Feed me, Seymour! But make it fructose friendly.

So now that you’ve wrapped your head around the complexities of gluten free catering (or, indeed, shuddered and been grateful you don’t have to worry about it), let’s look at catering for those who suffer from fructose malabsorption (sometimes known as fructose intolerance). Coeliac and fructose intolerance are both frequent causes of Irritable Bowel Syndrome (IBS), and have similar symptoms – abdominal pain (ranging from mild to severe), diarrhoea, bloating, gas, even throwing up. It can leave you exhausted both from the symptoms and because you’re not absorbing your food properly. It’s much nicer to avoid all of that, if at all possible!

The good news about fructose is that, unlike gluten, cross contamination isn’t usually an issue. So you don’t have to be 100% scrupulous about making sure the wrong foods don’t come into contact with the fructose friendly ones. The bad news is that fructose is, as yet, relatively poorly studied, so the information about fructose load in various foods is a little sketchy. We follow the rule “if in doubt, leave it out”, or if we’re feeling brave and healthy, we will occasionally try a food to see what happens.

My daughter and I are very sensitive to fructose, so this guide is good for those whose tolerance for fructose is very low. Many people with fructose malabsorption will be able to be a little more relaxed about some things.

The first thing you need to wrap your head around is that there is fructose, and there are fructans. Fructans are chains of fructose molecules stuck together, and there is little you can do about them other than avoid them. Foods that are unsafe due to fructans include onions of all kinds (including shallots and spring onions), garlic (although many fructose sensitive people can tolerate a little garlic), wheat, rye, some legumes, artichokes, asparagus, and inulin and fructooligosaccharides (which you will see as ingredients on many processed foods).

Unlike fructans, fructose can, to some extent, be balanced with glucose to make it easier to digest. This is why some fruits are better than others for sufferers, because some fruits have a 50-50 ratio of fructose to glucose.

“Safe” fruits include bananas, citrus, cantalope, pineapple, berries, and tomatoes. These are all ok for us to eat, but only in small quantities. The literature says that grapes are ok, too, but we have found only very small numbers of grapes to be bearable, and I suspect that the ratio varies for different varieties – which makes it very hard to know what is safe!

Unsafe fruits have more fructose than glucose, and include apples, pears, watermelon, mango, honeydew melon, nashi pears and all dried fruits. We can get away with small amounts of these things if we have some glucose at the same time, to balance the fructose.

Safe vegies include cauliflower, spinach, carrots, potatoes, pumpkin, sweet potato, mushrooms, cucumber, sweet corn and peas.

Unsafe vegies include broccoli, brussel sprouts, cabbage, beetroot, chickpeas and artichokes.

Safe grains include rice, buckwheat and quinoa.

As you can see, even if you add the lists together, there are a lot of fruits and vegies not covered. We simply don’t know whether they are safe or not.

Also on the “definitely unsafe” list are coconut cream and coconut milk (although the flesh/fibre is ok, as is coconut oil), honey, fruit juices, sweet wines, foods sweetened with fruit juice concentrate, agave nectar and, of course, fructose and high fructose corn syrup. Once again, all of these can be balanced with glucose, but only in small quantities.

Table sugar, or sucrose, is actually 50-50 glucose and fructose, so it is one of the things we can have, but only in limited quantities. That means we can use sugar or golden syrup in place of honey in many recipes, and fortunately maple syrup is fine, too.

So how do we actually eat on a day to day basis? There is an awful lot of label reading. Because of the need to avoid wheat, there is a high proportion of gluten free foods in our diet, like gluten free breads, biscuits, cereals, and pasta. Not all gluten free foods are safe though, those that include chickpea or besan flour, pea flour, dried fruit, inulin,  fructoologosacharides (FOS) or are sweetened with honey or fruit juice concentrate aren’t good.

Even though tomato is ok, we can’t have a lot of it, so I tend not to make tomato based sauces anymore. We use pumpkin a lot, to make meat sauces more sauce-like. We can’t use commercial stocks as they invariably contain onion or onion powder. That is also a problem with many sauces, although there are a few that are safe – notably tamari (gluten free soy sauce) and Chang-brand gluten free oyster sauce. Mayonnaise is often ok (again, subject to careful label reading).

As for herbs and spices, you really need to start being creative to get over the huge reliance western cooking places on onion and garlic. We use a lot of fresh garden herbs like basil, parsley and mint, and quite a lot of ginger, cumin, turmeric and good old salt and pepper. We can also use chili and some curry powders (although the girls aren’t wild about spicy food – notwithstanding the fact that they are both enthusiastic autocondimenters when faced with a pepper grinder!).

