when consuming other sweets. What is it about Diet Pepsi that could cause this reaction? I thought it was fructose-free.

    • Jan Modric

      Chris,

      there are few variations of Diet Pepsi, so I would need to know a list of ingredients in an exact drink you have drunk. “Diet” products are often sweetened by polyols (sorbitol, xylitol…) which may cause the same problems like fructose. Some individuals don’t tolerate some other sweeteners, like aspartame or splenda, and I can’t explain this theoretically; you may simply be irriated by some substances, so just avoid them.

      To know, if you can tolerate wheat or not, you can try some fresh, plain, unsweetened white bread. They are fructans in wheat that are irritating to some (not all) individuals with fm. Some tolerate small amount of wheat products, but not large amounts. Fructans are also in onions. So, it’s not necessary that wheat irritated you; they could be sunflower seeds or some added sweetener.

  • Chris

    I just wanted to add that I haven’t been officially diagnosed with FM at this point. My gastroenterologist looked at me like I was crazy when I brought this up the other day and thought it might be SIBO or celiacs instead (she also mentioned the breath test for FM isn’t very accurate and it is mostly a waste of time).

    But after keeping a food journal for a week it seems to me like the foods that have given me trouble (BBQ ribs, apples, cookies, ice cream, sun flower wheat bread) and foods that have not been a problem (tacos, pizza, plain yogurt, fish, rice, turkey, cucumber, cheese, rye bread) would maybe indicate FM. Also the bloating usually lasts longer when after eating ice cream or cookies rather than say the slice of sunflower wheat bread.

    The only things I can’t explain is the above mentioned Diet Pepsi symptoms and the fact that 4 slices of deep-dish pizza cause no symptoms at all whereas a slice of sunflower wheat bread would. Wouldn’t wheat be present in both?

  • lookingforanswers

    First I want to thank you for all the information you have provided.

    I have been battling with intestinal issues for about 5 years now. About 4 years ago I was told I had Ulcertative colitis. I was given many medications, which none seemed to work. About three years ago I had a very severe relapse and from a friends advice went on a gluten free diet, taking probiotics and colitis silver. I got much better within a week and was doing fine till about 2 months ago where a relapse started. I think this was caused by my eating of mango and papaya to help my peptic ulcer. Currently I am searching for answers and have a breathe test scheduled for next week. There are some gluten free items that I eat that I am not concerned about. This included the pamela’s pancake mix I have
    Ingredients
    Brown Rice Flour, White Rice Flour, Cultured Buttermilk, Natural Almond Meal, Tapioca Starch, Sweet Rice Flour, Potato Starch, Grainless and Aluminum-free Baking Powder, Baking Soda, Sea Salt, Xanthan Gum.
    Also Udi’s bread:
    INGREDIENTS: FILTERED WATER, TAPIOCA STARCH, BROWN RICE FLOUR, POTATO STARCH, SUNFLOWER OIL OR CANOLA OIL, EGG WHITES, EVAPORATED CANE JUICE OR SUGAR, TAPIOCA SYRUP OR BROWN RICE SYRUP, YEAST, XANTHAN GUM, SALT, BAKING POWDER (SODIUM BICARBONATE, CORNSTARCH, CALCIUM SULFATE, MONOCALCIUM PHOSPHATE), MOLD INHIBITOR (CULTURED CORN SYRUP, ASCORBIC ACID), ASCORBIC ACID (MICROCRYSTALLINE CELLULOSE, CORN STARCH), ENZYMES. CONTAINS EGGS

    Do you know of any gluten free products/brands that work for FM?

    Also I hear sweet tarts are ok?

    Thanks for all your help in advance!!

    • Jan Modric

      lookingforanswers,

      sweet tarts include dextrose (glucose) and maltodextrin as sweeteners, which should not be problematic. They include several additives for which I don’t know, if they could cause problems or not.

      Glucose can help in absorption of fructose, so adding glucose to foods containing frucose (amount of glucose exceeding amount of fructose) could help. Gluten free products that do not contain fructose, HFCS, sorbitol, xylitol or other polyols (except erythritol) should not be problematic in fructose malabsorption. I don’t know any exact products right now, but you should check ingredients and see.

  • lookingforanswers

    BTW I have a typo…I meant to say now I am concerned about the gluten free products.

  • advice please

    I want to get the advice of unsweetened almond breeze milk. I dont see almonds as suitable on the board, but I do see unsweetened milk.

    Thank you!

    • Jan Modric

      advice please,

      nuts or nut products, sweetened or not, may cause problems in certain individuals with fm. This is why I’ve put nuts in “to try” column above.

  • Sheila

    Hi, Jan! How’s my favorite dietician? If you’ve already answered about stevia, I apologize. I didn’t see it. As it contains no sugar, supposedly, what is the reason it is not on the approved list? Thanks.

