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?

Oh and I don’t have any symptoms of IBS no diarreah, constipation, gas just horrible heart burn and headaches and feeling overall sick. Lately getting laryngitis from it too.

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@grachelg

Yes. Was just going to ask the same. What can we do to control this crazy thing. I want to know how long you eat let’s say a half a banana which is not on the list but made me sick 6 hours later for 2 days make you sick? What symptoms do you have? What do you do for it? How can we not eat fruit for the rest of our lives? This is all new to me. I ate fruit all my life. Now the drs day I have fructose malabsorption and acid reflux. I feel sick almost every day. Can use advice on all fronts

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I was a big fruit eater too; now I don't eat any. You get so you don't even want it because you know the symptoms it'll cause. You try to compensate by making what you do eat taste really good. Did you see the long part above (about page 3?) about recipes and diet? That might help.

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@grachelg

Yes. Was just going to ask the same. What can we do to control this crazy thing. I want to know how long you eat let’s say a half a banana which is not on the list but made me sick 6 hours later for 2 days make you sick? What symptoms do you have? What do you do for it? How can we not eat fruit for the rest of our lives? This is all new to me. I ate fruit all my life. Now the drs day I have fructose malabsorption and acid reflux. I feel sick almost every day. Can use advice on all fronts

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Recipes and diet is page 5 not 3.

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@jackiem95

I am working with a nutritionist.

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Are you in NY or NJ looking for a nutritionist who knows about fructose malabsorption and lactose intolerance and acid reflux

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@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).

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@gut health, @jackiem95, @pjss48, @redhead63, @sarcomasurvivor, @gracheig. I called Mayo and they sent me the 20 page FODMAP Eating Plan and the Fructose Malabsorption Eating Plan since I am a patient. It quickly became apparent that neither would be that helpful for me. I couldn't eat a large part of the stuff in the FODMAP elimination phase so there would be no point in reintroducing the suggested foods. Also can't eat a lot on the fm plan. So, I saw a nutritionist locally yesterday about whether what I am eating so far is good in terms of nutrition, etc., and she said it was. That is nice to know. Am still trying to introduce some new foods, though, and it is helpful to know how long to wait between experiments, which the Mayo plans tell you. The FM eating plan had a couple sentences near the end that said something very true: "Changing what you eat and drink may not be easy at first. Think of these changes as a new lifestyle, rather than just diet changes. Make these changes part of your daily routine for the best chance of feeling better." That is the point I had come to because there had been no other choice. I had gotten so I had pretty much forgotten about the diet changes and restrictions until I started this discussion on Mayo Clinic Connect. Then it all came back big time. But, I wanted to share what I had learned to make it easier for others. If nothing else, know that it is possible to get to the new lifestyle phase! It may not seem like it, especially at first, and it will take some time. Don't give up. And thank you all for your input.

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@lelia

VERY LOW FRUCTOSE, LOW FODMAPS, AND GLUTEN FREE RECIPES AND DIET.
The recipes are very simple and delicious without any sugars to make it easier to stick to a restricted diet. We've developed them as we went along, and I want to share them to make it easier for others. No point in having to reinvent the wheel! Often we don't add seasonings until at the table, and then they are mostly salt and/or pepper. Note that browning food adds a lot of flavor!

I have fructose malabsorption, lactose intolerance, visceral hypersensitivity and sometimes small intestinal bacterial overgrowth. I am putting the recipes in the Fructose Malabsorption discussion section because I have found them to work for that condition, and it wasn't easy. There is so much that doesn't work, and it has been quite the journey since the viral food poisoning in 2002 I have yet to find a sugar or artificial sugar I can digest. I realize everybody is different, but we have to start somewhere. I welcome any tips anybody has; am still in the trial process and sometimes just don't feel like rocking the boat. Feel free to ask me any questions as well.

PART 1. CHICKEN BROTH. Just when you feel your worst you can only have chicken broth to eat. I have to make my own because all of the packaged versions I've seen have sugar(s) in them or seasoning I can't eat. Here's the easiest way I've found. Bring chicken thighs to a boil and simmer one hour or until done. Remove thighs. Using a measuring cup, pour the broth into wide mouthed canning jars. Place jars in refrigerator and hold until fat has solidified. Take the fat off, put the lids on (plastic are the best) and freeze. Alternately, take the fat off as you use the broth over a day or two. After thighs have cooled a bit, remove meat, divide into serving size portions, and freeze. Originally I used Cambell's no sodium chicken broth (no longer made) and was always very weak. The homemade version has much more nutrition and I never feel weak until the end of the second day or so.

