Logo

HealthSheets™

Limited/Restricted Fructose Diet for Dietary Fructose Malabsorption

Fructose Intolerance

Fructose intolerance is not the same as hereditary fructose intolerance. Fructose intolerance is the inability to absorb fructose efficiently. There currently is no specific enzyme to break down fructose in order for it to be absorbed. It can occur in people with irritable bowel syndrome and other stomach and intestinal disorders. High fructose corn syrup (HFCS) is a substantial source. Fructose is also found in some beverages, dairy products, processed foods and as a sugar is naturally present in fruits, some vegetables, and honey. 

Common Symptoms of Fructose Intolerance

  • Bloating

  • Abdominal pain 

                             

  • Diarrhea

  • Headache

                        

  • Weight loss

  • Fatigue

Treatment

Fructose cannot be completely eliminated from the diet. People tolerate fructose at different levels of intake and accept different levels of symptoms. Decreasing as many fructose sources as possible from the diet is the most effective treatment. Decreasing/eliminating the use of sorbitol may also help to decrease symptoms. Sorbitol is a sugar alcohol used as an artificial sweetener in many “diet foods” such as sugarless gum or candy, sugar-free jelly or jam, and some liquid medications. It is known to cause similar symptoms as fructose – especially when fructose and sorbitol are eaten together. 

General Dietary Guidelines

  • Individual tolerance to fructose can vary. It should be spread out in small amounts throughout the day. Foods containing fructose are better tolerated when eaten with other foods rather than alone.

  • Limit drinks with HFCS. If used, drink less than the recommended serving size, e.g., less than 12 oz of soda (may help to drink with a meal).

  • Eliminate products with ingredients that list fructose, crystalline fructose (not HFCS), honey, and sorbitol on the label, especially when present within the first few ingredients.

  • Avoid sugar alcohols which include sorbitol, isomalt, lactitol, maltitol, mannitol, xylitol, erythritol, and lactatol. These are often found in “diet or diabetic foods” such as diet drinks, ice cream, candy, processed goods, etc.

  • Check medications for fructose and sorbitol. They are not always listed on the label, so check with your pharmacist or the manufacturer if there are questions.

  • Review food labels frequently and carefully – they can be changed often. 

Fruits

  • Serving size is ½ cup – recommend up to 1 to 2 servings a day.

  • Fresh or fresh frozen fruit may be better tolerated than canned fruit.

  • Keep in mind tolerance may depend on the amount you eat at one time; may be better tolerated if eaten as part of a meal.

Acceptable

Foods to Avoid

Questionable Foods/Limit

  • Pineapples

  • Strawberries

  • Raspberries

  • Blackberries                    

  • Lemons

  • Limes

  • Avocado

  • Bananas

  • Rhubarb

  • Oranges

  • Cantaloupe

  • Prunes

  • Pears

  • Cherries

  • Peaches

  • Apples

  • Plums

  • Applesauce                     

  • Grapes

  • Dates

  • Honeydew

  • Kiwi

  • Blueberries

  • Sugar-free jam/jelly

  • Dried fruit

  • Canned fruit in heavy syrup

  • Other fruit

Vegetables

  • Serving size is ½ cup or 1 cup leafy green vegetables – recommend 1½ to 3 cups a day.

  • Cooked vegetables may be tolerated best as cooking leads to the loss of free sugars.

  • Keep in mind tolerance may depend on the amount you eat at one time; may be better tolerated if eaten as part of a meal.

Acceptable

Foods to Avoid

Questionable Foods/Limit

  • Asparagus

  • Cauliflower*

  • Green peppers*

  • Broccoli*

  • Leafy greens

  • Celery

  • Mushrooms

  • White potatoes                          

  • Shallots

  • Spinach

  • Pea pods

  • Cucumber*

  • Beans*

  • Squash

  • None                                   

  • Tomatoes

  • Corn

  • Carrot

  • Sweet potatoes

 

*Possible gas forming foods may need to be avoided.