So there you have it. Tricky, but not impossible. Of course, combining gluten free, fructose friendly, and my daughter’s reflux triggers gets closer to impossible, but that’s another blog or 20.

Many people who suffer food intolerances are more than happy to bring their own food, so that they can still join in and be social, without inflicting complicated cooking requirements on their friends. We are used to it, and for many of us it worries our hosts much more than it worries us. I often go to restaurants, eat before I go, and just have a coffee, if there is nothing I can eat. Let’s face it, it gives me a better chance of monopolizing the conversation!

If you’re planning to cater for someone with these food problems, it’s always worth talking to them first. Everyone has slightly different tolerances and sensitivities, and the super-sensitive may always choose to bring their own to be on the safe side.

Good luck, and happy cooking!

You might also be interested in my gluten free post

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17 thoughts on “Feed me, Seymour! But make it fructose friendly.

  1. I only just found this post, but so glad I found it! My daughter and I are both gluten free, and she’s looking more and more like she’s having trouble with fructose, as well.

    Darn it, just when we’d found a chickpea recipe she liked, too! Sigh.

    It’s nice to find others with similar issues and see how they are doing and what they’re eat. And get more info, too! :-)

  2. Aaaand, another post, LOL.

    Do you know of a good site on-line that has a listing of all the foods that have been safe for you? My daughter is super sensitive to gluten, which she gets stomach pain for, and sometimes it has made it very tricky to figure out if, say, a variety of bean was a fructose problem or was contaminated with gluten and is still safe to eat. There are so many lists that disagree with each other that it has made it a challenge to find out what we need to. :-(

    1. lindamciver

      Hi Shauna,

      No, I’m sorry, I have never found another site with a list – that’s why I wrote this one. BUT I do know that no beans are safe with fructose malabsorption, and for those who are super-sensitive (as I am, too), yoghurt and yeast and anything else with live cultures can be a problem. Feel free to email me at mciverconsulting@gmail.com if you’d like to chat directly. It’s an incredibly frustrating process, as I know only too well!

      Linda

  3. Miranda

    Great article Linda. I’ve been diagnosed for two years now but I still get confused. There seems to alot of different info. flying around. Some of the foods are no brainers – like onion, apples, pears… evil things (although we once liked each other just fine.) But you’ve mentioned beetroot & broccoli. They’re not in my Low FODMAP book… but perhaps my recent ingestion of said vegies explains a few nasty symptoms. Sigh!

  4. Cheryl Scappaticci

    Hi there! What is it you in AU with fructose malabsorption???? I so wish more information would be made known here in the US. All and I mean ALL of the “good” information I have found on this has been from you all “down under.” My poor Miah who is going to be 7 years old next week is only a mere 35 pounds and has been for almost a year. She suffers terribly from fructose malabsorption and no one and again I mean NO ONE here can I help her. I don’t mean to pat myself on the back but all the information I have figured out has been via the web and those of you in AU and your wonderful knowledge and research. I know her triggers and she has been eating a very boring, bland diet for a few months. In telling you all of this I’m just wondering if you know of any sites or anything with recipes or any other “ideas” that may help. I’m getting ready to pack several suitcases, my five children, and maybe my husband if willing to go spend a week or two in your wonderful continent hoping to find someone willing to show us a good way to help my poor baby girl pack on a couple of pounds. Any information would be so much more than appreciated. This is coming from a Mother who has worked with THREE G.I.’s, FOUR nutrionists, TWO naturopaths (on our third right now), and a partridge in a pear tree . . . . oh wait, pears are bad. Did I mention I have terrible issues with sarcasm? Just kidding. I guess we have to have a sense of humor to keep us going! Thanks for all the effort you have made in making your dietary issues known to help others. I’m sure it has helped many. Again, if you can help in any way whatsoever or can give me a name of someone who can, it would mean so much. Desparate doesn’t beging to explain what I am. I just want someone to help me help my baby girl. She is so sweet, loving, and gentle and it’s killing me not to be able to do more for her. The sarcasm has now been taken over by sadness. I suffer from the same thing to a degree but not at all to extent Miah does. The rest of our kids don’t. OK, I’m done. Sorry for rambling on. I apologize, I just don’t know what else to do! Again thank you for all you do, for reading, and any possible info you may have. Peace to you and yours.

