Fructose is known as "fruit sugar". It is present in fruits, some vegetables, honey, granulated sugar, agave syrup and high-fructose corn syrup. In the past, the human diet was lower in fructose than it is today--think of how hard it was to get honey in the wild, for example, or what a treat it would have been in the past to have fruit out of season, much less a never-ending supply of ketchup, cookies, candy and other sweets. Now it seems as though fructose is everywhere in our food supply.
Our capacity to absorb fructose is easily overwhelmed; it is almost considered normal to experience abdominal pain, flatulence, bloating or diarrhea when we overdo the amount of fruit or fruit juice we consume--many people have experienced this phenomenon. But some of us experience symptoms with much smaller intakes of fructose. And most of us overlook the impact that large portions of sugary sweets, baked goods and soft drinks can have. And what about those honey or fruit juice concentrate-sweetened energy bars? Interestingly, apples are part of the traditional BRAT diet sometimes recommended to fight diarrhea. Umm...maybe apples and apple juice aren't such a good idea for some people with diarrhea.
Diagnostic dietary fructose intolerance tests are available, but are not ordered as frequently in the US as they are elsewhere. If you suspect you don't tolerate fructose very well, try cutting back on soft drink and other sweets. Limit tomato paste. Choose small portions of fruits that are lower in fructose, such as kiwi, berries, citrus fruits, and bananas. Read labels, and avoid or limit portion sizes of foods sweetened with honey, fructose, high-fructose corn syrup, agave syrup and fruit juice concentrates. See if you feel better!
Fructose malabsorption can occur on its own, or it can be part of the larger IBS picture.The FODMAPS elimination diet in IBS--Free at Last! can help you figure out how fructose fits into your IBS scenario.
It is important to distinguish dietary fructose intolerance, described in this posting, from hereditary fructose intolerance, which is a serious, hereditary disorder requiring a truly fructose-free diet.
Click here for more details about dietary fructose intolerance and how it causes GI symptoms.
IBS-Free at Last is such a helpful book. FODMAPS was a new concept for me, and it makes a lot of sense. In the book, scientific principles are easy to understand. Thanks for reminding me about fructans, I had forgotten about them. School was a long time ago.
The Amazon reviews are great, and well deserved. I also appreciate the kindness that is apparent in the book.
Posted by: Linda Simon | December 17, 2009 at 11:17 PM
This is good to know. Thanks for sharing!
Posted by: Gluten Free Betsy | December 22, 2009 at 03:09 PM
Hi Patsy-
Very informative post. I'm with Linda, school was a long time ago, thanks for the reminder. This is really a timely topic even for those of us without significant GI issues with our food system glutted as it is with cheap sources fructose.
Posted by: Julie | January 09, 2010 at 12:05 AM
i always learn something new when reading your posts. Thanks Patsy! :)
Posted by: Nutrition to kitchen | January 09, 2010 at 12:10 AM
During our first Food as Medicine program last week at Green Mountain, I realized I really need to get up to speed on how to truly help people with IBS. So many of the women who come to us suffer with this. I'm ordering your book today!
Posted by: Marsha @ Green Mountain at Fox Run | January 11, 2010 at 07:09 AM
It is, indeed, a very common cause of misery. In the US, irritable bowel syndrome is the seventh most prevalent diagnosis amongst all physicians and the most common diagnosis made by gastroenterologists. It is the second leading cause of work absenteeism after the common cold, though people may not tell all when they call in. It causes a financial burden--total health care spending is 50% higher for people with IBS. Hope the book helps!
Posted by: Patsy Catsos | January 11, 2010 at 01:55 PM
Hi,
I've had chronic abdominal pain for many years. I recently had a fructose breath test and I am NOT a fructose malabsorber. (I was also tested for gluten sensitivity, and apparently I am NOT sensitive to gluten either.)
However, I have observed over the last few years that carbohydrates cause me pain. (I just haven't narrowed down which carbs are the culprits.)
Is it possible that I have problems with FODMAPs even though my fructose test came back negative? I am so confused.
Thanks for your help.
Posted by: Tonja | October 08, 2010 at 01:55 PM
Is Truvia ok as a non-sugar sweetener? I looked at the ingredients and it seems to contain some sort of sugar alcohol, so I'm guessing no (?) How about Stevia? I hear positive things.
Posted by: Elizabeth | December 14, 2010 at 01:15 PM
Stevia and Truvia are OK on the diet. See my post entitled "Stevia", link is http://www.ibsfree.net/ibsfree_at_last/2009/07/stevia.html.
Posted by: Patsy Catsos | December 14, 2010 at 03:15 PM
I have another question. I just finished the fructose challenge. The day after day 1 of the challenge, I felt terrible; however the day after the 2nd day of the challenge, I felt fine. I don't know how to determine if in fact I failed the challenge or not. Should I test for another day?
Posted by: Nicole Dye | March 03, 2011 at 02:14 PM
Wouldn't be a bad idea.
Posted by: Patsy Catsos | March 04, 2011 at 10:21 AM
Is corn syrup the same as high fructose corn syrup? If not, is it allowed?
Posted by: Nicole Dye | March 10, 2011 at 03:13 PM
The are different. Regular light-colored corn syrup is USUALLY almost pure glucose, although once I saw a bottle of corn syrup that listed both corn syrup and high fructose corn syrup on the label--so double check ingredients,and if is does not have added HFCS then you can use it.
Posted by: Patsy Catsos | March 10, 2011 at 09:01 PM
What about when corn syrup is listed in the ingredients for another item?
Posted by: Nicole Dye | March 10, 2011 at 10:03 PM
It would be allowed on the elimination phase.
Posted by: Patsy Catsos | March 11, 2011 at 02:50 PM
Is it common to fail the fructose challenge but not the special case challenges within the fructose category?
Posted by: Nicole Dye | March 22, 2011 at 01:47 PM
I wouldn't say it is common, but I can imagine a few situations that could explain it. There is far more fructose in agave, honey or high fructose corn syrup than in most normal size servings of fruit, so if the person used the sweeteners for the fructose challenge but used mostly fruits for the special case challenge, then fructose "load" could have been much higher on the fructose only challenge. Another possibility would be that a person could have a non-FODMAPs type of adverse reaction to one of the foods used during the fructose challeng.
Posted by: Patsy Catsos | March 23, 2011 at 01:05 PM
"2. It does happen that some people are sensitive to all challenge groups. And you are probably right about the polyols and the galactans because they are predictable laxatives and gas-forming components of food. I will write a blog post about how to go on if you "fail" all the challenges."
Will there still be a post regarding the above?
Posted by: Nicole Dye | March 30, 2011 at 11:40 AM