What the Heck is FructMal?

6 Apr

As mentioned before, I ate A LOT of fruit during March.  I’ll have to reign this habit in A LOT for April.  This month will be different in terms of its execution.  Up until this point, I’ve relied mostly on the research that I’ve compiled and my own discretion for designing each diet.  For this diet, I will have an ally!  A person whom I am very close to suffers from severe fructose malabsorption (FructMal for short).  I use the word “suffer”, because it’s appropriate.  She has shared personal firsthand accounts with me as to the numerous complications such a condition demands.  No restaurant outings for her.  I have already begun to pick her brain for some clarifications and recipe suggestions.  I also asked her to let me know if she notices any blatantly false information or advice that I might offer on the subject.  Unfortunately, dietitian credentials alone don’t mean much in terms of food intolerance knowledgability.  During the course of my college studies, we talked about celiac disease (an extreme form of gluten intolerance) and very briefly about lactose intolerance.  The discussion ended there.

Prepare yourself for a chemistry lesson…

Still there? 😉  Good!  Let’s get started.

Fructose, also known as fruit sugar, is found in more foods than the Average Joe might realize.  It is estimated that up to 30% of the Western population has some form of fructose malabsorption, a digestive disorder in which there are deficient fructose carriers within the small intestine.  As a result, the fructose from foods is not absorbed properly & numerous symptoms may manifest.  These symptoms may include, but are not limited to: nausea, diarrhea, constipation, abdominal pain, bloating, gas, vomiting, and/or even depression.  Research studies have found a low-fructose diet to offer relief to a large percentage of those afflicted with IBS.  My ally also has fibromyalgia and finds that fructose aggravates it.

Fructose malabsorption VS lactose intolerance:  While the symptoms seem comparable, FructMal and lactose intolerance are very different conditions.  Lactose is what’s known as a disaccharide (composed of 2 sugars).  A glucose molecule + a galactose molecule = lactose.   Lactose intolerance is due to an intestinal enzyme (lactase) deficiency.  Lactase is responsible for breaking this glucose-galactose bond.  There are digestive enzymes on the market to help with the digestion of lactose.  Fructose, however, is a monosaccharide.  Since it is already in its simplest form, fructose is not acted upon by any digestive enzymes.  It is absorbed (or not!) as is.  Another difference that can be identified is in the restrictions required.  In the case of fructose malabsorption, many different types of foods must be taken into consideration and possibly removed from the diet.  Consider our food system and its pervasive use of high-fructose corn syrup!  For lactose intolerance, remove the dairy and you’re golden.

I was able to identify one parallel between lactose intolerance, fructose malabsorption, and histamine intolerance.  If you can remember back to January (if not, check out the archives!), histamine intolerance (as well as lactose intolerance) exists on a spectrum.  Fructose malabsorption is the same way.  Some FructMal folks can handle more fructose-containing foods than others before the appearance of symptoms.

A completely separate condition, known as hereditary fructose intolerance, is caused by a deficiency of liver enzymes in which fructose ingestion can ultimately lead to kidney failure.  While hereditary fructose intolerance is certainly more dangerous in the immediate sense, fructose malabsorption can cause a lot of stress for affected individuals.  Quality of life can be greatly diminished with such a diagnosis (discovered through the use of a hydrogen breath test).

An interesting tidbit about fructose malabsorption is that you have to be a bit of a scientist in your approach to meal planning.  The allowed fruits for this particular diet are ones in which their glucose content is equal to or greater than their fructose content.  Glucose helps the body to digest fructose.  On the other end of the gamut, sorbitol (a sugar alcohol that’s naturally found in some fruits such as pears) diminishes the body’s ability to digest fructose.  For example, a peach would be considered favorable in regards to its glucose-fructose ratio but is still considered unacceptable for FructMal individuals due to its sorbitol content.  See?  Science!

Timing & portion sizes are two other factors that can make or break the success of a low-fructose diet.  If you have 1/2 a banana for breakfast, it’s best to wait AT LEAST 2 hours before eating tomato slices on your sandwich.  The acceptable fructose load varies from person to person, but keeping portion sizes of allowed fruits/vegetables small and spaced apart is a worthy strategy for all FructMal sufferers.  If the fructose load is too high, whether or not its balanced with glucose, symptoms may emerge.