    Cheryl S in Michigan, USA

    1. Miranda

      Oh Cheryl what an awful situation for you and your daughter. If you do come to Australia then you want to visit Shepherd Works (dieticians) run by Dr Sue Shepherd. She’s the one to thank for all her amazing research. Visit their website and start a conversation with them. They may even be able to share info. re US resources. The address is: http://www.shepherdworks.com.au
      Also a book I don’t have but it’s a US publication that looks great: Fructose Malabsorption, A survival guide at http://www.fructosemalabsorptionhelp.com
      I do hope you find the answers you need.

  5. Linda Carter

    I discovered in the 1980’s that I have Fructose Malabsorption, when I became a research subject for a biomedical research group because of episodes of sever digestive problems. The researchers and doctors told me that every time they tried to grow my cells in a sugar [particularly fructose] medium they would just die. They said it happened repeatedly, and soon realized that it was no fluke. All they advised was to stay away from sugar/sweets of all kinds, and eat fruit only in moderation. I kind of knew that since I was a little kid because of how I felt after eating sweets…so tend to avoid them. Also, we have known that I am dairy intolerant since babyhood – I was born in 1942, long before anyone here in the US knew much, if anything, about digestive disorders. Any doctor I have tried to talk to about my digestive problems, looks at me with glazed over eyes and is clueless. So, it has been a frustrating struggle to find answers,plus hit and miss over the years to figure out what foods trigger the episodes of nausea, bloating, diarrhea and projectile vomiting. After my last ER visit with my intestines almost swollen shut, I tried a gluten free diet on my own. Wow, what a remarkable improvement! Here was another piece of the puzzle that had been missing! So, I became convinced that I must have Celiac Disease on top of the Dairy Intolerance and sugar sensitivities. That sure would explain a lot of the extra co-symptoms that plague me: osteoporosis, autoimmune hypothyroid [Hasimoto’s], Sjorgens [another autoimmune disease that means the mucose membranes in the body don’t secret enough fluids], peripheral neurological problems and visual auras [migraine without the pain]. So, recently, we forked over the $$’s and did one of the best Celiac genetic test available today – the only test I could do without subjecting myself to 6-8 weeks of hell by craming my gut full of gluten to get the other tests. Surprise! Prometheus Labs told me that I do not have DQ2 or DQ8 found in 98% of Celiacs, so it’s “extremely unlikely” that I will ever develop Celiac Disease. Whoa! This was BIG news!!!!!! So, now I am wondering if what I thought was Gluten Sensitivity, since I reacted so well to the gluten free diet, was really Fructan Sensitivity all along? I have lots of questions! Do we know if Fructose Malabsorption is another of the autoimmune diseases? Does it cause villi blunting in the small intestines like Celiac? Are there other co-diseases that sometimes tag along –and does it cause malabsorption of vitamins and minerals that trigger the co-diseases? Boy, I wish someone would do a lot more research on this!

    1. lindamciver

      Hi Linda,

      There is a lot of recent research that shows that it is quite possibly to be severely gluten intolerant without having coeliac disease. And you can wind up quite severely malnourished due to either fructose malabsorption or gluten intolerance. Neither fructose malabsorption or non-coeliac gluten intolerance damage the villi as far as we know, but you are not absorbing your food properly, so you can wind up deficient in all kinds of things.

      I quite agree, we need heaps more research!

      Linda

      1. CJ

        Hi. I have been having fructose issues and histamine intolerances for the past few years. I have just discovered that I have a small intestine bacterial overgrowth (SIBO), diagnosed with a breath test, that was causing my symptoms. I suspect the overgrowth may have been from a course of antibiotics that threw my gut out of balance. I have been through 3 years of hell and I am only now seeing the light at the end of the tunnel so I am posting this in the hope that this info may lead others on the path to a diagnosis and better health.

  6. Larry

    Interesting post. I have the same problem I think but my doctor says she cannot test me because the government does not allow her. I have this problem for 20-25 years and nobody can test me for it. ( I live in Canada). I was looking for fructosin to start because right now there is nothing I can eat without affecting my digestion. By the way… Where do you get pure glucose?

    1. lindamciver

      Hi Larry,

      We get pure glucose at our local supermarket, and also at health food shops. At the supermarket here it’s marketed as “glucodin” and usually positioned with the energy drinks. Might be worth a look.

