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Fructose Malabsorption

Fructose Malabsorption

Fructose malabsorption is a digestive disorder whereby individuals have difficulty digesting the sugar, fructose.  This inability to digest can cause: bloating, cramping, gas, distention, diarrhea, fatigue, headaches, brain fog, mood changes, and constipation.

What is Fructose?

Fructose is a naturally occurring sugar that is rich in the following foods:

  • Fruits and fruit juices: apple, cherry, grape, guava, litchi, mango, berries, melon (honeydew and watermelon), orange, papaya, pear, persimmon, pineapple, quince, star fruit. Cooked fruit contains less fructose.
  • Processed fruit: barbecue/braai sauce, chutney, canned fruit, tins (often in pear juice), plum sauce, sweet and sour sauce, tomato paste.
  • Most dried fruit
  • High fructose corn syrup
  • Honey
  • Maple syrup
  • Agave syrup
  • Maple-flavored syrup
  • Molasses
  • Palm or coconut sugar
  • Sorghum
  • Processed foods
  • Sweet wines (eg. Dessert wine)
  • Vegetables with a high fructan content: artichoke, asparagus, beans, broccoli, cabbage, chicory, leek, onion, peanuts, tomato, zucchini
  • Wheat based products: flour, pasta, bread, whole-grain breakfast cereals
  • Inulin, a fructan, is high in: asparagus, dandelion leaves, garlic, leeks, onion, and wheat bran.


What Causes Symptoms?

Some individuals can not completely absorb fructose in their digestive tracts.  As a result, this food can sit for an extended period leading to bacterial fermentation which causes GI symptoms.  Symptoms of celiac disease and other digestive disorders can be similar to fructose malabsorption, making diagnosis sometimes difficult.

Malabsorption can occur at any age and symptoms can vary between people and with the amount of fructose consumed. While some people can easily tolerate small amounts with no discomfort, such may not be the case for other individuals.

How Do I Know If I Have Fructose Malabsorption?

Speak to your doctor about your concerns.  A Hydrogen Breath Test can confirm malabsorption.

What is the Difference Between Fructose Malabsorption (FM) and Hereditary Fructose Intolerance (HFI)?

These 2 conditions are very different and should not be confused with each other.  HFI is a genetic condition whereby infants are incapable of digesting fructose.  This condition can lead to serious conditions, such as liver disease, or fatality.  FM is a far less serious condition, which can lead to irritable bowel syndrome and should not be mistaken for HFI.

What Should I Do If Fructose Malabsorption is Confirmed?

Follow a low fructose diet that limits foods containing high amounts of fructose or fructans (form of fructose found in wheat and vegetables).   As everyone has different levels of tolerance it is important to limit fructose as much as possible for 4-6 weeks.

After that period of time, fructose-containing foods can be added in one at a time every 4 days.  It is important to keep the amount of total fructose low when introducing and to space out fructose-containing foods as much as possible in order to better identify which foods and amounts are most irritating.

For IBS symptoms, A FODMAP dietary approach, which reduces intake of potentially irritating carbohydrates such as fructose is recommended.   For more information on managing a FODMAP approach or reducing fructose in the diet, see a Registered Dietitian.





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