Up to 40% of people don’t absorb this sugar as well as they should, because they lack receptors for it in their small intestines. The unpleasant consequences? Fructose remains in their intestines where it’s broken down by bacteria to gases. These gasses cause a host of tummy symptoms including abdominal distension, bloating and gaseousness.
People who don’t absorb fructose well may also experience crampy abdominal discomfort, bloating, nausea or diarrhea after eating foods that contain this sugar. Many sufferers are unaware that fructose is the reason they have problems zipping up their jeans.
This condition is referred to as dietary fructose intolerance or fructose malabsorption. This is to distinguish it from a more serious condition called hereditary fructose intolerance, a genetic condition where the liver can’t break down fructose. Hereditary fructose intolerance can be life-threatening, whereas dietary fructose intolerance is usually more of an annoyance. A person may suffer from bloating and gas for years without knowing that fructose is causing the problem.
Fructose Malabsorption and Tummy Bloating: How Do You Know if You Have It?
There’s a test called the hydrogen breath test that doctors use to diagnose this condition, but most people can find out if the problem by keeping a food diary. Foods with a high ratio of fructose to glucose and foods containing the sugar alcohol, sorbitol or fructans, long chains of fructose, are triggers. Sorbitol is converted to fructose once it gets inside the body.
The best way to identify problems absorbing fructose is to keep a food diary for several weeks, carefully recording each food and any symptoms that occur after eating it. After a few weeks, you’ll be able to see whether foods high in fructose, sorbitol or fructans are causing the problem.
What Specific Foods Should You Avoid?
Foods that cause problems for people with fructose malabsorption include fruits with a high fructose-to glucose-ratio. Examples of fructose-rich fruits are pears, apples, papaya, mangoes, guava, watermelon, melons, grapes, and lychee fruit.
Other foods that can cause problems are foods sweetened with sugar alcohols such as sorbitol, foods containing high-fructose corn syrup, fruit juices, and honey. Some vegetables such as sweet potatoes, carrots, onions, artichokes, asparagus, and eggplant can be problematic as can products containing wheat. Common sources of sugar alcohols are sugar-free chewing gum, candy, diet drinks, and some medications. Dried fruit and wine can also trigger fructose malabsorption symptoms.
The good news? Avoiding these trigger foods prevents the tummy bloating and gaseousness that so many people with fructose absorption problems experience. The problem is high-fructose corn syrup and sugar alcohols are hiding in many packaged food products. It’s important to read labels and make sure you’re not unknowingly eating and drinking products that can bring on the symptoms.
The Bottom Line?
If you have tummy bloating and can’t identify the cause, start keeping a food diary or eliminate foods containing sugar alcohols, wheat, high-fructose corn syrup, fructans and large amounts of fructose, and see if the symptoms get better. There are certain fruits you can still eat if you have fructose absorption problems. These include most berries, plums, apricots, citrus fruits, and bananas. Enjoy these fruits, but stay away from ones that trigger intestinal symptoms. If the tummy bloating persists despite making dietary changes, see your doctor. Abdominal bloating and distension can sometimes be a sign of a more serious illness.
References:
American Dietitic Association. 106(10): 1631-9.
Medscape. “Evidence-Based Dietary Management of Functional Gastrointestinal Symptoms: FODMAPs in the Diet”
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