The most common question I get when someone is diagnosed with fructose intolerance is “do I have to cut out all fruit?” The answer simply, is no. The key foods of concern in fructose intolerance are:
- Fructose-rich foods or any fructose-containing food in large amount
- Foods with high fructose-to-glucose ratio (glucose enhances absorption of fructose)
- Foods with high fructose corn syrup (HFCS)- not common in Australia
- Foods rich in sorbitol (what we call a ‘sugar alcohol’ which can cause a lot of gas and distension in the gut)
- Foods rich in fructans or other FODMAPs (problematic only in some persons with FM*)- we will go into FODMAPS in another post, as these are the key problematic foods in IBS.
The usual symptoms of fructose intolerance are similar to any gut disruption, including bloating, diarrhea, constipation, flatulence and/or stomach pain.
So how can we reduce these ever so unpleasant symptoms?
- Only eat problematic foods in small amounts at each sitting (e.g. not more than 1 standard piece of fruit per sitting).
- Consume problematic foods together with other foods (as glucose and amino acids have been shown to increase absorption).
- Modify consumption of foods rich in fructans as they can induce similar symptoms.
So which foods are particularly high in fructose or have a large load per serve?
Apples, pears, honey, dried fruit, lychees, mango, cherries, grapes, and watermelon.
Berries and stone fruit are not as high in fructose, although they do contain sorbitol and other sugar alcohols which can bring about similar symptoms if had in large amounts.
The more favourable fruit options include: ripe bananas, jackfruit, kiwi fruit, passion fruit, pineapple, rhubarb, tamarillo, grapes, and passionfruits.
For those that are particularly sensitive, you can buy glucose tablets to consume at the same time as fructose rich foods, and this can help with the absorption of the fructose. You also can consume a smaller portion of the higher fructose containing foods to ease the load and aid absorption.
Fructans are found in wheat containing foods, they however need to be had in a very large dose, in order to induce symptoms. For this reason, there is no reason why wheat products should be cut out of the diet. What this does mean, is that if you are particularly sensitive, having honey and sliced peaches on a piece of whole wheat toast, would not be the best option.
As you can see, fructose intolerance does not mean you can not eat fruit, it just means you have to pick the right ones!
For more help structuring a healthy eating plan with fructose intolerance, I would highly recommend you see your local dietitian (APD) to help determine a more personalised plan for your self.