    • Jan Modric

      Sheila,

      I’ve interviewed some people with fructose malabsorption about stevia, and, by my surprise, many said they found it problematic. I currently don’t have any theoretical explanation for this, anyway, I did not want to tease readers with this sweetener, so I’ve just put it on the avoid list. I personally don’t have fm, and I have a sweet tooth, but still I don’t really have a problem going without any sweet food for weeks…

  • Sheila

    Maybe it’s all in their heads! Just kidding! I have been using it, though, moderately, as you probably should in all things, and I THINK it’s fine.
    I’ve written once—right after I ate a huge bowl of watermelon and was sick for three long days, several months back, which lead me to this site. I have never been able to eat onions, thinking it was an enzyme I was missing or something. I tested a big bowl of grapes yesterday,after abstaining from all the avoids and it was not a good idea. I was up all night. Looks like FM—and though you may get malnutrition if you don’t start eating right, you won’t die nearly as quickly as if you have Fructose Intolerance. I am trying to rule that out for sure, but it’s hard to tell only because I have read that some that have FI can actually tolerate a bit of fructose. Is that true? I thought if you had FI you wouldn’t be able to handle any fructose, or it would seem like a really bad idea. If it’s true that all people with Fructose Intolerance are a bit different, each being able to have a bit of fructose and others not, how in the world do you ever tell the difference (aside from the liver biopsy) between FM and FI? Write when you can. Thank you.

    • Jan Modric

      Sheila,

      onions are problematic for some with fm because they contain fructans (chains of fructose). Fructans are also in wheat. Grapes are high in fructose and sorbitol. Here’s a list of food examples with various amounts of fructose and sorbitol.

      Symptoms in hereditary fructose intolerance are usually much worse than in fm. They may include headache, vomiting, serious abdominal pain and feeling really sick. Symptoms appear as soon a fructose containing food is given to a child. Children with hfi develop aversion to sweet foods, while persons with fm usually don’t. Even tinny amounts of fructose, sucrose or sorbitol trigger symptoms in hfi – I have not heard of any mild variant of hfi. Maybe you have heard you can’t tolerate fructose in hfi, but you can tolerate a certain amount in fm. Various tests, besides liver biopsy, are available for hfi: fructose intolerance test with injection of fructose into the blood, urine test, genetic testing…If you can safely eat a piece of an orange (containing small amount of fructose) or small amount of table sugar, you probably do not have hfi.

  • Sheila

    Hi again Jan, Thanks. You make me feel better, though I think the diet for us with fructose malabsorption has to be worse than for HFI, well, even worse than the gluten-intolerant, diabetic or lactose intolerant. I sent a few websites that I remember to cause me confusion, and you probably already know about them (by the way, that’s a BIG deal to get your degree–very impressive)but I just wanted you to know why I asked you the questions I did and for others that you have helped. The first is a forum for folks with it. Now, maybe some have FM, that THINK they have HFI, so that’s the source of the confusion, but, some stated HFI for sure, and yet, talked about being able to eat a bit of this or that (things I thought that they absolutely NEVER should eat…and I can’t remember what they were without reading here again) and the second website is the laboratory, or at least one of them, that study HFI. I think I read that the onset of HFI can be at any age, and that symptoms are NOT always serious. So, if my memory is correct and I recalled it right, then you can see the source of my frustration. I believe someone with a degree in nutrition probably knows more about this than any doctor, though, maybe not a scientist who is actively studying patients with HFI only. Wow! Certainly a field with which to keep you busy, huh? I have my hands full just trying to determine my enemies at this point.

    Oh! I think the problem with stevia is the inulin or other things that may be in it. The brand that I have buying and love, due to there not being any other artificial additives is Sweet Leaf. I like it the best. I don’t use but a little bit at a time. In reading the label last night I realized that it does have inulin in it—an enemy as it is a fructan! So, if someone who is sensitive to those, like me, is consuming quite a bit, I can see their problem. Since I only found out about all of this a several months ago, I didn’t know about inulin as much. I’d like to find a stevia that is just stevia but, it’s hard to find. Any help anyone? I have another question for you:

    Will all fructans wheat, onions etc. equally give the same problems? As raw onions cause me horrible agony (cooked not as bad) does that mean that the wheat I eat will be just as problematic, or artichokes, etc. Or, is it that one won’t cause so much, etc. I’d like to rule out gluten intolerance also, another serious condition. Well, I have to say that Fructose Malabsorption is serious, too, if you keep eating the wrong things, you’ll die of malnutrition. What’s the differece if you die of malnutrition or die of cirrhosis of the liver, etc. Dead is dead, right? I have had a horrible time for several months. Thanks again. You are a tremendous help. As soon as I get my student money in (missed priority deadline so it’s gonna be awhile) I will send you a donation, for sure as I appreciate the info.

    http://hfiinfo.proboards.com/index.cgi

    http://www.bu.edu/aldolase/HFI/

    • Jan Modric

      Sheila,

      I’m not a dietitian, I’m not even a doctor, but I have a medical faculty. I’ve made some research about fm, hfi, also interviewed some people with these disorders.

