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How to Add Flavor Without Causing Fructose Malabsorption Symptoms: 7 Simple Ways

Check out this article: https://www.fructohelp.com/fructose-malabsorption-nutrition/add-flavor-without-causing-symptoms/

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How to Substitute Onions and Garlic With Low FODMAP Infused Oil (Recipe Included)

Following a low FODMAP diet or having to restrict your fructan intake due to digestive disorders like IBS or fructose malabsorption means not eating any onions or garlic. The result: Often dull and boring meals.

However, there is a great trick to get the flavor of onions and garlic back without triggering any fructan related symptoms. I’m talking of infused oil. Here is how you can make it and why it won’t trigger symptoms: https://www.fructohelp.com/fructose-malabsorption-nutrition/onion-garlic-infused-oil/

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How to easily check recipes for problematic food in the case of Fructose Malabsorption

Having to check recipes manually for problematic food in the case of fructose malabsorption is an annoying task. But now it can be done within a few seconds! The recipe checker will show you any food within a recipe that may be a problem.

How to use it

Just copy and paste the ingredients or the entire recipe into the provided text field and problematic food will be marked. That’s it! Alternatively, you can also type your ingredients directly in there: https://www.fructohelp.com/fructose-malabsorption-recipe-checker/

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Low Fodmap Diet for Fructose Malabsorption: A Perfect Fit or Not?

There is a widespread adoption that a low FODMAP diet might be the perfect solution for fructose malabsorption (FM). It actually improves the symptoms and people are experiencing relief through it.

However, there is a better, less-restrictive diet for fructose malabsorption. You will see in the following, why a low FODMAP diet is actually more of an “overkill” and what I prefer instead: 

Check out the full article here: https://www.fructohelp.com/fructose-malabsorption-diet/low-fodmap-diet-and-fructose-malabsorption/

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The Best Low FODMAP Diet Charts, Food Lists, Guides, and Books

I’ve put together a list of the best resources for a low FODMAP diet. You will find downloadable low FODMAP charts, free diet guides, and great book recommendations. Enjoy!

https://www.fructohelp.com/favourable-foods/

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Tasty Fructose-Free Recipes You Should Try

Cooking great fructose-free food doesn’t have to be difficult. You just need to know the right recipes. On the following page, you will find a collection of websites specializing in tasty recipes for people with fructose malabsorption.

The Fructose Friendly Chef

“Fructose and FODMAP friendly meal ideas, recipes and reviews.”

Melissa, the owner of this website, is a fully qualified chef, who was diagnosed with Fructose Malabsorption a few years ago and since then refines all her recipes so that people with the same impairment can enjoy them.

Fructose Free Me

“Cooking great food for fructose malabsorption, gluten-free, and low-FODMAP diets.”

Unfortunately, the author of this website stopped adding new recipes in 2015, but there are still some good recipes listed. Try it out.

Fructose Free Mom

“Navigating my son’s fructose malabsorption, food allergies, lactose intolerance, and gluten free diet.”

As an avid cook, baker, and mother of a son with Fructose Malabsorption, the author’s goal is to make her favorite recipes work with her son’s diet. Have a look and enjoy the recipes.

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Safe Sweeteners in Case of Fructose Malabsorption

On the following page, you will find sweeteners and sugar substitutes you can use without hesitation, you should be careful with, and you should avoid at all in case of Fructose Malabsorption. Please note, that the sweeteners you should be cautious with, shouldn’t be eaten during the first phase of the Fructose Malabsorption diet. Now, let’s dive in!

