IBS, Depression, and Skin Problems in Fructose Malabsorption

| 253 Comments

There is one problem with the Paleo diet for oh, about 30-50% of Europeans and maybe 15-20% of Americans – the low starch approach that encourages eating more fruit and sweet potatoes exacerbates many digestive, mood, and skin problems.

You hear about it often. “I’ve made all these positive dietary changes and suddenly I’m more sensitive to everything.” A possible reason for this might be that they have included in their diets more fresh foods that include more fructose and fructans.

What Is Fructose Malabsorption?

According to Wikipedia “Fructose malabsorption, formerly named “dietary fructose intolerance,” is a digestive disorder in which absorption of fructose is impaired by deficient fructose carriers in the small intestine’s enterocytes.”

This means that our ability to break down fructose is impaired and so fructose molecules travel down to the colon undigested. When anything makes its way down to the large intestine without first being broken down, the situation can get pretty ugly.

Many people with fructose malabsorption experience digestive troubles such as diarrhea or constipation, rashes, melancholy or anger, among others.

Symptoms

Symptoms of fructose malabsorption vary from person to person. Many of the symptoms are IBS- like symptoms and, in fact, fructose malabsorption may be one of the leading causes of irritable bowel syndrome.

  • Bloating
  • Cramping
  • Gas
  • Diarrhea
  • Constipation
  • Headaches
  • Itching and rashes
  • Acne
  • Eczema
  • Depression and low serum tryptophan concentrations
  • Carbohydrate cravings
  • Colic in babies

Testing

The test for fructose malabsorption is a simple hydrogen breath test – the same test used for lactose intolerance.

The poor man’s way to test for fructose malabsorption is by eliminating fructose and observing symptoms. This method works just as well since there are so many symptoms associated with the condition. If relief of all of these happens, you’ve figured it out.

Fructose Can Cause Depression

Surprisingly, the undigested fructose molecules in the intestine does a whole lot more damage to the body than just some annoying bloating, gas, and rashes. I mean, as if that weren’t enough, researchers have found that those free floating fructose molecules actually react chemically with tryptophan – the precursor to serotonin, one of the neurotransmitters that helps us feel happy – degrading it and lowering serum levels. Without tryptophan we feel depressed and irritable and weepy.

Researchers from the University of Innsbruck in Austria found a high correlation to depression and women with fructose malabsorption, although the same was not found in men. Another Spanish study found that 71% of the depressed adolescents they studied had sugar intolerance, compared with 15% of controls. A huge margin like this should not be overlooked.

Lactose and fructose malabsorption disorders combined were found to result in an even greater instance of depression.

Depression is more common in women with FM
We can thank Emily Deans, an MD with interests in evolutionary psychiatry, for clarifying the cause of the connection between women with fructose malabsorption and depression. Why not men she asked? The answer is because men have more tryptophan than do women.

“The researchers postulated that estrogen made the big difference. Estrogen activates an enzyme called hepatic tryptophan 2,3 dioxygenase that shifts the metabolism of tryptophan from making serotonin (happy) to making kynurenic (not happy). Women already have lower serum levels of tryptophan than men do (which may be part of the reason why we are more vulnerable to depression in the first place), so screwing up whatever available tryptophan in the diet with fructose may lead to even lower levels, and thus depression.”

Looks like if you’re a woman and you’re depressed, you had better get yourself tested for fructose malabsorption.

Safe Foods List

Not all fruits and sweeteners are created equally. Some of them have more fructose than others, and so some of them are safer than others.

Foods which can be eaten liberally:

  • Meat
  • Eggs
  • Milk – if lactose malabsorption is not also an issue
  • Yogurt
  • Cheese
  • Nuts (soaked is best for nutrition)
  • Olives
  • Leafy green vegetables
  • Broccoli
  • Lemons and limes
  • Coconut water (not milk!)
  • Butter and oils
  • Kiwi
  • Pomegranate
  • Glucose
  • Yams but NOT sweet potatoes (although yams are said to be high in anti-nutrients)
  • Plantain
  • Tapioca – same as yuca or casava
  • Potato
  • White rice

Foods to Avoid List:

Not only do fructose malabsorbers need to avoid fructose but they need to avoid something called fructans too. Fructans are long chain fructose molecules and they usually do the same damage as fructose. The amount of fructans vary in the following foods so add after eliminating all fructose and fructan containing foods, try adding some of these back one at a time and in small amounts to observe tolerance. Many of these such as coconut, onions, and wheat are quite high in fructans and usually don’t work for any of us FMs.

Fructose:

  • Most fruit juice
  • Dried fruit
  • Fruit concentrates
  • Apples
  • Pears
  • Apricots
  • Watermelon
  • Cantaloupe
  • Cherries
  • Grapes
  • Mango
  • Honey
  • Agave
  • Tomato paste
  • Corn syrup and high fructose corn syrup
  • Wine – dry wines might be ok in moderation

Fructans:

  • Wheat
  • Onions
  • Garlic
  • Leeks
  • Coconut milk and meat
  • Jerusalem artichoke
  • Asparagus
  • Chicory root

For a long list of sugar content of fruits check ThePaleoDiet.com. For the book on FODMAPs and fructose malabsorption, with a more complete list of fruits vegetables, fructose and fructans read The Complete Low FODMAP Diet.

Tips for Avoiding Fructose

The last and very important thing to know about fructose is that table sugar (sucrose) contains 50% fructose and 50% glucose. This sounds scary at first but, interestingly, glucose helps carry fructose through the intestines. So, when you eat table sugar, the glucose helps the fructose get absorbed. Since they get absorbed together, even if you don’t break down fructose, you can still absorb it aided by glucose. Now, f you eat a whole heck of a lot of sucrose, some of the fructose will probably escape down to the colon, unaided by the glucose, so don’t go overboard.

This little fact about glucose can be very useful when accidentally (or intentionally) eating something which contains a small amount of fructose. We can simultaneously eat some glucose (I use NOW brand dextrose) to avoid the ill effects of fructose. But remember, this only works in small amounts. If you decide to eat a whole entire mango, for example, adding glucose isn’t going to help you absorb that amount of fructose. As far as I know, the glucose trick does not work for fructans. You’ve just got to avoid those.

Author: Peggy the Primal Parent

The blog owner!

253 Comments

  1. Peggy,

    Thank you so much for this! It’s by far the best article on fructose malabsorption I’ve ever read. A few months ago I realized that eating fruit was the main cause of my bloating, acne, depression, awful gas, and horribly bad breath. I was pretty certain fructose malabsorption was the culprit and cut out most fruit (though oddly enough, fruits with peel-able skins don’t seem to give me as much of a problem. Like oranges, grapefruit, etc.). Unfortunately most of the symptoms persisted, though I did get a little bit of relief. Being sensitive to fructans has never occurred to me. I eat either onions or garlic almost every day. Right now I’m on the 3rd day of an all meat/offal/fat/bone broth diet (I’ve never been so not bloated in my life! It’s a wonderful relief), but when I start reintroducing more foods in a week or so I will definitely keep this post in mind. Thanks again!!!

  2. Hi Peggy,

    I’m glad you did this post, because it seems that all sorts of gut dysbiosis problems seem to accompany the Paleo diet. I’m very happy you and Evelyn have figured out your problem!

    For others with no such luck, however, I cannot recommend the book Gut and Psychology Syndrome more. If you’re cycling allergies and intolerances, bloated and miserable, or know already that your gut flora is out of balance, eliminating fructose isn’t always enough. Sometimes it can accompany, and even cover up, other problems with malabsorption.

    You say you were concerned that you might have passed on your bad microbial environment to her, and that’s possible. But it is far from irreparable! I sound like an advertisement, I know, but I have found major success on the GAPS diet (even relief from celiac) and would very much like to see your thoughts on it, if you have time to read it.

    Yes, yes… tl;dr. Thanks!

    • Jade,

      I tried specific carbohydrate and candida diets for a long long time years ago. For me it was the other way around. Candida diets and specific carbohydrate diets did nothing for me. Indeed, I agree that is a another source of trouble for people and they should investigate that too. Fructose malabsorption is a lesser known issue than specific carbohydrate and candida diets so I thought it deserved some exposure.

  3. Interesting post. My husband has celiac and we suspect he may also have fructose malabsorption. He was tested for it, so we’re just waiting for the results. The change in diet has helped a bit it seems. Our daughter, who is not yet two, follows a more-or-less paleo (at minimum gluten-free) diet with me. Food for thought, as you say. I’ll be keeping an eye out with her.

  4. Wow, I can’t believe garlic and onions are on the list!!! I have eaten an all-meat diet and STILL didn’t know why I felt like crap. I must try eliminating the garlic and onions. Thank you for your very informative post!

  5. Are the symptoms the same for kiddos as they are for adults? Did you notice Evelyn craving fruit in abundance at times then being nearly incosolable? I’m trying to help my daughter (1.5) who is a VERY fit kid but has a very round belly. I wonder at times if it is bloating or normal for an otherwise lean child to have such a round belly (she looks like the first pic of Evelyn almost all the time but, then again, she is a toddler…). I’m not sure if I am overreacting or not, any thoughts?

    • Dawn, try everything. Bloating isn’t normal. I too didn’t know what to make of my little toddler with the big belly. But it just went on and on and other kids didn’t have it. Evelyn also had gas and smelly feet. She did crave fruit quite a bit over the years but then she also didn’t eat grains usually so it could have just been a need for carbs so it’s kind of hard to say. Evelyn was always a really easy kid. Even when she clearly felt horrible, she wasn’t much of a fighter. (Except when we went to Colombia for a month and she practically lived on wheat. OMG that was horrible!)

      • Neither is B (a fighter). She is usually really easy going unless she is teething (and right now she is entering into the peak of the sensitive period for order aka the terrible twos). I’m going to try limiting her fruit I think (maybe a week without any since she would lvoe to be a fruitarian) and see if her symptoms reduce. We already eat very little to no gluten containing foods and limit dairy to fermented kinds. IDK. Thanks for your info though! I had pondered whether or not she could have this issue when she was younger and I was looking into the cause for all of her food intollerances so it may be time to try again.

        • I have a 2 year old daughter that not only LOVES fruit… she LOVES FOOD! She can out eat anyone. She has had issues with food from the get go… excessive spit ups, diaper rash, etc… In the process of getting my health coach certification, I learned about fructose malabsorption.. and realized that was the cause of my IBS symptoms and depression. The cleaner my diet became, it seemed like I became more sensitive to fructose. I would literally turn into a B***c within an hour or two after eating too much fructose or fructans. I learned that most of the time, the apple doesn’t fall from the tree, so I started to pay attention to my daughter’s diet. I noticed her moods changing after eating things like apple pieces or applesauce (loaded with fructose). We have given up gluten and most foods containing fructose. I keep my eye on her moods, but sometimes it is hard to tell if it is the foods or her just being two that causes her moods to change. I HATE food diaries with a passion, but I have started one to help me keep track of what she is eating and her moods and physical reactions. This is helping. I have noticed that eliminating her one cup of milk in the morning seems to help as well. I just want you to know that you are not alone. It is so hard when they can’t tell you how they feel and when some reactions can take up to 48 hours! Please keep us updated. We could learn from each other!

  6. Hmmm. I think I’ll be eliminating onions and garlic starting now.

    • You know, this may be the issue I’m dealing with too. I notice that things like, say, cornstarch in advil or the erythitol that is mixed in toothpaste make me awful bloated and constipated, and really only a meat and fats diet is tolerable… but I’ve never been one for sweets that were not fructose (or other ingredients listed in the “nos” area)-based. I always thought I just had a million allergies– but maybe I just have one rather encompassing one. This would be a very liberating thought– instead of tracking what I CAN’T have, to simply knowing fructose/fructans are the culprit and learnng what I CAN have. what a nice mind game, too.

  7. Would you consider extra virgin olive oil safe? I usually cook my meat in ghee and sprinkle liberal amount of garlic and onion powder! :-/

  8. I’m so grateful for this blog Peggy, you have really opened my eyes to the fact that one solution does not fit all even when it comes to healthy diets and living. I would never have considered before that someone could be allergic/sensitive to seemingly innocuous fruits and veg, and therefore doing themselves more damage by eating them. You really give another perspective on it and have given me cause for more thinking and experimentation for my own problems. I’m definitely going to have an IgG test in the future now – I probably should have had one a long time ago.

    Thanks for all the insight you post!

    • You’re welcome Lora! It still baffles too me how something so perfect as a simple fruit or a vegetable could be harmful. I am sure this is the result of a body gone wrong due to generations of bad diet both affecting our genes and our microbial environment. Once we’ve gotten to such a bad place, solving the problem isn’t simple. Simply eliminating all unnatural foods and toxins, and eating and living very cleanly, didn’t do the trick for me and many others. It’s sad to say, but for many of us the road to optimum health isn’t quite so simple. Thank god for blogs right? All of the people experimenting both on themselves and in labs and publishing it are helping those of us who are willing to persevere get out of this mess!

      • Dear Peggy,

        I suspect that celiac is often a cause of FM due to damaged villi, though I am sure other things can cause it also such as a severe parasite or bacterial infection in the small bowel where fructose is absorbed.

        It could also simply be due genetic variation through the medical community says it is not. I am not convinced, as it does seem to run in families (based on the people I have talked with who have it).

        I have had problems with fructose my whole life though I did not know it, and it got considerably worse after I became a vegan and started to overload my body with fructose.

        Like you and others who have commented here, I also seemed to be allergic to everything under the sun, but practically everything on a vegan diet has loads of fructose.

        I am now eating a diet of rice and leafy greens and have no bloating, no low blood, sugar, no irritibility, no aggitation, no impatience, no brain fog, etc.

        I cannot believe the answer was so simple and yet none of the doctors I have consulted over the years ever came even remotely close to implicating fructose as the main culprit in all of my problems with food.