PART 2. POULTRY. Bake the chicken, cornish hens or turkey. Boil white basmati rice. When the meat is done, remove from pan and set aside. Pour the drippings into a clear container such as a glass measuring cup, and let the fat rise to the top. After it has, skim it off with a gravy ladle or spoon. Then pour the drippings into the rice still in the rice pan. Serve with the meat. No seasonings are necessary while cooking; still delicious without them.

We also occasionally eat bacon-wrapped turkey tenders done on the George Foreman grill. I remove the bacon on a separate plate before eating the turkey; there is still a little sugar.

We also make canned chicken hash. We get the chicken at Trader Joe's because it has no additives (Trader Joe's Chunk White Chicken in Water). Microwave potatoes, peel, chop up and add to canned chicken. Mix in sage and/or thyme and a little extra virgin olive oil. Stir well. I sometime add a little bit of stir fried mushrooms.

PART 3. FISH. Salmon. Fry the salmon until well browned. At the same time, cook white basmati rice. When the salmon is done, remove from pan and set aside. Dump the cooked rice into the salmon pan and stir well, using the spatula to get up all the brown stuff in the pan. Serve the rice with the salmon. Again, no seasonings necessary.

Cod. Put in microwave dish. Drizzle with oil and add a little water. Cover and cook on high for about 6 minutes. As microwaves vary, check your unit's manual for cooking fish.

Orange roughy, tilapia, mahi mahi. Put in microwave dish. Drizzle with oil and add a little water. Sprinkle fish with thyme. Cover and cook on high for about 6 minutes. Again, check you microwave's directions.

Scallops. Boil basmati rice until done. Fry scallops until browned. Add rice to the scallops still in the scallops pan and stir, making sure you get up all the brown stuff. Serve.

PART 4. PORK. Fry pork chops until well browned.

PART 5. BEEF. Fry or grill hamburgers and steaks.
Meat loaf. 20 ounces ground beef, 1 c. quick oats, 2 eggs, 1/2 t pepper, 1/3 t ground sage, 2 T water. Mix all ingredients except meat and oats. Combine with meat and oats and stir well. Press lightly and evenly into greased loaf pan. Bake 350 degrees about 50 minutes.

Bacon wrapped fillets. We occasionally have these; I remove the bacon on a separate plate before eating the fillet. There is some sugar left on the fillet.

Arby's classic roast beef, plain, without the bun.

PART 6. EGGS. Fry, scramble, boil. I use canola oil. I eat eggs with fried potatoes and sometimes a piece of leftover pork chop from dinner. Occasionally I make an omelet with spinach (Trader Joe's frozen chopped spinach is great) and leftover cooked meat or fish from dinner.

PART 7. VEGETABLES. Cook all vegetables.
Spinach microwaves well. We steam the broccoli, broccolini and carrots. Broccolini or "baby broccoli" is actually a cross between broccoli and kale. Kale has fructans in it, so broccolini probably has some. However, it is so delicious and if eaten in moderation is tolerable. Incidentally, broccoli has lactose in it (and so probably broccolini) so I take a couple lactase tablets when eating it. Carrots have sugar in them, so I only eat one baby carrot every other day.

Green Swiss chard, celery in small amounts, and occasional mushrooms are also ok. Just learned mushrooms have polyols in them, but my reaction isn't that strong.

Potatoes. Boil, microwave or fry. Don't eat the skins because they have fructans in them.
Baked. Bake on the bottom shelf of the oven at 375 degrees so they are browned, giving them added flavor.
Fried. Microwave potatoes until done. Peel, chop up and brown on top of the stove. These are great with eggs, and especially good under fried eggs. I make enough for several meals and freeze in individual containers.
Mashed. Boil russets. When done, peel and mash, adding a little of the potato water (and broth if you have it). Add seasonings like sage or thyme if desired.
Arby's potato cakes.
Kettle brand potato chips, unsalted or salted. No crinkle chips – all I've seen have additives including sugars regardless of brand.
Onions. Rarely eat, and then only the clear liquid that comes out while quickly sautéing them. Remove the solids after sautéing. The solids, or the juice that isn't clear, are a definite no-no.

PART 8. GRAINS.
Oatmeal. Use quick oats. For a quick breakfast, microwave in a 2 c. measuring cup. Fill half full of oats and the remainder with water. Microwave on high about 1 1/2 minutes (or what your microwave specifies). It is good with Pompeian Extra Light Olive Oil sprinkled on top along with cinnamon.

Rice. White basmati rice works well. I believe brown rice has fructans in the husks. Tried jasmine rice but it tasted rather sweet compared to the basmati.
White rice noodles. Bought some but have yet to try them. Should be ok.

