GENERAL INFO..

Dylan is diagnosed with Fructose Malabsorption. He needs to be on a fructose-restricted diet. A lot of people ask me exactly what this means...I had a very difficult time understanding it myself...especially with the outdated/erroneous/misinformation on the Internet. The dietician at UW Childrens Hospital was wonderful. She explained everything to me so that I could understand and I'm so thankful to her.

I'm going to type word for word the information she gave me and what we went over in case anyone is interested.
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What is fructose?
Fructose is a natural sugar found in many foods. As a simple sugar, fructose is found in foods such as fruits and honey. When fructose is hooked to another sugar called glucose, it forms table sugar or sucrose. Fructose can form a longer chain called fructans found in vegetables and wheat. Because of the intense sweetness of fructose, the sweetness can be further concentrated into high fructose corn syrup and used in place of table suger in many soft drinks and sweets.

Why do I need to restrict fructose from my diet?
Some people have trouble digesting fructose. Fructose empties from the stomach more rapidly than other sugars. Fructose is absorbed or taken in by the small intestine in a couple of different ways. If glucose is present in equal amounts with the fructose, it helps the body use the fructose at the beginning of the small intestine. Free fructose without matching glucose is absorbed more slowly along the length of the small intestine. When frucose is left undigested, it is fermented by bacteria. This can cause side effects like bloating, abdominal pain, nausea, gas, diarrhea and constipation. These side effects can be controlled with a low fructose diet.

How do I follow a low fructose diet?
Some people can have small amounts of fructose and have no problems, while others need to avoid even small amounts in their diet. The amount of fructose consumed that produces GI symptoms in healthy adults can frange from less than 25 grams to 50 grams. It should be noted that a 16-ounce bottle of apple juice may contain more than 30 grams of fructose and a 20-ounce bottle of soda can contain up to 40 grams of fructose

To get started you will need to read food labels. Avoid drinks with high fructose corn syrup. For many people this change gets rid of their symptoms. Some people drink 100 grams a day of fructose in sweetened beverages and feel much better when they are stopped. Some fruits and vegetables naturally have a lot of fructose. Fruits that are balanced with both fructose and gluclose will be better absorbed wihich will reduce gas. Use the suggestions below to pick which fruits may be better tolerated.

How long do I have to follow a low fructose diet?
Some people will find relief of symptoms quickly by not eating high fructose corn syrup. Others will have to eliminate more foods for a longer period of time. Once your symptoms improve for 4-6 weeks, then you begin to add foods back into your diet. This will help you to see which foods you can have without side effects. Try adding only one food back to your diet at a time, and wait 4 days before trying another food...because fructose takes three days to pass through the gut.

What foods or food groups do I need to avoid?
*Avoid foods and drinks with high fructose corn syrup (candy, sodas, sweetened juice or punch).
*Avoid fruit juices. They are concentrated forms of fructose. It takes the juice from multiple pieces of fruit to make one glass of juice.
*Avoid commercial baked goods; most contain high fructose corn syrup.
*Avoid sorbitol (a sugar alchohol) and excessive amounts of other artificial sweetners (Splenda). These artificial sweetners cause symptoms in the gut similar to those caused by fructose; plus the combination of fructose and sorbitol worsens symptoms.

Sweetners to Avoid:

*Avage syrup
*Caramel
*Fructose
*High Fructose Corn Syrup
*Honey (1 Tbsp has 8 gm fructose)
*Invert Sugar
*Molasses
*Pancake Syrup
*Palm Sugar
*Sugar Alcohols: Mannitol, Sorbitol, Xylitol
*Splenda (sucralose)
*Always read labels to be sure companies aren't adding additional sweeteners, such as high fructose corn syrup
*Brown Sugar (some manufacturers are starting to add HFCS to the blend)

Sweetners that are OK to use in VERY LIMITED AMOUNTS: (NONE FOR DYLAN UNTIL 4-6 WEEKS OF DETOX!!)

*Barley Malt Syrup
*Brown Rice Syrup (make sure HFCS wasn't added on label)
*Dextrin
*Dextrose (available in specialty stores) 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 substitutes: Aspartame (Nutrasweet or Equal), Sugar Twin, Sweet One
*Stevia (truvia)