        I am very grateful to finally have this knowledge, but it would have been nice if I did not have to suffer for 25 years before figuring it out.

        Your daughter is very, very fortunate to know what she needs to avoid to feel good as such a young age, and she is blessed to have a mother who kept searching.

        I am still not sure if I have FM or HFI (Hereditary Fructose Intolerance) or a combination of both, as my tolerance for fructose is extremely low (much lower than what most FM-ers can eat, but not quite as limited as what HFI-ers can tolerate which is less than 2 gm of fructose per day without symptoms).

        I have been tested for HFI, but am still awaiting the results. I may have one copy of the HFI gene in combination with FM due to celiac and/or a hookworm infection that went undiagnosed for 18 years). But, either way, I feel so much better since eliminating most all fructose from my diet that I don’t really care what the test shows at this point.

        I am glad that you found the information I posted to be helpful.

        Blessings, Esmée

        • Sorry about the typos. I don’t see a way to edit my reply.

        • I don’t know Esmee. My daughter doesn’t have damaged villi (unless she was born with a defect!) and she cannot tolerate fructose. She has also never had HFCS, she didn’t eat any grains until she was 2 and then only white rice, she was breastfed for 1 1/2 years, didn’t eat sugar until she was 3, etc etc. So why can’t she absorb fructose? I don’t know the answer. I don’t presume to know the cause. I am sure there is a reason but I don’t know it.

          Likewise, my small intestines have not seen gluten in over 7 years. So why am I still so incredibly unable to absorb fructose? For me you would think that a lifetime of malnutrition, anti-biotics, sugar, bla bla bla did some serious, maybe permanent damage. But then, what about Evelyn? Maybe we actually have HFI and don’t even know it!

          • I completely agree with you. That is why I say that I am NOT convinced that there is no genetic component to fructose malabsorption. It may be that people with FM are more susceptible to other gut problems like disbiosis and parasite infections BECAUSE the fructose they are ingesting is creating an evironment which is conducive to these critters. I definitely do not presume to know the all the whys and wheretofores of the problem, so I appologise if I came across that way. I was just throughing out ideas.

            By the way, there is something wrong with the way your blog notifies followers by email of new comments. When I click on the link provided in the email message, it tells me that the link no longer exists, and then I have to search around your site to find the original post and then the new comment. I am not sure it is something you can fix, but it is a serious pain in the patuka. :oP

            • Oh no offense taken at all! We are all speculating about the causes. It’s not that I don’t think celiac could be a cause for some people, as it clearly disrupts the microbial environment and damages intestinal tissue. So celiacs may suffer from it more than others but is that the ultimate cause? Anyway, speculating in comments often is dry and cold so no worries. :)

              FM could certainly be the cause of other digestive ills, though, as you say, because of an overgrowth of pathogens eating up the undigested fructose. Maybe FM is responsible for celiac!

              Maybe FM is actually a natural advantage since it presumably would keep people from eating too much fruit, hence protecting their livers.

              Sometimes I think it is silly just how much doctors and scientists presume to know. Look at it from another angle and you get a totally different answer.

              (I will see if I can figure out what is going on with the comment emails. Thanks for letting me know!)

              • I do wonder about worms and other flora switching to living off of fructose and fructans when other food sources are no longer available. As gut flora is passed from parent to children, it makes sense.

                That being said – I wonder about the various genetic components, that can affect one’s predisposition toward these types of issues.

                I’m going to try a more FM diet with my DD, as I’ve wondered about FODMAPS for quite some time. Hopefully with GAPS we will heal the issues and she’ll be able to have fruit someday!

          • If she had any antibiotics before the age of three, that can result in the gut flora not developing and can cause these same issues. That is what happened to me, and food is difficult. Something to consider.

  9. So no garlic or onion as seasoning? What about garlic or onion powder? I tend to use a lot of chopped garlic (usually jarred in water) when cooking. I do notice I am more bloated when I eat a lot of fruit. I might have to look into this.

  10. I need a garlic/ onion replacement! I don’t function well without them!

    • I have tested positive for FM. I bought the only two books on the topic I could find. I read everything on the internet I could find and my doctor sent me to a registered dietician. I learned that you can cook with onions. They should be whole or in large enough sections to pull out. Then your food has the flavor but you do not digest the onions.

      When the breath test is given you get a number. Mine was very high, significantly higher than any patient that had been tested in that office. (three months ago) So I went on an elimination diet and only add one food every two weeks. I haven’t tried cooking with onion in this way yet, so I can’t tell you how it worked for me. I know I wouldn’t be able to tolerate onion or garlic powder.

    • Some people don’t eat onion and garlic for religious reasons. They use a plant with similar taste. It’s called asafoetida. I’ve no idea if it’s good for people with FM, but it’s known for reducing flatulence and stomach pain. Check this:
      http://en.wikipedia.org/wiki/Asafoetida

  11. Emily and Corey,

    I wish I could say garlic and onion powder are ok! Try them out and see how you do with them. They may be ok for you in small amounts.

    I quit eating garlic and onion powder about six months ago. It’s a sad thing but at least my tummy is happier!

  12. I’ve been on quite the food journey for two years now. Really just cutting out a lot of processed/junk foods (because I thought that was the key to being healthy). But over the last six months, it’s taken a more serious turn and I’ve realized just how crucial GOOD food is for our bodies. My eyes have been opened to the dangers of too many grains, wheat, etc. Even like you mentioned, fruits can turn on us if our bodies can’t handle them. It’s a day-by-day experiment.

    My issue is bloating. Just bloating. I don’t have any other symptoms listed above, but that is one I can’t seem to get past. Some days are better than others, but my average weight is around 112 (I’m 5’2 and it took me forever to get over 100lbs) yet over the last six-eight months, I’ve slowly gained 7 pounds. It’s a little odd to see such a high number (for me, please keep that in mind) on the scale. I believe some of it is due to the exercising I’ve been doing regularly, so there’s muscle build up, but it seems to have all gone to my stomach. No where else. And it makes me self conscious because I’m so thin every where else. (I mean, it didn’t even go to my boobs, which would’ve been nice!)

    So I’ve slowly been cutting things out to see if I can figure out what’s causing the bloating. Although there is definitely a layer of fat around my middle, the bloat is there too and I’m so tired of it. Any suggestions would mean so much! This blog is so inspiring and I love your posts!

    • Thanks Meghan! I know what you mean. Bloating was one of the few remaining symptoms I had for a long time too. If you’ve been there, severely bloated day after day, you know how frustrating and embarrassing it is. You feel like you just look ridiculous no matter how great the rest of you looks. And that’s aside from how icky it feels physically! I should do another whole post just on bloating. There are so many possible causes for it – fructose malabsorption being one of them. But then there is celiac, yeast overgrowth, processed foods, gut pathogens. Try eliminating the fructose and fructans and see if that helps. I’m curious, though, about your diet. If you also have a lot of belly fat, you might be secreting too much cortisol and insulin. This would definitely happen if you had FM or for various other reasons.

      • Hi Peggy! Thanks for your quick response. Yes, bloating is extremely frustrating and embarrassing. I don’t know what you would consider “a lot” of belly fat – to me, it’s a lot. But my friends don’t even notice. The few times I’ve mentioned how I’ve put on a little weight around the middle, they don’t believe me and tell me I’m crazy. My husband has never mentioned it and when I do, he also looks at me like I’m crazy. But going up a pants size and not seeing abs anymore (plus the roll I have when I sit) tells me things have changed. Not to mention the scale. I’d say I probably gained around 3-4 inches. Yet I wear a size 4/small in all pants/shorts. So hopefully this gives you an idea of what I’m dealing with. I can hide it pretty well, but it’s definitely there and it’s definitely time for it to LEAVE. :) I was diagnosed with an insulin issue last fall…. I basically need to eat every few hours (lots of protein) to keep things balanced. But as I’ve been experimenting, I’ve found that by cutting out what I call “fillers” (breads, crackers, chips, etc, even if they’re organic does not mean they are healthy!) and incorporating more nutritious foods (veggies, meats, cheese, etc) I not only stay full longer, but CRAVE those yummy foods.

        Reading your blog provides so much encouragement. I know you are cutting back, but just know you’ve reached a lot of people with your words and journey!

  13. Hey Peggy,
    Your determination to feel better is inspiring. You have been helping me narrow down my problems. I was looking around for fructose malabsorbtion “good and bad” food lists that might be more comprehensive, but I have noticed there’s a lot of contradictions. Like, some places say yogurt is okay…while others say it’s not. I’m actually confused now. How did you come up with your list? Also, are you eating any of the grains that don’t contain fructose…oats, rye, quinoa, amaranth….I’m just really confused. Here is where I looked:

    http://webcache.googleusercontent.com/search?q=cache:pXTdzu6Pj_gJ:sacfs.asn.au/download/SueShepherd_sarticle.pdf+fructose+malabsorption+food&hl=en&ct=clnk&cd=6&gl=ca&client=firefox-a

    • Ashton, when I first heard of it I too searched around for safe lists and bad lists. Many of the foods I found seemed contradictory too and that had me stabbing around in the dark for a while. The paper you posted is interesting – I haven’t read the whole thing – but notice how this, “a list of poten- tially problematic foods was compiled. These were basedon arbitrary cutoff values for the fructose and fructancontent of individual foods and were defined as: (a) foodsthat have naturally occurring free fructose in excess ofglucose (0.5 g/100 g); (b) a fructose load of more than 3 gin an average serving quantity of the food or beverage;and (c) substantial food sources of fructans (0.5 g/serv-ing)”

      So, while a certain fruit may be on their ok list, it could only be eaten as a single serving and not in the presence of any other fructose or fructan containing food. I think lists like this are really helpful for people who are either not as sensitive as others (maybe haven’t endured much leaky gut?) and/or for children. I don’t personally eat pineapple, for example, but Evelyn does. I’m pretty freaked out about fructose all together but she tolerates a very small serving of these safe foods at a time.

      The list you see on my website was a process. I’ve seen this type of list before like the one you posted and I chose to go off of that more than some of the other web lists. The reason being that they actually are reporting the fruits based on laboratory observed fructose/glucose content. Sorbitol, though, can be hard for some people to digest so they noted it, which is helpful.

      Anyway, the list you found is a decent one. Just don’t exceed a single serving of any fructose containing food at a time.

    • Here is a good resource for foods and a community to share experiences and ask questions. Charlie is the moderator and is very nice.

      http://fructosemalabsorb.proboards.com/index.cgi?board=ingredients&action=display&thread=4

      I do think different people have different tolerance levels and just because one food work for someone else does not mean that that same food will work for you. If in doubt leave it out.

  14. Also, I looked at some sites that sell the breath test. Most say they will only sell through physicians. And they are upwards of 300 dollars. Have you done the test? Do you know of any that are under 100 dollars?

    Do you think that leaky gut syndrome can happen simueltaneously with fructose malabsorbtion? This process is definately trial and error-very frusterating as you know. :(

    • Personally, I haven’t seen any breath tests that you can do at home. You’d have to go to an MD, nutritionist, or ND for the test.

      Trial and error for FM is kind of part of the game unfortunately. Everyone reacts to varying degrees. So even after you get an affirmative result, you will want to test out your limits with some of the safe fruits and fructan containing foods.

    • INSURANCE PAYS FOR THE TEST IF DONE

  15. OMG!
    Peggy, thank you so much! You might have just solved the mystery I have been trying to solve for about a year now. I went paleo (well, primal, really, since I eat high fat grass fed and fermented dairy)about two years ago after figuring out I had a huge gluten issue. But I keep having a somewhat gluten-like reaction to seemingly innocuous foods I ingest (mostly, made at home from scratch as I don’t eat out much due to my severe gluten intolerance). Some of the foods on the “avoid” list I already figured out I had a problem with although I never knew why. This really truly makes perfect sense, so I am going to give this a good try. THANK YOU!!!

  16. Thanks for the post, you’ve given me something to think about. I have been paleo for a year but I actually developed skin problems on paleo. I’m trying to figure out why. I had been trying the Specific Carbohydrate Diet but haven’t seen improvement yet. I’ve seen all kinds of theories as well, like not eating acidic foods and such. Sometimes I do get random unexplained bloating when I know I haven’t had gluten. I will pay more attention to what I’m eating when this happens.

  17. Ah Peggy…if only I could recoup all my co-pays and put it all right in your tip jar! Shit! Since you wrote this post, I cut out all fructose and feel AMAZING. Fruit has NEVER sat well with me and yet recently, I’ve needed more carbs after a grueling circus workout. I added more fruit. These little niggling things came back…nothing major…but still. This week has been amazing. Unfortunately, I just now read the comments and have some grass fed meatballs in the oven…with garlic and onion! Guess at least I have a clean system to test them out.
    When is your damn book coming out??? The world needs you in print.

    • You’re so sweet Jamie! Now would definitely be a good time to test out the garlic and onions on yourself while you’re feeling great (so sad if it doesn’t go over well), though sometimes onions will be problematic and not garlic so, the test may not be entirely accurate. ;)

      Guess what, I’ve completely finished writing the book! As of this weekend. Super cool feeling. So now I’m going to take a reading break for a couple of weeks and then start on the first and biggest round of revision. Then, off to the publisher for editing! It’s a coming…

  18. This post really has me thinking. Since going paleo, I too am waiting for some of my symptoms to go away, the way they have for so many others. Acne, for sure is one of them, as well as depression. Depression is better – by far – but it still lurks and I feel like I need to keep digging to figure out why. I wouldn’t be at all shocked if this issue affects me. I already know that I have a crazy sensitivity to sweets. This could also affect my daughter as well, who has the bloating thing so bad I’ve actually brought her to the doctor thinking something horrible was going on in her little digestive track. Well, maybe something is.
    Giving up the fruits will be ok, same with sweet potato (sigh, where the heck am I going to find yams??). What amazes me are the veggies and coconut milk. That is going to be very hard for me. I eat onions so much (and adore asparagus) – it will be a big adjustment to try eliminating all this.
    Thanks for posting this, and although it will be a little challenging, I really am going to give this a shot to see if myself and/or my daughter sees improvements. I’m sure if we do, we won’t be missing the onions and asparagus so much anymore.
    One big question for you: Is coconut oil out? I’d hate to keep using it when I should have stopped it as well. Thanks!

