Fructose Malabsorption

Posted by CL @lelia, Dec 5, 2018

I'd like to start a discussion on fructose malabsorption, how to control it, what to eat and not eat, etc. . Is anybody interested?

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guthealth | @guthealth | Jan 7, 2019

In reply to @baponline "I see the Mayo nutritionist in person. After my tests, my Mayo GI initially gave me..." + (show)

@baponline

I see the Mayo nutritionist in person.
After my tests, my Mayo GI initially gave me the Mayo Clinic Fructose Malabsorption Eating Plan and recommended seeing the nutritionist, which I did. She then gave me the FODMAP Eating Plan (20 page booklet). I don't know if it is available online or how you get it if not a patient.

There are no firm rules about which foods you start with or the order but the Plan highly recommends you follow their rules/ recommendations if you want to figure out which foods caused your symptoms. You reintroduce 1 FODMAP group at a time and 1 food at time. My nutritionist gave me the order of FODMAP groups to work. The groups (in the order I'm working) are Galactans, Polyols, Fructans, then Fructose (I don't have an issue with Lactose; if so, they would be a group as well).

Within each group there are a a list of foods. You start at the bottom of the list and work up (from lowest FODMAP to highest). What she has me doing is 1 new food every 3 days. Eat the (last) food on the list for day 1, 2 and 3. If on day 1, I don't feel well then wait until I feel better (maybe 3 days) and then try the next food on the list. I then know that I cannot tolerate (or eat) that food. I can always try again in smaller amounts.

If I can tolerate that food, then I wait a day and start with the next food in the same group. As I work myself 'up' the list for the food group, if I find 2-3 in a row that don't work for me, then I probably won't be able to tolerate anything else higher in that food group list.

Once complete a group, go back to basic diet before starting next group and stop eating foods from the first group. Wait about 3 days before starting the new group. Etc.

It is very tedious, but the whole goal is to figure out what you can eat.

There is a website she recommended: http://blog.katescarlata.com/tag/fody-foods/
It contains a Low FODMAP grocery list.

Plus http://www.fooducate.com to get label information of lots of different types of groceries.
And http://www.fodyfoods.com for low fodmap foods you can purchase. They have a really good snack bar (since my old favorite protein bars weren't making my stomach happy!)

Also, for gaining weight there is Nestle ProNourish digestive wellness drink (gluten free, suitable for lactose intolerance, low FODMAP).

Jump to this post

Thank you for sharing all this information

baponline | @baponline | Jan 7, 2019

In reply to @pjss48 "What's left to eat?" + (show)

During FODMAP elimination phase, I could eat variety. Fruits like bananas, blueberries, cantaloupe, lemon, raspberry, strawberry, tangerines; veggies like green beans, carrots, eggplant, kale, lettuce, potatoes, spinach, tomatoes, zucchini; meats like chicken, turkey, beef, fish,pork, shellfish. I could have eggs, peanut butter, butter, margarine, olive oil, beer, wine, coffee, tea. Seasonings like salt, pepper, parsley, oregano, dill, rosemary, etc.

I know I can handle lactose so I had milk, cheese, etc. Was totally gluten free.

The biggest issue is sweeteners in prepared foods and sauces, salad dressing, etc. Absolutely NO garlic or onion. So I use olive oil and lemon on alot of things to provide flavor. Yes, it is fairly bland and limited in scope.

Hard to eat out or at someone else's home. My friends understand and are very patient with me when I order at restaurants!
I have to be very specific with the waiter about how to prepare the food and what not to include, etc.

Obviously everyone is different and may have other health conditions/GI issues that make this more difficult.

A good resource for Low FODMAP foods is http://www.katescarlata.com/
Also https://www.monashfodmap.com/. Monash Univ in Australia created low FODMAP diet for IBS

Hope this helps!

CL | @lelia | Jan 7, 2019

In reply to @guthealth "Thank you for the info on breath tests. Many GI doctors are not enlightened about these..." + (show)

Have you though of eating foods that bother you and then having the breath test? Then you'd know whether or not you have fm. Just a thought. It's not too later.

CL | @lelia | Jan 7, 2019

In reply to @baponline "I see the Mayo nutritionist in person. After my tests, my Mayo GI initially gave me..." + (show)

@baponline

Once complete a group, go back to basic diet before starting next group and stop eating foods from the first group. Wait about 3 days before starting the new group. Etc.

It is very tedious, but the whole goal is to figure out what you can eat.

There is a website she recommended: http://blog.katescarlata.com/tag/fody-foods/
It contains a Low FODMAP grocery list.

Also, for gaining weight there is Nestle ProNourish digestive wellness drink (gluten free, suitable for lactose intolerance, low FODMAP).

