Ever heard of fructose malabsorption? How about something a little more mainstream-friendly… fructose intolerance?

No? Me either, until I stumbled across the medical term while researching sugar.

Not only is fructose malabsorption common, but this ailment also has a variety of causes including stress. So, what exactly is it?  Fructose malabsorption — also called dietary fructose intolerance — is similar to other intolerances — such as yeast, lactose, and gluten — in that your body has a super difficult time processing fructose. And, much like these other intolerances, it mostly affects your gastrointestinal system with bowel movement issues, bloating, and can even lead to irritable bowel syndrome (IBS).

So, how do you know if you have fructose malabsorption? What causes it? How to do you treat? And, what in the world actually is fructose?

Let’s take a deeper dive into this lesser-known yet very common intolerance and answer these questions.

What is Fructose Malabsorption?

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The American Gastroenterological Association (AGA) explains that “fructose malabsorption is a digestive disorder in which the body is unable to break down fructose (the sugar in fruit), and it may cause bloating, stomach pain, heartburn, diarrhea, and gas.”

Basically, when it comes to fructose, your “body is not able to break it down during digestion,” therefore leaving undigested fructose traveling through your digestive tract.

Why can’t the body break down fructose?

When someone suffers from fructose malabsorption, they generally have a “deficiency of carriers,” specifically, “fructose carries found in the enterocytes (cells in your intestines) [which] are responsible for ensuring fructose is being directed to where it needs to go.” Not only will this fructose “build up in your large intestine,” as soon as the “undigested fructose reaches the bowels it reacts with naturally occurring bacteria,” and this reaction leads to the series of unpleasant symptoms listed above. While symptoms may vary from person to person depending on your specific body type most people suffering from fructose malabsorption experience heartburn, bloating, diarrhea, belly pain, and gas.

Fructose Malabsorption versus Hereditary Fructose Intolerance (HFI)

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It’s important to note that fructose malabsorption is a completely separate condition than a much more serious one called hereditary fructose intolerance. Hereditary fructose intolerance “is a condition diagnosed very early in life when a baby starts eating food or formula,” and is a very rare genetic condition. In fact, HFI affects only “1 in 20,000 to 30,000 people and occurs because the body doesn’t make the enzyme needed to break down fructose.” While fructose malabsorption leads to unpleasant symptoms, hereditary fructose intolerance leads to incredibly “serious health issues such as liver failure.”

What is Fructose?

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You’ve most likely heard the word sugar thrown about quite a bit these days, specifically that the standard American diet has too much of it. The word itself might be well known, but the intricacies of sugar’s design are less well known.

While we could spend an entire article talking about the different kinds of sugar — including sucrose, glucose, galactose, lactose, maltose, sucrose, and xylose — today we’ll focus on fructose.

When someone refers to fructose, they are selectively talking about “the sweetest of the naturally occurring caloric sweeteners,” which is found naturally in table sugar, agave nectar, “fruits, fruit juices, honey, and even some vegetables.” Since fructose is the sweetest tasting of the different types of sugar, it’s also used in a compound called HFCS, which is “present in candy, baked goods, and sodas, and other processed foods.”

HFCS is a manufactured sweetener created from enzymes and corn starch (basically, pure glucose), which is then turned into a syrup that generally contains either “42 or 55 percent fructose and 45 percent glucose.” Basically, HFCS is a fructose-based form of table sugar or sucrose.

I mention HFCS is such detail to illuminate the fact that fructose is found not only naturally in certain fruits and veggies, but it is also added and hidden in many processed foods. Therefore — much like those with a gluten or yeast intolerance — those that suffer from fructose malabsorption have a steady climb to avoid this popular sweetener!

What Causes Fructose Malabsorption?

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While hereditary fructose intolerance is quite rare, fructose malabsorption is actually very common and affects “up to 1 in 3 people,” and the causes might also be quite common to trending health concerns. Fructose malabsorption can be caused by an imbalance of your gut bacteria (also called microbiota), a high intake of refined and processed foods, inflammation, stress, and it can even be set off by preexisting gut issues such as irritable bowel syndrome (IBS).