    • Casey,

      I found this list of foods quite helpful:

      http://www.ibsgroup.org/forums/topic/138274-printable-fodmap-diet-chart-for-your-convenience/

      It seems to be more accurate than TheFartingPear.com

      I love onions too, but they steadily bloat me if I eat them. It’s not horrible at first, but cumulative effects really cause problems for me. I used to like asparagus until I had a really bad experience a few months ago after eating it, so now I have an aversion.

      The list thinks sweet potatoes are okay. So is a small amount of fruit. Apparently, as long as at least 50% of the sugar is glucose/dextrose, then the fructose won’t reach your colon. I haven’t experimented much with fruit yet, but I plan too. I’m not crazy about fruit, so I feel no rush to do so. I am looking to add more safe starch to my diet such as yams to provide fuel for the good bacteria in my gut. I don’t want any sugar alcohols, inulin or FOS/MOS (prebiotics) as they bloat me like crazy. I found yams (several varieties) in a local Asian market. Yams are in the oven and will be dinner soon. I’ll take several strains of probiotics when I eat the yams.

      Good luck!

  19. Oh, I wanted to also say – your daughter is beautiful!

    • Casey, GREAT question about the coconut oil, like you, I am curious about what Peggy thinks about coconut oil. In my experience, I have NO trouble with coconut oil at all but cannot tolerate coconut milk/ meat. Really interesting, until now, could not figure out what the deal was.

      And, Peggy, I am really curious about a couple more things: apples and cherries are on the “avoid” list but I have observed that I have no issues with heirloom “old world” (typically pretty sour) apples only available from a small handful of farmers and morello tart cherries (the ones usually used in various concoctions but I just love them straight fresh when seasonal). Yet, I do not tolerate sweet apples (the ones you can get from grocery store) and “normal” (bing, etc.) cherries. Does this make any sense?

      Thank you!!

      Thanks!!!

      • Julia,

        It’s funny how far experimentation takes us and then leaves us so utterly confused. It was the same with me about the coconut oil/milk. I couldn’t figure out for the life of me why pure coconut would affect me (not the guar gum from the canned milk) and not the oil. Mystery solved thank goodness.

        Anyway, I would imagine that the fructose/glucose ratio actually varies from apple to apple but who’s going to test all the hundreds of varieties of apples out there? In addition to that, you’re dealing with much less total sugar content in your heirloom apples (yum) so there isn’t as much fructose that can cause a problem to begin with. If you digest them fine then continue eating them!

        • I can have juice made with celery and green granny smith apple, but no other apple can I get near.

        • Do you consume coconut butter or does that have fructose too?

          • I don’t know about coconut butter. I would guess that has coconut particulate in it. But coconut oil is fine! And just to clarify, it’s not that coconut meat has fructose. It has fructans.

            • Dear Lizzie and Peggy, I have found that coconut butter (is it the same as cream-coconut?) affects me terribly while coconut oil is totally fine (and I love it!). The butter though, whether cooked or eaten just like that by small chunks at a time (it’s delicious to my taste, so it was a sad discovery lol) left me bloated for hours, if not days and caused cramps and other issues.

    • Casey, thank you! Eliminating fructose is a little daunting at first, but once you get the hang of it, it’s alright.

      Coconut oil is fine. As long as it is pure oil and not “coconut butter”, it shouldn’t hurt you and is really quite beneficial as I’m sure you know. My daughter and I eat it with no problem.

  20. Julia, now that you mention it, I have the same thing – tart cherries and some apples are ok, but the stuff from the store is brutal. Weird.

    I also cannot tolerate coconut milk. Every time I would try to make coconut curry I would take just a few bites and then get so bloated I just didn’t want to put any more in my mouth. For some reason I kept thinking it had to do with th taste, even though I love the flavour of coconut and the same ingredients used to make curry based on heavy cream would go down just fine!

    Has anyone else noticed this tendency in themselves – confusing a vague feeling of dislike for a certain food/dish as based on flavour when it actually comes back to a negative physical sensation like bloating?

    I think I’m ok with fresh coconut meat, but I will have to test it. The oil is definitely fine.

    The onion thing I figured out a while ago. The single worst combo is wheat + raw onion. Immediate, horrible heartburn/bloating/nausea. Actually, I’ve found that as long as I practice total raw onion avoidance my wheat tolerance goes up considerably.

    OH! Here’s a major mystery I’ve got, and I’m curious if anyone else has the same thing: I find I can occasionally tolerate some freshly baked sourdough with only the mildest symptoms, barely any bloating. The next day though, that same bread will give me *horrible* bloating/nausea/heartburn/digestive upset, and it will get worse each subsequent day that I try to eat the bread. Why on earth would this happen?? The only thing I know of happening as the bread stales is that the starch retrogrades, but I have no idea how that could produce this sort of effect!

    • Alexandra,

      I don’t touch bread or gluten so I haven’t observed this bread effect myself.

      But what you said about coconut milk and curry I can relate to. I have found myself turned off by the taste of coconut many times yet at other times, I love the smell. I thought it was pretty weird too for the longest time but now I attribute it to my reaction to the meat and milk. As long as I’m not reacting to it, the smell doesn’t bother me. I don’t like the smell of bananas much either and I am allergic to them. But then I am also allergic to rice and have celiac disease but think the smell of a pot of rice cooking or a loaf of bread baking is divine. Go figure. :)

    • Alexanra,

      This is SO cool! While I have no interest in reintroducing gluten back into my life, this (your experience after avoiding onions re: tolerating wheat better) gives hope. I just would love to be a bit more “relaxed” about wheat when dining out on occasion (talking about trace amounts) as, right now, I am super paranoid as getting any gluten exposure for me is super bad. But, until now, I had NO idea about the whole FM deal.

      And while I am no Tom Ferris:-), I might try to experiment with sourdough after I feel awesome again after giving the FM diet enough time just to play with this as this is truly fascinating.

      This is simply HUGE. Peggy, hats off to you again! I would have NEVER found this information otherwise.
      It is QUITE possible that my wheat intolerance is actually due to FM and NOT gluten intolerance per se (I never tested as the idea of ingesting gluten in order to test medically was pretty awful and I have no interest in going that route).

      Alexandra, your experience with not tolerating same sourdough the following day after the previous somewhat “benign” exposure makes sense. Your body produces a whole bunch of digestive enzymes designed to digest food. The less favorable the food is to your body, the harder your body has to work and the more of the enzymes will be used to digest it, whenever possible. It sounds like your body does a great job on getting that sourdough stuff in but it probably gets pretty taxed in the process. Which means it uses up a lot of your digestive enzymes on that 1st exposure and likely needs time to “manufacture” them again. Which means that the next day exposure is just way too soon and your body is defenseless against that same sourdough it dealt with o.k. the previous day. Makes sense?
      As to new vs. old wheat, this is a great article:
      http://www.huffingtonpost.com/mobileweb/2012/02/18/wheat-gluten_n_1274872.html

      • Julia, I know what you mean about wanting to be a bit more relaxed about occasional exposure. For me it’s in large part because I hate the ‘gluten-free alternatives’. They still makes me feel crappy (sometimes worse!) and they don’t taste as good. I’d rather just have the real thing very occasionally than let myself have ‘safe’ alternative treats more often. Besides, there’s nothing good about the unfermented legume flours, excess amounts of sugar, and other crap that’s to be found in the replacements.

        Anyway, I have gone for long stretches of flat-out gluten avoidance and would still get digestive and other issues. Less often, but enough to make me wonder if there are other food I’m reacting to. Peggy’s list is very helpful because every time I’ve searched on FM in the past there would be so much incomplete and conflicting info that I’d get annoyed and decide to just experiment and try to identify things by myself, but there are just SO MANY foods that it’s very hard to keep track of everything in your mind. This way I have a solid list to work back against.

        Also, for those of you now suspecting FM and looking to cut some of these foods out, I have also observed that an overdose of red wine has a similar effect AND, what’s worse, makes me much more sensitive to all these foods for a long period of time (1-2 months!). I haven’t been able to determine whether just a glass of red wine has any negative effect, but I do know that I feel better overall if I avoid it, so I just try to do that. (no such issue with distilled liquor so it’s definitely something in the wine. I had always thought that the amount of fructose left over in wine is pretty negligible, but maybe not)

        • Alexandra,

          We MUST be twins:-)! It is exactly the same story for me with red wine. I don’t avoid it as I love my red wine and (very dark) chocolate together but I have to be very careful as well.

          • Me too with the red wine! In fact, that was supposed to go up on the avoid list. I must have forgotten it. Oops. Very dry wines can be ok but wines that are even a little bit sweet are seriously problematic. I have always noticed that vodka works just fine but wine, while I love it, makes me ill. It always seemed odd to me though that sometimes I was fine with wine, other times it seemed to totally ruin my life. Now I know it has to do with the sugar content…

            • Do you mean like the difference between dry and extra-dry? I have noticed that most California and Australia wines, which tend to be ‘jammy’, affect me more, but I always assumed that it had something to do with sulfite concentration, although I don’t actually know if they have more.

              • Oh my goodness so did I! Sulfites, salicilates, on and on. Most wine bottles don’t specify if it’s dry or extra dry so I’m not entirely sure how you’re supposed to be super safe about this. Maybe a wine expert will drop by the site sometime and explain. Maybe we could head out to Napa Valley and discuss it with the experts over a really nice weekend! :D

                • Haha, really nice as long as we aren’t being fed fruit and problematic wine!

                  I guess I’m lucky because the liquor control board here in Ontario has good labelling, so it says on each label in-store whether it’s extra dry, dry or otherwise, sometimes even giving values (1-3 for dry and higher for others). Actually, they label it on the website as well, so you could always check there. The only issue is that it depends on what they’re stocking at the moment, but it’s worth a look anyway.
                  http://lcbo.com/lcbo-ear/jsp/ProductSearchNonVintages.jsp?language=EN

                  I also found an interesting blog post by a Sonoma winemaker who insists it’s NOT sulfites.

                  http://westwoodwine.com/blog/2006/07/sulfites-or-why-do-i-have-headache.html

                  • I am seriously just digging this. FINALLY something to tell me it is not all in my head:-).
                    I have trouble with California reds but have no issue with Oregon Pinot Noir and Italian or French red wines.

                  • Thank you so much for posting that…because then I had to sneak over and give him updated information, LOL. He’s a bit out of date on the whole idea that anaphylaxis is the only reaction to sulfites – it’s not even the most common one, just the most noticeable.

  21. Accumulative effect. Common with gluten intolerances.

  22. The bacteria that ferment the starch in the sourdough process break down parts of the gliadin/gluten proteins to the point where some Celiac’s can tolerate it. A small study was done in Italy with some Celiac patients. They could tolerate sourdough bread, but not regular bread.

    Still with all the potential immunologic problems that can develop from sensitivity/intolerance to wheat/gluten, its really not worth the future heartache to eat the stuff.

    • I’m talking about the exact same loaf of bread a day later. This happens with sourdough to the same degree as any other bread.

      I agree that wheat is still not worth eating in terms of protection for the future, but once in a while the cultural roots pull hard enough that I give it a try again. Maybe occasional use has a hormetic effect? Haha, not in this case I think.

      I am curious though about the positive health that Weston Price found in some whole wheat eating cultures. Can screwing with a plant’s genes really make that much of a difference?

      • Out of curiosity, have you tired eating some fresh sour dough one day and then eating from a totally different loaf the next day and the next? If you didn’t experience any problems this way then I too would wonder if there were something happening to the digestibility of the bread over time. Although, I don’t know what.

        • I have done that, and it’s fine! I feel shitty in other ways if I eat it too much/often but if only eat, say, a slice of same-day baked artisanal bread day after day I feel pretty decent. So it definitely has something to do with a change in the bread itself. It’s quite a mystery to me.

          • I should add, this is not wheat specific. It happens with all-spelt and all-kamut loaves as well. Probably rye too, but I couldn’t tell because rye messes me up very badly even freshly baked.

    • After reading that article, I decided to test myself (a confirmed celiac through intestinal biopsy). I had not eaten any wheat for over 15 years at the time of my experiment. I have now say that souring the dough did not make it any more compatible for me than not souring the dough. I still became enormously bloated and broke out in DH lesions in less than 24 hours which took a full week to go away. I was very sick for 3 dyas, and I did not feel right for almost 2 weeks after eating the sour dough bread. I don’t recommend others to try this experiment.

  23. I have the same problem, not officially diagnosed with gluten intolerance but I know I can’t handle it. A tiny bit is ok every now and then, but once it builds up I have problems. Stomach pain, gas, and bloating, and the worst is headaches and muscle knots. Check out the book “Wheat Belly,” it’s very eye-opening about the GMO wheat and consumption in America!

  24. Great post Peg, but any thoughts on the root cause and cure, beyond simply gut dysbiosis and avoidance of certain foods?

    I have had a similar journey, and found significant improvement, but not total relief, on a whole foods paleo like diet. However, I too have fructose malabsorption and what I believe are linger related health issues (e.g., intermittent impaired sleep, exercise recovery, and executive function).

    I have been searching, researching, experimenting for 3+ years to no avail. In my mind, the fructose malabsorption, and my linger health issues, are just symptoms of an underlying and yet to be identified problem. Perhaps it is wishful thinking, but remain optimistic that I might one day identify and resolve it.