Jump to this post

Thanks so much for all this info! The nutritionists didn't have this info the times I was at Mayo, but I'lll check into it now. I've probably already done most of it on my own -trial and error. Tried and can't eat legumes including peanuts; same for corn, tomatoes, summer squash (shaped like a cucumber), cucumbers, asparagus, red/rainbow chard, green and other color peppers, fruit of any kind (used to be my favorite), etc. Even spices/herbs a problem. The fructose/glucose balance doesn't work for me, so can't eat sucrose. Tried glucose tablets once for energy, and boy was that a mistake! Go figure.

CL | @lelia | Jan 7, 2019

In reply to @lelia "Have you though of eating foods that bother you and then having the breath test? Then..." + (show)

Should also mention the breath test involves drinking a large glass of fructose before they do the breath test. So, you wouldn't have to have gone off your diet.... I'd like to think fm is curable, but have my doubts since it is caused by injury to the lining of the intestine. Mine has not improved; still need to watch what I eat. Good luck.

guthealth | @guthealth | Jan 7, 2019

In reply to @lelia "Should also mention the breath test involves drinking a large glass of fructose before they do..." + (show)

I am enjoying eating what I can without experiencing diarrhea. Will continue to work with the nutritionist and consider a breath test if she or the physician suggest it. Not sure whether I will ever be able to eat like I used to. But I am so thankful that I can eat food without the food hurting my gut. I was in very bad shape just two months ago.

CL | @lelia | Jan 7, 2019

In reply to @guthealth "I am enjoying eating what I can without experiencing diarrhea. Will continue to work with the..." + (show)

I so glad things are going well for you! Sometimes it is hard to want to rock the boat. I'm at that point too. Should be trying to broaden my diet, but sometimes the side effects aren't worth it.

sarcomasurvivor | @sarcomasurvivor | Jan 8, 2019

In reply to @lelia "Should also mention the breath test involves drinking a large glass of fructose before they do..." + (show)

Thank you all for this valuable information. The Mayo gastroenterologist did do a hydrogen breath test twice and confirmed SIBO both times. There was no mention of a fructose or lactose intolerance hydrogen breath test. There was no referral to a nutritionist either, only a recommendation to try pelvic therapy, which has been nonproductive after months of therapy.

jackiem95 | @jackiem95 | Jan 8, 2019

In reply to @sarcomasurvivor "Thank you all for this valuable information. The Mayo gastroenterologist did do a hydrogen breath test..." + (show)

If by “pelvic therapy” you mean the pelvic floor exercises, biofeedback etc., my primary care doctor referred me for that awhile back after months of diarrhea with then no diagnosis of its cause. The therapist was extremely knowledgeable, caring and well trained in pelvic floor dysfunction therapy. Of course The therapy didn’t do anything to stop the diarrhea and at the time I didn’t think it was helpful. But now I am glad I went through the therapy because I have much better control when I feel an attack coming on—no more “accidents” while searching for a bathroom. So maybe your therapy hasn’t been totally unproductive.

CL | @lelia | Jan 8, 2019

In reply to @lelia "VERY LOW FRUCTOSE, LOW FODMAPS, AND GLUTEN FREE RECIPES AND DIET - SUPPLEMENTS AND DRUGS Since..." + (show)

NAMES OF SUGARS AND IDENTIFYING SUGARS IN DRUGS AND SUPPLEMENTS.
This is the last installment of the information I wanted to share with you. Boston University has a web site which lists 20 - 30 names for sugar. Google "Boston University Sugars Table" and click on "Table Sugar." This list is intended for those with hereditary fructose intolerance, which is a totally different malady from fm, so ignore whether the table says you can eat the sugar or not. Just use it to identify names of sugars. Incidentally, glycerin is the same as glycerol, a sugar alcohol. Next, you can go to another invaluable federal database called Daily Med. Daily Med lists all of the prescription drugs and gives the package label insert for each. For example, indications and usage, contraindications, precautions, adverse reactions, dosage and administration, ingredients and appearance, etc. Go to "ingredients and appearance" at the bottom of the page and look up the drug ingredients, which includes the so-called "inactive" ingredients. These are often types of sugars, and armed with the Boston University sugars table info, you can decide whether the drug is low sugar or not. Some examples of sugars included in drugs, even those for digestive issues, are sucrose, lactose, corn starch, mannitol, etc. For example, Prilosec has sugar in it (I believe sucrose); why would they put sugar in a pill designed for digestive issues??? Daily Med is a U.S. National Library of Medicine database; the URL is dailymed.nlm.nih.gov. I kept tract of which drugs were ok for me and their inactive ingredients, and made an alphabetical list. For drugs that weren't ok, I made another list of their inactive ingredients that weren't on the ok list. Over time I came to learn the ok inactive ingredients, and could identify ok supplements as well using this information. I imagine the Boston U. Sugars Table would be useful in identifying sugars elsewhere such as in condiments. Hope this helps.