      HFI usually causes symptoms as soon as the affected child tries the food containing fructose. Howewer, some of them get diagnosis only years later, because HFI is a rare disease…

      Good point about stevia and inulin. It’s always a *product* you buy and eat, so it is good to check “nutrition facts labels” (I’ve added two lists of problematic and non-problematic substances into the article). If it is inulin in onions, which irritates you, than inulin in wheat products, artichokes, asparagus and leeks may also irritate you – but small amount of inulin may be OK (this is to try and see). But onions also contain fructose…

      Fructose malabsorption is far from being considered as a deadly disease. Actually, anyone consumpting large amount of fructose (few pears in a row, for example) would likely suffer from bloating and diarrhea in the next few days, since we all have our individual limits of fructose absorption.

  • Paul

    For almost 3 yrs I have been suffering with a gas , intestinal gurgling and grunting , very loose stools. This along with the anxiety, depression and loss of sleep caused by it. I have seen several Dr.s had G.Is, been on many meds none of which has helped in the least. 5 days ago my wife showed me an article on FM and I decided to test myself and go F free. IT TOOK ONE DAY to see MAJOR improvments! ONE DAY!! Why is this problem not more well known about??? If this continues to work I feel like I’ll have a whole new lease on life. I’m elated!! Thank you SO MUCH!!

    • Jan Modric

      Paul,

      fm is now known for some years, but it is still considered as pretty new, and many doctors haven’t even heard for it.

  • amy

    Jan,

    hi again. I just want to say thank you again for this website. I am sitting here with my pad and paper trying to write things down that my daughter (10) can have. She is probably one of the world’s pickiest eaters who has a horrible diet to follow. Potatoes and rice are not her thing and are considered two of the better staples of this diet. And, she sneaks food and I can tell when she does because she has meltdowns of drama…sigh. Are there any other websites that are good for meal ideas? I am clueless and overwhelmed by her diet and my son’s diet (he has celiac).

    I feel as though I am drowning in not knowing how to cook and dread stepping foot into my kitchen.

    thanks again!

    • Jan Modric

      amy,

      dietsolutions.net.au
      Here si a group of dietitians who are pioneeres in fructose malabsorption research. They also deal with celiac disease and other food-related issues.

      groups.yahoo.com
      search for “fructose malabsorption” and you’ll find few supporting groups

      hfiinfo.proboards.com/index.cgi?board=Recipe
      This is the discussion forum for peole with hereditary fructose intolerance, which is not the same as fm, but the diet resembles a lot.

      http://www.healthhype.com/fodmap-diet-foods-to-avoid-in-ibs-bowel-disorders-with-bloating-and-gas.html
      This is my article about low-FODMAP diet that could help understand why some nutrients may be problematic.

      I guess your daughter has some *trouble* with fm. If she becomes aware of a direct connection between the troble and the food eaten before that, she would be maybe willing to avoid problematic foods. You can encourage her to start a diet diary with foods eaten and symptoms followed…

      For you it is important to have a “safe list” of foods, foodstoofs and nutrients that don’t cause her problems (on the basis of the diet diary). I have added two lists of safe and to avoid *nutrients* above in the article. If she can eat bananas, she can probably eat oranges and maybe berries (all sorts). It would be really good to know if she can tolerate gluten (no matter having celiac disease or not).

  • Sheila

    Hey again. It’s strange that some on the HFI forum can tolerate certain foods that do have a bit of no-no’s in them. Now, do you know what it is that makes one HFI (not a FructMal) be able to “handle” some of these certain foods and some not. As serious a disease as HFI, you would think they should not have any kind of plant (alfalfa sprouts don’t appear, for example, to have any fructose in them)with ANY bit of fructose. (I’ve ruled HFI out, and thank you)but have had severe diarrhea/constipation (alternating) for months and have determined some problems. I am not vegan by choice. I am allergic to milk, fish and meat (doc say I shouldn’t eat eggs also. Fructans and fructose culprits. Do you have access to a source, a list of all foods containing fructans? I wanted to test for gluten-intolerance, but found out spelt, rye, oats, kamut and barley also have fructans. Is there a grain that does NOT have fructans, that also has gluten, just for the sake of my test? The USDA database is also spotty for information containing the breakdowns of the various sugars. Are they logging this info in this seemingly new discovery, maybe as we type? Do you think they will have this info on labels soon for all of us? And, I only say that this is very serious, because if you keep having diarreah, you will not be absorbing many nutrients you eat and though you won’t get liver problems, malnutrition ensues.

    • Jan Modric

      Sheila,

      as far as I know wheat is the only grain that contains fructans in amount that could trigger symptoms in individuals with fm. Note, that fructans do not trigger symptoms by the principle of fructans “intolerance” or “allergy”, but because they drag water into the intestine, and they are broken down by colonic bacteria and yield gas. For this to happen certain *amount* of fructans is needed, and wheat and onions are almost the only two things that can cause symptoms because of fructans content. Leeks, chicory, asparagus and Jerusalem artichokes, and grains you’ve mentioned would hardly be problematic, so I don’t see the point in seeking for foods with small amount of fructans. I don’t know what will happen with nutrient labels. Even fructose is not listed separately for now.

      Are your allergies confirmed by a registered allergologist? I don’t recall allergy to meat, at least not to meat in general.