    Any thoughts or comments would be greatly appreciated!!

    • Steve,

      I absolutely believe there is a root cause of all of these problems like celiac, fructose malabsorption, etc. It may be that humans aren’t meant to over eat the stuff to begin with and when they do they show signs of malfunction. In a wild setting, where food choices are more limited, discovery of these intolerances would be simple. You’re only eating a handful of foods to begin with, eliminating a few things here and there until you narrow it down would be easy. Not to mention there is wisdom in the generations which is never lost.

      I believe it is only the complexity of our diets and environment which make all of this testing necessary; we can’t solve the problems on our own anymore.

      Now, on the contrary, it may not be natural at all to develop intolerances (though it makes sense to me that it is perfectly natural when one overconsumes a food which is not ideal for humans). But maybe we are supremely adaptable to our environments and can tolerate just about any reasonable hunter gatherer diet. If this is true then I am guessing it is the damage done to our genes both in utero and after, which sets us up for trouble and weakens our bodies to the degree that healing may be elusive. For example, you have a mother who eats garbage, her mother ate garbage, she feeds you garbage (if not formula), gives you NSAIDS and anti-biotics every time you’re somewhat ill, you play with lead toys, drink out of BPA containers, and the list goes on, you’re going to have challenges.

      Not only do these factors weaken your immune system and change the course of your growth as a child, but your genes are not adequately methylated (i.e. your genes are essentially sick and you are more susceptible to developing the countless ills inside your genes).

      So, can we ever figure out a way to repair, on the deepest level, the damage that was done to us throughout the course of our lifetimes? Maybe we can. We absolutely can re-methylate our genes. Our bodies want to give us another chance. But reprogramming takes time and it takes adherence to a very clean diet and lifestyle. I’m giving it a shot. Over the last 7 years since going Paleo I have changed so dramatically, it’s really hard to believe. My body has healed beyond my expectations. And I am still going at it too. We’ll see how far my efforts can take me in the end, how much of it just isn’t reversible, and how much of it is just the way nature wants us to be.

      • That’s very inspiring Peggy. Before I found your blog, about half a year or so ago, I was starting to feel hopeless with the whole diet thing. Paleo helped but not enough, and I was very confused about it. Now whenever I feel overwhelmed with the task of figuring out these myriad reactions and resolving lingering health problems I come here and read some of your posts about successful resolutions you’ve had with your health.

        It’s very supportive to know that someone else has been able to do it, especially starting out with even more symptoms than me. You also opened my eyes to the fact that it really could be *anything*, not just the well-known major offenders like grains and PUFAs.

        Of course, it’s still a loooong journey of experimentation, but when you write things like that above I feel bouyed by the hope that resolution *is* possible. :)

        Sorry for the sappiness there, but it’s true!

        • Don’t apologize! Why else would I be doing this if not to give some aid and consolation to people searching for it! It is nice to be reassured that I can make some difference in other people’s lives based on the experience of my own successes and failure. Thank you!

      • Our early human ancestors absolutely did NOT eat a diet with much fructose. It was a VERY ocassional food (like when they raided a bee hive or found a berry bush) and it was very seasonally limited. Most of the researchers in this field (especially Dr. Robert Lustig, Dr. Richard Johnson, and Dr. Frank Lyons) recommend limiting fructose intake to 15-30 gms a day. Most people today eat over 100 gms day in and day out which is completely not in alignment with our ancestral diets. Never has fruit been available year-round from every part of the globe until very very recently.

    • Steve, I have the same feeling, that it must be some solvable problem and all the minor symptoms (I hve similar lingering health issues) and observed reactions to various foods are not causes, but effects of the greater problem. But I have also failed to identify what it is, and sometimes I think it must be just wishful thinking.

      On the other hand, it could just be something a bit more complex. For example, maybe it is ‘simply’ gut disbiosis, but mere avoidance of problematic foods is not enough to heal it. On the other hand, my attempts to repopulate my gut with homemade ferments have more often than not led to bloating and gastrointestinal pain. But maybe there is something else actively screwing with our guts? Something in the water? I don’t know.

      I have observed one strange thing, which is that I seem to tolerate ALL foods better when I’m spending a lot of time in the outdoors. A day in the forest will often lead to a better-digested dinner, and a week at the hunt camp has me able to well-digest just about anything for the duration (even the aforementioned staling bread!). Could it having something to do with the sterility of our environment? Maybe restaurant food is more problematic for many not necessarily because of hidden contamination but because of more stringent ‘food safety’ protocols than what most of us practice at home? I’m sounding like a bit of nutjob here… But what else could account for the outdoor/indoor, or rather, outdoors/city difference?

      • Alexandra,

        My daughter was asking me who cleans the water for us to make it drinkable. And after explaining water treatment plants to her I thought, WTF are we doing? Pure water? Are you kidding me? Who the hell drinks pure water on this planet!!!?

        It’s more like it’s something not in the water! The sterility of our environment is a REAL issue. Can you get up to the mountains to get your hands dirty more often? I would love to see someone experiment with that. :)

        I’ve written about bugs and dirt a couple of times.
        http://theprimalparent.com/2011/05/11/a-dirty-kid-is-a-happy-kid/
        http://theprimalparent.com/2011/11/14/symbiotic-relationship-with-parasites/

        • Hmmm, I think I will try to make a concerted effort to get dirtier this year. I never take my shoes off outside anymore, which I used to love doing as a child. I do eat with dirt on my hands, especially when we’re digging for ramps (it’s that time of year again!), but this really only happens maybe 4 times a year. I’ll try to get out of the city more often and get intentionally dirty then. We’ll see!

          Otherwise I practice ‘terrible’ hygiene by modern standards, at first because I grew up that way and was obviously fine, then because I realised it was protective. The glares people give you when you don’t wash your hands coming out of the bathroom! If only they saw me handling raw pork and chicken and then barely rinsing my hands for a couple seconds. Haha.

          It’ll be interesting to see what happens in 10-20 years when people’s recent (how long has it been?) obsession with hand sanitisers shows its long-term effects. The body is certainly very adaptable, but I don’t think it will be pretty.

  25. Pingback: Teach Kids to Read “High Fructose Corn Syrup” in Ingredient Lists | The Primal Parent

  26. Thank you for this post, Peggy!

    Upon finding out you have Fructose Malabsorption, did you no longer think you are allergic to rice? Can you still have it?

    Ever since the day I stopped eating high-fructose fruit I started feeling better, too, but I feel okay eating rice. I find Paul Jaminet’s recommendations working pretty well.

    • Sophia, I don’t just think I’m allergic to rice – according to my tests I am quite allergic to it! Now, I do belive that our allergies can change and that we can heal in time so maybe one day… But for now I have no desire to play with fire.

      What I have found that may interest you is that I have no issues digesting starch per se as I had previously thought. When fructose and onions are present in my diet, my digestion is very limited. So, yes, things have definitely changed!

  27. Ok is this why I have gas eating onions and a stomach ache when I have full fat coconut milk? If I have a little coconut milk it’s ok but if I have a little more my stomach hurts SO BAD. This is very interesting. I have some experimenting to do….

  28. Thanks especially for the pics of your little girl. My 5 year old’s belly looks just like her “before” shot. Showing my daughter the pictures made her agree to the diet. Thank you!

  29. Pingback: Fructose Malabsorption | Mark's Daily Apple Health and Fitness Forum page

  30. I stumbled upon this post at what seems to be an opportune time. I have been paleo/primal for about a year, which initially cleared up my acne and remedied other problems I have been dealing with. I have since had some recurring acne and stomach issues. Yesterday I ate a mango (first time in at least a year) and ended up with terrible gas for the entire day. The mango was the last thing I would have identified as the culprit, but after reading this it seems likely that the fruit was the problem. I will definitely try eliminating fructose and see if it clears up my remaining problems. If so, that would be fantastic, as I have currently eliminated eggs and dairy to see if that would solve my skin issues. I would much rather be able to eat eggs than fruit, especially since my parents have some happy yard-roaming chickens that lay some very vibrant and delicious eggs!

    • Great post! The same little bird who popped in with a message about FM, is a friend of mine, and she helped me out so very much too! Eating very small portions of fruit, 1-2 times a day works out ok, but more and I have horrible skin problems. And I only discovered this the hard way, trying to be fruitarian:) Cod liver oil and zinc have both helped decrease my sensitivity, but I’m still cautious.

  31. You don’t know how excited I was to stumble on this blog today. I was just writing to nutrition gurus and ready to spend an arm and a leg to find out what the hell was wrong with me. I’ve been told I have candida, gluten intolerance, a condition that developed from Lymes. I would change my diet- I tried Paleo, Raw, and still had trouble with migraines and anxiety attacks. I could never figure out exactly what my problem was. FM makes perfect sense. I cannot wait to try an elimination diet to see if this makes a difference. Thank you so much. I was beginning to think I was insane or that I would never figure this thing out!!!!
    xoxo
    J

  32. Thanks for this post!
    I’ve always had bloating issues after eating. When I was younger, it wasn’t so bad, and I also didn’t really realize it was gas–I just thought I had a small stomach and felt “full” really quickly, when actually it was probably all the extra gas in my intestines causing the pressure and full feeling.
    I’ve also had a lot of nausea issues in the past, too.
    The bloating got REALLY bad, last winter when I was doing a very low-carb GAPS diet. I was eating lots of fiberous veggies, pureed in soups, which included onions and garlic, but no fruit.
    In the past, and also this end of winter/spring, I’ve been eating a lot of fruit.
    At first I didn’t really think I had FM issues, because I thought it’d be more in the small intestine, and my bloating/gas occurs in the colon mainly. However, after reading up a bit, it appears that FM can manifest as gas in the colon! I also read on the PHD blog that when someone has issues with fiberous things, its usually a colon problem/pathogen.
    I seem to get the worst symptoms when I’m eating fructose (usually in the form of honey and fruit) AND starchy carbs like potatoes and white rice.
    I tried cutting out just the starchy carbs, on advice from Paul (of the PHD). This helped a little, but I was still getting bloated.
    So now I’m going to try and cut out the fructose, and instead try to get my carbs in glucose (white rice, brown rice syrup, maybe a little potatos) and see what happens.
    What it sounds like to me is that I might have FM issues, as well as some sort of gut pathogen or bacterial imbalance that causes gas production with fructose as well as fiber. I’m hopefully going to get the Metametrix GI Panel test done, to see what specifically is going on in my colon pathogen-wise, because I think there has to be SOMETHING in there that’s not supposed to be…:-P
    So, gas and bloating in the lower intestine, definetly linked to fiber, possibly to fructose. (I’m also dx’d with multiple sclerosis, and have had amenorrhea since going off the pill 3 years ago, and many small cysts on my ovaries. I’m only 27 :-(. A functional med doc I talked with thinks I have estrogen excess. Not sure if this is related or not?)
    Do you think my symptoms sound like fructose malabsorbtion?

    • Sile,

      I think you’re thinking clearly and on the right track with your investigations, for sure. It’s quite possible that FM is your issue or even FODMAPs. If either of those are your problem, GAPS wouldn’t do you any good and could be quite irritating. Many of the GAPS recommendations would destroy me.

      I quit eating all fiber years ago, not realizing that some veggies are different from others and that fructose and fructans are the absolute devil for me. So, now, I find that I can eat some veggies instead of none at all. It’s really nice!

      I still don’t know what to say about healing pathogens in the colon. No one out there – PHD, Gut Sense, Kresser – has made any recommendations which have worked for me. So maybe they’re on the wrong track. Maybe pathogens is not the problem for everyone or maybe pathogens cannot effectively be eradicated as they claim. As soon as I figure it out I’ll let you know! But I do think that fructose malabsorption is a huge player in the world of digestive upset and it is absolutely worth it to get tested or try eliminating fructose and fructans. FM causes bloating in the lower intestine since the unabsorbed fructose molecules travel down there where they don’t belong. So, just the location of the gas alone doesn’t tell you that a pathogen is the cause.

  33. Great post! I have been dealing with the same issues myself since I caught a parasite travelling in South America… I have recently written a post about fructose malabsorption on my blog too: http://www.eat-real-food-paleodietitian.com/paleo-diet-and-fodmap.html

  34. Peggy,
    Could lack of good bacteria cause fructose malabsorption? My son was on heavy doses of antibiotics when he was a baby. As he grew older, he developed ADHD symptoms. He couldn’t eat fruit, grains, or anything sweet without having maj

    • Sorry, got cut off. He would have major meltdowns when he ate fruit, grains, and sugar. I started supplementing his diet with fermented food, particularly coconut kefir. He can now eat berries and rice without incident.

      • Honestly, I cannot claim to know the cause. It doesn’t sound like your son was suffering strictly from FM, though, since all carbs were causing problems. But definitely, the changed terrain in the gut after anti-biotic use, especially long term, can cause all sorts of problems.

  35. Thanks for the post, Peggy! I definitely think I need to experiment with this since I’ve been having these symptoms for quite some time now – I’ve been eating Paleo for about a year and a half and it has helped tremendously in other areas, but I’m still having some digestive problems. This might be a dumb question, but do you think taking some digestive enzymes may help? I obviously want to try and eliminate foods that trigger FM, but do you think those would help get your gut get back to normal? Is it even possible to get yourself back to normal, digestive wise, and eventually start adding those foods back in?

    • Lindsey,

      I tried digestive enzymes diligently for a long time. They never did anything for me at all. None of the expected results ever came to fruition in my body. But for you, it’s possible that you actually are deficient in enzymes, unlike me, so I can’t recommend that you don’t try them… Reading and experimenting will probably lead you to answer eventually, if not now.

