by Hanna Hanula

At the beginning of my journey towards wellbeing, I suffered from fructose malabsorption that forced me to eliminate the yummy fruits and certain vegetables from my diet for several years. As difficult as it was, I managed to heal the underlying gut conditions that allowed me to reintroduce fruits back to my diet and now I eat them daily!

What fructose malabsorption actually is?

In a nutshell, it is a digestive disorder in which the body cannot break down fructose - aka the sugar in fruit. It may cause :

bloating,
stomach pain,
heartburn,
diarrhea
gas.

Clearly not what you want from eating watermelon or some grapes!

If you experience any of those symptoms, you might have got yourself an answer to what is wrong – still, better go to visit a doctor and ask for a test, especially if the symptoms are harsh. The clinical diagnostic test that is commonly used is quite similar to the one used to test lactose intolerance. It is called a 'hydrogen breath test.' If the result shows a high level of hydrogen, it can indicate that a person has difficulty digesting fructose. However, you can also use a simple elimination diet to diagnose malabsorption yourself. You can avoid all foods containing fructose for a limited period and see how your body feels.

Fructose intolerance is currently one of the most common food intolerance, and it can be due to many causes that include:

imbalance of good and bad bacteria in the gut
high intake of refined and processed foods
preexisting gut issues such as irritable bowel syndrome (IBS)
inflammation
stress

There are three different types of it, and we should not confuse one with the other.

Fructose malabsorption is a type of food sensitivity that affects even up to 40% (!) of those in the western hemisphere. If it happens only later in life, when we are adults, it is caused by a reduced gut ability to absorb fruit sugars. Like other food sensitivities, behind the problem is our overall health and balance (or rather lack of it), lifestyle choices and, naturally, (over)exposure to fructose. As a result, we are not able to properly absorb and digest it. We are focusing here on this type.

Another type is fructosuria or hepatic fructokinase deficiency, a harmless disorder when someone lacks a liver enzyme, called hepatic fructokinase, which can break down fructose. People with this condition are usually not even aware of it and do not need treatment. On the contrary, the last type is a severe and sporadic genetic disorder. It is called hereditary fructose intolerance. It happens when the liver cannot help the body break down fructose, which then accumulates both in the liver and kidneys, and might cause serious and potentially fatal complications, such as liver and kidney failure. However, the good news is that it is currently treatable and manageable. Hereditary fructose intolerance is a congenital disorder, which means that most babies will have symptoms already when they begin eating solid foods. In turn, that can help with the early diagnosis.

Back to fructose malabsorption: why does it happen?

Well, to use an easy and straightforward example, one study has shown that the fructose intake of the average American adult is currently 80 grams a day. Our parents' generation took in only around 16 to 24 grams a day. Just imagine the difference in our gut when it comes down to the quantity. Fructose is often being added to many processed and packaged foods as a flavoring agent and a preservative. We just consume too much of it daily!

When we shop for groceries and even check the labels, we can see that fructose is described on food packages as 'fruit sugar.'

Consumers might think that this is a healthier and more natural option than just pure sugar. Food producers exploit this trick and, indeed, often use pure fructose as a sweetener. As a result, high fructose corn syrup consumption has increased over 1,000% (!).When you go grocery shopping, pay attention to the labels and try to avoid :

high fructose corn syrup
agave nectar
crystalline fructose
fructose
honey
sorbitol
fructooligosaccharides (FOS)
corn syrup solids
sugar alcohols

Also, globalization and air transport allow us to enjoy the fresh fruits all year long, rather than during peak season. This means that our digestive systems are exposed to more of this type of sugar than ever before. And of course, it has an immense effect on our health in the long run.

What is always a good idea (and a real necessity when you have issues with fructose breakdown) is to limit – or exclude – sugar. It is called a low fructose diet.

Reducing fructose's daily intake will ease the symptoms within several days or weeks, based on your condition's severity. And once those symptoms gradually improve, you will be able to slowly reintroduce fruits to see how much fructose you can tolerate. Typically, people with fructose malabsorption can consume between 10 to 15 grams of fructose a day without experiencing any problems. So yes, for sure, you will not come back to the level of 80 grams per day, not even 24 grams per day, but it is still better than nothing.

First, we should target and eliminate foods containing high fructose levels like :

sodas,
apple juice and cider,
honey,
pear juice,
sweet desserts like candies, cookies, and ice-cream.

I advise avoiding packaged baked goods as most of them contain high fructose corn syrup. The same goes for caramel, licorice, and pancake syrup. Instead, use coconut sugar and coconut syrup!

When it comes to fruits, you need to limit or boycott :

apples,
pears,
prunes,
dates,
figs,
kiwi,
grapes
watermelon.

Easier to tolerate for the gut would be:

grapefruits,
nectarines,
raspberries,
pineapples,
strawberries
blueberries.

It will help if you eat small portions of fruit, preferably on an empty stomach and before noon to optimize its digestion. Of course, please, avoid fruity drinks, juices, jams, and jellies.

Vegetables that may cause problems are mainly:

onions,
garlic,
asparagus
leeks,
artichoke
chicory roots.

Unfortunately – that was difficult for me – you should avoid coconut milk and coconut cream, because they are high in sugar. The same goes for ketchup and soy sauce since those condiments are sweetened with fructose. That is the main problem as we don't even realize when some products have hidden sugar inside. You could check, for example, your medicines, vitamins, and supplements – you might be surprised how many of them contain fructose and/or sorbitol. Oh, and last but not least: avoid chewing gum, even if sugar-free!

While fructose malabsorption may improve with a reduced fructose diet, this condition may also suggest that small intestinal bacterial overgrowth (SIBO) and /or Candida is at play. In either case, probiotics, digestive enzymes, natural antibiotics, and anti-fungal remedies plus a modified diet may be recommended.

And once you heal the underlying condition or simply reduce the fructose intake for a longer time, you will be able to enjoy the food you like so much – including fruits - again. I'm a living example it is possible!

About the author: Hanna Hanula from Souliciously Hanna is a Certified Nutritionist, Naturopath and Mindset Coach specializing in the gut-brain axis