Patient / parent / carer information
You have been provided this leaflet as you or your child has symptoms that may be caused by fructose malabsorption.
What is fructose?
Fructose is a simple sugar found naturally in many fruits and vegetables. Table sugar is also called sucrose, and is broken down in the body into fructose and glucose.
Fructans are long chains of fructose which are found in some vegetables and wheat based products.
What is fructose malabsorption?
Malabsorption is a term used to describe difficulty in digesting or absorbing nutrients from foods. Fructose is absorbed in the small intestine. The amount of fructose that people can absorb is often different; with children typically absorbing less than adults. Fructose that has not been absorbed in the small intestine passes into the large intestine.
In the large intestine, the presence of fructose draws fluid in to the bowel, which can lead to diarrhoea. Bacteria in the in the large intestine rapidly ferment fructose, which produces acids and gases, mainly hydrogen and carbon dioxide. These gases cause the main problems; flatulence (wind), bloating and abdominal pain.
Fructose malabsorption can be diagnosed by a hydrogen breath test. A drink of fructose containing water is given on an empty stomach and if hydrogen is detected on the breath within one hour, the person is regarded to have fructose malabsorption. This test may not always be needed if a dietary trial of a reduced fructose diet is successful.
Fructose malabsorption should not be confused with fructose intolerance, a hereditary condition diagnosed in infants, which involves a deficiency of the liver enzymes that break up fructose.
What is the treatment for fructose malabsorption?
The treatment is a diet low in fructose, which is achieved mainly by reducing fruit and vegetable intakes, especially fruit juices. The amount of fructose eaten before symptoms develop varies widely among people; some children will have problems with small amounts of fructose, and others can eat more.
Most children with a positive breath test to fructose can tolerate fructans (long chains of fructose) in wheat based products well and therefore we recommend exclusion of wheat only until symptoms resolve, or for up to a maximum of two weeks.
Table sugar (sucrose) is also often well tolerated, however as it is broken down in the body into fructose and some children may experience symptoms. If after two weeks of following the restricted diet detailed below your child’s symptoms do not resolve, you should consider excluding sucrose from your child’s diet. Please contact us to discuss this if required.
| Food group | Favourable foods | Unfavourable foods |
|---|---|---|
|
Food group
Fruit Have only one portion of fruit at a time, up to two portions per day. A portion is what fits into the palm of your child’s hand. |
Favourable foods
Apricot, banana (ripe), blackberries, blueberries, cranberries, grapefruit, kiwi, kumquat, lemon, lime, mandarin, nectarine, orange, passion fruit, peach, pineapple, plum, raspberries, rhubarb, strawberries |
Unfavourable foods
Apple, cherries, guava, grapes, honeydew melon, lychee, mango, papaya, pear, persimmon, quince, star fruit (carambola), watermelon All fruit juice/ smoothies (such as apple, grape, prune, grapefruit, orange, tomato) All dried fruit Coconut milk/ cream Fruit pastes and fruit sauces (for example tomato paste, tomato chutney, plum sauce, sweet and sour sauce, barbecue sauce, ketchup) |
|
Food group
Vegetables (cooked vegetables contain less fructose) Aim for three portions of vegetables per day to meet your five a day. |
Favourable foods
Avocado, carrot, cauliflower, courgette, cucumber, garlic, green beans, lettuce, mushrooms, parsnip, peas, peppers, potatoes, pumpkin, squash (for example butternut), swede, sweetcorn, tomato, turnip |
Unfavourable foods
Artichokes (globe and Jerusalem), asparagus, cabbage, leeks, radicchio leaves, shallots, spring onion, sweet potato, vegetable juices *Broccoli, cabbage, Brussels sprouts, legumes (for example chick peas, soya beans, split peas, baked beans, lentils) |
|
Food group
Sugars, sweeteners and preserves |
Favourable foods
Aspartame, dextrose, glucose, glucose syrup, lactose, maltodextrin, maltose, malt extract, saccharin |
Unfavourable foods
Agave nectar, caramel, fruit sugar, golden syrup, honey, jam, lemon curd, maple syrup, marmalade, molasses, North American sweets, sugar (sucrose), sweets, treacle Sweet foods with one of the following ingredients: Corn syrup solids, fructose, fructose-glucose corn syrup, fruit sugar, fruit juice concentrate, honey, high fructose corn syrup, invert sugar syrup, isoglucose, levulose, sacharose, sucrose, sugar, tagatose *Isomalt, lycasin, maltitol, sorbitol, xylitol, sucralose, stevia |
| Food group Meat and poultry | Favourable foods Fresh meat and poultry |
Unfavourable foods