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  38. Thanks for another great article, I have found your website helpful in SO many ways. I’d like to try abstaining from frustose/fructans for a while to see how it goes,(I’ve had issues with many of these foods “mysteriously” but couldn’t figure out why) but have two questions:
    1. Do you know if Liquid Aminos (made from soy) in small amount (say 1T in a marinade) would be a problem or have many fructans/fructose? I can’t find this anywhere. I think it is made from fermented soybeans.
    2. Do you know if grapefuit/lime/leomn natual flavor in mineral water (unsweetened) would likely be problematic?

    Not sure if you’d know but I figure it’s worth asking. Thanks!!

    • Well Kirstin, I can’t give you an absolute yes or no but I can tell you that I drink the juice of about 2 lemons a day with no problem whatsoever. I don’t do flavored stuff though so I’m not sure about the “natural” flavors. Also, I use a small amount of tamari when I eat sashimi and that does not cause me problems. I hope this helps!

  39. I thought I had issues with fruit because I was sensitive to carbs. Then I read this post and thought perhaps it was fructose, epecially since I react badly to honey. So I spent a couple weeks experimenting on different foods and am wondering if it is fructose after all. I react to Citrus Fruit, grapes/raisins/grape juice, Bananas, pineapple, blueberries, raspberries, honey, large amounts of dates,tomato, onion, carrot. And when I abstain from all of these I seem to do ok with minimal amounts of white sugar and potato, which I couldn’t do before. Coconut doesn’t seem to be a problem though maybe I would have to cut it out for more than a week to check. Some of this list makes me think I could have a problem with amines and salicylates and not fructose at all. What do you think? I am so confused and don’t know what to do next. Should I do an elimination diet for fructose? for amines/salicylates? The list of vegetables this would cut out is enough to make me cry, but I would do it if it might actually cut my fatigue/brain fog. I am already low carb paleo, so I eat meat and eggs daily, with some veggies for dinner.

    • Hi, I think maybe you should just go and get the fructose malabsorption test done if possible. Then at least you would know for sure if you cannot absorb fructose.

  40. I know FM is one of my many problems. I’ve been diagnosed with Ulcerative Colitis and am working hard on the diet to cure it. Most of my life I’ve been a huge fruit eater, so this is really hard for me. Recently I read a list on alkalizing foods and found dates on the “good” list, which was very surprising. I seem to do OK with them. Where are they on the fructose list? Can you tolerate them? Thanks for your insightful blog!

  41. This is fascinating. Thank you for posting Peggy. I am curious did you also get tested for SIBO?

  42. Ok, I’ve been trying to research this a little more to get an idea of what is ok and not ok in the vegetable area and it seems impossible. Depending on where you read, a vegetable is in and out. Like eggplant – one source says it is fine, another says avoid at all costs. And, I can list a bunch of veggies I’m finding the same conflicting info on.

    What would you suggest as the best approach to changing diet to test for fructose malabsorption? I’m trying to understand this from the vegetable perspective.

  43. Peggy, I hope this isn’t a dumb question. Do you know whether or not kombucha has fructose/fructans in it? Or does it depend on what in it that has been fermented?

    • Sarah,

      Kombucha is usually made from sucrose and tea and it is fermented long enough to become pretty close to sugar free. Whatever is left probably isn’t enough to cause any harm. I am quite sensitive to fructose and kombucha is fine for me. The flavors I drink are plain, citrus, and ginger. I won’t touch the ones made with fruit because many of them have given me a stomach ache in the past. Though cranberry would probably be fine, I don’t drink that one either.

      Beware of honey kombucha! Those have been problematic for me in the past.

      • I always had problems with fruit in the past.A few days ago i ate 430 grams of bananas measured without peel and had very serious gastrointestinal discomfort,even when i woke up i had my stomache growling.A lot of people can eat all the fruit they want and never have any problems.Life is a bitch.Is there no cure for this????

  44. Fructose can cause terrible acne. I know that from the first hand. I foun anti-acne recipe on prettyandsmart.net
    Mix 1 teaspoon of honey with 1 teaspoon of cinnamon. Wipe your acne spots with this mixture and leave it on your face for 20 minutes.

  45. Thank you Peggy,
    This post is incredibly helpful. I have been battling digestive pains for the past four years now, and to say the least they are ruining my life! I am a 19 year old college athlete and as the years go on it is becoming harder and harder to exercise. Clearly, this is a huge problem for a soccer player. This past year has been the worst. It is also impossible to listen to my teacher in class because I am so uncomfortable or in so much pain.
    I have seen countless doctors, have had various tests ran, and have tried multiple medications that have not gave me any relief. A few weeks ago I finally found out I was lactose intolerant, which came as quite a shock! Today, I have been lactose free for three weeks and my symptoms have not been relieved in the least bit, also a shock. I was supposed to be tested for fructose intolerance but I had to go home for the summer and so I will not be tested until I return to Phoenix in the fall and go back to the Mayo clinic. I think that I am probably also fructose intolerant.
    I was wondering if I am lactose and fructose intolerant, what is there left to eat? I am already so active that I am hungry all the time and it has been hard staying full on my new lactose free diet. I want to try also being fructose free but I am not sure then what to eat especially if meats, onions carrots and garlic all contain fructans, and most fruits contain fructose.
    I was wondering if before you found out you were fructose intolerant if you ever had such difficulty exercising because of pain? My pains will differ, sometimes my stomach feels like complete liquid and if I run it seems as if the liquid travels down my left side creating horrible tearing pains making running impossible. Sometimes it feels as if my whole abdominal region is filled with painful gas. Sometimes it feels like the gas is trapped right above my bladder and makes sitting in class very uncomforatable. I have many different stomach pains that I deal with. I am just wondering if anyone has every experience anything like this and found that they were fructose intolerant.
    Thank you for all of your help and taking the time to write this article!!
    -Leanne

  46. I’m so glad I came back and reread this post more thoroughly – I’ve had bone broth, raw duck egg, sauerkraut and raw carrots (and fed my kiddos the above plus raw seared/raw beef and green beans and carrots). My oldest daughters’ mood is my main barometer – happy, calm kid = we’re on the right track with her diet. But onions and carrots and green beans! We have those almost daily. And I feel bloated (which I felt depressed and frustrated about and promptly consumed a bar of dark chocolate). But the bloating happened first and my bad mood. When I’d only had the raw duck egg and the bone broth I felt great – happy, energetic and flat tummy-ed (tummied?). More observation to follow…I really am going to print this list out and post it to our fridge.

  47. Just found your blog and I’m a paleo eater with fructose and lactose malabsorption. Here’s a few tips I’ve discovered after having this for 3 years. I stuck to a low FODMAP diet really strictly for about 18 months to heal my gut (my vili were flat) and only started reintroducing foods after that. You can cook with onion but can’t eat the flesh (weird right?). Coconut water is ok but the milk is a no-go. I only eat fruit maybe twice a week and I find this helps. Just a few thoughts that may help you all x

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  50. Stumbled across your blog from Mark’s Daily Apple. I started Primal eating in June as a way to cure my migraines, my son’s migraines (he’s 8) and to LOSE weight. I was diagnosed with Fructose Malabsorption a year ago and gained 12 pounds trying to figure out what to eat. Hard to believe but it happened. Anyway, since starting primal I have lost 8 pounds and feel super. I have had GI distress my entired 36 years of life. I was even hospitalized as a toddler with chronic diarrhea. I have tried lactose, milk free, yeast free, gluten free, meat free diets. None of them helped. Glad to have come across your blog. Great to find something not only primal but FM related. So odd to find that combo. I can’t wait to read more about what you eat. It’s quite the journey. Especially starting this last with my kids being 8, 10, and 13. They have not enjoyed the pantry being de-void of junk. The breakfast omelettes have hopefully made up for some of that though. :)

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  52. I know apples are on the no list, but what about apple cider vinegar? I always use about a tablespoon or so in my bone broth. Is there a more preferable acid for pulling the minerals?

  53. Thank you for this information! My family and I have been primal most of this year and it seems to work really well for my girls. I also lost about 10 pounds in the beginning, but I cannot get rid of my acne or eczema and have stalled on weight loss. I have plenty more to lose so I was getting frustrated. I will definitely be trying this method of eating, although being in a foreign country now hasn’t helped me find the more unique foods that are required to maintain a special diet.

  54. Thank you as well. This is break-through information for our family. I’m so grateful to have come across this.

  55. I want to thank you for this article. I’ve had IBS for over 10 yrs and worked with several different holistic practitioners and diets. This really makes sense and has never been brought up before. I avoid many gluten, nut, soy, junk, carageenan, caffeine, dairy foods and more. I bloat & have flatulence after too much fructose, but always blamed it on something else. I do remember on lab test showing that i was “fructose sensitive” but that ND only said it was no big deal, but we need to fix my leaky gut first. I also have the MTHFR gene, so my liver is sluggish and may not be able to handle converting so much to glucose. I will be experimenting with eliminating/ reducing these foods you listed.

  56. I made something homemade breaded yesterday with whole organic non-gmo corn meal and am having a very unhappy digestive system today. You have whole corn listed, so it’s one more red flag for me with IBS and many delayed food allergies I’ve been avoiding. I usually avoid corn, but tried something new. Thank you.

  57. The comment about wine not being OK, but dry white wine probably being OK shows that whatever you’re reacting to, it’s not fructose. Red wine has no fructose at all in it, while even “dry” white wines can have 30 g of sugar in a cup (usually a mix of glucose and fructose, depending on the yeast, and whether the sugar was added after fermentation). So if you’re reacting to red wine, and not to white wine, it’s not fructose.

  58. i’m another one who did gaps, but still had lingering issues with bloating. another symptom to add to your list is fatigue. for years, i have gotten SO tired after eating most meals. to the point where i had to sleep for hours at 10am, even after sleeping ten hours at night! it turns out FODMAPs has been a huge part of the problem. that, and bone broth, of all things! (not sure if it’s the onion, apple cider vinegar, or amines).

    nice to be on this journey with you.

    the fructose malabsorption yahoo group from australia has been so incredibly helpful. you may want to join for lots of helpful advice.

    warmly,
    churyl

  59. It’s so nice to see a post like this – not enough people know about this problem!

    One thing I thought I’d add re: the yogurt. For some people with fructose malabsorption, yogurt is actually not so great. Bloating seems worse after it. Best guess I’ve heard is that the live bacteria cultures in it seem to simply add more bacteria that can consume the undigested fructose and it adds to any bloating and digestive issues. So it’s not really a fructose problem, exactly, it’s more just a, hmmm, a bloating instigator? ;-)

    I have not heard anything on this re: other fermented foods that still contain live bacterial cultures, but I wouldn’t be surprised if it would cause the same potential problem.

    • Thanks for adding that piece of advice! If I eat sweetened yogurt or if I eat yogurt with any fructose or fructans I get super bloated. True for me with any ferment.

      • So frustrating, yes? I looked into this for months before realizing that I react to sulfites rather than fructose (also can’t have onions or garlic, wine’s bad, and fermented foods naturally produce sulfites, so that’s out, too. A lot of similarities). but we’re looking at this for our little boy, now, so I’m glad that I kept all the research I did!

  60. Has FM been linked to anxiety or just depression?

    I’m pretty sure I had FM before becoming pregnant, however, it went away after I got pregnant. I haven’t delivered yet, so I’m also curious to see if it returns after she’s born.

    • Oh and I also wanted to ask you if you now avoid fructose or just Evelyn? How does Evelyn do on such a restricted diet for a child? I remember when I cut out fructose…doesn’t leave you with too much to eat. Although based on the red pepper sandwich it seems she can still eat some dairy. I have issues with dairy too. Thanks!

      • I do avoid fructose and fructans, much more so than she does. She’s ok with a little fruit. I’m not.

        She does exceptionally well on her diet. But she really went through a rough period of constipation for a while, which I don’t think she’ll ever forget. I don’t even have to tell people what she can and can’t eat. She tells them herself! And yes, she seems to do ok with some dairy, thank goodness. If she ate just like me, that might be rough. (I avoid dairy most of the time, unless I’m in screw it mode.)

  61. Hey Peggy,
    I was wondering how long it was before you saw the first signs of your daughter’s bloating going away, and how long it took before her bloating was completely gone?

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  63. Thank you for your post. I have been eating paleo for about 3 years and have been feeling great. I am 12 weeks pregnant and have noticed that aside from just nausea and food aversions typical with pregnancy, I am also experiencing new food intolerances. I payed attention to what I was eating and after getting especially sick after eating grapes, realized that I have become fructose intolerant. Do you have any idea if this can be brought on by pregnancy? I have never had any of these problems before my pregnancy. It has been hard to know what to eat. I’m afraid to eat anything! I hope it goes away after my pregnancy. I couldn’t find any info on the Internet about a correlation between FM and pregnancy.

    • Beth, pregnancy can make a person more sensitive to foods. While I was pregnant I became very sensitive to nightshades. My joints would hurt, my tummy rumbled, and I got reflux if I ate peppers, tomatoes, or potatoes. I’m always slightly sensitive to them but it was so pronounced during pregnancy. Be sure you are getting enough nutrition to help strengthen your immmune system and digestion.

  64. Thank you.
    After years of pains, cramps, feeling like my intestines are going to blow up, looking pregnant, depression, miscarriage, mood swings, acne, constipation, fatigue, being told to eat more fiber/drink more water/exercise, being treated like it’s in my head (YES, it’s in my head, it would be in your head too doc. if you felt like this..).
    It has effected my social life, my personal life, my personality.
    It has consumed my time, my life.
    And here’s it is… the answer.
    Thank you!

    • Wow Laila, minus the miscarriage part this sounds exactly like me, and definitely the part about docs (and everyone else) saying it was all in my head. I don’t know if I mentioned this on the blog before but I think hypochondriacs are probably a very rare thing. People just don’t understand how anyone can be so miserable and so they pass it off as insanity. :)

      I am excited for you!

