Fructose Malabsorption

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.

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.

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).

Finally got a chance to check out all the links on low FODMAP eating (except for the Mayo eating plans - couldn't find). Unfortunately the items have much more sugar than I can digest. If a person's IBS is caused by something other than fm, or the person has fm on the mild side, these sites would probably work. Recipes had chocolate, salsa, garlic, beans, etc. which don't work for me. But, thanks for your informative e-mail! I may try linking up with a Mayo dietician.

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.

Hi:
Fructose diet is very difficult but you can manage the diet. No sugar at all including no gum, no honey no soda etc. Just look at the labels for any form of sugars if you cannot pronounce the ingredients on the package then don’t buy it because it most likely have some hidden sugars.
Also no fruits and fruit juices.
You can also goggle and y-tube for more information or you can go to a nutritionist and hopefully your insurance will pay for the Nutritionist. I have fructose so bad that I cannot eat onions, garlic, peas and carrots. I had to experiment with different foods. My tip off with Foods was to keep a daily log of everything you eat and see how you react. I would get the diarrhea the next day that was how I was able to tell what I can and cannot eat.

This is why working with a nutritionist, at least at first, is so important. I have been on a Low FODMAP diet for two months and I am not eating any of the items you mentioned. No garlic, no onions, no chocolate and very little sugar. That is what happened to me at first. I went to the websites, read the food lists, and started to eat stuff that triggered more diarrhea. The diet starts very restrictive and slowly expands to other foods. It is important to follow a certain method for the diet to work. It is not just a matter of reading a list and start eating Low FODMAP foods. I almost gave up on the diet until I went to see the nutritionist and we adopted a method. Can’t emphasize this enough. It is how foods are first eliminated and then very slowly reintroduced. One can’t just randomly eat all the foods that are listed on the FODMAP diet. The diet must be individualized to your needs and specific problem, I.e., CDiff versus SIBO versus FM. It may be that some people can eventually eat onions again while someone else can never even look at onions again. You may be able to eat very little at first, which is what happened to me. I am very slowly now reintroducing foods. Garlic, onions and chocolate are not even in my horizon at this point. Still, I have not experienced diarrhea in two months and gained 10 of the 20 lbs I lost by following this diet under the supervision of a nutritionist.

I have fm very bad as well. But, since I have the constipation version, I had no indication like diarrhea of what food was ok and what wasn't. I was always bloated and gassy to one degree or another until I got it figured out what I could eat and started using Phillips Milk of Magnesia on a regular basis. The latter also took care of the SIBO. Some food bothers my stomach immediately, like fruits and fruit juices, honey, soda, gum, etc. but others do not. I can't eat onions, garlic, peas and carrots either. Sometimes I can eat a few nuts, sometimes I can't - I figure it depends upon how much fructose is already in my g.i. tract, and there is no way for me to really know that. I agree - it is very difficult to manage, but it does become pretty routine when you aren't trying new things! Thanks for replying.

This is why working with a nutritionist, at least at first, is so important. I have been on a Low FODMAP diet for two months and I am not eating any of the items you mentioned. No garlic, no onions, no chocolate and very little sugar. That is what happened to me at first. I went to the websites, read the food lists, and started to eat stuff that triggered more diarrhea. The diet starts very restrictive and slowly expands to other foods. It is important to follow a certain method for the diet to work. It is not just a matter of reading a list and start eating Low FODMAP foods. I almost gave up on the diet until I went to see the nutritionist and we adopted a method. Can’t emphasize this enough. It is how foods are first eliminated and then very slowly reintroduced. One can’t just randomly eat all the foods that are listed on the FODMAP diet. The diet must be individualized to your needs and specific problem, I.e., CDiff versus SIBO versus FM. It may be that some people can eventually eat onions again while someone else can never even look at onions again. You may be able to eat very little at first, which is what happened to me. I am very slowly now reintroducing foods. Garlic, onions and chocolate are not even in my horizon at this point. Still, I have not experienced diarrhea in two months and gained 10 of the 20 lbs I lost by following this diet under the supervision of a nutritionist.