What sweeteners you can use

Dextrin

Dextrose

Erythritol (E 968)

Glucose

Lactose

Maltodextrin

Maltose

Rice syrup

Spelt syrup

Sugar substitutes: Sweet One®, Stevia®, Sugar Twin®

What sweeteners you should be careful with

Brown sugar

Lactitol (E 966)

Lactulose

Oligosaccharide & Polysaccharide (e.g. Inulin)

Raw sugar

Sucrose (glucose:fructose=50:50)

Xylitol (E 967)

And finally, what sweeteners you should avoid

Agave syrup

Caramel

Corn syrup

Fructose

High-fructose corn syrup (HFCS)

Honey

Invert sugar

Isomalt (E 953)

Maltitol (E 965)

Mannitol (E 421)

Maple syrup

Molasses

Palm sugar

Sorbitol (E 420)

You can find all that information also in the figure below. Please feel free to print it and carry it with you during your grocery shopping.

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The Food List You Need When Having Fructose Malabsorption

https://www.fructohelp.com/favourable-foods/Despite some restrictions on your eating habits, there is still a lot of food to enjoy without experiencing any symptoms of Fructose Malabsorption. Once you know it, your well-being will be significantly improved. I will show you what is favorable to eat and what you should avoid for eliminating symptoms and restoring normal digestion.

Small amounts of fructose from time to time are good in the long-term

As I mentioned on the Fructose Malabsorption Diet page, you should avoid fructose entirely only in the first phase of the low fructose diet. Avoiding it further would probably worsen your symptoms in the long run.

So keep trying, add some fructose to your meals, e.g. low fructose fruits like bananas, and slowly find your dose. This will vary over time and may probably increase by doing the low fructose diet. For me, it worked out really well!

How to sweeten your food in case of Fructose Malabsorption

If you like sweet stuff from time to time, I can give you some good news: You do not have to pursue total abstinence.

You may use sucrose in small amounts,  as it consists equally of glucose and fructose, but you will feel better by choosing safe alternatives. These alternative are for example Stevia or dextrose.

Do not use honey or sweeteners like sorbitol to sweeten your food as they will worsen your symptoms.

You can find more information on the Sweetener page. Check out the table and the figure there for a large list of favorable sweeteners and sweeteners to avoid.

And this is what you can eat when having Fructose Malabsorption

Despite some forbidden foods, there is still a lot of food to enjoy without having any symptoms. Here is an extract of favorable foods:

Rice

Potatoes (no sweet potatoes)

Gluten-free pasta, rice noodles

Meat (check the ingredients if marinaded)

Fish and seafood (check the ingredients if marinaded)

Eggs

Unsweetened milk products

Salad

Oil

Vinegar: cider vinegar, herb vinegar (avoid balsamic vinegar)

Vegetables: pumpkin, zucchini, chard, celery, spinach, avocado, broccoli, rhubarb

Fruits (you have to test them individually): banana, papaya, lime, lemon, mandarin

Nuts

Tea

Fresh herbs (oregano, basil, ...)

Herbs often contain high amounts of fructose. But as only small amounts are typically used for cooking, they should not invoke any symptoms.

Read the full article: https://www.fructohelp.com/favourable-foods/

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These Tips Will Help You Dealing Better with Fructose Malabsorption

Add glucose to improve the absorption of fructose

As mentioned under Facts and Symptoms, glucose acts as a piggyback transport for fructose. This means that you can occasionally add glucose, such as dextrose, to high fructose foods. If you can’t resist anymore. But please keep in mind, that you consume a lot more sugar than is ideal that way. And this is for sure not healthy. So please do it only on occasion.

Consume fructose on a full stomach, after meals

By doing that, fructose is released from the stomach slower and delivered to the small bowel over a longer period. This improves the absorption of fructose.

Make a pause of at least 2-3 hours between fructose-containing foods

This is important, as your body cannot handle large amounts of fructose properly at the same time.

How to reduce Fructose Malabsorption symptoms by restoring the intestinal flora

Intestinal rehabilitation for getting rid of abnormal bacterial colonization is a further step towards improved symptoms. The low fructose diet is an essential part of that process, but you can further support that process by adding special supplements (e.g. psyllium husk powder) to your daily intake. I usually drink a glass of water with half a teaspoon of psyllium husks before breakfast. And this further reduced my symptoms of Fructose Malabsorption in the long-term.