  • Sheila

    Good afternoon! Thanks for the info. This is all new so I’m just getting it down. I was about ready to cry again over the fact that maybe oatmeal, etc. is bad. Great news for me, as it’s almost a complete protein, along with other “grains” I eat regularly. Yes, unfortunately, it’s been determined that I am allergic to these things. I’ve known that for a long time, but ignored it as I wasn’t giving up meat! I complied several years back due to the health problems from that but I do blow it now and again, especially at the fair! Technically, I am allergic to milk and fish. Due to the polyps in my nasal passage and other things, he wanted me to come back for more testing and I have had two doctors now tell me to abstain from all meat and eggs (protein in eggs is similar to milk) as they believe my chronic asthma is a symptom more of a meat allergy. I am only allergic to a few pollens. I also have been formally diagnosed with RA (again, probably a symptom of allergies instead of a real disease, or so the medical literature alludes to) and Migraine Disease (looks like the wheat is the culprit here). A great article by Dr. Mark Hyman from the New York Times talks about how wheat can be the problem for many many “diseases” and can save a ton in healthcare. Good news for all of us, but, I am being careful as nothing is engraved in stone. I do eat chicken and turkey right now, while I am testing for my particular tolerances to fructose and fructans (haven’t gone to the doctor on this…it’s hard, as everyone knows to find a good doctor and fructose malabsorption seems pretty clear cut, just hard determining your particular thresholds(hope to God I can eat beans, and it seems I can) as I can live with joint pain and itching more than living on the toilet! You’re so great to talk to.

  • pbnj

    I am pretty darn sure that I have FM, and I have a two dumb questions that I think could be interesting to the forum:

    1) does having FM mean that fewer Calories are absorbed from fructose-containing foods during digestion? (that’d be one very cool thing about it)

    2) I am single, and work from my home, so I don’t really have too much issue with embarrassment. I love my apples and pears and grapes and honeydew. So, I may make 4 trips to the bathroom every day. If I continue to consume these items, am I going to make things worse over time or is this likely to be as bad as it gets? I realize as people get older, bodies change, but I want to know if I am making the long-term situation worse by continuing to eat the fun fruits. If it is something that I can live with, am I okay to eat the fun fruits still and be confident that I am not somehow damaging myself and making myself more FM than I am today? (I know it is not an allergy, but they say allergies get worse with more exposure).

    Thanks Jan for everything, the page and the personal answers.

    • Jan Modric

      pbnj,

      a “weight-loss program” by inducing diarrhea with fruits is a NO-GO. Individuals with fm usually do not lose weight. Continuos diarrhea (full of sugar) may lead to fungal infection around the anus, malabsorption of certain minerals, like iron, or vitamins, inflammation of the small intestine due to small intestinal bacterial overgrowth (SIBO). I doubt you’d enjoy symptoms of these conditions. This would very likely worsen fm, at least temporarily.

  • Sheila

    Hi pbnj, Though I’m not a doctor, etc., I have to say that the calorie-producing nutrients are carbohydrates, fats, and proteins, so it would be likely that interruption of those nutrients would happen from fructose malabsorption. You have given me great ideas for more study. Also, diarrhea is not normal, even if it did cause you to lose weight (I have lost weight, but, only when my symptoms are severe, as in after the big bowl of watermelon….arrrgh)otherwise, I don’t lose weight. Currently, thanks to Jan’s thread, I have this pretty much under control. For lack of a better phrase, soft-serve type is WAY better than water stools. I just don’t if even in that condition if I am absorbing all the nutrients (vitamins,minerals,water, protein, carbyhydrate and protein). Do NOT try to lose weight like this. It won’t happen and you’ll get really sick.

    Jan, do you know if the aforementioned nutrients are absorbed/not absorbed in the same place as fructose (well, obviously, carbohydrates are absorbed there)?

    • Jan Modric

      Sheila,

      a person with fm usually does not have malabsorption of many other nutrients, especially not likely malabsorption of fats or proteins. Fm is not a disorder of the small intestine as such, which would therefore affect absorption of all other nutrients, but it is a disorder in which an amount of fructose-carrier molecule called GLUT5 in the intestinal mucosa is reduced, so, a person with fm can absorb lower amount of fructose than a person with normal amount of this molecule. So, theoretically only absorption of fructose is affected, since other nutrients are not dependent on that carrier molecule.

      For some reason, absorption of polyols (sorbitol, xylitol..) is also affected in fm.

      In practice, fructose malabsorption is sometimes accompanied with lactose intolerance (these being two separate disorders), or small intestinal bacterial overgrowth (SIBO), which sometimes follows fm, since the unabsorbed fructose feeds bacteria in the small intestine. These bacteria can cause inflammation of the small intestine, which can then actually affect absorption of various nutrients. But SIBO only sometimes occur in fm.

      For fat or protein or mineral or vitamin malabsorption to happen in fm, there should be a prolonged, severe diarrhea, which would flush these nutrients through the bowel, before they would be able to absorbed. Appropriate stool and blood tests to confirm such malabsorption exist.