  65. Hi Peggy
    I found out a couple of months ago I have IBS after suffering for years and years with most symptoms such a relief. Yet i then have gone traveling and I havn’t been following the IBS allowed foods and I’m really struggling to do the right thing. I suffer badly with bloating, constipation headaches every day and feeling flat. Any advice? So hard when on holidays to not have the control of cooking your own meals and avoiding holiday temptations which are around all the time.
    Really want to feel motivated and not so slumped.

    Look forward to hearing from you

    P.s
    Do you know if I can have apple cider vinegar?

    • Unfortunately, if you have FM, you aren’t going to feel good if you eat foods containing fructose and fructans. I know it is so difficult when you travel. But it’s almost more necessary then because you need to be on the ball all day every day. And you are supposed to be making good memories not bad ones. Just try to remember that if a food does not bring you continuous joy, don’t eat it. Within a couple of days of getting back on track you should feel good again.

  66. Hi Peggy,
    I have a question about breastfeeding and how it’s affecting my newborn–
    My son is 19 days old today and I’m exclusively breastfeeding. I have been “strict” paleo since he was born (I was on/off of paleo while pregnant) but unfortunately he still seems to have pretty bad gas and its getting worse I think. He can’t get through a feeding without straining like he is in pain/trying to push something out, wakes up pulling his legs into his belly, and just seems generally uncomfortable. He doesnt cry a whole lot, but with the other symptoms you can tell he has gas. And it doesnt help that he is extremely hard to burp, he seems to try to push everything out the other end… Although I’m eating “paleo”, I do eat a ton of fruit…all day long, and since I’m BFing of course I’m always hungry, so I eat more of it than usual as my go to snack. (for example today so far my fruit intake has been 3 big apples, 2 bananas, & 2 plums—-I guess you wouldnt call my diet “strict paleo” either since I’m eating an overabundance of fruit..) I also eat eggs, turkey, chicken, fish, beef, some vegetables, etc. But I avoid all the “conventional gassy foods” like broccoli, chocolate, caffeine, etc. Could eating so much fruit be causing his gassiness? Thanks for any help!

    • Lots of things can cause gassiness, and many newborns experience this. Dairy can affect babies (I don’t know if you’re eating dairy). Some babies aren’t bothered at all by traditional gassy foods. Oversupply can cause digestive issues (does your baby choke and cough while nursing? and pull off occasionally with milk shooting out at him?). Do you hold him close to you and upright after nursing? Sometimes holding him with his legs bent up in a squat position, towards his belly, with his back against you, can help. It’s so hard when they’re in pain like that! You’re doing the best thing for him by nursing. Good luck!

  67. Hi Peggy,

    I am a 20 yr old college student and I was diagnosed with fructose malabsorbtion when I was 15. For the last 5 years, I have been watching my diet on and off. This past year, my mood has changed, I have been battling with anxiety and depression. Also, in this past year, I have NOT been careful to stay away from fructose. I just read your blog and I want to say that it has finally clicked that I NEED to watch what I eat if I want to get rid of my physical and mental symptoms. Thanks for all your information! Even though I am not a parent yet, and probably won’t be for a while, your blog is still super informative, and I learn a lot. I am taking a human evolution anthropology class in college, and some of your information parallels to what we learn! Thanks for your research, and I will certainly let you know how I feel in a month.

    – Abby

  68. re:
    Onion replacement: The green (only) part of spring onions
    Garlic replacement: Asafoetida powder

  69. Fructose is a big problem for me and I like to avoid it as much as possible. I eat primally the vast majority of the time but sometimes I just really want something sweet.

    Honey, HFCS and table sugar do not sit well with me so it’s been near impossible to enjoy a treat (on the rare occasion I want one).

    I’ve found a cool hack for this though: corn syrup. You read that right! Not HFCS but pure corn syrup aka glucose syrup. Literally, this stuff is just pure glucose and maltose (which is just 2 glucose molecules bound together) and a few other polysaccharide forms of glucose. I’ve found that I can use this and not experience any adverse effects.

    Obviously, corn syrup is not an ideal choice for sweetening but it is way better than the GI upset I experience from any forms of sugar.

    • Desiree,

      I figured corn syrup would be a good option as it is supposed to be all glucose but if you look into the processing of corn syrup you will find that some corn syrup manufacturers actually use some amount of HFCS in their blend. But anyway, you can still use glucose powder which is called dextrose or corn sugar.

  70. Can FM cause you to not want to eat? My daughter (2) has had a hard time starting to eat foods. She was and is breastfed. She was doing really well eating 3 times a day a pretty good amount. The last two weeks she won’t open her mouth for anything. I have been trying to find a reason her belly might hurt and cause her to not want to eat. She loves fruits and oatmeal. Wondering if she could have FM and not want to eat because of it?

    • Adults seem to be prone to overeating with FM but I have read that kids with FM will often be turned off by fruit. Whether this extends to other foods, I don’t know. If you think about it, though, a child might not want to eat if they are having stomach aches, gas, or reflux. I would look into it.

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  72. Thank you so much for this =] I’ll be trying out lots of it.

    I got this 7 years ago. And doctors told me I reacted worse than anyone they’ve had in there. The line on some chart they showed me went straight through the ceiling.

    I got bad lists, bad advice, it was so unknown back then. I searched the net for over a year. But nothing amazing like this was out there. And somehow, it has been a blindspot. Everyone in my fructose group had diarrhea, I was constipated. So not before long I felt I was at 30& energy, always constipated. Sleep was really bad. And I was obsessed with trying to find what to eat.

    Payed nutrition experts, went to doctors. Kept getting lists. But they always said all meat was fine, most of the papers I got even recommended whole grain, and pasta was fine too.

    I kept thinking I was over sensitive. Man, this is something. Won’t get to excited, in case it doesn’t help me. But if it does, oh boy, I can start living again yay

    So thanks a lot <3

  73. We just found out my daughter has F.M.Seeing your daughter on here has given some comfort to my daughter that its a condition that can be controlled (though i wish upon no one) it’s been a year of doctors visits and Er visits. After reading this i finally see some light at the end of the tunnel. I say this because it had started affecting her heart. Thank you again Im glad to have this info to get started on making my daughter feel better.

  74. I love your website!

    I’m trying very hard to eliminate my acne. Do you think white potatoes are a “safe starch” for acne sufferers? I currently eat seafood, meat, fats, eggs and sometimes red peppers and squashes.

  75. I discovered that onions were a major problem for me about 6 years ago, but had never heard about fructose malabsorption until this year (going to an acupuncturist/Chinese med practitioner to help with my allergies, skin problems, and digestive issues). When I made the connection between onions and gas, it was life-changing. I also seem to have problems with products that have inulin added (so many yogurts and other probiotic products have it! not cool!!).

    Seeing as how I still have issues, it’s probably time for me to do a true elimination diet. Has anyone had experience with eliminating FODMAPs for a period of time and being able to eat them again (in small amounts) once you’ve healed your gut? I would have to think that many of us just caused damage over years of eating processed foods etc and don’t have a genetic or permanent intolerance.

  76. Hey, I cut out all grains for 3 weeks now. And my inflamation, rashes, juachy stuff was covering my stomach. Like bloody wounds at times, real mess. Now 90% of it is gone, can still see some scars. But it’s almost nothing. Really hoping it never comes back.

    Pretty amazing ,still struggle a lot with what to eat. Biggest problem is breakfast. Now Im eating Samon for breakfast, steak for afternoon, and samon again for breakfast. With added rice or potatoes. And as a side dish I have spinach, and that’s literally all I eat.

    Really want some propper breakfast, anyone got tips xD??

    • try oats , buckwheat . buckwheat is not really wheat . that and all unprocesed meat is my
      safe food.anything else has severe issues. if you can tolerate this do this for at least. 30days before trying other things. 46 years of hell and a lot of cash . had to figure it out my self. hope this will help.

      Gerald

  77. Do you have any personal experience with mushrooms? The farting pear site gives contradictory info.

  78. Hi Peggy,
    Thank you so much for this post!! For years now I’ve been trying to figure out the causes for all of my food intolerance’s and problems, and I honestly think this is part of my solution. All of my symptoms and my “known” problem foods line up. When I went paleo my symptoms didn’t go away and it seemed like I just started getting MORE sensitive! I’ve tried every diet under the sun, and have eliminated/reintroduced almost every item of food you can name but still hadn’t nailed anything down 100%. Recently I was eating a lot of fruit and honey *cringe* for the vitamins/antioxidants and because honey is supposed to be “so easy to digest”… Now (for the last couple of weeks) my body is protesting with severe symptoms, and I’m having trouble tolerating anything at all. I’ve read conflicting stories about how to deal with FM, from a 0/low-carb approach, to a mostly rice and spinach approach, maybe with some potatoes. Since my system is so upset I’m having a hard time telling what I can handle and which approach to take, as I seem to have trouble with everything. I’ve been eating a lot of white fish and chicken because they “seem” to be the least problematic. Do you have any recommendations for someone in this situation? I’d really appreciate any advice I can get! It’s so frustrating finding out you were doing the exact opposite of what your body needs to be healthy…

    Thank you!!

    Charlene

  79. Hey you can order a test online for fructose malabsorption without a doctor, it’s called breath trackers I believe.

    That said I ordered the fructose malabsorption test and sibo. I was positive for both. I’ve been feeling bad for about a year and a half, I’ve known for a long time I felt better lower carb and off gluten but this was a new thing. It happened after a few courses of antibiotics.

    One day a couple months ago I realized eating apples made me feel ill, then I noticed the same with pears, blackstrap molasses and Lara bars. Googling this finally brought me to your page so thank you! =)

    Have you looked into your fructose malabsorption being related to or caused by sibo? Or is the sibo caused by fructose malabsorption? Ahhh there is so much conflicting information about this. Also, any thoughts about antibiotics or herbal antibiotics for the sibo?

  80. I did have fructose malabsorbtion too but 3-6 months of autoimmune paleo diet usually heals leaky gut and I can eat fruits again. Actually I do plenty. If you are still fructose intolerant look for ways to heal your gut. I would try 1. zero alcohol, 2. vitamin D. Eating fruits after the summer season that provides plenty of vitamin D (which keeps intestinal mucosa non permeable to fructose) is perfectly primal.

    • That’s interesting Martin, how long did you do the autoimmune paleo? And you consumed zero alcohol the whole time? Ahhh that seems difficult….also did you have a test for fructose malabsorption?

      • In my case it took about a week or two to see first results, 3-6 months heal gut completely. I actually drink zero alcohol since. It is difficult but that is my choice after reviewing all this http://www.leakygutresearch.com/leaky-gut-and-alcohol/
        No tests but I reacted to foods a lot so after seeing I was reacting to sweet stuff I bought in the pharmacy pack of 100% glucose and 100% fructose and sweetened my drinks. The reaction to the fructose sweetened drink clarified a lot.

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  82. I have to say thank you my daughter also has FM and we just found out in Nov. It has been a struggle for us to find meals that she likes though…may I ask if you have a site that you like to use to find meal ideas?? She was super picky before we found out and now its 10xs worse as in just making sure she is getting a balanced meal. Any help would be great thank you so much.

  83. Hi ,
    Congratulations about your discovery :)
    I was wondering if there is any fructose or fructans with coconut oil since I read that could help candida (one other cause for bloating and fatigue). Does the link you provide considers fructans also? I also like very much avocado, but looks like it has a bit of fructose…:(

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  85. Thank you for this post. My 3 year old daughter has had a big bloated belly and complained about stomach pains since she could talk. We kept her in a similar diet of paleolithic with organic starches like rice and potatoes. We didn’t realize bloat could be an issue until this week when she decided to not eat certain foods so I have fed her mostly salads and meat this week and her belly flattened. I thought she was oddly chubby but turns out this could be the answer. I cook 95% of our meals with garlic and onions. I grew up eating those meals and have always suffered from depression and bloat. The only time I didn’t suffer was when I did Atkinsfor 5 months but then suffered from severe constipation. Thank you so much!!

    • Vannessa, wow! Getting to the bottom of a long time issue is a great feeling isn’t it? I think I should do a post solely on garlic and onions because for many who have gone low carb due to food intolerance, who have already eliminated fruits, garlic and onions are the only culprits remaining. And what culprits they are!

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  87. I suggest you to read raypeat.com – he have some strange claims but maybe he is right – he claims the problem is not fructose but the fiber or seeds in the fruits, also claims there is big difference between fruits – ripe or unripe organic or not organic. I have read people have success with his diet. Also there is a diet by dr Wai called wai diet – she also recommends fruits and fruit juices for acne and alot of people have good results

    • Hi Pesha. I have read a lot of Ray Peat’s essays and did try his diet. Also, many years ago I ran into Wai and tried that idea. It was pretty horrible. Fruit is just a no go for me. Her diet made my acne so bad back then, I almost thought it was a joke. Anyway, I am quite well avoiding fruit and fructans and no longer have acne so I’m not complaining.

    • I wanted to add that I think Ray Peat writes some really interesting articles. And he was one of the ones that inspired me to start eating carbs again. I don’t want to discount his research but the whole idea of juicing oranges didn’t work for me and neither did eating loads of ice cream. ;)

      Somewhere on my website I talked before of an orange juice experiment I did many years ago. It was fun for a bit but never produced the results I was after.

      Like Ray Peat, I too believe that there is something about fiber that disrupts digestion, blood sugar, and hormones. I mean to read more on his thoughts on this.

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  89. Thanks for this great article! I believe my daughter may have FM too. She is bloated a majority of the time. She is 5. She also has a swayback posture with her bloated tummy sticking out. Her doctor said that with constant bloating and the stomach muscles being undeveloped, it can cause a child to develop this type of posture. I am concerned about it as I want it to be corrected. In the pictures it is hard to tell but it looks as though Evelyn may have a swayback posture too? Could she have developed one too from her previous bloating? If not, please forgive me for implying she may have a swayback posture! If she does (or did), I am wondering if it corrected itself after the bloating went away and if not do you have any ideas or plans to help her fix her posture?

