Fructose Malabsorption & the Low-FODMAP Diet

When an apple a day no longer keeps the doctor away…

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Hey, YOU!

This page, like the rest of my website, is currently getting a long overdue makeover. It’ll be back up and running in the next month or so! See you soon 💕
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89 thoughts on “Fructose Malabsorption & the Low-FODMAP Diet

  1. Thank you for your help Rachel!

    I am gluten free 99% of the time (I occasionally have a slice of low fodmap bread), I have the Monash University Traffic light app to help determine what I can and can not eat and also check EVERYTHING I eat.

    I know that some things, that I can supposedly eat will affect me more than other things so I avoid them aswell.

    I saw my dietician last week and she told me to take buscopan (a muscle relaxant). For the first week I took it 3 times a day (breakfast, lunch dinner), for the second week it will be twice a day and the third week once a day. It’s reduced the pain a little bit but I still get some. I’m worried the less I take, the more the pain will come back.

    She seems to think that I’m not actullay reacting to the food anymore, it’s just my muscle have reacted like that for so long it’s muscle memory, so they continue to do so.

    I will continue to keep trying things until I am out of pain (hopefully before my year 9 graduation in 8 weeks!).

    Thank you for the advice, I will be sure to tell you what ended up being the problem.

  2. Ella,

    Your symptoms are almost exactly what I experienced before I was diagnosed with FM. There are actually two types of it- Hereditary Fructose Intolerance (you lack the enzyme to break down fructose in your liver) and Dietary Fructose Intolerance (you have a breakdown transporting the fructose to your liver but once there it can break down). The dietary form is also frequently called fructose malabsorption. The hereditary form, if not diagnosed in very young childhood (think under 5) can be fatal.

    For me, it started with a never ending ache with moments of intense, stabbing pain. It was so bad there were times I literally could not even consume water for days because the pain and nausea was so bad. I would alternate between constipation and diarrhea. The pain was just below my ribcage on the left hand side, it was a constant ache that would periodically feel like I was being stabbed repeatedly and the knife was being twisted. It felt like a Charlie Horse in my intestine.

    My GI specialist, after lots of tests, said he didn’t know what the issue was. I had a period of almost 2 months between our initial visit and an upper GI scope (camera in through your mouth). Between the inital visit and the scope, he had me on basically rice and lean, baked or grilled meat. No fruits, no vegetables, no spices or seasonings. I started feeling a little better towards the end of the 2 months. Then, after the scope before the biopsy results came back and I had a followup with him, I started eating vegetables and fruits again and the pain came back within hours. I did a LOT of research based on those symptoms and found FM. During my followup visit, I told him the new information and what I had found that fit the symptoms. I asked for the hydrogen test and he told me that what i had already done was a better indicator, and told me to “take lactate and hope it helps.” His reasoning was there may be crossover. I had to fight for a referral for a nutritionist to work with me through an elimination diet. After working with a nutritionist and following an elimination diet religiously in late 2012 and 2013 I found I cannot tolerate fructose or fructans. My fructose load tolerance in the beginning was less than 5 g per DAY for almost 2 years before I could handle more. Even when it occurred in conjunction with glucose. It has been over 5 years now and I still find myself in extreme pain if I mess up. But… it has gotten better. It took a few years before I could incorporate some things, like wheat, back in. Now, I can even eat pizza or the occasional salad if I am careful with ingredients. I have found a lot of the things on Ashlyn’s list that are safe for her I can’t have, even now. Every one has different levels of what they can tolerate.

    I found a few things that may help you too- 1) avoid wheat until you see some change- the highest source of fructans in most diets is wheat. Even though they have ruled out Celiac (they did with me too) it can lower the amounts of other foods you can have. 2) Investigate EVERY ingredient in things that are premade- evaporated cane syrup or evaporated cane sugar are VERY high in fructose. So is honey. Evaporated cane sugar is a sweetener in a lot of foods, even almond milk, which is allowed on the elimination diet. 3) If you have a smart phone, get an app that can look up fructose content (and if you look it up and don’t find the breakdown of sugars, especially if it has a high sugar content, avoid it until you are reliably feeling better and can challenge with that food). 4) In general fermenting and cooking breaks down fructose and fructans. I have found that drying doesn’t seem to do this, so dried oinion/garlic or dried fruits are (for me at least) even worse than having something fresh. 5) Fiber is great for most people, however…it can make symptoms worse or mask the cause of a symptom. Until you are feeling better, unless your doctor tells you to take a fiber supplement, you may want to consider minimizing the fiber in your diet. If I have something with a lot of fiber and something even borderline (even now) I will have an episode of pain and other issues for a few days.