PART 9. GRILLING WITH A CHARCOAL GRILL.
This is the grill we have, and the starter fluid would get on the food and bother my stomach so we had to quit. Then discovered the "charcoal grill chimney starter," which is metal tube you fill with charcoal and then light newspapers underneath to start the charcoal. Now we can eat grilled food again!

PART 10. POT PIE TOPPER.
Bake russets at 375 degrees on the bottom shelf of the oven. When done, mash, adding egg and seasonings. Mold into desired shape

PART 11. OILS.
Canola oil
Olive oil – Pompeian Extra Light Tasting and Pompeian Extra Virgin olive oils are no sugar and very good tasting. Be careful and don't use just any olive oil, since olives are a fruit and olive oil often contains olive juice.

PART 12. SPICES AND HERBS. This is a tricky area.
Cinnamon, sage, thyme, salt and pepper are fine.
Tried rosemary, oregano, and fresh cilantro and these were not ok.
Basil and bay leaf are supposed to have no sugars, but have yet to try them.
Perhaps some no- sugar spices/herbs contain fructans?

PART 13. DESSERT.
Potato chips with cinnamon on them. My only dessert for years.

Nuts with cinnamon. Fry Planters Deluxe Mixed Nuts (remove the pistachios first) in Extra Light Tasting Olive Oil until browned. Add cinnamon after removing from pan. Let cool, and then store in refrigerator or freezer about 1 week to give the nuts a chance to absorb the cinnamon flavor. Nuts have sugars in them so eat in moderation.

Shortbread cookies. 1 c. almond flour (not meal), 1/4 t. salt, 1/4 c. Pompeian Extra Light Tasting olive oil, and 1 t. Frontier Coop Organic NonGMO vanilla extract. Eat in moderation. Almonds have fructans and perhaps fructose in them; vanilla extract has sugar in it

PART 14. BEVERAGES
I am still drinking mainly distilled water, since out city puts chloramines in the water and they bother my stomach. Can get by with a glass or 2 of city water daily but that's it. Plain black and plain green tea are supposed to be sugar free but have yet to try them.

Eating out, I ask for water from the faucet, no ice or lemon, since water through the pop machine has sugar in it.

PART 15. L-ALANINE AMINO ACID. This supplement has been shown by researchers at a university in Iowa to help the intestinal wall absorb fructose. It helps a lot. I use probably 8 t. a day when I eat potato chips, baby carrots, drugs/supplements that have sugar in them (more on this topic later), etc. If you get it at BulkSupplements.com it is very affordable. I get it as a powder and mix it in water before using. Put 2 heaping T in a 2 c. glass measuring cup, add 1/4 c. water, and microwave on high for about 1 1/2 minutes. After removing it from the microwave, stir well and then add water to the top of the measuring cup to make 2 cups.

PART 16. SUGAR CONTENT IN FOODS. The U.S. Department of Agriculture has a priceless site called USDA Food Composition Database, at
ndb.nal.usda.gov. Not only does the site give sugars in foods (fructose, sucrose, lactose, etc.), it RANKS the foods by sugar content. To look up basic foods or drinks, click on Nutrient Search, select up to 3 nutrients such as total sugars, fructose, etc., and then selected to food group you want to learn about, such as spices and herbs, cereal grans and pastas, etc. There are many other nutrients besides sugars, so the database would be useful for a lot of people. This database is the perfect example of your tax dollars at work!

This entry wouldn't be complete without thanking the doctors and staff at Mayo Clinic and our local university medical center, including a medical librarian (also an MD) who did a lot of online searching for me. My husband has also been a wonderful help, offering moral support, cooking, etc. I could not have gotten to this point without them. Also, thanks to Mayo for Mayo Clinic Connect so we can have a chance to help each other. 1/2/2019

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@jackiem95, @guthealth, @baponline, @pjss48, @redhead63, @sarcomasurvivor, @gracheig. Just discovered a delicious truly no sugar bacon that went down fine! It is made by a company called Pedersen. There are 2 varieties. 1. Uncured No Sugar Buckin Bacon (pork, hickory smoked). 2) Uncured no sugar hickory smoked turkey bacon. Health food stores may carry these, but not here. Here they carry a Pedersen no sugar pork bacon that does contain the added natural sugars citrus extracts and pomegranate extract. You can order the bacon by calling the Simple Grocer 1-325-451-7545. (Simple Grocer is the distribution center for Pedersen products.) The bacon is shipped frozen in dry ice. The Buckin bacon is lower fat than the usual bacon, which is a good thing. It is probably the best bacon I've ever had.