However, intestinal rehabilitation programs should only be done after consulting a medical professional.

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Fructose Malabsorption Medication: Xylose Isomerase

How Xylose Isomerase will make your life so much better

And here is the best part: Xylose isomerase is an enzyme that converts excess fructose into glucose, as illustrated in the figure below. Glucose can then be absorbed along the entire small intestine with the aid of a specific protein called SGLT-1.

This means that dietary supplements of Xylose Isomerase improve the symptoms of Fructose Malabsorption significantly.

I take that medicine before eating high-fructose meals that would usually lead to nasty consequences, and I am absolutely thrilled by their effect. And with effect, I mean “no more symptoms”!

Please note, that diabetics and people suffering from hereditary fructose intolerance (HFI) should not use it.

Study confirms the effectiveness of Xylose Isomerase

In a study with 65 patients in whom fructose malabsorption has been diagnosed by a hydrogen breath test the year before, patients randomly received a drinking solution with xylose isomerase or a placebo together with 25g fructose.

Those patients that received xylose isomerase showed a significantly decreased breath hydrogen excretion (a sign that fructose was absorbed much better), and significant improvements in nausea and abdominal pain. Bloating improved as well, but not in a statistically relevant amount. A larger study may have also proven its significance.

References

Komericki P., Akkilic-Materna M., Strimitzer T., Weyermair K., Hammer HF, Aberer W. Oral xylose isomerase decreases breath hydrogen excretion and improves gastrointestinal symptoms in fructose malabsorption – a double blind, placebo-controlled study. Aliment Pharmacol Ther. 2012;36(10):980-7.

Read the full article: https://www.fructohelp.com/medication-xylose-isomerase/

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How to Improve Fructose Malabsorption with a Proper Diet

There are several highly effective ways to treat fructose malabsorption – starting with a low fructose diet, some wonderful drugs, which let you eat whatever you want as long you take them before your meal, and some valuable tips to enhance fructose absorption. Already curious? Then read on.

Get relief from Fructose Malabsorption symptoms with a fructose reduced diet

So let’s start with the low fructose diet. Maybe you think, that the solution might be eliminating any fructose-containing foods from the diet. But it is not that simple … or that awful.

Not every food that contains fructose may be a problem for you. Other naturally occurring sugars like glucose also come into play. As I describe under Facts and Symptoms, glucose aids the absorption of fructose along the small bowel. This means that fruits such as papaya can be eaten by malabsorbers without any annoying consequences, as these contain more glucose than fructose.

Fructans are also problematic

Unfortunately, dietary exclusion of fructose in its purest form (as monosaccharide) is not the only thing you should do. You should also avoid fructans during that phase as you might also have difficulties in absorbing them. The role that fructans play in Fructose Malabsorption is still focus of several studies, but it is usually recommended to reduce their intake when having Fructose Malabsorption.

So what are fructans? Fructans are chains of fructose molecules, which normally end with a glucose unit. They can be found in several grains and vegetables, such as artichoke, leek, and onion.

Avoid sorbitol as it worsens Fructose Malabsorption symptoms

Sorbitol is a sugar alcohol that is often used as an artificial sweetener in sugar-free (“light”/diet) food. It naturally occurs in stone fruits, such as peaches, cherries, and plums, and often appears in dried fruits, like raisins and figs. Sorbitol worsens the absorption of fructose. Right now, the reason is not fully understood and still under investigation. One reason may be its laxative effect by drawing water into the large intestine. This stimulates bowel movement and reduces the time in which fructose can be absorbed within the small bowel. Another reason may be that sorbitol inhibits the GLUT5 transport protein.

So, what exactly should I do?