    Lastly, I know it’s hard. Hang in there. You, and your parents, have to advocate for your own health. I have heard too many times from doctors “do this/that and hope it helps” without real, practical help. I think it was most of 2 1/2 years before I didn’t have to write down everything I ate and drank, including time, and (sorry to be gross) elimination habits. In that journal I also had to keep track of if I had pain, gas, bloating, etc, when it occurred, and on a scale of 1-10 how severe it was. It took a long time, and a lot of work, to figure out my personal loads. And I still screw it up sometimes. Unfortunately this deeply personal and only you can do the work to discover your trigger foods and amounts. I was the first case of FM my nutritionist had ever had, but the basic tenets of an elimination diet were still the same and she taught me tools to help figure things out and manage it day to day. It was money well spent to work with a nutritionist. Since I am a bit OCD in researching, I did a lot of research initially that helped me understand a lot better. On YouTube I found a lecture titled “Sugar: The Bitter Truth” given by Dr. Lustig to a group of medical students. It’s very, very in depth on how your body breaks down different sugars. It helped me to better understand the process and where my body was breaking down, and helped me start to carry things like Ashlyn suggets (glucose powder, etc) for emegencies. Good luck. I hope this helps.

  3. I was diagnosed with fructose intolerance six months ago (I believe my doctor meant FM). I’ve been low FODMAP for 5 months and nothing is really working. It improved to a point, but never got better from there. I’m seeing a dietician regularly, and she is stumped. I’m 14 and it’s getting very difficult not knowing what’s wrong and how to improve it.

    I’m having dairy becuase without it, I lost weight quickly. I’m only skinny and have no weight to lose. I did try going off dairy, but once again, it only improved to a certain point. I’m taking bioceuticals intestamine to strengthen and re-build my stomach tract, and tried probiotics but they made it worse.

    My dietician has told me to drink Powerade and not to have anything cold as it will make my stomach react. But. Before she told me not to, when I got pain I would suck on ice and use a ice pack, and that stopped the pain.

    The pain isn’t the same everytime. It aches, burns, stings, like a knife stabbing me, sometimes it’s like I’m nervous (I’m defienetly not). I don’t poop daily and I feel nauseated almost every time I eat, or even drink.

    It was about 10 months ago I saw a doctor about the pain. I’ve had every test imaginable. Except a camera down my throat. One of my doctors said it’s to intrusive, but my dietician thinks it should be fine. I’m hoping if I get the camera, it will tell me the news I’ve been waiting for, but I’ve been disappointed so many times before.

    Does anyone have any ideas of what else could be going on?

    I’m not:
    Celiac
    Lactose intolerant
    Gluten intolerant
    Iron deficient
    No ulcers in my stomach
    No other allergies

  4. I was diagnosed with fructose intolerance six months ago (I believe my doctor meant FM). I’ve been low FODMAP for 5 months and nothing is really working. It improved to a point, but never got better from there. I’m seeing a dietician regularly, and she is stumped. I’m 14 and it’s getting very difficult not knowing what’s wrong and how to improve it.

    I’m having dairy becuase without it, I lost weight quickly. I’m only skinny and have no weight to lose. I did try going off dairy, but once again, it only improved to a certain point. I’m taking bioceuticals intestamine to strengthen and re-build my stomach tract, and tried probiotics but they made it worse.

    My dietician has told me to drink Powerade and not to have anything cold as it will make my stomach react. But. Before she told me not to, when I got pain I would suck on ice and use a ice pack, and that stopped the pain.

    The pain isn’t the same everytime. It aches, burns, stings, like a knife stabbing me, sometimes it’s like I’m nervous (I’m defienetly not). I don’t poop daily and I feel nauseated almost every time I eat, or even drink.

    It was about 10 months ago I saw a doctor about the pain. I’ve had every test imaginable. Except a camera down my throat. One of my doctors said it’s to intrusive, but my dietician thinks it should be fine. I’m hoping if I get the camera, it will tell me the news I’ve been waiting for, but I’ve been disappointed so many times before.

    Does anyone have any ideas of what else could be going on?

    I’m not:
    Celiac
    Lactose intolerant
    Gluten intolerant
    Iron deficient
    No ulcers in my stomach
    No other allergies

  5. Hi Ashlyn. That’s an awesome guide on the low fodmap diet that you’ve created for people – very useful, thanks very much!

  6. Hi Ashlyn,
    After reading your piece on FM I thought this is exactly my thoughts, feelings and everything I have been through for the past five years. I’ve had so many tests and all the doctors keep saying to me is that I have IBS. Onions are my nemesis and I am bedridden for a week if I have them by accident. Even onion powder makes me really ill. After much research and going cold turkey with so many foods over a long period of time, I came to the conclusion that fructose is my problem. Reading your blog has confirmed it for me and I am heading to the doctors to take the breath test. Thank you so much for writing this piece as I don’t know anybody that has been through the same thing. I gave your piece to my fourteen year old to read and he said mum, it’s as if you have written this! I am going to make everyone I know read it so they can understand my situation! I have been miserable, desperate and particularly this year suffering mentally due to my symptoms and you have given me hope and an understanding to move forward. Thanks again, I am very grateful xx

  7. This post/site is such a great FM resource! Thanks for compiling everything all in one place. I was diagnosed with FM a couple of years ago.

