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The best way to approach Fructose Malabsorption from a dietary perspective, is to first eliminate all possible sources of fructose and fructans. Then, after approximately six weeks, begin reintroducing foods one at a time to determine your personal tolerance level. As cooking and commercial freezing can affect fructose levels, treat cooked, raw, and commercially frozen versions of the same foods as though they were "different" foods.
Fructose naturally occurs in fruit. The highest levels being found in apples and pears, the lowest levels in citrus. Avoid fruit and fruit products. In processed and packaged foods, fructose is a common sweetener. It is listed as fructose, fructose syrup, or HFCS (high fructose corn syrup). Any fruit content listed on the label of a processed food would, of course, also constitute a fructose content. Avoid any packaged food or beverage with these ingredients.
Fructans, or chains of fructose molecules which end in a glucose molecule, are found in a wide variety of vegetables and grains. Avoid wheat, spelt, kamut, and brown rice. Rye, oats, buckwheat, and white rice are fine. Also safe are the "alternative grains", so called because they are not technically grains. These include teff, millet, amaranth, tapioca flour, potato flour, corn flour and many others. Fructans also occur in the many members of the onion family, such as white and yellow onions, shallots, leeks and chives. Anecdotal information suggests that it may be the bulb itself which contains the bulk of the fructans, the greens being more tolerable; but that must be determined by each sufferer on an individual basis. The onion may be used to flavour dishes such as soups, stews, casseroles and stir-frys, so long as the onion itself is not consumed. Keeping the onion pieces large, or putting them in a cheesecloth packet can aid in the removal of the onion before the dish is served. Fructans are also found in artichokes, asparagus, green beans, and concentrated tomato paste.
Dextrose (also known as Glucose) can help a FructMal absorb fructose! Dextrose and fructose bonded together in equal proportion is a sugar called "sucrose" which most people know as common table sugar. FructMals have no problem absorbing sucrose, so if you are afraid you might be eating something with hidden fructose, consume some dextrose at the same time. You'll basically be making sucrose in your digestive system, and the fructose will be absorbed. Don't get too excited though! This trick only works in small doses, and the ratio must be at least 1:1 (a little excess dextrose is okay, but excess fructose will lead to a fructose reaction). Also, this will help out with fructose, but not fructans. Dextrose powder is available at many health food stores, in some areas dextrose/glucose tablets are available. Keep some with you all the time!
The opposite is the case with the sugar alcohols often used as sweeteners in gum and candy, even toothpaste. Sorbitol, Mannitol, Xylitol and the other "-ols" inhibit fructose absorption. So if you consume fructose and dextrose and think you're okay - make sure there isn't anything like sorbitol in the mix, or you're shooting yourself in the foot! If you consume table sugar for example (which is half dextrose and half fructose) then chew sorbitol sweetened gum because you think you're doing your teeth a favour....remember: that sorbitol is going into your digestive system and tipping the scales unfavourably. The reason apples and pears are the worse fruits for FructMal is that they have high levels of fructose and naturally-occurring sorbitol. A double-whammy!
As the primary symptoms of Fructose Malabsorption are the direct result of bacterial action in the intestine, the introduction of additional bacteria should be avoided. On a similar note, FructMal sufferers should avoid foods that overly stimulate intestinal bacteria. Thus, foods that are "probiotic" (in other words, contain active bacterial cultures) like yoghurt should be avoided. Also foods which are "prebiotic" (or actively feed and stimulate bacterial cultures) such as chicory/inulin. Chicory/inulin is also known as FOS which stands for fructooligosaccharides. Avoid anything probiotic or prebiotic or advertising "active bacterial cultures".
Remember, all these foods do not have to be avoided forever. Eliminate them all for four to six weeks, then begin to reintroduce them to determine your own personal tolerance levels. Introduce only one food at a time in one form (only raw, or only cooked, or only commercially frozen). Wait several days, as it may take some time for the symptoms to manifest. Then, let your body rest for a few days to a week before trying another food.
The food list I used to link to has disappeared into cyberspace... but this info is also EXCELLENT:
This is a more involved document than the link I had up previously. Not as simple, but more detailed. Sue Sheperd is one of the "big names" in fructmal circles.
***** It is best to reintroduce foods under the supervision of a Health Care Professional, especially if you have anything worse than the mildest of symptoms. Personally, my reactions involve nothing worse than an embarrassing need to get to a toilet quickly! LOL! I, therefore, have not sought direct supervision. However, GI symptoms can have serious health implications and a doctor's supervision is ALWAYS best for children, people with more complex intolerances, or anyone whose symptoms are anything even approaching dramatic. When in doubt - seek a doctor!
Obviously, your quest for relief is never truly over until you have been properly diagnosed by a physician! Get your hydrogen/methane breath test!
Feel free to contact the site with any questions!
Tips and Tricks
Hint: check the label in your area, but in Canada, the first listed ingredient in Coffee-Mate brand coffee whitener is dextrose syrup. This is a great thing to know if you're out, and forgot your dextrose powder!
created by A. Thompson 2008