In general, for Fructose Malabsorption treatment it’s best to restrict the intake of foods with high fructose and a fructose:glucose ratio > 1, fructans, and sugar alcohols like sorbitol. Check out my Favourable Foods, my free nutrition guide, or one of the apps you can find in My Resources for detailed information about what food contains how much and therefore should be avoided or can be eaten without nasty consequences.

Studies have shown – and this is also my personal experience – that following a fructose reduced diet will bring you a significant improvement in symptoms. After about 1 month of strict Fructose Malabsorption diet, I haven’t had any symptoms of cramps, pain, diarrhea, heartburn, and hypoglycemia anymore. And this is awesome!

Besides that, fructose is no essential nutrient for a human and is unlike glucose no preferred energy source for muscles or the brain. It will be converted into fat to a large extent. So, reducing the ingestion of fructose will also have other positive effects.

And here are the important phases of the low fructose diet

Phase (Elimination): Try to eliminate fructose, fructans, sucrose, which is broken down by the human body into glucose and fructose, and sorbitol, which is also converted to fructose and glucose, for 4-6 weeks. I know it is hard, as fructose hides everywhere. But you should try it. Your fructose thresholds may somewhat increase by doing so.

Phase (Testing): Then, gradually reintroduce small amounts of fructose to determine your new threshold. For example, start with fruits with a fructose:glucose ratio of 1 or less and low sorbitol content (e.g. bananas and grapes). Do not try to eliminate fructose completely from your nutrition after the first phase. Otherwise, your symptoms may worsen in the long term, as the production of the GLUT5 transport protein will be reduced.

Phase (Low fructose nutrition): Your goal should be a fructose reduced nutrition without any Fructose Malabsorption symptoms after the first two phases. If you follow the first two steps properly, this can be a possible goal for you!

More useful rules for the Fructose Malabsorption diet

Avoid the following foods or reduce them:

All dried fruits

Stone fruits, which contain high amounts of sorbitol, such as peach and apricot

Sugar-free (“light”) candies, gums and drinks, as they are sweetened with sorbitol or other sugar alcohols

Fruit juices and sweetened soft drinks

Sweetened milk products and yogurts

Sweet baked goods, as they are often made with fructose or at least sucrose

Foods with high fructan content, such as wheat, tomato paste, artichokes, onions, asparagus, and chicory

Food that causes flatulence, like cabbage and legumes

Tips for an effective and more pleasant fructose-free diet:

Check out my Favourable Foods or one of the apps you can find in My Resources for foods you are allowed to eat

Use alternative sweeteners for sweetening foods

Eat only completely ripened bananas, as they have a better fructose:glucose ratio

Drink no cider and no sweet wines

Strictly avoid onions, as these are one of the greatest contributors to the Fructose Malabsorption symptoms

Read food labels carefully! (I was shocked to see onions, artificial sweeteners like sorbitol, and fructose on so many labels.)

Keep in mind, that such a diet may lead to a deficiency of certain nutrients. So please consult a doctor or a nutritionist, if you are feeling bad during that diet or if you are just uncertain.

But now, I want you to take action and give it a try!

References

Susan J Sheperd, M Nut Diet, APD*; Peter R Gibson, MD, MB, FRACP. Fructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for Effective Dietary Management, Journal of the American Dietetic Association, 2006:106:1631-1639.

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How to Test for Fructose Malabsorption

You can not be certain that you suffer from Fructose Malabsorption until using a professional test. Testing Fructose Malabsorption is commonly done using a hydrogen breath test, which measures hydrogen (and methane) production within your body after consuming fructose. It is a safe and non-invasive technique with a sensitivity and specificity of about 98% and 86% respectively.

The test is based on the failure to absorb fructose in case of Fructose Malabsorption. Bacteria metabolize non-absorbed fructose to either hydrogen or methane. These gasses are partially absorbed into the blood and reach the lung. So, the more of these gasses are present, the less fructose has been absorbed.