  • Sheila

    Jan, Also, I really have to thank you again for helping me see the differences between HFI (Hereditary Fructose Intolerance) and Fructose Malabsortion. I went back and read all the various articles you have written—should have done that first, or I wouldn’t have asked you so many questions!

  • Sheila

    You have to be right, as everyone always is remarking how healthy, or young I look! Great evidence. I was really spooked when I had a severe bout of this, always avoided onions, and for years have avoided wheat, well, all “starchy” carbohydrates (not anymore, just no wheat) and after the large bowl of watermelon I ate in late July, causing me to think I was gonna die soon if I didn’t get it figured out. At least with us whatever we’re called, Fructmals, (can’t there be a better name-sounds like we’re alien)it can sure make you feel like you’re gonna die! Thanks again Jan. I’ll see you soon.

  • simonesydney

    Hello Jan

    Thank you for this extremely helpful information resource. I think my 8 month old daughter may be having trouble with fructose. Introducing solids has been extremely difficult and she wakes up most nights every couple of hours with stomach pain and excessive wind. The one thing she would eat was apples and carrots and reading you article I see that these could be the worst things for her. Question is what can I give her instead. I have managed to introduce a few other things like potatoes and parsmips but she will only eat them if I add apple to sweeten them. I am wondering whether I should stop sweetening with apple and just use brown suger instead. I would like to try some other fruits, and judging by your research was thinking of rhubarb, gooseberries, cranberries. All of these would need sweetening with suger. She is also dairy intollerent and so far I haven’t found a grain she can tolerate. She still receives most of her nutrients from breastmilk (cannot tolerate infant formula) How effective is the hydrogen breath test – would it be suitable for a baby? I live in Switzerland and have found medical community rather unsupportive in helping me identify what her problem is.
    I would really appreciate your input as I am rather desperate.

    • Jan Modric

      simonesydney,

      fruits that can be less problematic (low fructose) are bananas and oranges. Most berries are low in fructose, but they contain some sorbitol or xylitol, which are often problematic in fructose malabsorption (fm), but this can vary from person to person a lot.

      Sugar is composed from glucose and fructose, but glucose helps in absorption of fructose , so many individuals with fm can safely eat a certain amount of sugar. Brown sugar is not much worse or better. If she can’t tolerate carrots (which are not so high in fructose), I have some doubts, she will be able to tolerate sugar, but not sure. A safe sweetener in fm would be glucose, though (sold as dextrose or glucodin).

      If your daughter is gluten intolerant (celiac disease), she would have problems with wheat, rye and barley (and possibly, but not necessary, oats). Corn and buckwheat should not be problematic neither in celiac d. or fm. White rice should be also ok. If she is not gluten intolerant, she could still have problems with wheat (due to high fructans content). Lactose-free milk exists. Most hard cheeses contain almost no lactose.

      I think breath tests are not performed in babies, but there are stool tests for lactose intolerance and fructose malabsorption, and blood test for a celiac disease available. One common “complication” of fructose malabsorption and lactose intolerance is small intestinal bacterial overgrowth (SIBO), since unabsorbed fructose and lactose feed normal intestinal bacteria. Dx in older children and adults is made by a breath test, not sure, how it is made in babies…It is usually treated with antibiotics. SIBO can be suspected when all irritant foods are removed, but symptoms still persist.

      One approach is to breastfeed her exclusively for some time – if symptoms go away, SIBO is not likely the cause. Then you can introduce certain safe foods one by one.

  • simonesydney

    Hi Jan

    Thanks for your very helpful response. Based on your advice I will avoid berries. Reading around I thought I might give figs a go. What do you think about sweetening with maple syrup – is that better than sugar? I bought some buckwheat a few weeks ago but have been nervous to try it on her after all the other grain failures. Perhaps I should try buckwheat mixed with banana. I don’t think I can manage to exclusively breastfeed again – I am so worn out already.

    • Jan Modric

      simonesydney,

      to find out for sure, if buckwheat is ok for her, you can sweeten it with pure glucose for the first time, since glucose should not be problematic, but you don’t know for bananas. If you are sure carrots irritate her, then many other foods from the “to try” list above may be problematic for her…maple syrup is in the same column, and figs are even in the “to avoid” one, since they are high in fructose.. So, try to stick with foods in the “safe to eat” on the beginning until her symptoms go away. Glucose (dextrin, glucodin), and erythritol should be ok – I believe you can find them as independent products in markets.

      Here’s another table, which lists foods from highly to less problematic according to their fructose content

  • CW

    Hi Jan

    My gastroenterologist and GP have both recommended I try the low-FODMAP diet to deal with an unpleasant range of IBS symptoms (gas and bloating, nausea, and alternating diarrhoea and constipation). I’m not sure about it, as many of the foods that the diet excludes don’t seem to lead to problems for me – while I have reacted badly to oranges and pineapple in the past (with acid and gas). Have had a few nasty attacks of massive, uncomfortable bloating accompanied by nausea in the last week – most of which seemed to come on immediately after eating dessert (sugar-sweetened), and one of which came on after a single glass of wine.