    I was wondering if you have had much success with Kombucha? I am thinking of trying these since I haven’t found a probiotic that helps (that doesn’t contain harmful ingredients for FM sufferers).

  8. Hi Ashlyn,
    I thought your information was very helpful and insightful. I made an appointment to see a Functional Medical Doctor. In the past I’ve had problems with candida. I saw a naturopath doctor in Canada. I lived in Lubbock, Texas at the time. After I saw the doctor in Canada I came back emotionally and physically exhausted and was hospitalized for suicidal thoughts and depression. Unfortunately their is not a naturopathic doctor near me.

    I have discovered recently that I can’t digest foods like apples and pears. Grapefruit does not seem to cause problems. I suspect I have FM and Sibo. I have been concentrating on healing my gut. Does FM improve once you are able to heal your gut.

    Your struggle and personal story with FM was very encouraging and extremely helpful. I would definitely buy your recipe book. Thank you for helping so many people that are hurting and struggling emotionally due to FM.

    Sincerely,
    Guy

  9. Thank you so much for this blog! Being FM is not easy that is for sure and I am going on 10 years. I look forward to fresh ideas. I love your humour about stinking the place up. Lol 😂 FMs and their families can relate. Ha… Let’s just say I know how to clear a room. Hehehe… Thanks again!

  10. Hi Ashlyn. What a wonderful informative blog. Thank you. I was diagnosed with FM 5 years ago (hydrogen breath test) but was not given any other info by my doctor except a list of foods to avoid. No explanation of how FM works. No mention of fructose loading, so I assumed I could eat a bucket of pineapple etc. I am going to find a dietician that specialises in FM and try and get my gastric problems resolved. Look forward to your recipe e book greatly!!

  11. Hi Nancy, I’m so sorry I didn’t see this comment sooner. How is your son at the moment? This will help me form a more relevant response…

  12. Thank you! I learned a great deal from your post. I haven’t had a breath test but, now, I plan on finding one or asking my doctor if they have this test available.

  13. Hi. My son was recently diagnosed with FM and lactose intolerance and he has been on a strict FODMAP – no lactose diet for 3 weeks and is still doubled-over in pain – in bed most of the day. I suspect something else is going on, too. For those of you with fructose malabsorption – is your pain something you can live with? Does it ebb and flow? His is constant and he hasn’t been able to go to school in MONTHS. He does not have SIBO or Celiac. Signed – Desperate Mom

  14. This is so helpful! Thank you so much!

    I didn’t see it on this list, but I live in Mexico and tamarind is very common here; anything to do with it gives me the worst stomach aches. 🙁

  15. Hello Ashley,so delighted in finding your blog. I can relate to everything you have written.Dining out a disaster.So many more tasty foods that you have suggested is exciting.Agree that feeling stressed before a meal is definitely a bad combo. You are so kind and helpful in so much information you have written.A million Thankyous.

  16. Oh, dear Ashlyn! This page is a life saver! I was unexpectedly diagnosed with FM before a endoscope for an unrelated health problem. I now have a whole pinterest board dedicated to my lowFODMAP diet. The posts and recommendations are, just as you said, all different!! This is probably the best and most comprehensive explanation of FM and diet recommendations I’ve found!! I am your newest fan! In a world and internet where it is overwhelming to the newly diagnosed, thank you for taking the time to research this relatively unknown food intolerance.

  17. I am finding things getting worse as the years are going on. I now can’t seem to have anything with any sugars in. I am intolerant to preservatives and additives, so gluten free bread a no no!!! Is this normal or do I have something else wrong with th stupid gut??

  18. Wow, I’m glad i found this site was diagnosed 3 months ago and just given a piece of outdated paper with foods on to eat and avoid. Look forward to this as had many problems with my stomach in the past few years with H pylori, gluten lactose and now this fructose malabsorption. Love from Dubai UAE xxxx

  19. Hi there Greg, my apologies – I’ve fixed it up now, but it was supposed to say that SAVOY cabbage is to be avoided in amounts larger than 1/2 cup, however red and common cabbage should be tolerated quite well in abundance. Thanks for bringing this to my attention!

  20. I recently did t b e breath test and found I’m lactose. ..fructose & sorbitol intolerant… …he elp…..don’t know what to eat….what to do?