The diagnostic process in case of Fructose Malabsorption

Testing Fructose Malabsorption is performed after a short fasting period of 8-12 hours. During the last 2 hours, you are not allowed to smoke and exercise. 3-4 measurements are taken directly after fasting and serve as basal level. You then consume a small amount of fructose, typically between 25 and 35 g (a glass of orange juice contains about 15 g fructose)  and your breath is analyzed for hydrogen/methane every 15, 30 or 60 minutes for 2-4 hours.

If the hydrogen level rises above 20 ppm (parts per million) over the lowest value within the test period, you typically get diagnosed with Fructose Malabsorption. If methane is produced instead, then the limit is about 12 ppm.

For those, who like watching videos, I have also attached a nice one explaining that process.

If you want to perform that hydrogen breath test by yourself, it is now possible for US citizens. Aerodiagnostics has made a test kit available for use at home.

Read the full article: https://www.fructohelp.com/testing-fructose-malabsorption/

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Facts and Symptoms of Fructose Malabsorption

What is Fructose Malabsorption?

Fructose malabsorption is a digestive disorder in which the absorption of fructose in the small intestine is impaired. This leads to several abdominal symptoms like bloating, pain, and cramps. For a long time, the public didn’t know of that disease and physicians often overlooked it. Today we know, that almost 30% are suffering from some kind of Fructose Malabsorption. 30% of these people show the typical symptoms. Please keep in mind, that Fructose Malabsorption is often called Fructose Intolerance in public. You will see further down on this page why this is wrong. It is also no fructose allergy, as some people may guess.

What is fructose?

Now, some facts about fructose, what it is and how the human body (usually) absorbs it.

Fructose is a naturally occurring sugar, a so-called monosaccharide or a single sugar. It belongs to the short-chain carbohydrates such as lactose and sorbitol. You can find it in most fruits, honey, some vegetables and in table sugar (sucrose). As it is sweeter than glucose, it is unfortunately used in many processed foods and beverages, although it is no essential nutrient for a human.

There are two ways of absorbing fructose:

The first way is slow but specific for fructose. Fructose is normally absorbed along the entire small intestine with the aid of a specific protein called GLUT5.

The second is fast but occurs only together with glucose, which acts as a “piggyback” transport. A rule of thumb states that one molecule of glucose enables absorption of one molecule of fructose.

This means, that fructose in excess of glucose is potentially malabsorbed if the GLUT5 fructose transporter is not efficient enough or the transit of fructose along the small bowel is too fast.

What is wrong in case of Fructose Malabsorption?

In case of Fructose Malabsorption, the GLUT5 transporter is impaired, such that fructose is absorbed along the small bowel only to a limited extent. The remaining fructose reaches the colon and gets rapidly fermented by intestinal bacteria, as shown in the figure.

Bacterial fermentation finally results in a formation of hydrogen, carbon dioxide, methane and short-chain fatty acids (e.g. butyric and acetic). I guess you already know, what kind of symptoms these products probably cause. But more about that in a moment.

Furthermore, untreated Fructose Malabsorption leads to a proliferation of intestinal bacteria and yeast, which metabolize the fructose. This worsens the symptoms over time.

The amount of tolerated fructose varies greatly among fructose malabsorbers. Some people may be able to ingest small amounts of fructose without experiencing any problems, while others show symptoms even after tiny amounts.

The main symptoms of Fructose Malabsorption

So what are the main symptoms of Fructose Malabsorption? When fructose malabsorbers ingest too much fructose or ingest it in the wrong way they mostly suffer from

bloating,

cramps,

stomach ache,

diarrhea,

nausea,

heartburn,

metabolic disturbances, including hypoglycemia,

and sometimes

vomiting,

fatigue and

dizziness.

The main symptoms may be similar to the often diagnosed Irritable Bowel Syndrome (IBS). But please notice, that IBS only stands for the occurrence of multiple symptoms, including abdominal pain and changes in the bowel movements, and not for a specific disease.

Read the full article: https://www.fructohelp.com/facts-and-symptoms/