    I’m interested in your thoughts…

    • Jan Modric

      CW,

      Low-FODMAP diet excludes many *possibly* irritating foods, but this does not mean you would react to all of them. If some of foods listed in the low-FODMAP diet are ok for you, you may eat them, without having a feeling you “cheat”. It’s the diet that has to fit to you, not that you have to fit the diet. Low-FODMAP diet basicly consists of low-fructose and lactose-free diet. If you react to oranges and pineapples, you may have fructose malabsorption. You may (not necessary) additionally have lactose intolerance (if you can’t tolerate milk, you would still likely tolerate many hard cheeses, since they are low in lactose or lactose-free).

      One complication of both fructose malabsorption and lactose intolerance is small intestinal bacterial overgrowth (SIBO). Diagnosis is with a special breath test, treatment is with antibiotics. Another cause of bloating and nausea after the meal (and heartburn) is Helicobacter pylori infection of the stomach. Diagnosis is with blood or breath test or biopsy of gastric mucosa made during upper endoscopy, treatment is with a combination of antibiotics.

      You may try a low-fructose diet by sticking to “safe to eat” foods for 3-4 days. If this helps, you probably have fructose malabsorption. If it does not help, you may extend the diet to low-FODMAP diet (link in the article), and if still no relief, you may ask for tests for SIBO and H. pylori.

  • DrMommyN

    Jan, Wow, I need to read every single comment here. I’ve not found this great of information from anyone, including my doctor!

    I was diagnosed only a month ago. Still in a bit of denial, throwing tantrums because I can’t eat anything without symptoms. I’m doing my second round of the HCG diet, which is very limiting, so decided to do an elimination diet at same time. Still symptoms. Only things besides meat, spinach, celery, was Bragg’s amino acids (which I think is a soy product.) What does one flavor their food with? No ketchup, onions, garlic, ginger (I think it was a problem), vinegar (except distilled)! A bit frustrated now. Some days are better than others.

    Jan, can you tell me if a higher hydrogen breath test indicates I will be more sensitive? I had a baseline of 8, and was 256 after 2 hours. Thanks again for all this GREAT info!

    • Jan Modric

      DrMommyN,

      high values at hydrogen test probably mean you will be able to eat only foods with low amount of fructose, polyols (sorbitol, xylitol…), fructans (in wheat and onions) and galactans (in legumes, cauliflower, Brussel’s sprouts).

      So, when starting with the diet, try to have only foods from the “safe to eat” column above. Maybe you won’t tolerate any fruits and fruit products. Many individuals can tolerate wheat and legumes, so this is to try and see. You can initially exclude them and introduce them back later and see what happens.

      White rice, potatoes, corn and buckwheat products might be fine.

      About flavoring: enjoy natural taste of foods. For example, if you cook potatoes in the vapour, not in the water, potassium does not leak out and gives potatoes a full, pleasant taste. Certain brands of bottled mineral water may have a really good taste. Bread with seeds eaten without any spreading may be delicious. Still there are some spices listed, which may be ok.

  • Jorgiemom

    Jan, not to bore you with the details of my issues, but I’m sure glad to find this site! Back in Feb of this year, I decided to take back my life. I felt like a 60 year old in a 28 year old’s body. I was arthritic, had acid reflux, blurred vision, brain fog…you name it. I thought I was becoming a hypocondriach.I had a really bad pregnancy and I wonder if it had to do with this.

    After my first child,I went to see an internist re: my stomach and he did an unltrasound, etc. I never got to do the breath test, but he sent me home telling me to take some zantac. To no avail, I was getting worse and it was after my second pregnancy (sick again) that I noticed my energy levels were really low. I needed at least 1-2hour nap a day to keep me going. I decided to do a yeast elimination diet. I felt amazing after 3 weeks on it, my allergies were all gone, PMS gone, energy super high, and headaches gone as well, body odor gone, you name it! I started to re-introduce foods, but now after so many months, I’m slowly going back down that same path and I’ve changed my diet completely. I read the SugarBusters book, which was great, now I just ordered a book on Specific Carbohydrate Diet, which gives me some hope. Now I’ve found this! A lot of what people are saying on here really rings true to me. Like I ate brown rice pasta the other night with some cauliflower and a huge salad, the next day I woke up feeling like I got hit by a mac truck. I was reading here that cauliflower is a no-no! That’s great! I do have issues with corn though and I’m trying to go completely grain free because I feel better that way. Is there anything else I should consider? A dietician is starting to sound like a necessity for me. I guess, I don’t know where to start? I wonder though if my nausea and severe vomiting during pregnancy was related to this b/c all the morning sickness food they suggest like crackers nearly killed me. I always felt that my poor pregnancy was an indicator of my body’s poor state of health. Cheers and thank you!

    • Jan Modric

      Jorgiemom,

      if possible, make a list of foods you can eat without problems and then eat only those for few days until you get symptoms free. Then start to introduce some other foods (one by one, every other day) you think they might be fine. Run a diary about foods and their effect. Give each food two days to be sure about its effect. Plain and degermed corn is usually not problematic in fructose malabsorption, also not in celiac disease, so maybe you are allergic to corn. If you decide to start with low-fructose diet, stick with foods in the “safe to eat” column, and additionally remove foods you know they may be problematic for you.

