Fructose intolerance: dietary tips, foods & practical advice

Dietary recommendations for fructose intolerance

Introduction: Around one in ten people experience symptoms such as bloating, cramps and diarrhea after eating fructose-containing foods. If fructose intolerance is diagnosed, a one- to four-week period of abstinence is usually prescribed, during which fructose should be avoided completely if possible. This guide shows step by step how a low-fructose diet can be designed and provides practical tips, examples and a clear presentation of suitable foods. If the symptoms improve, low-fructose foods can be reintegrated into the diet. Those affected should permanently avoid fruit juices, dried fruit and sweets sweetened with fructose or sorbitol.

1.Basics of fructose intolerance: Fructose, also known as fruit sugar, is found in fruit, vegetables, sweets and drinks. In the case of fructose intolerance, the sugar is insufficiently absorbed in the small intestine, which leads to fermentation in the large intestine.

• Symptoms: Flatulence, abdominal cramps, diarrhea, fatigue, concentration problems.
• Frequent sources of error: Fruit juices, hidden fructose in ready-made products, sorbitol in sugar-free sweets.

2. Diet in three phases

Phase 1: Elimination phase or grace period

In the elimination phase, the consumption of fructose should be reduced to 1 to 2 grams per day. This allows the intestines to recover. Aim: To alleviate symptoms by avoiding foods containing fructose.

Explanation of how to use the table

• Fruit and vegetables: Give preference to low-fructose varieties such as bananas or zucchinis. Avoid high-fructose foods such as apples, pears or asparagus. If you eat vegetables, cook them beforehand if possible to make them more digestible.
• Dairy products: Natural yogurt or milk without added sugar are allowed, provided you are not lactose intolerant. However, avoid fruit yoghurts or buttermilk with flavorings.
• Side dishes and baked goods: Potatoes, rice or polenta are ideal side dishes. Ready-made products containing fructose such as jam or ready-made muesli should be avoided.
• Drinks: Water, unsweetened tea or coffee are safe. Avoid fruit juices and soft drinks, as these often contain high levels of fructose.
• Sweets and ready-made products: Avoid sweets such as chocolate or cakes and products sweetened with sorbitol or fructose, as these can make symptoms worse.

If there is no improvement after 4 weeks of abstinence at the latest, a doctor should be consulted. He or she can determine whether there are any other illnesses such as lactose intolerance.

Practical tip: Replace fruit yogurts with plain yogurt with a small amount of cinnamon or lactose-free yogurt.

Phase 2: Test phase

Diet for fructose intolerance: gradually reintroduce foods. Fructose intolerance requires a conscious adjustment of the diet. After an initial phase of abstinence, it is important to slowly reintroduce suitable foods into the diet in order to test tolerance. Below you will find an overview of suitable foods and tips for alleviating symptoms. Aim: Determine individual tolerance limits.

Procedure: Reintroduce low-fructose foods in small quantities. Observe symptoms and keep a food diary. Example: 1/2 banana as a snack, 1/4 apple after a meal.

Foods for slow reintroduction

• Fruit: Avocados, limes, papayas, rhubarb, mandarins, acerola, apricots, satsumas, bananas, honey, sugar or watermelons and berries such as blackberries, blueberries, gooseberries, cranberries, strawberries, raspberries or currants are suitable.
• Nuts: Suitable are: Walnuts, hazelnuts and sunflower seeds.
• Vegetables: Suitable are: Runner beans, peas, cabbage, melanzani, black salsify, artichokes, radishes, chard, gherkins, kohlrabi, asparagus.
• Leek vegetables: Small quantities of boiled or sautéed onions and leeks are suitable. Shallots are often easier to digest.
• Bread: Stale bread is usually better tolerated.
• Side dishes: Pasta is suitable.

Phase 3: Long-term adaptation

Long-term therapy for fructose intolerance: Long-term strategies for better tolerance

Goal: Stabilization of the diet with foods that are well tolerated.

Fructose intolerance requires not only a conscious diet, but also long-term adaptation to individual fluctuations in tolerance. Factors such as stress, illness or hormonal changes - for example during the menstrual cycle - can increase the body's sensitivity to fructose. In such cases, it may make sense to temporarily reduce fructose consumption, but not to avoid it completely, withthe aim of stabilizing the diet with foods that are well tolerated.

Why it is not advisable to avoid fructose completely

Completely avoiding fructose over a longer period of time can lead to the body reacting more sensitively to fructose. Even small amounts can then trigger symptoms. The aim is therefore to find a balance in which the body is regularly confronted with small amounts of fructose in order to maintain tolerance.

Low-fructose diet: practical tips and long-term strategies

Low-fructose alternatives: Combine low-fructose foods with glucose to facilitate absorption in the intestine.

Long-term tips: Avoid sugar substitutes such as sorbitol, as these often make symptoms worse (e.g. in sugar-free chewing gum).

Dealing with fructose in everyday life: tips for better tolerance

1. Small portions of fructose: Consume fructose in small amounts throughout the day. Fruit portions should not exceed 120 grams per meal.
2. Avoid hidden fructose: Read the ingredients list of ready-made products carefully. Common sources of hidden fructose are: "fructose sugar" or "fructose syrup" in muesli. Ready-made sauces such as ketchup or BBQ sauces.
3. Glucose as a helper: Glucose (dextrose) improves the absorption of fructose in the intestine. Sprinkle a small amount of glucose powder on low-fructose foods, for example. Rule of thumb: one gram of glucose per gram of fructose. Be careful not to consume too much glucose, as this can cause diarrhea.
4. Watch out for sorbitol: Sorbitol inhibits fructose absorption and should be avoided. It is often found in stone and pome fruit and in industrial foods such as sugar-free sweets. Sorbitol, a sugar substitute, can exacerbate symptoms and is often found in: Sugar-free sweets. Chewing gum and diet products.
5. Foods that should be avoided in the long term. Some foods exacerbate symptoms of fructose intolerance. You should avoid: Fruit juices. Dried fruit. Diabetic products with fructose or sorbitol. Chewing gum and sweets with fructose or sorbitol.
6. Promote intestinal health: Regular exercise, intestinal massages and pro- and prebiotics strengthen the intestines. A high fluid intake supports digestion and can alleviate discomfort.
7. Use spices separately: Ready-made spice mixtures can contain fructose. It is better to use individual spices.
8. Check your medication: Check whether your medication contains fructose and discuss alternatives with your doctor.
9. Supplement zinc and folic acid: Fructose intolerance can be accompanied by a lack of zinc and folic acid. A targeted intake of these nutrients can be useful.

Conclusion: finding a long-term balance

A diet for fructose intolerance requires patience and attention. With an adapted selection of foods, conscious handling of fructose and a gradual reintroduction of low-fructose foods, symptoms can be reduced in the long term. It is not necessary to give up fructose completely - a balanced diet helps to improve the body's tolerance in the long term.

Vivomed - Gastroenterology Bern and our nutritionists will be happy to provide you with individual advice or a nutrition plan.

Author: Dr. med. Stefan Schlosser - Vivomed - Gastroenterology, Bern