This knowledge, along with trial and error, allows a person with fructose malabsorption to make better dietary choices.  For example, my ally uses dextrose powder while making breakfast bars to increase their glucose content.  One blog I read discussed using Sweet Tarts as a medicine of sorts.  Sweet Tarts are practically pure glucose and taken 5-10 minutes before a fructose-rich food can help aid in its digestion.  Finally, a drug you can pop like candy! 😉  This strategy, however may only work for certain fructose-containing foods and will not help with the digestion of fructans (to be explained below).

Like others diets I have followed, there’s a lot of conflicting advice out there as to which foods are appropriate for fructose malabsorption.  This is due mainly to a lack of adequate research.  The diet guidelines below were mostly structured according to the following website & the first edition of the book it references: http://www.ibsfree.net/ibsfree_at_last/2012/04/summary-of-updates-in-second-edition.html.  This book was written by Patsy Catsos, a registered dietitian who specializes in gastrointestinal health.  She uses the most current research available to provide the following recommendations.  Patsy is also in the process of creating a collection of FructMal appropriate recipes!  Other sources (including my ally) were consulted as well.

Off the Menu: (All bold items are those that I currently eat on a regular basis and will be the hardest for me not to eat!)

*Dairy: all dairy is acceptable, but I’m planning to continue avoiding it

*Grains: wheat as a major ingredient (minor amounts are acceptable such as wheat-derived food additives for example), rye (Wheat and rye contain fructans which are long chains of fructose.  These are often poorly digested in FructMal.  My ally finds that she can tolerate small amounts of refined wheat.  However, for the purposes of my experiment, I will avoid this.)

*Vegetables: leeks, onions (green parts of spring onions are allowed), asparagus, Jerusalem artichokes (1/2 cup globe artichokes are controversial but considered safe by Patsy’s most up-to-date research), shallots, broccoli (All of these veggies are rich in fructans).  Note: It’s considered safe to cook with large pieces of onion or garlic as long as you remove them before eating.  This should allow the fructose malabsorber to infuse their dish with flavor without infusing their insides with pain! -[ Update: Turns out I lied!  Fructans are water soluble.  Don’t try this at home!]

*Fruits: apples (fresh/cider/juice/sauce), pears, dates, green bananas (fructans), figs (except for Indian figs also known as prickly pears), all dried fruit (prunes, raisins, etc.), apricots, peaches (my favorite but not in season yet!), sweet cherries (love!), mangoes, watermelon; all fruit juice is to be avoided except for 1/3 cup portions of orange, grapefruit, lemon, or lime juice.

I guess the easier question for this category is what fruits CAN I eat?: RIPE banana (1/2 medium), blueberries, cranberries, grapefruit (1/2 large), kiwi (1 medium), cantaloupe, pineapple, rhubarb, strawberries, tangelo (1 medium), tomato/tomatillos (1 medium or 1/2 cup), papaya, oranges (1 small), grapes (controversial – some may contain trace amounts of sorbitol which is best avoided), some exotic fruits that I’ve never had: durian, dragon fruit, jack fruit, & rambutan -serving sizes for all fruits = 1/2 cup.

*Meat, poultry, eggs & fish: all are acceptable provided they do not contain any restricted ingredients (such as BBQ sauce made with high-fructose corn syrup!)

*Legumes/beans: all are acceptable provided they do not contain any restricted ingredients (such as molasses found in baked beans)

*Spices & herbs: garlic powder & onion powder (fructans still kickin’ it in the dried/powdered form)

*Condiments: apple cider vinegar, tomato paste, soy sauce (traditionally prepared with wheat, it’s safer to use tamari which is wheat-free soy-sauce)

*Food additives/misc: chicory-based coffee substitute, inulin, FOS, sorbitol [Note: Coconut meat, milk, and cream were previously thought to be unsafe but are now listed as being acceptable.  Most coconut milk that you buy contains guar gum.  This additive can have a laxative-like effect.  Guar gum combined with coconut’s high fat content might leave ANYONE feeling bloated and icky after its consumption.  Try making coconut milk at home instead.  All you need is a bag of dehydrated coconut, hot water, a blender, and some sort of straining device.  Check this out: http://www.smallfootprintfamily.com/how-to-make-coconut-milk]

*Fun Stuff: high-fructose corn syrup, honey, agave nectar, molasses, brown sugar, sweet wines, any sweetener in excess.  Acceptable sweeteners in 1 1/2 TBSP portion sizes: maple syrup, marmalade, granulated sugar, confectioners’ sugar, raw sugar, dehydrated sugar cane juice, table sugar (sucrose), beet sugar, cane sugar, brown rice syrup.  As for alochol: 4 oz of red or wine wine & unsweetened spirits (such as vodka, gin, & whiskey) are considered safe.

