Intro. and a question :)

[nekome]

Hi everyone!

My name is Marielle, I'm 27 years old. I've been struggling with health issues for some time now but only this year really started my journey towards getting to the bottom of my problems and hopefully someday soon become healthy.

I was officially diagnosed with fructose intolerance about a month ago while going through the process of getting tested for Celiac disease (confirmed by a Hydrogen breath test). I had to take a 10 day round of intense antibiotics to address bacterial overgrowth in my small intestine.

I just met with a clinical nutritionist today and walked away with sheets on basic guidelines for a low fructose diet. She likened it to having lactose intolerance and said that eating fructose would not do any internal damage; however, it would lead to discomfort through stomach problems. Prior to meeting with her, I did some research and found conflicting information. I tried to bring up the topic of fructans in foods like onions and garlic to see if I needed to almost omit those from my diet. The nutritionist said that she didn't think it was necessary in my case to be so strict (she doesn't agree with how restrictive "FODMAPS" is). The guideline she gave me is slightly vague in some areas, although I can gather that items high in fructose should be avoided. I'm still pretty confused about this whole thing and what it means in terms of my diet.

Is there a difference between fructose malabsorption versus fructose intolerance? (is one more forgiving than the other?)

Can anyone else here with fructose intolerance share some information on what works for them food wise?

I understand what works for someone else may or may not work for me, I just wanted to have somewhere to start in figuring this all out.

Thanks!

[kate]

Hi Marielle,

Welcome to the site. Hopefully we'll be able to give you some answers and help you on your way in getting to grips with Fructose.

Fructose Malabsorption and Fructose Intolerance are the same thing. Fructose Malabsorption is the new name for it. There is another condition called Hereditary Fructose Intolerance which is a whole different kettle of fish. It would be tested for via genetic blood testing or a liver biopsy though and is a lifelong condition which results in an individual being unable to break down fructose leading to liver and kidney damage, whereas FM is a condition whereby an individual has difficulty absorbing the fructose in the gut. Charlie has done a good summary about FM in the "General Facts on FM" section.

As you already recognise, everyone is different and there is conflicting and vague information about what foods should be avoided. My daughter has FM. Here are a few things that we've learnt along the way....

Firstly fructose is in pretty much anything that grows in the ground but as different people have different tolerance levels its all about finding an individual's tolerance level.

Secondly, fructose can be absorbed on the back of glucose. This means that if a food has fructose it may still be well tolerated if it has more glucose in it than fructose. Bananas are an example of this. So FM is to do with the absorption of 'free fructose' ie fructose in excess of glucose.

Thirdly, as you know, fructans are chains of fructose and are found in wheat, onion and a few other things. My daughter tolerates wheat fine but others don't.

Fourthly, table sugar is sucrose which is a disaccharide made up of equal glucose and fructose. Some people tolerate it and some don't. Other sugars (cane, brown, molasses, treacle, golden syrup, honey, etc) all have excess fructose so aren't well tolerated. Sorbitol is a sweetner which is broken down by the body into fructose and something else (I forget what) so it can't be tolerated by many. Its found in stone fruit and many "sugar-free" items.

In terms of the diet, I'm sure you've been given lists of safe foods. There seems to be discrepancy in what is considered safe when you look online. This is because of the free-fructose vs total-fructose issue plus the fructan issue and different tolerance levels. So it will probably be a case of 'trial and error' for a while.

If your nutritionist has suggested you don't need to cut out fructans then I would follow that advice initially and see how you go, because removing wheat from your diet on top of everything else would be really hard.

This is what I would consider a fairly safe diet....
MEAT/FISH - any, but watch out for processed meats such as sandwich ham. Cooked sandwich ham tends to be OK (in the UK anyway) but cured ham all seems to have sugar in it.
GRAINS - pretty much any. Avoid brown rice as it has more fructose in it than white rice. In the USA I know sugar is added to rice sometimes so watch out for that, depending on where you live. Bread often has sugar in it. We've been caught out with bread that had molassas or brown sugar in it. If you're in the UK I can suggest brands that we buy.
VEG - spinach, mushrooms, cauliflower, broccoli, green beans and green pepper are what my daughter tolerates, in that order with spinach being the lowest in fructose. Potatoes are OK although the red varieties contain more fructose.
FRUIT - Banana, citrus and berries have the lowest fructose. The order for berries (lowest to highest) is blueberries, blackberries, raspberries, strawberries so try them in that order.

Stick with basics rather than processed as much as possible. Marmite works well as an alternative to stock which is full of veg. I've found the food search at www.thefartingpear.com very useful. I know there are iphone apps that you can get too which will give you the fructose content of different foods. www.nutritiondata.com is also very useful but a bit more cumbersome to use.

Hope that helps to get you started...

[Charlie Arnold]

Hi Marielle,

Kate has already answered you pretty well already which is just as well as my computer is throwing a strop at the moment and keeps crashing so will keep this brief for now.

I am in the process of trying to update alot of info so hopefully will get alot done over the next few weeks to give you some more answers.

One question, did they decide you are celiac at the end of the day too, if you are then you do need to eliminate gluten too. If not it is up to you if you go full force and eliminate everything for now or wait and see.

There are several ways of approaching the diet and unfortunately everyone is different it would seem in their responses to fructose levels so there is alot of trial and error to start with. If you have been suffering long term from this you may find a total fructose and fructan exclusion is your best starting point to help heal and settle the gut, there is rarely any serious permanent damage from fructose malabsorption (FM) but it can lead to a very inflamed intestines for a while which need to be settled first and their absorption improved. Therefore if it is appropriate and a suitable time to go on a really limited diet for at least four months then you may find you then can detect your tolerance levels much quicker afterwards. If you are more limited because of work restraints etc and keeping enough energy then do a month of sugar and fructan free to really clear the gut then start with the safest foods first and see what happens.

FM can start for so many different reasons it would seem, can you identify any in your life eg bad gastro bugs that may have triggered it?

Sadly there is alot of misinformation out there and alot of nutritionists don't realise the full impact of this diet especially if they haven't dealt with it before so you may find that you have to go with your instincts for the best results. Also alot of foods are ok in one country but completely different in others. Where in the world are you, if you add it to your profile under signature then it will show up then people in that country may be able to give you better advise on what to eat. It used to show up on the side profile but this new format doesn't seem to do it.

Your best starting point is to clear out your food cupboards, learn to read labels very very thoroughly, become best friends with nutrition data and finelli databases which I will link to in the top section and become a good cook if you aren't already as the more you can cook from scratch and know exactly what goes into the food the better for now. You will be surprised what sneaks into foods and they only have to declare it if it makes up a certain percentage of the final ingredients. Alot of cheap meats we discovered are injected with sugar water....... as Kate said, rice has stuff added, I discovered a microwave rice in England has orange juice added ...... why?........

Start with very basic foods and keep a diary as then you can cross reference as soon everything can become a blur. Also sometimes you get an accumulative effect over several days........

But most of all, don't worry, please feel free to ask anything, no matter how trivial, this is very doable and you are far from alone. And with FM life gets alot better as the system settles and copes with more as time goes on.

All the best

Charlie

Wow, my computer didn't crash........ yipppeeee