You might love the sweetness that a ripe apple, a handful of grapes, or a refreshing glass of orange juice brings to your day. But what if your body doesn’t feel the same way? For some people, these seemingly healthy choices can lead to an array of uncomfortable symptoms. In this article, I’ll deep dive into fructose intolerance and malabsorption, outline the symptoms to look out for, provide a list of high-fructose foods to avoid, and shed light on managing these conditions effectively. Let’s get into it!
What is Fructose Intolerance?
Hereditary fructose intolerance is a condition that affects a person’s ability to digest the sugar fructose (a simple sugar found primarily in fruits). This can lead to several unpleasant symptoms and can significantly impact a person’s quality of life. Individuals impacted by this condition typically begin to exhibit indicators and symptoms during infancy.[1] This typically occurs when their diet starts to include fruits, juices, or other foods that contain fructose.
Fructose Intolerance Symptoms
Affected individuals with fructose intolerance develop signs and symptoms of the disorder in infancy when fruits, juices, or other foods containing fructose are introduced into the diet. Fructose intolerance is no sly fox; it often announces its presence loud and clear. If you are fructose intolerant, you may experience a variety of gastrointestinal symptoms such as:
- Abdominal pain
- Bloating and gas
- Diarrhea or constipation
- Nausea or vomiting
In some cases, people may also experience symptoms like fatigue, headaches, and mental confusion. These symptoms typically appear after eating or drinking foods high in fructose. Affected infants may fail to grow and gain weight at the expected rate (failure to thrive).
Continuous consumption of foods high in fructose can trigger detrimental effects on the liver and kidneys. These impacts can manifest as a yellowish tint to the skin and eyes, a condition known as jaundice, an expanded liver or hepatomegaly, and chronic liver disease, also known as cirrhosis. If fructose exposure persists, it may lead to more severe outcomes such as seizures, coma, and in the worst-case scenario, death due to liver and kidney failure. Given the harsh symptoms that arise upon fructose consumption, most individuals with hereditary fructose intolerance tend to develop an aversion towards fruits, juices, and other fructose-rich foods.
What is Fructose Malabsorption?
It’s important to note that although fructose intolerance and fructose malabsorption sound similar, they are VERY different. Fructose malabsorption is thought to affect approximately 40 percent of individuals in the Western hemisphere (yikes!).[1] In people with fructose malabsorption, the cells of the intestine cannot absorb fructose normally. So, fructose then travels to the colon (the large intestine), where it is fermented by bacteria, leading to a range of symptoms including bloating, diarrhea or constipation, flatulence, and stomach pain.[1]
High-Fructose Foods to Be Aware Of
If you are fructose intolerant, it’s crucial to be mindful of your food choices. There is no cure for hereditary fructose intolerance, but it is manageable with a fructose-free diet followed for life.[2] Many foods, especially fruits, contain high levels of fructose. However, remember that fructose isn’t just found in fruits; it’s also in processed foods, sweetened beverages, and honey.
Here’s a list of some common high-fructose foods to be cautious of:[3]
- Apples, pears, mangoes, watermelons, and cherries
- Asparagus, sugar snap peas, and artichokes
- Honey and agave nectar
- Soft drinks and fruit juices
- Processed foods with high fructose corn syrup
Read product labels carefully and avoid foods containing:[4]
- Fructose
- High-fructose corn syrup
- Honey
- Agave syrup
- Invert sugar
- Maple-flavored syrup
- Molasses
- Palm or coconut sugar
- Sorghum
Managing Fructose Intolerance and Malabsorption
Navigating fructose intolerance might seem a bit like being a ship without a compass, as there’s not a wealth of published data out there to guide us. However, the key lies in playing detective with your diet. Find those sneaky fructan-filled foods that might be causing you trouble, and once identified, gently phasing them out of your diet.
Individuals with fructose intolerance should also consider the low-FODMAP diet. The low-FODMAP diet may improve symptoms in approximately 70% of individuals with functional gastrointestinal disorders.[5] This diet does help in cutting back on fructose, but it also includes reducing other types of sugars and carbohydrates. It’s a bit more on the strict side compared to a low fructose diet. While it can certainly aid in managing fructose malabsorption, it might actually be a bit more restrictive than what an individual with fructose malabsorption might typically require.
Working with a dietitian experienced in gut health can be a game-changer for someone that’s experiencing fructose intolerance or malabsorption. They can provide personalized advice based on your specific needs, tolerances, and preferences.
In conclusion, while fructose intolerance and malabsorption can pose some dietary challenges, it’s manageable with the right knowledge and resources. Identifying high-fructose foods, adopting a low-FODMAP diet, and working with a dietitian are all practical steps towards improved gut health and overall well-being.
References:
- Hereditary fructose intolerance. Medlineplus.gov. Retrieved July 10, 2023.
- Burkhart, A. (2023, February 3). What is fructose malabsorption? Is it the same as fructose intolerance? Amy Burkhart, MD, RD; The Celiac MD.
- Holloway, C. (2021, March 1). What is fructose intolerance? Cleveland Clinic.
- Fructose intolerance: Which foods to avoid? (2022, January 21). Mayo Clinic.
- Tuck, C., & Barrett, J. (2017). Re-challenging FODMAPs: the low FODMAP diet phase two: Re-challenging FODMAPs. Journal of Gastroenterology and Hepatology, 32 Suppl 1, 11–15.
