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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Nutrition

Medical Nutrition Therapy: Fructose-Restricted Diet (376)

Medical Nutrition Therapy: Fructose-Restricted Diet (376) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Nutrition

376



Fructose-Restricted Diet


What is fructose?
Fructose is a natural sugar found in many foods like fruits and honey. When fructose is attached to a
sugar called glucose, it forms sucrose or ‘table sugar.’ Long chains of fructose are called fructans and
are found in certain vegetables, wheat, and other foods. Fructose is very sweet and is often made into
high fructose corn syrup, used in soft drinks and processed foods.


Why do I need to restrict fructose in my diet?
ξ Fructose Malabsorption – This is a condition in which the body does not digest or absorb
fructose well. Because of this, fructose becomes fermented by bacteria in the colon. This can
cause bloating, abdominal pain, nausea, gas, and diarrhea.
ξ Hereditary Fructose Intolerance – This is a very rare genetic disorder. This is when the liver
is not able to help the body break down fructose. Symptoms can be more serious. This disorder
requires more than just restriction of fructose.


How do I follow a low fructose diet?
People have different degrees of tolerance to fructose. Most have problems with concentrated sources
of fructose like high fructose corn syrup and honey rather than reasonable amounts of fruit. You will
need to read food labels and become familiar with foods high in fructose.


How long do I have to follow a low fructose diet?
Some people will find relief of symptoms quickly while others need more time. Once your symptoms
improve for 4-6 weeks, you can slowly add foods back to your diet and test your tolerance. Try adding
only one food back to your diet at a time and waiting 3-4 days in between.


What foods or food groups do I need to avoid?
ξ Avoid foods and drinks with high fructose corn syrup (candy, sodas, sweetened juice).
ξ Avoid commercial baked goods. Most of these contain high fructose corn syrup.
ξ Avoid sorbitol (a sugar alcohol). Fructose combined with sorbitol can worsen digestive
symptoms. Sorbitol is commonly found in sugar free candy and cough drops.
ξ Try limiting fruit portions to ½ cup at a meal or snack.
ξ Limit sweets to small servings. Enjoy sweets with a meal not as a snack, if possible.
ξ The amount of fructose that produces GI symptoms in healthy adults can range from less than
25 grams to 50 grams. The levels that cause discomfort in healthy children have not been
studied. Keep in mind that a 16-ounce bottle of apple juice may contain more than 30 grams of
fructose and a 20 ounce bottle of soda can contain up to 40 grams of fructose.

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Sweeteners

Limit or Avoid: Choose these:
ξ Agave syrup
ξ Caramel
ξ Fructose
ξ High Fructose Corn Syrup
ξ Honey
ξ Invert Sugar
ξ Licorice
ξ Molasses
ξ Pancake Syrup
ξ Palm Sugar
ξ Sugar Alcohols: Mannitol, Sorbitol,
Xylitol (for some people)
ξ Sorghum
ξ Always read ingredient labels to be
sure the manufacturers aren’t adding
other sweeteners, like high fructose
corn syrup.
ξ Barley Malt Syrup (about 2% fructose)
ξ Brown Rice Syrup
ξ Brown Sugar
ξ Dextrin
ξ Dextrose—available in specialty stores
and online (binds free fructose in gut to
absorb), can be used in recipes
ξ Glucose or glucose syrups
ξ Lactose
ξ Maltose, Isomaltose
ξ Polycose
ξ Raw sugar or Turbinado sugar
ξ Real Maple Syrup (Limit to 1 T)
ξ Sucrose (Table Sugar/Cane Sugar)
ξ Sugar substitutes: Aspartame*
(Nutrasweet® or Equal®), Sugar Twin®,
Sweet One®, Stevia®, Sucralose
(Splenda®)*

*Certain artificial sweeteners like Sucralose or Aspartame may not be well tolerated

Although some sweeteners are OK to use, some people may not tolerate large amounts consumed at
one time.

Fruits
ξ Eat fruit in moderation as part of a meal. Do not eat fruit separately as a snack.
ξ Avoid fruit drinks, juices, jams, jellies, and chutneys.