  • Jorgiemom

    thank you for your quick response. I’ll see what I can come up with, it’s so laborious. I’ve scheduled an appt with a DO in the area that looks at medicine holistically. So, I’ll see what she thinks as well. Today I’ve cut out the fruit and it seems I’m digesting food okay and my liver isn’t bothering me as bad after eating some lentils either. But it takes a little while for symptoms to settle in, I can see it more in my mood swings, which a quite severe from these food thing. Is there anyway I can print out this list? Thank you!

    • Jan Modric

      Jorgiemom,

      if you have a printer, find a print command in your browser menu and print it. Most food intolerances can be managed by appropriate diets, which is simple and free.

  • Juliebuchholtz

    What about pumpkin? I know that it is technically a fruit. I do see squash on the avoid list so wondering if my extrapolating pumpkin to the avoid list is correct.

    • Jan Modric

      Juliebuchholtz,

      I had a pumpkin in a safe column under proteins…now I moved it to vegetables…the same column.

  • Tim

    Hi Jan,

    I am trailing a FODMAPs diet after the advice of my nutritionist due to bloating and excess flatulence. Being very active (triathlons) I have always taken my fluid and food intake seriously. Now I have to rethink a lot of what I have been doing. One think you could help me with please is for a while now I have been making my own Energy Bars. The primary binding ingredient has been HONEY, a little brown sugar and butter. I would not have guessed that the honey was potentially contributing to my bloating and flatulence!!! The remaining ingredients vary slightly but mostly stay the same. I use various nuts, seeds and small amounts of dried fruits, such as Blueberries, sultanas and Cranberries. I have just trialled replacing the honey with Golden Syrup but since then I have read conflicting views as to if it is okay. Your list has it as ‘To Avoid’.

    Is there anything else I could use as a substitute for honey in making my energy bars? I have been using them extensively on the bike, general consumption during the day or after a run or swim. I prefer them rather than buying off the shelf Carb Bars.

    To be honest I am feeling quite lost in regard to what I can eat for snacks during the day. I can only eat so much fruit (and that has to be spaced out over the day). At home I walk back and forth in the kitchen from the pantry to the fridge and then back again saying ‘there is nothing in there I am aloud to eat’. I am used to having a massive apatite due to my training and consuming everything in sight (healthy stuff though) and now I am still doing the same training but I’m struggling with replacing my spent energy stores. I have a Half Iron Man in six months that I have just started training for and the biggest concern at the moment is sticking to this FODMAP diet and still satisfying my fluid and food intake appropriately.

    Any help or suggestions?

    • Jan Modric

      Tim,

      excessive bloating and gas may be due to a specific disorder, so the appropriate diet depends on that:
      – in fructose malabsorption, there are fructose, sorbitol and other polyols, which are problematic. In this case honey, most fruits and foods high in fructose or polyols would likely irritate you. A 4 day low-fructose diet (sticking with the safe foods above) would likely help.
      – in lactose intolerance, lactose from milk and other dairy products would irritate you. A lactose-free diet would help.
      – in celiac disease, a gluten-free diet would help
      – if nothing of above helps, you might have a small intestinal bacterial overgrowth (SIBO) *additionally* to any of above disorders. A breath test performed by a gastroenterologist exists; if positive, treatment is with antibiotics.
      – intestinal parasites can also cause excessive bloating and gas. Diagnosis is with a stool test for parasites, treatment with prescribed antiparasitic drugs.

      From the viewpoint of the low-FODMAP diet (which is a low-fructose + lactose-free diet), it’s not only honey, which is problematic, but also other components of the bars: dried fruits and nuts. There are several syrups listed in the “to try” column. The only common safe sweetener in fructose malabsorption is glucose (sold as dextrose), though. So, first try to confirm/exclude common food intolerance. If you can eat a handful of prunes without getting bloated, you don’t likely have fructose malabsorption; if you can drink a glass of milk, you don’t likely have lactose intolerance, and if you can eat wheat, barley and rye, you don’t likely have celiac disease.

  • Clancy

    Thank you for this article and all these comments made and answered. It has been so helpful.
    I wonder about stevia? I knew to look out for problematic fillers, like chicory powder. What is in the stevia leaf, or extract itself that is a trigger? I thought it didn’t have any sugars in it at all?

    • Jan Modric

      Clancy,

      I’ve interviewed several people with fructose malabsorption about which foods and sweeteners trigger their symptoms, and, by my surprise, stevia has come out as a common trigger, so, I’ve put it into the “to avoid” column above. I can’t provide any theoretical explanation for this. Stevia is not problematic for all people with FM, though.

  • Tom

    You have sucralose (splenda) in the “Avoid” column. Other places on the Internet say it’s fine. Can you explain?

  • Melanie

    Thank you for this awesome, helpful Website!

    I have some brief URGENT questions:

    Is peanut butter, like Jif or Smuckers OK?

    Is it ok to bake with plain white flour?

    Is Margerine OK?

    Is Domino sugar OK for baking or as a sweetener?