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@lelia

@jackiem95, @guthealth, @baponline, @pjss48, @redhead63, @sarcomasurvivor, @gracheig. Just discovered a delicious truly no sugar bacon that went down fine! It is made by a company called Pedersen. There are 2 varieties. 1. Uncured No Sugar Buckin Bacon (pork, hickory smoked). 2) Uncured no sugar hickory smoked turkey bacon. Health food stores may carry these, but not here. Here they carry a Pedersen no sugar pork bacon that does contain the added natural sugars citrus extracts and pomegranate extract. You can order the bacon by calling the Simple Grocer 1-325-451-7545. (Simple Grocer is the distribution center for Pedersen products.) The bacon is shipped frozen in dry ice. The Buckin bacon is lower fat than the usual bacon, which is a good thing. It is probably the best bacon I've ever had.

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The company name is Pederson, not Pedersen.

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Hi Mayo Clinic Connect community,

About 2 years ago, I started having excessive gas and to a lesser extent increased belching. I have no other gastrointestinal issues – no bloating, diaheraa, or constipation – but the gas is really bad to the point that I’ve spent the last year restricting my diet and avoiding dating out of embarrassment.

Right now, I’ve found that the gas is reduced if I restrict my diet to plain Greek yogurt, avocados, lean meats, white rice, soy sauce, plain bagel, and cream cheese. That’s not a long list and not a sustainable diet, I know. I’ve noticed increased gas when I eat eggs, oatmeal, sugary muffins and cookies with high fructose corn syrup.

I was diagnosed with some type of sucrose intolerance when I was 10 years old. My symptoms then were vomiting and stomach pain. It was so long ago there may have been symptoms I don’t remember. Either way restricting/eliminating sucrose from my diet eased my symptoms. My doctor thought I would grow out of it and 2 years later I was able to eat sucrose without those nasty symptoms. But with this new digestive issue, I wonder if sugar malabsorption is an issue.

I’m seeing a GI doctor about this next week Has anyone else had excessive gas as your only symptom? Did you get a diagnosis?

Thanks!

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I have been having acid reflux for over a year and have recently been diagnosed with fructose malabsorption. Trying to stick to a food plan. Always feeling the reflux and heartburn. On omeprazole 20 mg. There are no fruits I can eat between the 2 conditions and this is upsetting. I do not eat or drink wine, coffee, carbonated drinks, garlic, onions, pepper, chocolate , vinegar, all citrus, all fruits, mint, tea, tomatoes… and yet I still feel sick almost after every meal. I also get migraines on occasion. Any advice on what I can still do to feel good!

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Hi everyone,

You may notice that I combined your messages with this existing discussion on fructose malabsorption. I did this as I thought it would be beneficial for you to connect or reconnect with members who are discussing much of what you are experiencing.
If you click on VIEW & REPLY in your email notification, you will see the whole discussion and can join in, meet, and participate with other members talking about their or their loved ones' experiences.

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@atxer

Hi Mayo Clinic Connect community,

About 2 years ago, I started having excessive gas and to a lesser extent increased belching. I have no other gastrointestinal issues – no bloating, diaheraa, or constipation – but the gas is really bad to the point that I’ve spent the last year restricting my diet and avoiding dating out of embarrassment.

Right now, I’ve found that the gas is reduced if I restrict my diet to plain Greek yogurt, avocados, lean meats, white rice, soy sauce, plain bagel, and cream cheese. That’s not a long list and not a sustainable diet, I know. I’ve noticed increased gas when I eat eggs, oatmeal, sugary muffins and cookies with high fructose corn syrup.

I was diagnosed with some type of sucrose intolerance when I was 10 years old. My symptoms then were vomiting and stomach pain. It was so long ago there may have been symptoms I don’t remember. Either way restricting/eliminating sucrose from my diet eased my symptoms. My doctor thought I would grow out of it and 2 years later I was able to eat sucrose without those nasty symptoms. But with this new digestive issue, I wonder if sugar malabsorption is an issue.

I’m seeing a GI doctor about this next week Has anyone else had excessive gas as your only symptom? Did you get a diagnosis?

Thanks!

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If you have a mild case of fructose malabsorption the main symptom could be excessive gas, I think. I have an extreme case, and before it was diagnosed I had so much gas I had "explosive" belching. Also had other symptoms as well, many of which could be related to the gas like GERD, bloating, etc. Good thing you are going to a GI doctor.