Fructose Content of Common Fruits
Fructose is absorbed in the small intestine in a couple of ways. If glucose is present in equal amounts
with fructose, the body absorbs fructose better. Free fructose without matching glucose is absorbed
more slowly, and this may cause digestive symptoms for some.
ξ Start with small portions of Easier to Tolerate fruits at meals (See first table on page 3). They
have a lower number of grams of fructose and are lower in “Excess Fructose” so will cause less
gas and other symptoms.
ξ When the “Excess Fructose” column says “Glucose,” the fruit has a good balance of glucose
and fructose to help the body digest the fructose. For example, apricots are low in fructose and
are balanced with glucose to help absorb the fructose. Apricots usually do not cause problems.
ξ When the “Excess Fructose” column lists the grams of excess fructose, this indicates that there
is no balance of glucose to help absorb the fructose. For example, bananas and mangos are
equally high in fructose, but mangos cause more digestive problems because of their excess
fructose which ferments in the gut, compared to bananas which also have glucose.


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Easier to Tolerate Fruits
FRUIT SERVING SIZE FRUCTOSE (GRAMS) Grams
Excess
Fructose
Apricot 1 fruit .33 Glucose*
Cantaloupe 1/2 cup diced 1.5 0.27
Raspberries ½ cup 1.5 0.31
Plum 1 fruit 2 Glucose*
Peach 1 medium 2 Glucose*
Nectarine 1 medium 2 Glucose*
Blackberries 1/2 cup 2 0.07
Grapefruit ½ fruit 2 0.2
Pineapple ½ cup chunks 2 0.32
Strawberries 1/2 cup sliced 2 0.38
Honeydew 1/2 cup diced 2.5 0.24
Orange 1 fruit 3 0.39
Cherries ½ cup 4 Glucose*
Blueberries ½ cup 4 0.07
*Note: “Glucose” means this fruit has more glucose than fructose

Harder to Tolerate Fruits
FRUIT SERVING SIZE FRUCTOSE (GRAMS) Grams
Excess
Fructose
Kiwi 1 fruit 4 0.22
Raisins 1 miniature box
(1 oz or 30 raisins)
4 0.28
Watermelon 1 cup diced 5 2.7
Banana 1 medium 6 Glucose*
Grapes ½ cup 6 0.7
Mango 1 whole 6 4.1
Orange Juice 1 cup 6.4 0.54
Persimmon 1 whole 2 ½ inch
diameter
9.3 0.2
Apple 1 medium 10 4.48
Prunes ½ cup 11 Glucose*
Pear 1 medium 11 6.18
Apple Juice 1 cup 14 7.69
Dates ½ cup 14 Glucose*
Figs, dry ½ cup 17 Glucose*
Adapted from USDA National Nutrient Database for Standard Reference, Release 20
ξ Avoid these harder to tolerate fruits until you are feeling better (see table above).
ξ Once you are symptom free, you may be able to slowly add 1-2 new fruits weekly. If side
effects return, decrease the amount of fruit in your diet (continue to avoid juices).

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Tomatoes
Many people have problems eating tomato products. Traditional spaghetti sauce made with tomato
paste is bitter from the skin so a sweetener is usually added. Store-bought spaghetti sauce has 11
grams of sugars. This is twice the amount of sugar that is in plain tomato sauce. After you are
symptom free, if you want spaghetti sauce, try making your own sauce. Use the simple recipe below,
or you can also purchase “no sugar added” tomato sauce. You will still need to limit your portion.

FRUIT SERVING SIZE FRUCTOSE
(GRAMS)
Grams
Excess
Fructose
Fresh Tomato 1 whole 1.7 grams 0.15
Tomato Sauce ½ cup 2.03 grams Glucose*
Canned Tomatoes ½ cup 1.52 grams 0.2
Tomato Paste 1 Tablespoon 0.48 grams 0.01

Spaghetti with Meat Sauce:
½ pound hamburger, browned and drained 1 teaspoon Oregano, or to taste
2 cloves fresh garlic, minced 1 teaspoon Basil, or to taste
16 ounces tomato sauce Salt and pepper to taste

After meat is browned and drained, add garlic, oregano, and basil. Add tomato sauce, salt and pepper
to taste and simmer for about 20-30 minutes while pasta cooking. Do not eat more than ½ cup serving.
Try having the sauce with gluten-free noodles. You may also add other herbs or spices.

Vegetables
ξ Some vegetables contain fructose, but are well balanced with glucose. Half cup portions should
not be a problem.
ξ Eat vegetables as part of a meal for better tolerance.
ξ If you have issues with diarrhea, avoid whole kernel corn. It is not well digested.