      If you can’t do the tests, you can still try following the diet. It’s tricky to balance, though, since it’s a matter of balance – for example if you have something that includes table sugar and some fruit at the same time, that will probably tip you over the edge, where just having one or the other would have been fine. I’d recommend cutting way back on anything that includes fructose or fructans, and then add things back slowly, in small amounts, to see what you can tolerate. If you cut way back and still have symptoms, then fructose is unlikely to be your problem.

      1. Larry

        Thank you for the info. I’m afraid to look at anything on the shelf that is prepared already. But I will look for glucose. Have you heard about fructosin? I do a lot of trips in US and I will be looking for something like this but so far all the calls I made I have been told that they did not hear about it. Thank you for the info.

  7. Doni

    A lot of people diagonse celiac, turns out may have fructose malabsortion instead. A gluten-free diet would have beneficial effects in any event, because it bans wheat, which is a big no-no for fructose malabsortion. But this may help examplain why many of gluten-frei diets still fail to feel completely fine.

    But the research is crazy. They are now a number of lists around, and some items can be in either depending where you look! I have now read that new researchs indicates coconut is not a problem. That beans are never to be touched, but one can eat chickpeas and lentils in moderation. That both pre- and pro-biotics are bad… And I don’t know what the deal is with brassicas, which I love and have so many health benefits… Depending where you look they may tell you they are (or not) fine if fermented (as in sauerkraut), or in small quantities for broccoli and sprouts, or if they are cooked or pickled… it is darn confusing.

    1. lindamciver

      It is completely confusing, I agree. I can’t tolerate chickpeas at all, even as besan flour. I suspect there are many varieties of fructose problems, including those who can’t tolerate fructans but are fine with fructose, and possibly vice versa. I also suspect that many fruits and vegetables vary in their fructose/fructan content according to variety, time of year, and ripeness, which just adds to the complexity, and may explain why there are so many different research results out there. Keeping a food diary can help map symptoms to particular foods, but it is a long and tedious process. On the bright side, I have less stomach pains now than I have ever had in my life, so it’s worth persisting!

  8. Sam

    Have you tried Gluten Free Asafoetida Powder? you need to be careful which one you select as some are not gluten free and some are not fructans free but they do exist in the free-from form. Its a good substitute for garlic and onions. it stinks in its uncooked form, but if you heat it in a small amount of oil it becomes very similar to onion/garlic flavour.

    1. lindamciver

      Thanks Sam. I have speculated about asafoetida from time to time, but never tried it. Good to know what to look for!

  9. Michelle

    Hi all ~ sorry for the long post, its a subject close to my heart after 4 years of my toddler being so sick with no cure in sight… until we moved & found Professor Cameron, head of Gastroenterology at RCH, Melbourne!
    Just wanted to add to the amazing conversation & the unknown science of fructose malabsorption. We too live in Australia, the home of Dr Sue Shephard. My daughter is now 11yrs, she was finally diagnosed by Prof Cameron at the Royal Children’s Hospital when she was 5 as having an off the scale wheat IgE allergy (blood test) as well as fructose malabsoprtion (hydrogen breath test done twice as the first one showed no issue). After a year from ages 3-4 of full blown breathing issues (almost put on an epi-pen) diarrhoea and stomach cramps RCH diagnosed her condition. The dietician Prof Cameron referred us to was the ex-head of dietetics at RCH and at age 70, she saved my daughters misery & gave me the knowledge of how to read labels and what she could/could not eat. The list became bigger as to what she couldn’t eat, but at the same time I am astounded as to how much we can eat! My suggestion, like the earlier one is go to Sue Shephard’s website, she works with Professor Cameron and those at Monash Medical Centre/Monash University http://www.med.monash.edu/cecs/gastro/fodmap/description.html and they are the centre of all research re fructose malabsorption amongst other IBS conditions. It is true to say that most GF foods are perfect, but not to be touched if they have any of the fructo-oligosaccharides (FOS) found in; wheat, rye, onions and garlic or galacto-oligosaccharides (GOS) found in ; legumes/pulses are used ~ besan, pea, soy flours etc. We never buy prepared foods at the supermarket, with careful label reading there are some bottled sauces that are suitable, namely Masterfoods red wine/garlic & portuguese marinades (sesnsitivity to garlic varies amongst fructose sufferes whereas all sufferers can not tolerate any onion at all). Onion is the pure fructan and worse offender present in nearly every commercially made food either in the form of dried vegetable, powders or fresh ~ I also can;t believe how normal plain salted chips can have wheat added to them to make “flavours” better… “Thins” potato chips are the worst! Good Luck all :)

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