What I Ate My First Day with Fructose Malabsorption:

(Note: Some of the following foods were prepared with shallots & garlic powder before discovering those to be “unsafe”.  With so much conflicting information, it’s hard to make appropriate meal plans at the start of each new diet.  I’ve decided to finish up the leftovers of what I’ve already prepared and then avoid any newly discovered offending foods after that.)

Breakfast: Scottish oats w/ almond butter, cinnamon, & 1 small kiwi

Lunch: Lentil soup made with carrots, celery, shallots, swiss chard, miso, & lemon juice

Supper: Spinach hummus & homemade mock tuna salad w/ corn chips;1/2 of a marinated grilled portabella mushroom; 2 strips of tempeh bacon (YES! FINALLY!) on a portabella mushroom (used as a bun – really good – try it sometime! :)) w/ spinach hummus, 1 slice of tomato, & spinach

Next post: Brown Rice Syrup + Nut Butter Breakfast Bars (recipe idea courtesy of ally :))

Sources:

Undisclosed ally with years of trial and error under her belt 😀

Catsos, P. (2008) IBS-FREE AT LAST! Pgs. 46,47,48,49,54,61,62-64.

http://www.enotes.com/topic/Fructose_malabsorption

http://en.wikipedia.org/wiki/Hereditary_fructose_intolerance

http://en.wikipedia.org/wiki/Fructose_malabsorption

http://www.ibsfree.net/ibsfree_at_last/2012/04/summary-of-updates-in-second-edition.html

http://www.livestrong.com/article/501721-brown-rice-on-a-low-fructose-diet/

http://www.metsol.com/wp-content/uploads/2011/02/Guidelines-for-Fructose-Malabsorption-Management.pdf

http://sacfs.asn.au/download/fructosemalabsorptionjune07.pdf

http://www.uihealthcare.com/kxic/2008/06/fructose.html

http://www.int-med.uiowa.edu/News/Stories.asp?displayID=129

http://www.int-med.uiowa.edu/News/Stories03.asp?displayID=64

http://robnstephfamily.blogspot.com/2008/08/fructose-malabsorption-diet.html

http://www.smallfootprintfamily.com/how-to-make-coconut-milk

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4 Responses to “What the Heck is FructMal?”

  1. melanie barta August 27, 2013 at 12:29 am #

    I have FructMal. I have found that the most accurate and up to date research on this comes from Monash University in AU. Though I am in the US I have joined a Facebook group of people there who share my pain. They have made a huge difference to me by sharing their knowledge.

    • thehungryguineapig August 28, 2013 at 8:10 pm #

      Thanks for sharing Melanie! I have heard a lot about Monash University. I keep up with my FructMal updates through the websites of Patsy Catsos: http://www.ibsfree.net/ and Kate Scarlata: http://www.katescarlata.com/. I understand there is an app from Monash University that provides FODMAPs research updates as well. I don’t have a fancy phone that allows for such things, but I think it’s great that there is so much more awareness these days!

  2. Jim Lockerby August 31, 2016 at 3:15 pm #

    Hmm it looks like your blog ate my first comment (it was super long) so I guess I’ll just sum itup what I wrote and say, I’m thoroughly enjoying your blog.I as well am an aspiring blog blogger but I’m still new to everything.Do you have any points for rookie blog writers?I’d definitely appreciate it.

    • thehungryguineapig August 31, 2016 at 7:53 pm #

      Write about things that interest you/that you are passionate about and want to learn more about. Adding web links for individual research is also nice, depending on whatever topics you plan to blog about. Be sure to use/cite reputable sources. I often spent more time editing than writing an actual post which I think is beneficial to make sure that you are saying things in the way you want to say them. Try to keep the language interesting by alternating your vocabulary. I have retired from this blog, but it was a fun project at the time. Happy blogging and thanks for reading! 😀

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