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 GROUPSAFE TO EATTO TRY (IN MODERATION)TO AVOID
SUGARS AND SWEETENERSAcesulfam 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.
FRUITSCumquat, 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.
VEGETABLESBouillon, 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 CEREALSBarley, 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, tortillaWheat (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, sunflowerLegumes: chick peas, lentils, lima, mung, soy (including tofu);
Nuts
Meat, fish (if processed, sweetened, or commercially breaded); coconut milk/cream.
DAIRYPlain, unsweetened milk, yogurt, cheese.Sweetened milk products, ice cream
SAUCES AND SPICESBasil, 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.
DRINKSWater: 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 TIPSCooked 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 .

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About Jan Modric (249 Articles)
Health writer
  • 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?

  • 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?

  • 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.

  • 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?

  • 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.

  • 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.