IBS, Depression, and Skin Problems in Fructose Malabsorption
31 Mar
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.” After years of wondering about the same thing, I may have slowly stumbled upon one, of maybe many, possible reasons for this.
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. I myself started to see a connection to fruit and my skin as well as my mood and digestion. This led me to some pretty strict elimination diets. If only I had known years ago that there were just some specific foods I needed to avoid…
Discovery Through Experimentation
I’ve mentioned countless times on this blog that, while going Paleo initially helped with many of my symptoms, it wasn’t the cure all that I had hoped for. Even after going Paleo I was still so bloated I looked five months pregnant, I still had skin issues, and I was still depressed, among other symptoms.
Going Paleo did offer so many positive benefits that I had never seen before with any other diet modification, I was well convinced that some version of it was right for me, but those few remaining symptoms were quite a blight on my self image and physical comfort.
I am stubborn and so I experimented and experimented trying to figure it out.
Finally, about 3 years into being Paleo, I narrowed my diet down to almost nothing but raw fish, raw meat, fresh juices from celery, wheatgrass, carrot, and spinach, plus white rice. That was the extent of my diet for a good two years and it was absolutely amazing.
But I guess I was just too thrilled with feeling good; I wasn’t careful about making sure my diet was perfectly wholesome. I quit making broth, never ate saturated fats, was probably missing some B-vitamins, and I may have taken a little too much to drinking in my newfound youth (blush, kinda feel stupid about that). Whatever the reason exactly, I developed a raging allergy to rice (and several vegetables which I didn’t find out about until years later) and had to quit my miracle diet. ;(
After playing around again with your usual Paleo diet and never feeling so awesome again, I went super low carb. That worked too by god! No fatigue, no depression, no acne, no nuthin. I felt great. But my extremely low carb approach came with its own set of complications. It was hard to eat enough meat and fat. I wasn’t eating veggies because, like so many others, I thought I was allergic to everything.
Until one day, about 7 or 8 months ago, someone popped round the blog and dropped a gem of advice in the comments. Maybe you should look into fructose malabsorption. It made sense. I had figured out on my own years ago that fruit does me much harm. Maybe I needed to avoid it like I avoid gluten.
Now the success with these two vastly different diets makes perfect sense.
I eliminated Fructose.
While I had thought I was reacting to everything I put in my body, I had only been reacting to fructose.
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 more common in women with FM
We can thank Emily Deans, my favorite 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 should be eaten in moderation only:
- Bluberries
- Straberries
- Raspberries
- Cranberries
- Kiwi
- Ripe banana
- Pineapple
- Oranges and grapefruit
- Maple syrup in small doses – doesn’t work for everyone
- Table sugar in small doses
- Distilled liquor
Foods which can be eaten liberally:
- Meat
- Eggs
- Milk – if lactose malabsorption is not also an issue
- Yogurt
- Cheese
- Nuts
- Olives
- Leafy green vegetables
- Broccoli
- Lemons and limes
- Glucose
- Yams but NOT sweet potatoes
- Plantain
- Tapioca – same as yuca or casava
- Corn Tortillas
- Potato
- Rice
Foods to Avoid List
Foods containing fructose:
- Fruit juice
- Dried fruit
- Fruit concentrates
- Melons
- Grapes
- Cherries
- Peaches
- Pears
- Apples
- Apricots
- Guava
- Mango
- Pomegranate
- Whole corn
- Honey
- Agave
- Tomato paste
- Corn syrup and high fructose corn syrup
- Wine – dry wines might be ok in moderation
Foods containing fructans:
- Wheat
- Onions
- Garlic
- Leeks
- Coconut milk and meat
- Jerusalem artichoke
- Green beans
- Carrots – tolerance varies
- Asparagus
- Chicory root
For a searchable database of foods containing fructose check out the website The Farting Pear.
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 part essentially holds the hand of the fructose part and helps it along. They are absorbed together so that the fructose doesn’t have to make the terrible trip down to the colon where it doesn’t belong. Now, if 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.