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  93. Hi Peggy,

    Wow! I am so glad I came upon your page :) I was diagnosed 5 years ago with Celiac, however I have been struggling ever since. Stil not feeling 100%, lots of bloating, headaches, gas pains, sometimes diaherra and feeling depressed. I am very good at watching what I eat and am VERY active with exercise and yet still can’t budge any weight off my body, and needless to say feel better. I was went for further food testing and was told that my body does not do well with fructose and sugars. This began me to go searching on the net and I came upon your page. I have printed off your list of safe and unsafe foods and can’t wait to get started. Again, I feel very overwhelmed as I did when first diagnosed with Celaic…but I am sure in time I will get the hang of it :) After reading your post it all makes so much sense to what I am feeling and symptoms…wow. I had no idea….I was told that my body is not able to break down the sugars or fructose. I look forward to reading more of your posts.

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  95. Peggy, thank you. I have been living with an until-now unnamed condition my entire life, constantly having to tell people I can’t have this or that because sweet foods don’t agree with me. I had to deal with people doubting me because they’d never heard of such a condition, or people insisting I must be able to have “natural” sugar, i.e. fruit.

    And yet oddly (I thought) I could eat fruits like blueberries and blackberries just fine.

    It was all very confusing and frustrating. And that doesn’t even begin to describe the discomfort of the symptoms I’d experience if I ever did eat something sweet!

    Or as it turns out, something with a high fructose to glucose ratio.

    Fructose Malabsorption describes me to a tee.

    Sadly, even doctors throughout my life pleaded ignorance to my claims of upset stomach, bloating, gas, and a plummeting mood from eating sweet foods.

    I know there’s been a lot of work done over the years to educate the public about dairy and gluten intolerances, but it seems like FM is almost completely off the radar.

    Hopefully as more people such as yourself put the word out there, that will change.

    Thanks again!

    • Darcy, I am right there with u. It is very upsetting to go through life with this, and not have people or doctors understand or respect it. I was always told by doctors to just live with it, and by people that I was focusing too much on it.
      In my world there’s always an answer. And ‘Just live with it’ is not it..
      After years of suffering and trying various diets, I found this page. It lead me in the right direction, and I’m finally on track. I found a doctor that listened and actually had heard about Fructose Malabsorption and I am working with a dietitian that specializes in it :) I’m not all there yet and I do have flares and set backs, but I’m so much better and happier and healthier.
      Hope u find ur way through the jungle of information that’s popping up on the subject these days. Fructose Malabsorption is slowly being more and more recognized.
      U might like the FODMAP app for iPhone and iPad from Monash University. They do a lot of research and update all the time..
      I wish u great health..

  96. Thank you for this post! I have been playing the trial and error game for SO long with my stomach issues, and this post really resonated with me. Even as a kid, I’d naturally stay away from all types of sweets–I have a definite salt tooth instead. I actually drank some Almond Milk tonight with 22g of sugar and got all the terrible stomach symptoms outlined above. A quick google search yielded this post, and a lightbulb went off! Thank you for sharing your experience with this and for helping others (like me!) come what step closer to figure out what works for them!

  97. I just ran across your blog and I wanted to know first what did you eat and for how long to remove all irritants from your system. Second, what then did you eat after all of that? This is why I ask…I have been having frustrating issues for years now. I’ve been to numerous doctors who all do blood tests, tell me I’m normal, and look at me like I have two heads (both of which are idiots) and tell me there is nothing wrong with me. I’ve even had my hormones checked to see if my issues are hormone related. The tests always come back normal. My issues are (and you’ll see why I’ve been to thyroid doctors, hormone doctors, and regular doctors….I’m contemplating an allergist next): HORRIBLE insomnia, low energy, low mood (but I’m NOT depressed, therefore no thank you to anti-depressants), itchy itchy scalp, constipation, ringing in my ears, night sweats, waking several times in the night, brain fog/memory issues, alcohol intolerance, fatigue, throat issues (thought it was my thyroid flaring), migraines, INCREASING food intolerance. I know you are not a doctor, and I’m not asking your opinion on all of the above. I think I’m close to hitting the nail on the head..I hope…with checking food intolerances. Coming upon your article was almost a lightbulb moment. This list of foods that are problem foods are almost everything I eat. My husband and I also turned to Paleo and I did feel better on it…but I’m still having issues. SO, (sorry for being long winded) what did you end up eating? how do you deal with restaurants/family meals? Is there a good website that will guide me in doing a cleaning out so to speak….Thank you for listening and for any help you can give.

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  99. Hi just read your blog. I like you have been searching for ages to find the diet that makes me feel good! I love fruit and over the years have definately eaten too much. Two months ago I started an elimination primal type diet and felt great for the first week then had a cold etc etc. thought it was linked to ketosis. Carried in and have felt a but better but not as great as hoped. Have been eating lots of onions leeks asparagus and coconut. Four days ago couldn’t resist trying fruit again and have felt so grumpy over last few days and sad too! Think I will try total fructose elimination. Just one question. I was getting a lot if my fat through coconut oil and milk. How do you manage? Not totally sure about dairy. So think I will keep off that too for a while. Any advice most welcome and thank you for great article
    Bernadette

    • Hi Bernadette,

      Coconut oil is fine. You can also have olive oil. Eat the fattier fishes, meats, and eggs. That’s pretty much what I do these days. I don’t add a whole lot of additional fat anymore. But I do plenty of eat natural fatty foods.

      Sounds like your diet is consisting of lots of problem foods so you will probably be feeling much better as soon as you cut them out!

  100. Hello Peggy! I accidentally (divinely) stumbled upon your site after searching and searching for a potential reason why my stomach has been severely distended/bloated all day after eating coconut flour pancakes with strawberries and honey for breakfast! I have to say…. After reading about you and your daughter’s struggles with FM, a light bulb went off, and I broke down a bit! I have been Paleo for almost a year and it has helped me in many areas (leveling out hormone levels, detoxifying my system of chemically processed foods). However, recently after doing a Whole30, I became extra sensitive to foods that I previously believed I was capable of digesting! Since then, my bloating, which had for the most part left, except during my menstrual cycle, has returned after eating certain foods! I was dumbfounded about the fact that I had never even heard of Fructose Malabsorption, when I came across info for it! I have suffered from Chronic Fatigue Syndrome for 19 years, and had hoped that eating Paleo would be the answer to my health issues as it has for so many! Well… As stated, my bloating has returned, my depression and irritability has cyclically worsened, my severe menstrual cramps (which I have had two laser surgeries for the removal of endometriosis to help) have not improved, the mild tremors I have suffered from for years have not gone away, my energy level is still almost non-existant, and as my illness is defined… I am still not able to experience a truly restful night of sleep! My life has pretty much been one of mind over matter, and I have had to fight my way through everything…. College, work, the recording studio, family/friendly functions etc! I know that I have found your info, expertise, and story for a reason because I have to be honest and tell you that….I have been on the brink of just giving up! Not life….. I just didn’t know where or what to turn to?! All I do, other than try and work towards my career is research diet and nutrition to heal myself! I so desire to fulfill the dream that I was placed on this earth to live out, which is to be a recording artist…. But I know I cannot successfully do that without my health! My question to you is, because I have probably been to between 50-75 different types of doctors in my 34 years on this earth, who have tried and attempted to help me with every medication, crazy detox, vitamin medley, etc, and have ruled out all major illnesses/disorders…. What kind of doctor would best be able to help me with not only the FM test but with helpful, nutritional knowledge? And also…. The symptoms that I have experienced all of these years…. Do you think they could possibly all be caused by FM? All these years….. :-/

    • Maya,

      I sympathize with the fight just to get through everything. This was me too.

      I am really tempted to begin a coaching program for problem cases. I simply don’t have the time as things are to delve into individual specifics.

      What doctor would be best for you? I don’t know. I never found a doctor that was any good for me either! You could try working with one of the many Paleo coaches but I don’t have any personal experience with any of them.

      As I understand it, the Whole30 advises eating lots of plant food. I personally don’t. I think that is generally really damaging to an already damaged gut.

      Narrow your foods choices down to meats, fish, eggs, and starch for a week and see how it goes. Eliminate butter even just to be safe.

      Let me know if this helps.

      Peggy

      • Thank you so much for your reply Peggy! I will be getting my FM breath test ASAP! Plus, I intend to try out your dietary suggestions and eat only meat, eggs, and starches! Since I have gone Paleo, I cut out rice and potatoes! I was living off of meat, eggs, veggies, and sweet potatoes! Now I know, that if I am in fact a FM sufferer that sweet potatoes are out! My question is…. What type of starches do you suggest? I read that plantains are on the ok list, and I am not opposed to re-introducing my old starch friends (white rice and potatoes) back into my diet, if they will help to relieve my symptoms! I just long and pray to be healthy and out of this food coma! Also…. A few Paleo staples that I have been wondering about! I know that coconut oil and fresh herbs and spices are ok, but may I still eat bacon, such as the Applegate or U.S. Wellness brands? And a few others…. Coconut Aminos, Red Boat Fish Sauce, and Palm Oil? Sorry for asking so many questions, but I am new to all of this and the Paleo dietary guidelines for FM sufferers are different!

  101. This post is so fascinating and informative! I discovered it in my quest to understand why gluten-free pizza crust could make me so bloated, and the answer is in the fructans. As a health coach this will be insanely useful for my clients. Thank you!

  102. Peggy, I just want to thank you for sharing this information. I read the article last year & thought it sounded like me, but over the past decade of trying to solve my digestive troubles everything sort of sounded like me, so I’ve become a bit skeptical about ever really figuring it all out. Ever since crohns disease 15 yrs ago, I’ve been 100% organic & have been sugar-free/grain-free/package-free for a couple of years now. I’ve managed to control my crohn’s w/o meds these 15 yrs by clean eating, but could never be relieved of bloating/gas/pains/inflammation/eczema/brainfog. This year I’ve found myself mostly drawn to researching nutritional ketosis & have resonated with folks like you who have a mostly meat diet. During my hubby’s last deployment I ate mostly meat & cheese & felt really great, but upon his return included lots of tomatos, bells, onions & berries since those are his staples & all the misery returned. This article came back to mind & I finally took the test- positive. I’m partly happy since this makes sense of my symptoms, but I’m overwhelmed by the amount of food with fructans/fructose. I have much to research & learn… but I sincerely want to thank you for this article. I had NEVER heard of this before & might never have known had it not been for you. THANK YOU!

  103. You can use garlic and onion infused oils. FODMAPs are water-soluble, but not oil-soluble

  104. This is a great article. Thank you so much for it. I have started blogging my experience with Fructose Malabsorption. I love these blogs. They are still very helpful to me trying to figure out this whole diet.
    http://controllingthecrazy.blogspot.com/2013/04/the-diagnosisdiet-that-both-saved-and.html

  105. I have fructose malabsorbtion, lactose intolerance, IBS and egg, banana, pineaple alergies. And all of my digest problems started suddenly at 33 year old! Since that, 5 years, I can’t eat almost nothing, not even “good fod”. I intake lactase and fructasin pils, but don’t help me (just for lactase a little bit).
    What is wrong with all of my “sistem’?? What can I do??? I does all the medical tests posible, colonoscopy etc etc.
    I’m still positive, not depresion, but my body, my brain need much more to can work again, to functionig again,I’m too young to lett down for anything! I can’t help anybody around me, I can’t do anything, I can’t have children, and my menthal skills are no useful for anybody,,,,
    Our problems are verry simple, we need a new generation of enzymes and good probiotics and even good parasites?

    Maybe I must learn much more of this life lesson.
    Or maybe I learn, finaly say: Help me if you can! Please!!!!!!!!!!

    Sorry for my english, the mouvies are my only teacher.

    Best regards for all of you!

  106. Thank you so much for your reply Peggy! I will be getting my FM breath test ASAP! Plus, I intend to try out your dietary suggestions and eat only meat, eggs, and starches! Since I have gone Paleo, I cut out rice and potatoes! I was living off of meat, eggs, veggies, and sweet potatoes! Now I know, that if I am in fact a FM sufferer that sweet potatoes are out! Or are they? I saw on some lists that a half a sweet potato may be tolerated! My question is…. What type of starches do you suggest? I read that plantains are on the ok list, and I am not opposed to re-introducing my old starch friends (white rice and potatoes) back into my diet, if they will help to relieve my symptoms! I just long and pray to be healthy and out of this food coma! Also…. A few Paleo staples that I have been wondering about! I know that coconut oil and fresh herbs and spices are ok, but may I still eat bacon, such as the Applegate or U.S. Wellness brands? And a few others…. Coconut Aminos, Red Boat Fish Sauce, and Palm Oil? Sorry for asking so many questions, but I am new to all of this and the Paleo dietary guidelines for FM sufferers are different!

    Update: Since Monday, I have been eating only meat, fish, eggs, a little spinach, cucumber, coconut oil and some salt and pepper for cooking, and white rice (since I’ve read that brown rice may be problematic) and potatoes! Some of my bloating has already gone down but the morning after eating my first potato, I woke up with body aches and a stiff neck! I’m sure this is due to inflammation, and the nightshade effect! :-/ So, I guess potatoes are out for me! I’m trying to be patient and I will continue on in my journey! Not gonna lie and say that I don’t miss fruit, but I went cold turkey without them! For me, I have never had the extreme digestive problems! My major symptoms for the last 19 years, have always been the chronic fatigue and brain fog! I’m just praying for relief soon! So once again, I’d appreciate your starch suggestions?!

    • Hi Maya :) I just received my positive for the test a week ago, so I’m still searching everywhere for good info, but I’m pretty sure I read that cucumbers were high in fructose. you might want to check that out. good luck to you!

