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Science
not clear on handling fructose intolerance
March 06, 2008
Suzanne Havala Hobbs
We
hear that fruits and vegetables are good for what ails you.
Nutrients in these foods support health and help protect against
heart disease and some forms of cancer, among other benefits.
Pile your plate with heaping helpings is the prevailing advice.
Unless you suffer from fructose intolerance.
People with fructose intolerance – also called fructose
malabsorption – have trouble digesting foods that contain
fructose, a natural form of sugar found in fruits and vegetables,
many sweeteners, and some breads and cereals. Symptoms include
gas, bloating, nausea and diarrhea.
One reader, recently diagnosed with a double whammy –
lactose intolerance and fructose intolerance – told
me that her symptoms resembled those of irritable bowel syndrome.
(Her doctor ruled out celiac disease.) Poking around on the
Web, she learned that some experts think fructose intolerance
is underreported and that the prevalence of high fructose
corn syrup in processed foods and drinks may be contributing
to the problem.
“I am so hungry and miss fruits and vegetables so much
and the benefits of the fiber!” she wrote. “I
would be interested in any suggestions or resources you can
recommend.”
Unfortunately, the guidance is somewhat murky at this point.
In part, that’s because the science is not clear about
the extent to which fructose in the diet may contribute to
gastrointestinal problems, nor how well elimination diets
work to relieve the symptoms. In elimination diets, suspect
foods are removed for several days up to several weeks to
see if symptoms disappear.
One five-year study by researchers at the University of Iowa
found that people with carbohydrate intolerances did get some
relief from their symptoms when they ate a diet low in fructose.
Pulling that off takes commitment, though.
Large amounts of fructose are found naturally in fruits, fruit
juices, honey and maple syrup. Other forms of sugar break
down into fructose once they’re digested. Sorbitol,
a sugar alcohol used in some “sugar-free” products
such as hard candies and sugar-free chewing gum, is an example.
Table sugar, or sucrose, is another example. All forms of
granulated sugar (white and brown), confectioner’s sugar,
corn syrup, and foods sweetened with these forms of sugar
are off-limits on a low-fructose diet. That means steering
clear of soft drinks, sweet tea, candy, cake, cookies, pie
and ice cream.
Some people may be sensitive to the amounts of fructose in
certain vegetables including carrots, tomatoes, beets, onions,
peas and corn. Sweet breads and sweetened cereal products
may pose a problem, too. More details and guidance are available
online from the University of Iowa at http://www.uihealthcare.com/topics/medicaldepartments/foodandnutrition/dfi/index.html.
Eliminating all fruits and a substantial number of other nutrient-rich
foods may also make it necessary to take a vitamin and mineral
supplement. Read labels carefully, though, because some supplements
contain – you guessed it – fructose and sorbitol.
Like so many food intolerances, sensitivity to fructose can
also vary from one individual to another. Some people may
be able to tolerate small amounts of fructose, while others
may experience symptoms after even the smallest amounts of
the sugar.
Like the reader, some people may also suffer from more than
one food sensitivity at the same time.
That’s why most people with food intolerances could
benefit from individual diet counseling from a registered
dietitian. Dietitians are trained to manage complicated dietary
problems, help you sort out seemingly conflicting advice and
prioritize your diet goals.
If you do decide to enlist the help of a dietitian, understand
that not all dietitians are equally comfortable or qualified
working with all types of diets. Get a referral from your
health care provider or call the American Dietetic Association
at 1-800-366-1655 for the names of local dietitians with the
expertise you need.
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