    So the ingredients of a simple cake or brownie are OK? Eggs, sugar, oil, cocoa, baking powder?

    Plain noodles or do they have to be rice noodles?

    Are nuts “safe” or are they “safe in moderation”? All nuts?

    • Dr. Chris

      Hi Melanie

      Most of the information is laid out in the article above. Unfortunately we cannot comment on specific foods in your case as readers tend to use this information without consulting with a dietitian. This puts us at risk of liability, often from the very same readers who asked the questions, when their condition worsens.

      If you have been diagnosed with fructose malabsorption then your doctor will refer you to a reputable dietitian. There may be other factors to consider in each case which cannot be covered here.

      Readers please do not mention brand / trade / commercial names of products as it affects our ability to offer this type of free question and answer service. You may chat privately with a qualified doctor or dietitian by clicking the Ask a Doctor Online link towards the top article. It is a paid service and all information is kept confidential. The Health Hype team will not be held liable for any misuse of information. Questions containing trade names, contact details and links will be deleted in the future.

      • impaler

        I’ll rephrase one that im curious about. Is margarine, (specifically promise brand margarine), to be avoided for people with fructose malabsorption?

  • Melanie

    OOps, another more question:

    you wrote “hot Mustard” as not allowed, but what about plain yellow mustard?

    Plain (not garlic) Pickles?

  • Melanie

    Another Question:

    Is plain Breyers vanilla Ice cream OK?

    Also, there is NOT even one gluten-free waffle that doesnt have fruit juice in it, and almost all gluten-free cereals have molasses, fruit juice or some other ingredient that seems bad- any advice on these?

  • Melanie

    Is Celestial Seasonings herbal teas OK? They have no sugars, but are “fruit flavored”, and have “soy lecithin”- is soy lecithin ok?

  • ph_yoyo

    Hi,

    I don’t know if have FM, I will get tested soon, but I do have lactose intolerance and SIBO, small intestinal bacterial overgrowth. I’m on lactose free diet whcih helped a little, but my SIBO wouldn’t go away with several courses of antibiotic(rifaximin).

    Will FODMAPS diet works for me? or I have to make more carbohydrate restriction because of SIBO?

    How can I get red of SIBO? and is there any connection between FM and SIBO?

    How to get started on FODMAPS diet?

    • Dr. Chris

      Hi ph-yoyo

      First confirm that you have fructose malabsorption. There is a tendency for people to catch on to certain popular terms of the day and attribute their existing, similar symptoms to these conditions and then fixate on a diagnosis. Many people suffer with FM but it is not as common as it is sometimes made out to be. Sometimes the “hype” around it makes light of those patients who are battling with the condition on a daily basis.

      With that said, FODMAP diet may work for you. The focus should be on the TYPE of carbohydrates that you restrict. There is specific treatment for SIBO which you need to discuss with your doctor – antibiotics are part of the treatment but probiotics are also a consideration. Please don’t buy over-the-counter probiotics from your local health store. Speak to your doctor first. Many probiotics on the market today are NOT of any value in the management of certain conditions but prolific marketing and a lack of regulations have allowed fairly “useless” products to become popular. FM may contribute to SIBO and often exacerbate an existing case of SIBO. You need to speak to a dietitian about a proper dietary approach once the diagnosis of FM is confirmed. Please speak to your doctor and if you have not done so as yet, consult with a gastroenterologist for the management of your condition.

  • Glennis Griffith

    Hi,
    I have been using your nutrition-guide-for-fructose-malabsorption for the last 4 weeks, Thank you so much I haven’t felt this good for up to 25yrs. (I am now 51 years old)
    I’m in New Zealand and there doesn’t seem to be a test for fructose malabsorption available, (unbelievable) especially when it isn’t that uncommon. I have been taking Lopermide Hydrochloride USP 2mg as often as required. Which as helped me just to cope, for years. I am now cycling a lot and need help to know what sports nutrition I can take?

    • Dr. Chris

      Hi Glennis

      We generally don’t advise patients on specific supplements and so on. This should be discussed with a dietitian and I know from experience that there are many very competent dietitians in New Zealand who could be guiding you through this. Given your increased activity, you need to consider a greater intake of calories and protein provided that it does not include foods mentioned in the “Avoid” column. Hydrogen breath tests and stool acidity tests are available in New Zealand but you may have to see a private gastroenterologist. Cannot comment on areas outside Auckland though.

  • Reg

    A couple of nitpicky notes: “sensible to sorbitol” s/b “sensitive” and is there such a thing as “grouts” or should it be “groats”?

    And a question: I notice that chocolate is not mentioned in the list. I realize that there are many, many types of chocolate/cocoa, etc. Is the complexity of the item the reason it’s not there?

    • Dr. Chris

      Hi Reg

      These notes will be forwarded to the editor. Cannot speak on behalf of the writer. Thank you for bringing it to our attention.

  • nd

    Can the writer give citations for where the information in this article was found? I too am confused by the discrepancies between sites that offer a list of foods to avoid, try, and use in moderation. I would like to see the facts and statistics to back up the above information.