Vegetables that
may cause
problems
Serving Size Fructan (Grams) Notes
Asparagus 6 spears 2.6
Leeks ½ cup 5.6
Onions 2 Tablespoon 2.1 (may cook with but
remove the chunks)
Jerusalem artichoke ½ cup 15
Garlic 1 Tablespoon 0.5
Globe artichoke 1 globe 5.5
Dandelion greens ½ cup 3.1
Chicory roots ½ cup 15 Common additive in
high fiber products


5


Limit or avoid these vegetables if you have trouble with gas
ξ Beets
ξ Broccoli
ξ Brussels sprouts
ξ Cabbage
ξ Cauliflower
ξ Legumes/baked
Beans
ξ Green peppers
ξ Mushrooms
ξ Sugar snap peas

Dairy Products to Avoid
ξ Flavored or sweetened milks (chocolate and others)
ξ Flavored or sweetened yogurts
ξ Sweetened condensed milk
ξ Flavored coffee creamers

Beverages to Avoid
ξ Carbonated sweetened beverages, particularly citrus flavors
ξ Fruit and vegetable juices, lemonade and other sweetened juice drinks
ξ Milkshakes and malts
ξ Beer, sherry, port and other fortified wines

Allowed Beverages
ξ Water, carbonated water
ξ Milk
ξ Glucose-sweetened energy and sports drinks
ξ Powdered drink, sugar-free (or with allowed sweetener)
ξ Coffee or tea
ξ Alcoholic drinks (limit to 1 ounce): gin, rum, vodka (from grain or potato), whiskey, dry
white wine, or red wine

Other Foods to Avoid or Modify
ξ Avoid chewing gum (both sugar and sugar-free).
ξ Avoid chocolate and most other desserts. Cocoa powder with allowed sweeteners is
okay.
ξ Avoid condiments sweetened with fructose. For example: catsup and soy sauce.
ξ Avoid coconut, coconut milk, coconut cream. These are high in sugars.
ξ For sandwiches and salads, chop up dill pickles instead of using sweet pickle relish.
ξ Check medicines and vitamins for hidden fructose and/or Sorbitol.

Breads and Starches
If your symptoms do not improve after removing high fructose corn syrup and limiting the fruit
you eat, you may need to watch your intake of fructans in breads and starches. Wheat-based
foods contain fructans and/or high fructose corn syrup. These can increase symptoms. Most
people just need to avoid breads with honey or high fructose corn syrup. They can then eat other
breads as desired.






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Breads and Starches
Avoid: Choose these:
ξ Whole wheat bread
ξ Whole grain cereals
ξ Graham crackers
ξ Wheat pasta
ξ Commercial cakes, cookies or muffins
ξ Wheat flour
ξ Products with dried fruits, fruits, honey,
coconut or added sugar
ξ Instant flavored cereals & granola

ξ Rye bread, gluten-free breads
ξ Gluten-free cereals
ξ Rye, corn or rice cripbreads
ξ Rice noodles, gluten-free pasta, brown
rice (for fiber) or white rice
ξ Gluten-free cookies and cakes
ξ Rice flour, Spelt Flour, Other gluten
free flours


Constipation
If you are having issues with constipation, talk to your doctor about a bowel management
program. If you are constipated, the bacteria in the gut have longer to feed and ferment on the
sugars in the gut from the foods you eat. As the sugars feed those bacteria, the bacteria grow
which causes gas and abdominal pain.

References:
Barrett JS. Clinical Ramification of Malabsorption of Fructose and Other Short-chain
Carbohydrates. Practical Gastroenterology. 2007(Aug);53:51-65.
Shepherd S. Fructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for
Effective Dietary Management. J Am Diet Assoc. 2006;106:1631-1639.
USDA National Nutrient Database for Standard Reference, Release 27. If you have more
questions please contact UW Health at one of the phone number listed below. You can also visit
our website at www.uwhealth.org/nutrition

The Spanish version of this Health Facts for You is #417

Teach Back:
What is the most important thing you learned from this handout?
What changes will you make in your diet/lifestyle, based on what you learned today?

If you are a UW Health patient and have more questions please contact UW Health at one of the
phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition.
Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s
Hospital (AFCH) can be reached at: (608) 890-5500.
Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770.

Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright 4/2015 University of Wisconsin Hospital and
Clinics Authority. All rights reserved. Produced by the Clinical Nutrition Services Department and the Department of
Nursing HF#376.