      • Hi Kristen! I’ve checked about a dozen lists and cucumbers were on the compliant/Low FODMAPs side! They actually have an equal ratio, 1:1 of fructose and glucose! I believe it’s pickles and/or sweetened pickles (relish) that are on the no no list! Thank you so much for your concern though! It helps me to stay on my toes, so I know that I am always doing the best thing for my body! After all…. We FructMals have to stick together!☺

  107. I have been dealing with FM for years and no one could figure out what was wrong. I remember starting to get more and more sick when I was a freshman in college, 19 years old. I am now 25 years old, and the doctor’s have finally been able to pinpoint what is wrong with me. They assumed in the beginning it was just FM, but I am quickly finding out Fructans are a problem for me as well. I have a follow-up appointment with my gastroenterologist soon, and I hope to get him to refer me to a dietician so I can make sure I am getting all the vitamins I need to. It is very hard to get all of the nutrients I need with as little food as I can currently eat. I love hearing other people’s stories with FM and their experiences. It is helpful to see how other people react to certain foods.

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  109. omg.I am 24. I feel like ive been sick my whole life with bloating,nausea, generally just feeling unwell. I always felt i was being a hypercondriac n always felt like ppl must be tired of my winging. I was generally healthy, but always sick… I thought i was loosing my mind. Then started ignoring it more. But i sat down thinking my body is trying to tell me something! I had 2 colonoscopies done which were all ok.and im not celiac. I was told to cut out wheat to see if that would help incase i was just intolerant. it did help a little. I recently got a blood test done to get an actual diagnosis. I am intolerant small amnts to wheat, gluten, almonds, whole egg, oats, and medium amt to cows milk. But its stilll not quite right. I still feel bloated and get headaches daily. I am very interested in getting the Hydrogen Breath test done! I am so overwhelmed by it all. the feeling of ‘why cant i just be normal’ :( but ive just got to face it. this is just the way it is. I am going to try cutting out fruit and see if this is my answer. I guess for the rest of my life its going to be beef, chicken, fish, some vegetables and rice???? is this right?

  110. Id also like to note. In earlier years as a teenager. I overdosed on laxatives for years to try and be skinnier.. I would binge drink.. vomit etc. I also took numerous difference diet pills. Im assuming all of this has done significant damage to my gut. Aswell of years of not eating as well as i should have + preservatives etc. Hence could this be the reason i am this way?

    • The reasons we have digestive trouble vary. It could be due to the laxatives. It might be a result of a processed foods diet as a child, formula as a baby, anti-biotic doses, drugs, alcohol, prescription meds, stress, mercury fillings, root canals. The ways we hurt our digestive systems is endless.

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  112. I went Paleo in January to try to eliminate the what the doctor told me was a mild case of GERD, although it didn’t feel mild to me and it never really felt like heartburn either. Since then I have been able to stop taking PPI’s every day and feel better most of the time but sometimes I relapse and get bad pain in my lower abdomen and back. I feel like it is mostly connected to fruit–especially bananas, pineapple, grapes, raspberries and apples and whole grains like oatmeal. I have never noticed it with onions and garlic, but sometimes I do have pain when I haven’t eaten any fruit which confused me. It seems like it could be FM but I am dreading eliminating more foods from my diet. I also have acne which improved a little with my Paleo changes, but didn’t disappear completely. I need an owner’s manual for my body!

  113. I have also had issues with regularity since going Paleo and eating a handful of prunes every day has helped with that. Should I stop eating those? I have read almost every variation of this diet out there from GAPS, to SCD, to Fast Tract, and they all vary slightly. Do you find that small amounts of dairy make you break out? I have a hard time eliminating all cheese.

  114. If I believe this fructose malab. might be a possibility for me, then would you think I need be on the SCD diet? There is fruit and some other things you suggested not be eaten if that is the case, meaning fruc. malab. Should I try not eating the fructose items first?

  115. Hi Peggy, I just came across this article. I have been trying for quite some time to heal my hormonal acne through diet, and am on the verge of starting a very low carb diet and eliminating fructose. Already pretty much dairy free and grain free. Really fascinating information, but I think what resonated with me most was the story about your daughter. My daughter will be 2 next month, and although she is growing and developing quite well, she has always had a distended looking belly. It was noticeable even when she was just a few weeks old; enough so to have a discussion with the pediatrician. When she was exclusively breastfed before starting solids she would only poop about once every 4 or 5 days or so. She seemed constipated, but they were never solid poops, so I assumed this was just “normal” for her. Once she started eating solids she started pooping more frequently. I breastfed her until she was a year and a half, and have never given her cows milk, but instead have made her coconut milk from dried, unsweetened coconut flakes. Anyways, she has been pretty much gluten/grain free for the most part, and her diet is primarily eggs, meat, fish, cooked veggies in soups, butter, limited dairy (no milk), nuts, seeds, and FRUIT. She has fruit multiple times a day, and I have always thought this was fine since I wasn’t feeding her starchy carbs and milk. Fruit is her main carbohydrate. And she always looks bloated. She is this tall, robust, strong toddler, with a protruding belly. Since she has had it her whole life I just figured this was her “normal” and part of toddlerhood. Sorry for the rambling, but I’m curious if your daughter had any constipation/weird pooping issues. Again, since she started solids she pooped more frequently, and at this age she poops almost every day, but sometimes she seems so uncomfortable before she poops and says “Ow” often. When she was younger she would even cry before she pooped. But I haven’t considered it constipation, since her poop is never solid; always loose. Again, at first this worried me, but then I read an article written by a pediatric specialist who said that toddlers should have poop the consistency of hummus, and that most toddlers today have poops that are too solid. I’m so sorry for all the “poop” talk, but I figured since you are a mother, you know how it is:) I’m just really curious if your daughter had any of these elimination issues too. Thank you so much for sharing your experiences!

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  118. Thank you SO much for this post! I was DXed as Celiac 2 years ago. After going gluten free, I started reacting badly to dairy, soy, corn, eggs, peanuts, peas..and the list keeps growing. I went Paleo, but was still having a LOT of issues. After a few tests at Mayo Clinic last year they said I “probably” had a severe case of SIBO. Antibiotics didn’t help, so I started probiotics. Symptoms continued. A food log wasn’t helping me connect the dots as to what was making me miserable. I thought maybe yeast..and used an enzyme for that.
    I just went to the Mayo Clinic again. I told them I was getting more intolerances. I had rashes/itching, insomnia, was depressed, bloating, burning tummy, headaches,nausea at times, mood swings, burping, etc.
    I craved Kettle chips. I questioned if I still had SIBO, or yeast, or leaky gut. I was told that yeast and leaky gut are nonsense. They said SIBO wasn’t likely. They suggested I go on stronger antidepressants and up my dose until I wasn’t having symptoms. This suggested it was “all in my head”. They agreed to redo the SIBO test, but with fructose to see what happened. I found out I’m fructose intolerant. They gave me a brief pamphlet and told me to look it up..and sent me on my way.
    Your post is one of the first I read and it’s so helpful. I was having a hard time figuring out what I COULD eat with my other food intolerances too. Do you know if coconut oil is well tolerated? I use it for it’s health benefits, but wonder if it’s healthy for us?

  119. What an excellent post! Really well written and helpful both to me as well as my clients. I have been doing a lot of work on this over the years and I conducted my own elimination diet as I have such bad digestive problems (exacerbated by years of steroids and antibiotics). The worst offenders for me were fructose, sorbitol (I used to chew gum) and lactose. Everything has changed now and I now have no acne, no bloating (used to be awfully painful) and my mood has changed completely. It is amazing how many areas of my health it has improved – beyond even the digestive stuff. I used to think it was just simple glucose that was my problem but it wasn’t. As a nutritionist I spend most of my working life buried in research papers and I happened to stumble on FODMAP stuff a year or so ago. I was looking for something to show a client and stumbled across your website. She has a young child with similar problems and this blog post helped us both, so thank you. Keep up the amazing work you do!

  120. I just found out about fructose malabsorbtion today. I am so happy I stumbled across this blog. It has been very informative. I have been really sick off and on for YEARS now. In fact I had gone vegitarian several times thinking that it would be healthier and I would feel better, but I was so wrong! I just felt worse and worse! I would eventually get so sick (I would spend alot of time throwing up), that I would stop being a vegetarian and I would feel somewhat better (although I would still have a bloated, achey stomach most of the time). I think the thing that surprises me the most is the onion thing. I don’t like onions, but if they are in food and I can’t pick them out I get horrible stomach cramps, bloating, and nausea. I am so happy to see that it isn’t “all in my head” as some people have told me. I will have to try watching my fructose intake and see what happens. Thankyou!

  121. Thanks for your post! Seeing your daughters tummy reminds me of mine. Since middle school at least I would get very bloated. I was told I had acid reflux and went on a diet eliminating acid. I remember eating a lot of Alfredo and feeling better but not all the time. When I went to college it got worse. I’m sure it had a lot to do with cafeteria food and I was eating a lot of fruit at the time because I decided to get healthy. At that time I had been going to my GI dr and he did an upper GI and told me I had no signs of acid reflux. I was told I had IBS and told to go on a probiotic. Things got so much worse and in my second year I hardly got out of bed. My friends were going out and I was feeling depressed all the time and in constant pain. My dr decided to try the fructose test which I am so grateful for. Most doctors have told me it is not something many doctors check for so it’s great that he did. I am symptom free most of the time but it is no longer unbearable and I’m able to live life. It has been 6 years since I was diagnosed and I haven’t found a ton of articles so thank you for your wonderful site. I had not heard about the depression and skin problems and not it makes sense! Thank you!

  122. Wow i am blessed beyone measure to find the website. I have had bloating issues all my life, plus a list of issues. My biggest problem it is got so bad my throat and tongue are swelling! and the glands in my throat! I always have a rash and my nose gets red like Rudoph! I have been to a list of ENTs for 30 years and they all say I have acid reflex! I had a gluten test done a couple weeks ago and it was neg. Which i told the dr it would be! they refuse to listen. I have been eating apples because i was told by a dr that would help hahah dumb! I am also wondering if I have issues with corn? Or maybe its all the fructose? Thank you so much for the amazing help!

  123. Great story! I was wondering- as far as the rest of the foods not on either list, would you stick with the Paleo diet? I am lost and don’t know how to handle my (similar) problems. I have tried a low FODMAP (close to Paleo diet) and found zero relief of my EXTREME bloating, fatigue, depression, pain and many stomach problems-if anything I got worse. Not sure if my symptoms are even related to fructose malabsorption. =/ How much of the Paleo diet did you change besides eating less fruit? I am having trouble knowing exactly what foods are “safe”.

  124. So lovely to read what I’m beginning to realise for myself, but always a self doubter needed the confirmation that there are other people out there going through this. This ‘summer; I have had awful allergies which I thought I’d said goodbye to at the end of childhood. On top of that I have been struggling with eczema for the first time over the last two or three years and now beginning to get arthritis like symptoms. The latest and weirdest thing is wrinkles on the tops of my fingers that are now beginning to crack. I’m sure the doctors think I am mad when I say I know that my skin just isn;t repairing itself the way it used to. They just look at me like you’re in you’re late thirties you’re aging get a grip.
    So I started excluding lots of things and was realising even onions were causing me problems. So I’ve been internet surfing and a few days ago came up with the FODMAP stuff. But today still hugely bloated thought it has to be tthe coconut milk it is the only fruit I am consuming. I’m not consuming any grains, carbs, sugar, no rice, no sugar, just green vedge, bamboo shoots, carrots, meat, almonds and olives. My energy levels are low and I am running a half marathon in two days.

    So I will give up the coconut milk.

    Are you still doing the paleo and what’s the story with white v brown rice?

    Great article, thanks again.

    Eve

  125. Peggy,

    I hope you don’t mind that I cited your website for one of my blog posts. I am a new sufferer of Fructose Malabsorption, so it was absolutely awesome to read someone elses story! It definitely seems that until I can get into a dietician, the online community is my best support network. Thanks for sharing yours, and your daughters story. At the risk of sounding like I am promoting myself, feel free to read and follow my journey at: http://fitfabulousandfructosefriendly.blogspot.com.au/

    Love Carra

  126. Thank you for this post – I have known I have Fructose Malabsorbtion for 3 or so years. This last week I started adding in coconut butter to my diet at the suggestion of someone who is following a PALEO diet. Wow, turns out I can’t tolerate it AT ALL. Coconut water often has sugar added (I tried it too) and had a bad reaction to it.

  127. This is really interesting…I’m currently on a quest to finally figure out why I am constantly bloated and gassy and have always had eczema problems. Seeing the image of your daughter brought to mind the fact that even as a young girl I had major problems with constipation, even to the point where I lost my appetite for 3 months from being so stuffed up and was severely underweight as a 10 year old. I also suffered from depression and severe panic attacks as a child. Now as a 27 year old I’m still trying to figure out why I’ve always been so imbalanced, and this could be it. I’m giving this a shot!!

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  129. My 16 year old son was diagnosed (with the aid of a hydrogen breath test) with Frucotse intolerance just this morning…and he was suffering from just about every symptom you listed…most prevelant was the depression (and for years he had been treated with antidepressants for this), skin problems, and many trips to the ER and doctor because of IBS symptoms he was experiencing. I was doing research while waiting to talk with the dietician and came across you blog and was soooo glad I did…for years my son has been suffering with depression and IBS issues and not one time was any of it ever linked together…now I’m finally seeing the light at the end of the tunnel!!! Thank you so much for telling your story. I found your article very informative!!!

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  132. Pingback: Food Intolerances: Fructose Malabsorption, Lactose and Histamine Intolerance: living and eating well after diagnosis & dealing with the elimination diet | WWW.JUSTINFOHUB.COM