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@grachelg

I have been having acid reflux for over a year and have recently been diagnosed with fructose malabsorption. Trying to stick to a food plan. Always feeling the reflux and heartburn. On omeprazole 20 mg. There are no fruits I can eat between the 2 conditions and this is upsetting. I do not eat or drink wine, coffee, carbonated drinks, garlic, onions, pepper, chocolate , vinegar, all citrus, all fruits, mint, tea, tomatoes… and yet I still feel sick almost after every meal. I also get migraines on occasion. Any advice on what I can still do to feel good!

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I'm so sorry you're still having problems. What you don't eat sound so familiar! I posted a diet and recipes further up the pages in fructose malabsorption, and also info re sugars in drugs and supplements. Omeprazole has sugar in it; that probably isn't helping It's possible you might also have lactose intolerance and small intestinal bacterial overgrowth. After over 13 years I finally got to a point where I am stable with the fm, so started this fm discussion to help others in the same predicament. Hopefully you can find some answers and get it under control!

Liked by harmonyln

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@lelia

I'm so sorry you're still having problems. What you don't eat sound so familiar! I posted a diet and recipes further up the pages in fructose malabsorption, and also info re sugars in drugs and supplements. Omeprazole has sugar in it; that probably isn't helping It's possible you might also have lactose intolerance and small intestinal bacterial overgrowth. After over 13 years I finally got to a point where I am stable with the fm, so started this fm discussion to help others in the same predicament. Hopefully you can find some answers and get it under control!

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I have been diagnosed with fm and lactose intolerance and acid reflux . I no longer have bacterial overgrowth. I do not have gas. My symptoms were constant heart burn and bloating. Yes now see a nutritionist and started a Low FODMAP diet with the elimination of foods for fm and reflux. I have also been taken off gluten. There is not much that I can eat. And only drink water. I have eliminated my vitamins and pro biotic since they all have some form of sugars not allowed. Would love to find a probiotic, calcium and multi vitamin I can take. My menu is basically salmon, chicken, quinoa, brown rice all gluten free.. oatmeal, hard boil eggs, carrots and cucumbers, lettuce. I tried a half slice of Muenster cheese in an omelette and had severe diarrhea. I was a cheeses addict before this all started. So I will try it again at some point maybe a quarter of a slice and maybe fat free. I tried tuna in oil and felt terrible after. So no oil for me. Will try in water soon.
Nutritionist is very helpful. Also doing stress management excercises. I have not touched a fruit in about a year. Trying to feel good for more than 5-6 days.

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@grachelg

I have been diagnosed with fm and lactose intolerance and acid reflux . I no longer have bacterial overgrowth. I do not have gas. My symptoms were constant heart burn and bloating. Yes now see a nutritionist and started a Low FODMAP diet with the elimination of foods for fm and reflux. I have also been taken off gluten. There is not much that I can eat. And only drink water. I have eliminated my vitamins and pro biotic since they all have some form of sugars not allowed. Would love to find a probiotic, calcium and multi vitamin I can take. My menu is basically salmon, chicken, quinoa, brown rice all gluten free.. oatmeal, hard boil eggs, carrots and cucumbers, lettuce. I tried a half slice of Muenster cheese in an omelette and had severe diarrhea. I was a cheeses addict before this all started. So I will try it again at some point maybe a quarter of a slice and maybe fat free. I tried tuna in oil and felt terrible after. So no oil for me. Will try in water soon.
Nutritionist is very helpful. Also doing stress management excercises. I have not touched a fruit in about a year. Trying to feel good for more than 5-6 days.

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Low FODMAP diet has a lot of sugar in it, even the "maintenance" dose before you start reintroducing more FODMAPS. I can't eat any FODMAP foods to speak of. Brown rice hulls have chains of fructose in them called fructans, so you might want to switch to white rice. Carrots, cucumber and lettuce have sugars in them. Most vegetables do have sugar in them. If you read through this entire fm discussion entry you may get some ideas of what to take/eat. For example, I tell the brands of the drugs and supplements (including calcium) I take that may work for you as well. Again, good luck!

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Hello, I am the mom of a 13 yr old boy with fructose malabsorption. He was finally diagnosed at Mayo 1st week of June 2018. He finally became pain free once we eliminated fructans, although I did not realize there are fructans in potato skins! Regarding L-alanine, how much do you take per body weight? do you need to take it on an empty stomach before you eat food? We have had no help in re-introducing foods. Dieticians repeatedy tell us "everyone is different, you just have to try." When my son has even 3 bites of a food, he reacts 6 hrs later and is laid up with abdominal pain, weakness and severe constipation for 5-6 days. As a mom, it is very sad to see my son curled up for so long and he is missing school. Do you have any suggestions on how to choose foods to re-introduce and how to decrease the likelihood of a reaction? Thank you!!

Liked by jeanneschnepper

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