Many people have problems eating tomato products. Dishes like spaghetti with marinara sauce have a larger portion of sauce. Traditional spaghetti sauce made with tomato paste is bitter from the skin so a sweetener is normally added. Commercial spaghetti sauce often has double the sugar content verses plain tomato sauce. After you are symptom free, if you want spaghetti sauce, try making your own sauce using this simple recipe. You will still need to limit your portion. 

 

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 to 30 minutes while pasta is cooking. Do no eat more than ½ cup serving. Try with gluten-free noodles. Note: other herbs or spices may be added. 

Protein

  • Plain meats without breading are acceptable

  • Read labels closely on processed meat (lunch meats, brats, hotdogs, etc.)

Breads and Starches

  • If removing high fructose corn syrup and being mindful of how much fruit you eat does not control your symptoms, you may need to watch your intake of fructans in breads and starches. Wheat-based foods contain fructans and/or high fructose corn syrup which can increase symptoms. Most people just need to eliminate breads with honey or high fructose corn syrup. Then, they can eat breads as desired.

Acceptable

Foods to Avoid

Questionable Foods/Limit

  • Rye bread

  • Whole wheat bread

  • White bread

  • Rice noodles

  • Wheat pasta

  • Regular pasta                              

  • Gluten free breads, pasta, cereals

  • Commercial cookies, cakes and muffins

 

  • Rye, corn or rice crispbreads

  • Products with dried fruits, honey, fruits, coconut or added sugars

 

  • Gluten free cookies, cakes

  • Instant flavored cereals, granola

 

  • Brown and white rice

 

 

Beverages

Acceptable

Avoid

  • Water, carbonated water

  • Milk

  • Glucose-sweetened energy and sports drinks

  • Powdered drink, sugar-free (or with allowed sweetener)

  • Coffee and tea (if adult)

  • Alcoholic beverages (limit to 1 ounce): gin, rum, vodka (from gain or potato), whiskey, dry white wine, or red wine (if adult)

  • Apple juice, apple cider

  • Pear juice

  • Carbonated sweetened beverages, particularly citrus flavors and certain diet beverages containing Splenda®

  • Vegetable juices

  • Lemonade and other sweetened juice drinks

  • Milkshakes and malts

  • Beer, Sherry, Port and other fortified wines  

Dairy Products to Avoid

  • Flavored or sweetened milks (chocolate and others)

  • Flavored or sweetened yogurts

  • Sweetened condensed milk

Other Foods to Avoid or Modify

  • Avoid chewing gum (both sugar and sugar-free).

  • Avoid chocolate and most other desserts. Cocoa powder with allowed sweeteners is okay.

  • Avoid condiments sweetened with fructose.

  • Avoid coconut, coconut milk and coconut cream. These are high in sugars.

  • For sandwiches and salads, chop up dill pickles instead of using sweet pickle relish.

What About Sweetners?

Acceptable

Avoid

  • Barley malt syrup (contains about 2% fructose, so may not be as well tolerated)

  • Brown rice syrup (check label to make sure high fructose corn syrup was not added)

  • Brown sugar (small amounts)

  • Dextrin

  • Dextrose - available in specialty stores and online (binds free fructose in gut to absorb); can be used in recipes

  • Glucose or glucose syrups

  • Lactose

  • Maltose, Isomaltose

  • Polycose

  • Raw sugar or Turbinado sugar

  • Real maple syrup (Limit 1 Tablespoon)

  • Sucrose (table sugar/cane sugar)

  • Sugar subsitutues: Aspartame (Nutrasweet® or Equal®), Sugar Twin®, or Sweet One® 

  • Agave syrup

  • Caramel

  • Fructose

  • High fructose corn syrup

  • Honey

  • Invert sugar

  • Molasses

  • Pancake syrup (not real)

  • Palm sugar

  • Sugar alcohols: Mannitol, Sorbitol, Xylitol

  • Splenda® (sucralose)

  • Always read labels to be sure the companies are not adding other sweeteners, like high fructose corn syrup.