HELPFUL HINTS:
* Eat foods with fructose in small amounts and spread them over the day
* Your body may be able to digest foods with fructose when eaten with other foods.
* Keep a food journal of what was eaten and your symptoms. You may see trends.
* You may need to use a daily vitamin if you find you must cut back on most fruits and vegetables. Talk to your doctor or dietician for vitamin recommendations.

~~~~~~FRUITS~~~~~~
**fruits to try after 4-6 week detox** remember only try one food and wait 4 days to try another. the (*gluctose) means this fruit has more glucose than fructose)

FRUIT..... SERVING SIZE..... FRUCTOSE (GRAMS)..... GRAMS EXCESS FRUCTOSE(-GLUCTOSE)

APRICOT..... 1 FRUIT........ .33.................. *GLUCOSE*
CANTALOUPE.. 1/2 CUP........ 1.5................... 0.27
RASPBERRIES .1/2 CUP........ 1.5................... 0.31
PLUMS....... 1 FRUIT........ 2.0................... *GLUCOSE*
PEACH .......1 MEDIUM....... 2.0................... *GLUCOSE*
NECTARINE... 1 MEDIUM....... 2.0................... *GLUCOSE*
BLACKBERRIES 1/2 CUP........ 2.0................... 0.07
GRAPEFRUIT ..1/2 FRUIT...... 2.0................... 0.2
PINEAPPLE ...1/2 CUP........ 2.0................... 0.32
STRAWBERRIES 1/2 CUP........ 2.0................... 0.38
HONEYDEW ....1/2 CUP........ 2.5................... 0.24
ORANGE ......1 FRUIT........ 3.0................... 0.39
CHERRIES ....1/2 CUP........ 4.0................... *GLUCOSE*
BLUEBERRIES. 1/2 CUP........ 4.0................... 0.07

FRUITS TO AVOID...

KIWI .......1 FRUIT........ 4.0... 0.22
RAISINS ....1 MINI BOX..... 4.0... 0.28
WATERMELON .1 CUP.......... 5.0... 2.7
BANANA .....1 MEDIUM....... 6.0... *GLUCOSE*
GRAPES .....1/2 CUP ........6.0... 0.7
MANGO.......1 WHOLE........ 6.0... 4.1
ORANGE JUCE 1 CUP ..........6.4... 0.54
APPLES .....1 MEDIUM....... 10.0 ..4.48
PRUNES .....1/2 CUP........ 11.0 ..*GLUCOSE*
PEARS ......1/2 CUP ........11.0 ..6.18
APPLE JUICE 1 CUP ..........14.0 ..7.69
DATES...... 1/2 CUP........ 14.0.. *GLUCOSE*
FIGS,DRY... 1/2 CUP........ 17.0.. *GLUCOSE*


~~~TOMATOES~~~

FRUIT........ SERVING SIZE FRUCTOSE(GRAMS) EXCESS FRUCTOSE
Fresh Tomato 1 whole ....... 1.7 grams....... 0.15 grams
Tomato Sauce 1/2 cup ....... 2.03 grams...... *glucose*
Canned Tomatoes 1/2 cup .... 1.52 grams...... 0.2 grams
Tomato Paste 1 Tbsp ........ 0.48 grams...... 0.01 grams

Many people have difficulty tolerating concentrated 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 has a total of 11 grams of sugars which is twice plain tomato sauce. After you are symptom free if you want spaghetti sauce, try making your own sauce. LIMIT YOUR PORTION!

VEGETABLES:

*eat as part of a meal

AVOID: asparagus, leeks, onion chunks, dandelion greens, chicory roots,

Vegetables that are 'gassy' and may want to avoid:
Broccoli, brussel sprouts, cabbage, cauliflower, cucumbers, raw, legumes/baked beans/peppers (raw), radishes (raw), scallions

DAIRY PRODUCTS TO AVOID
* Flavored or sweetened milks (chocolate and others)
* Flavored or sweetened yogurts
* Sweetened condensed milk

BEVERAGES TO AVOID: {Dylan will be restricted to drink only water and white milk]* Carbonated sweetened beverages, particularly citrus flavors and certain diet beverages containing Splenda.
* Fruit and vegetable juices. Lemonade and other sweetened juice drinks.
* Milkshakes and malts
* Beer, Sherry, Port and other fortified wines

BREADS/STARCHES
Wheat-based foods contain fructans and/or high fructose corn syrup which can increase symptoms {{I believe so far Dylan is sensitive to wheat...whole grain}}
Avoid:
*whole wheat breads (or limit)
*wheat pasta
*commercial cookies/cakes/muffins
*products with dried fruits/fruits/honey/coconut/sugar
*instant flavored cereal and granola

Better choices of bread
*rye
*gluten-free breads, pasta, cereals
*rice noodles
*rye, corn or rice-crispbreads
*gluten-free cookies and cakes
*brown rice (for fiber) or white rice

OTHER FOODS TO AVOID OR MODIFY
* avoid chewing gum (both sugar and sugar-free)
* avoid chocolate & most other desserts (cocoa powder with allowed sweetners is okay..BUT LIMIT!!!)
* avoid condiments sweetened with fructose containing sweeteners: catsup and soy sauce
* avoid coconut, coconut milk, coconut cream, these are all high in sugars