High-Fructose Fruits to Avoid

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Along with many high-fructose processed foods such as soda, cereal, fruit juice, ice cream, candy, and cookies — to name just a few — there is a slew of manufactured high-fructose sweeteners that are added to other processed foods. Make sure to read labels for these high fructose sweeteners which include high fructose corn syrup, agave nectar, honey, sorbitol, corn syrup solids, sorghum, molasses, invert sugar, maple-flavored syrup, palm sugar, coconut sugar, sugar alcohols, and plain old fructose.

Keep in mind that some vegetables are also a bit higher in fructose such as asparagus, peas, and zucchini and have the ability to cause a flare-up in symptoms.

After you’ve eliminated the list of manufactured sweeteners and the very few high fructose veggies, it’s time to take a look at naturally occurring high fructose fruits. If you’re diagnosed with fructose intolerance then you’ll want to limit or avoid fruits that are higher in fructose including all dried fruits, “juices, apples, grapes, watermelon,” mangoes, plantains, pears, pineapple, and apples.”

Low-Fructose Foods for Malabsorption Intolerance

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While there seem to be many foods to avoid or limit, there are also a host of plant-based foods that are not only low-fructose but also brimming with other nutrients. Nutrient-dense foods can help alleviate some of the causes such as imbalanced gut microbiota and irritable bowel syndrome.

Leafy Greens

Wild Green Quinoa Salad/One Green Planet

Leafy greens are generally safe for almost any diet, which means they are a perfect filler for those suffering from fructose malabsorption. One of the leafy green staples that is not only affordable but nutrient-dense is spinach. Spinach is a great source of calcium, iron, magnesium, and potassium, as well as omega-3 fatty acids and vitamins A and C. Plus, this delicate and versatile green is super easy to integrate into your diet in creative ways. From simple salads — such as this Wild Green Quinoa Salad — to hearty breakfast recipes — such as this Scrambled “Eggs” — to green soups — such as Green Spinach and Tahini Soup.

Blueberries 

Nutrient Dense Blueberry Smoothie/One Green Planet

If you’re looking for a safe fruit option, go for berries! Berries are lower on the glycemic index (meaning they won’t cause as drastic of blood sugar spikes) and they are lower in fructose content. With that said, keep in mind that all fruit has fructose — it’s why fruit is so sweet — therefore, while berries are a better option, you’ll want to limit your intake. Try to choose recipes that mix fructose with a healthy fat such as this Nutrient Dense Blueberry Smoothie, which mixes frozen blueberries with coconut oil, almond butter, coconut milk, avocado, and adaptogenic cacao.

Avocado

Greek Avocado Toast/One Green Planet

Avocado is the save all plant-based food that is not only incredibly nutrient-dense but also offers a helping of healthy fats including monounsaturated, polyunsaturated, omega-3 and omega-6 fatty acids, as well as a small dose of saturated fat. It is also a great source of dietary fiber and happens to be low in fructose. All of these aspects mixed together make avocado one of the best foods to integrate into a fructose malabsorption specific diet. Plus, due to avocado’s creamy texture, it’s a great culinary substitute such as this in this Chocolate Avocado Pudding recipe — substitute stevia or monk fruit sweetener for the maple syrup! — or smeared raw on toast such as in this Greek Avocado Toast recipe.

Carrot

Source: Carrot Cake With Creamy Cashew Lemon Frosting

If you’re hankering for something sweet, but want to avoid high fructose fruits and veggies, try incorporating carrots. Not only are carrots are a great source of vitamins and minerals, but they also happen to be naturally sweet while also low fructose. Carrots are a perfect raw snack to keep in your bag or at work, but they are also a wonderful ingredient to use in sugar-free, yet naturally sweet recipes. Try a few of these low sugar, sweet recipes: Creamy Sweet Potato Pasta, Carrot Coriander Soup, or this Raw Carrot Cake With Cashew Lemon Frosting.

We also highly recommend downloading our Food Monster App, which is available for iPhone, and can also be found on Instagram and Facebook. The app has more than 15,000 plant-based, allergy-friendly recipes, and subscribers gain access to new recipes every day. Check it out!

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