Solving a Life Long Problem
My daughter Evelyn had also been bloated quite often since she started eating solids. I never knew why. I almost figured she inherited my own bad microbial environment which I had developed after years of bad diet and anti-biotics. Turns out neither of us are in such a bad place after all. We just were fermenting fructose like crazy. (I had tried, very religiously, candida diets and anti-microbial herbs and probiotics to no avail.)
Finding out what had been causing my remaining persistent symptoms which the Paleo diet couldn’t cure was wonderful – it’s a miracle to not be stumped anymore. But to find out what is causing your own child’s discomfort is a relief beyond any other.
Evelyn has fructose malabsorption too. After all these years we finally got to the bottom of it. We have our lists printed out and hanging on the fridge. We give them to her friends, her dad, and school. She knows most of the foods herself but she likes having the list handy too.
Here is a picture of her one evening when she was bloated and very sad because she was constipated, juxtaposed with her new flat bellied self. Depression was never one of her symptoms… yet. I’m sure if she had hit puberty before finding out about this, that would have hit her too, just like it has hit all of the women in my family. Hmm, food for thought.
The Bloating Is Gone Forever
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!!!
You’re welcome! I’d love to hear how it goes. Garlic and onions are such an unsuspecting culprit. Isn’t an absolutely amazing feeling to suddenly not be bloated anymore? I love to hear stories like yours.
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.
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.
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!
I know the feeling! There was a time when I too was wondering why in the world I had problems eating all meat. I wasn’t actually eating all meat. Garlic and onions are often killers for us fructose malabsorbers.
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!
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.
Would you consider extra virgin olive oil safe? I usually cook my meat in ghee and sprinkle liberal amount of garlic and onion powder! :-/
There are no fructans in olives so you’re good with olive oil.
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.
P
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!)
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.
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.
Thanks Connie. I have read that about onion as well. Onion juice would definitely be a tasty and nutritious addition to many dishes, though I haven’t tried it ey either…
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!
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!
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.
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.
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!!!
I hope so Julia! When I learned of fructose malabsorption I was pretty sure from the beginning too because I had already narrowed down so many of the foods. Good luck to you!
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.
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…
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!
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.
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.
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!
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.
Accumulative effect. Common with gluten intolerances.
The theory behind the rotation diet I suppose.
That’s not it (although I obviously don’t tolerate wheat well), because if I chuck it and get fresh stuff the next day it doesn’t happen. Anyway, we don’t come to Peggy’s site to figure out how to make wheat more digestible, I was just curious if anyone else had observed the same thing.
Hahaha. My fault. I posted your question on my Facebook page ecause I thought it was interesting.
Wheat or not.
http://www.pennilessparenting.com/2012/04/removing-gluten-to-heal-seasonal.html#more
Sorry, i saw the facebook post and then went to read some other blogs and saw this article referencing how wheat has been bred to contain more gluten in recent years vs what would have been eaten in the past. Thought it might help answer the conundrum.
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.
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!
I agree checking out wheat belly might be revealing. He illuminates the difference between wheat now and
Wheat a long time ago. It is likely that the success Weston price had with wheat may have been because it was a very different wheat.
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.
https://theprimalparent.com/2011/05/11/a-dirty-kid-is-a-happy-kid/
https://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.
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!
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….
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!
Cori, that is so cool! I’m sure my daughter will be happy to know that she’s making a difference in someone elses life.
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.
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
Sounds like the story of my life Jane! please let me know if it makes a difference. I would love to hear back from some of the people giving this a shot for the first time.
Thanks for this post!
. A functional med doc I talked with thinks I have estrogen excess. Not sure if this is related or not?)
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
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.
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
Great article about FODMAPs, Aglaee! Just to clarify for readers who don’t know about FODMAPs, fructose malabsorption is not the same thing as FODMAPs intolerance. A person could have an impaired ability to absorb fructose, yet have no problem with lactose, for example. Fructose is in the FODMAPs category but FODMAPs encompasses quite a bit more than fructose.
Thanks! This will really help me I think!
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.
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.
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!
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.
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!
This is fascinating. Thank you for posting Peggy. I am curious did you also get tested for SIBO?
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.
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????
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.
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
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.
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