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 .

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