Doesn’t sound pleasant, does it? These are common symptoms for people who struggle with fructose malabsorption.
What is fructose malabsorption?
Fructose is a sugar molecule that is found in many common foods. In addition to being present in the diet as free fructose (in fruits and honey), fructose is a component of sucrose, and also presents as fructans, present in some vegetables and wheat. When a patient presents with fructose malabsorption, they are not able to properly digest and absorb these molecules – often due to poor gut lining health – creating a bacterial imbalance that causes the symptoms outlined above.
To identify if fructose malabsorption may be the problem for my patients, I conduct in-clinic testing in conjunction with an extensive questionnaire. These questions include:
- Do you not feel great after eating fruit on an empty stomach?
- If you eat fruit on an empty stomach with yoghurt, do you feel ok?
- Do you get gut pain high up under your ribs?
- Does eating fruit give you diarrhoea and gassiness?
- Have you decided that you are going to try and be healthier and eat more fruit, but you are just feeling worse?
For patients that answer yes to these questions, that is a good indication of a fructose malabsorption issue. I also conduct testing to see if there are food intolerance issues also at play, as I often find these present at the same time.
How to treat fructose malabsorption?
Like for many food intolerance problems, treatment starts with addressing gut health and rebuilding the gut lining to be less permeable.
It is also important to eliminate high-fructose foods from the diet, and foods containing fructans. Examples of foods to avoid include:
- High fructose fruits: apple, pear, guava, honeydew melon, mango, nashi fruit, papaya, quince, star fruit, watermelon, cherries, grapes, persimmon, lychee
- Sweeteners: Including honey, high-fructose corn syrup, corn syrup solids, fructose, fruit juice concentrate
- Processed fruits: for example dried fruit; fruit juice; canned packing juice; fruit pastes and sauces including tomato paste, chutney, plum sauce, sweet and sour sauce and barbeque sauce
- Coconut: including coconut milk and coconut cream
- Fortified wines: sherry, port
- Problematic fructan containing foods: wheat based foods, onion, leek, asparagus, Jerusalem artichoke
Argh, sounds like I’ll be starving! What can I eat?
It is important to treat fructose malabsorption under the guidance of an experienced practitioner to identify what your body can and cannot tolerate. However, typically foods that do not trigger a reaction include:
- Fruits with glucose in balance with or in excess of fructose: apricot, nectarine, peach, plum, blueberry, blackberry, boysenberry, cranberry, raspberry, strawberry, kumquat, grapefruit, lemon, lime, mandarin, orange, tangelo, ripe banana, jackfruit, kiwi fruit, passionfruit, pineapple, rhubarb, tamarillo
- Wheat free alternatives: Even if not wheat intolerant, people with fructose malabsorption often manage wheat free options better.
Sharon Hespe, is a degree qualified naturopath that specialises in food intolerances. She runs a successful clinic in Hurstville Grove in Sydney’s southern suburbs. Her philosophy is to treat each person as an individual, as we all have different health challenges, some are food related, gut related, stress related, or the reason for their health problem has not yet been discovered.