  21. Hi Ashlyn, I was diagnosed with severe Fructose Intolerance yesterday and have been lactose intolerant all my life so not adverse to living by a strict diet. The FODMAP explained to me why I could eat some foods one day without an issue and the same food the next and i would have issues. I really enjoyed your blog and have a query. I must be misreading something as I think its states that cabbage is a veggie to avoid however further down it states that you can eat both common and savoy in abundance. what am a missing ?
    Thanks Regards
    Greg

  22. Hi Joan, I only just came across this comment as I was reviewing the page – so sorry! It sounds like all your digestive issues are symptoms of a much larger problem, and hence why you’re reacting to so-called safe things like meat and veggies. Have you been to a naturopath? It’s always a controversial thing to say and I’m not qualified to give you specific advice but if I were you I’d be steering clear of western-style doctors and dietitians (since they clearly haven’t worked for you) and find a great naturopath who will try to find the root and cause of your problem, not just treat the myriad of symptoms. Also, ask the naturopath if they think water fasting would help for you (you can do your own research on this as well). Finding a great naturopath is key – ask around and do research. Hope that helps x

  23. Ashlyn…
    I would definitely be interested in your e-book. Once it’s in the making, I can let a group of fellow FMers know.

  24. Hi there! No idea how I missed this comment as it’s so large and wonderful, but sorry that I did! Your symptoms sound awful and you absolutely shouldn’t have to live like that. I’d seriously suggest finding a great naturopath who will help you understand that Frucmal and similar “intolerances” are mere symptoms of a larger problem, and that’s why it’s so hard to treat or “cure”, because everyone’s reasons behind developing it vary. When I’ve finished Uni next year and have more time on my hands, I really want to write an eBook with lots of new (strictly) low FODMAP recipes and a bit of a “how to deal” plan with helpful resources etc. Do you think you’d be interested in purchasing it if I were to do it? I need to ensure that it’s sell-able before I pour months of hard work into it haha! I’ll also be writing a blog post to gauge interest levels on this and to ask if there’s anything in particular people would like to see in it, so I’ll be very open to suggestions! Xxx

  25. Thank you for sharing your story and helpful advice. I was finally diagnosed 2 years ago with FM (and a long history of reflux and diverticulitis and all the listed problems for many years With countless gastroscopies and colonoscopies which diagnosed inflammation)and gleaned more from your site than everything else I have been told and read. That includes 2 dietitians and several doctors ( most doctors I have been to refuse to admit that FM exists)
    Sometimes I just need someone to “talk ” to about a problem without going to a dietician or being misunderstood by yet another doctor.
    Thank you for making the complex problem somewhat more simplified and humorous

  26. Hi Jacky, it sounds like your daughter’s body is completely burnt out – I doubt whether a low fructose diet alone will be the sole answer as it sounds to me like her food intolerances and leaky gut are a mere symptom of a bigger problem. Stress can wreck havoc on the entire body and especially the digestive system, and it’s a vicious cycle because the digestive system in turn when unhappy impacts hormones and other organ function – I’m sure the naturopath went through this with you? I sincerely hope you’re closer to finding an answer and getting your daughter’s health back on track. I will ask you this – before all these symptoms, was your daughter a natural stress-head, perfectionist, have a tendency to get worked up/highly strung or a poor sleeper due to restlessness/overthinking/can’t shut off? If so, I’d be looking into yoga, meditation and counselling because those personality traits (= STRESS + nervous system over-working) are a recipe for the issues you’ve mentioned above, and thus need to be addressed before her digestive issues have any chance of getting better… XXX

  27. Hi Wendy, thanks for your comments! Wow, I haven’t heard of those methods of cooking and freezing onion/garlic before – amazing! I’ll have to give it a go. Thanks again 🙂

  28. Thank you for your lovely comments, Emma! Means a lot. I hope your daughter’s body is beginning to heal. You’ve no doubt done this already, but if you haven’t, I’d recommend finding a really good naturopath who specialises in digestive disorders. They can work wonders when dietary intervention alone doesn’t fix things xxx

  29. Hi Jo, very sorry to hear that. I would highly recommend getting onto a good naturopath and dietitian. Have you tried/entertained the idea of water fasting? If not, do some research on it, it might benefit you tremendously xx

  30. Gosh thanks so much for that info Catherine, I had no idea Mintec contained sorbitol, I wouldn’t have tried it in the first place if I saw that! Can’t believe I didn’t react to it because I still react to sugar free chewy! I’ll take this recommendation off straight away. Thanks again x

  31. Hi Ashlyn,
    Love your writing style, so good to hear your perspective on this issue! I have had FM for 5 years and have been going along ok until a few months ago I started getting symptoms really badly again, and led to feeling super low. I’ve gone back to a fairly strict diet and slowly feeling better. I have lost a lot of weight though, but can’t find any info on how to gain weight – any ideas? Thanks for your great insights cheers Jo 🙂

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