Processed meats with added sugar such as frankfurters, tinned meat, hams, honey cured meats, ready meals |
| Food group Fish | Favourable foods Fresh, frozen, tinned | Unfavourable foods Fish tinned in tomato sauce |
| Food group Meat substitutes | Favourable foods Tofu, Quorn | Unfavourable foods |
| Food group Eggs | Favourable foods All | Unfavourable foods |
| Food group Milk and milk products |
Favourable foods
Whole, semi-skimmed and skimmed milk, cream, plain cheese, cottage cheese, yoghurt, ice cream |
Unfavourable foods Fruit yoghurt |
|
Food group
Cereals, grains, bread and flour |
Favourable foods
Buckwheat, gluten-free pasta, gluten-free bread, maize (corn), millet, oats, oat muesli, porridge, quinoa, rice, rice flour, rice noodles, rice cakes, wheat free breakfast cereals (for example cornflakes, puffed rice, honey nut cornflakes), wheat free rye bread Wheat in small amounts, for example in sauces or as a small ingredient in foods Homemade cakes and biscuits using allowed ingredients and sweeteners |
Unfavourable foods
Wheat based products such as pasta, breakfast cereals (for example bran flakes, Weetabix, Weetos), cakes, cereal bars, crackers, pastry, pizza bases, bread, sweetened breads (for example fruit loaf, brioche) |
| Food group Fats and oils | Favourable foods Butter, margarine, vegetable oil, lard, suet | Unfavourable foods |
| Food group Seasoning |
Favourable foods
Salt, pepper, gravy granules, stock cubes, fresh/ dried herbs, spices, mustard, marmite, Bovril, mayonnaise, salad cream |
Unfavourable foods Fruit pastes, fruit sauces |
| Food group Nuts and seeds | Favourable foods All in small amounts | Unfavourable foods Marzipan |
| Food group Drinks |
Favourable foods
Tea, coffee, cocoa, soda water, mineral water, low calorie squash and fizzy drinks flavoured with saccharin and aspartame |
Unfavourable foods
Fruit juice, vegetable juice, fruit squash, diabetic squash, fizzy drinks, North American soft drinks, tonic water Soft drinks with one of the following ingredients: Corn syrup, fructose, fructose-glucose corn syrup, fruit juice concentrate, high fructose corn syrup, isoglucose, levulose, sacharose, sucrose, sugar, tagatose, isomalt, lycasin, maltitol, sorbitol, xylitol |
| Food group Miscellaneous | Favourable foods Gelatine, food colouring, baking powder | Unfavourable foods Soup, diabetic products, sugar free gums and mints |
*Not rich in fructose but known to cause bloating, abdominal pain and loose stools in some children
Reintroduction of fructose into the diet
Once symptoms have resolved on a strict low fructose diet, you should determine the amount and types of foods your child can tolerate.
Fructose is reintroduced in six steps. Focus on each step for around 3 to 7 days, but it may take longer. This will depend on how many foods you are reintroducing from each list.
If your child develops symptoms, return to the stage they last tolerated and try again with the next stage every 3 to 6 months.
You do not need to introduce all of the foods on each list. It is easier to focus on foods your child previously enjoyed.
Step 1
Reintroduce wheat-based foods, for example bread and pasta. Use white products, rather than wholegrain. If symptoms return on the reintroduction of wheat, please contact us to discuss alternative grains.
Step 2
Reintroduce one food from the following list. If no symptoms occur, reintroduce others from the same list, if the food is usually in your child’s diet.
- Onion
- Leek
- Asparagus
- Artichoke (globe and Jerusalem)
- Chicory
- Radicchio leaves
Step 3
Reintroduce one of the following. If no symptoms occur, reintroduce others from the same list.
- Fruit pastes and sauces (for example plum sauce, sweet and sour sauce, barbeque sauce, tomato chutney, paste and relish)
- Coconut (milk and cream)
- Honey, jam, marmalade
- Foods containing one or more of the following ingredients: corn syrup solids, fructose, fructose-glucose corn syrup, fruit sugar, fruit juice concentrate, honey, high fructose corn syrup, invert sugar syrup, isoglucose, levulose, sacharose, sucrose, sugar, tagatose
Step 4
Reintroduce one portion of fruit from the following list and if no symptoms, reintroduce others. A portion is what fits into the palm of your child’s hand, which may not be the whole fruit.
- apple
- pear
- guava
- honeydew melon
- mango
- papaya
- quince
- star fruit (carambola)
- cherries
- grapes
- persimmon
- lychee
- watermelon
Step 5
Reintroduce the following dried fruits. Please note that one portion of dried fruit is less than a portion of fresh fruit.
- dried apricots/fig (10-15g)
- raisins (10-15g)
Step 6
One small glass of fruit juice/ smoothie (you may wish to dilute with water).
Step 7
Normal diet.
Contact
dietitian: ………………………
Tel: ………………………………
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CB2 0QQ
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