Q. My doctor says I have fructose malabsorption. There is mixed information on whether cane sugar/ syrup as a “safe” sugar for those with this problem. A lot of health food products seem to use it. Is it considered gut friendly, friendly in limited amounts, or to be avoided altogether?
A. While being diagnosed with a medical condition is never fun, finding out that you suffer from fructose malabsorption (or lactose intolerance, or Celiac disease…) can be a real turning point! The dietary changes that such a diagnosis triggers can finally bring relief from mysterious, long-standing, and sometimes crippling symptoms. Most people are so happy to finally feel better that they don’t even mind going without certain foods. And often, identifying the true culprit allows them to resume eating other “falsely accused” foods.
What is Fructose Malabsorption?
I talked in detail about fructose malabsorption in a recent Nutrition Diva podcast
As you’ll see in the chart below, cane sugar (aka white sugar or granulated sugar) is on the “safe” list because it contains as much glucose as fructose. (Glucose aids in the absorption of fructose.) If it were the only type of sugar or fruit listed in the ingredient list, you should be OK.
BUT…
There are two reasons to consume even “safe” sugars in moderation. Although balancing fructose with an equal amount of glucose helps the body absorb the fructose better, it’s still possible to overload the gut with too much fructose, triggering symptoms.
Secondly, too much sugar can cause all kinds of other problems that have nothing to do with fructose malabsorption. Which is why I recommend that everyone limit added sugars (even the “healthy ones”) to 5-10% of calories.
Safe foods for those with fructose malabsorption
| More than 50% fructose (AVOID) | At least 50% glucose (OK IN MODERATION) |
|
|---|---|---|
| Fruit | Apples Guava Honeydew Mangoes Papaya Pears Raisins Watermelon Fruit Juice Blends | Apricots Bananas Blueberries Blackberries Cantaloupe Grapefruit Lemon Lime Oranges Peaches Pineapple Plums Rasberries Strawberries |
| Vegetables | Asparagus Artichokes Sugar Snap Peas Summer Squash Tomato Paste Tomato Juice | Most Other Vegetables |
| Grains | All Grains | |
| Sweetners | Agave Nectar Fructose Fruit Juice Concentrate Honey High Fructose Corn Syrup* Molasses | Brown Sugar Granulated Sugar Maple Syrup |
| *High fructose corn syrup can contain anywhere from 42% to 55% fructose. Although the 42% variety would not be a problem for those with fructose malabsorption, the 55% would. Unfortunately, there’s no way to tell the percentage of fructose in corn syrup from the way it’s listed on the label. To be on the safe side, avoid all foods made with high fructose corn syrup. | ||
See also: Molasses and maple syrup: more nutritious sweeteners?
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I am confused after reading your blog…every other site states that beet sugar is the safe sugar choice for people who are fructose intolerant (like me). And, cane sugar is not considered “white sugar”… actually, “white sugar” is “table sugar” (aka beet sugar). Please clarify all this for me, thank you.
White table sugar can be extracted from either sugar beets or sugar cane. Either way, the result is pure sucrose, which is equal parts fructose and glucose.
There are differences between Fructose Intolerance and Fructose Malabsorption.
How do Agave fit in??? Good, Less Bad????
Agave nectar is not good for the fructose intolerance people. It has
55.6 g/100 g of fructose and 12.43g/100g of glucose. The fruits and vegetable that are higher in glucose than fructose are ok. Reason: Glucose enhances absorption of fructose, so fructose from foods with fructose-to-glucose ratio 1, like apples and pears, are often problematic regardless of the total amount of fructose in the food.
My son was recently dx with fructose malabsorption. Since he drank the straight fructose drink for the test, he seems extra sensitive to the flavor of fructose. He can taste it in different baked goods, and won’t continue to eat it, even though is gastro doc said he could eat dextrose along with those foods in order to better digest them (like when we eat out). He insists he can taste fructose in sweet tea I make at home with white table sugar. He used to love it but now gags and goes to brush his teeth. Could he be extra sensitive to the fructose component of table sugar?
How is stevia?
Although stevia is a sweetener, it is not a sugar and does not contain fructose.
I am searching for answers as to whether or not Allulose sweetener is ok for folks with fructose malabsorption? There seems to be a distinct lack of information on it.
Did you get an answer?
Allulose does not contain fructose. More here: https://foodinsight.org/what-is-allulose-a-different-kind-of-low-calorie-sweetener/
Can Monk fruit or coconut sugar be use if you are fruitous intolerant?
Monkfruit is a noncaloric sweetener and contains no fructose or glucose so that should be perfectly safe. Coconut sugar appears to contain slightly more glucose than fructose and so it should be OK but should still be consumed in moderation. More here: https://www.medicalnewstoday.com/articles/323047#coconut-sugar-and-fructose
My 5 year old is recently dx. Is there a good alternative for brown sugar? I want us to be able to bake again so she can enjoy as well as the rest of us
I was recently diagnosed with fructose intolerance along with an intolerance to regular table sugar and I’m not sure how to go about it. I like to bake and would love to find a good alternative. I found a sweetener that has monk fruit and inulin fiber do you think that would be safe for me? Another thing I found was monk fruit with erythritol but I’m not sure how safe the erythritol is, would you have more information about that?
Neither of those sweeteners contain significant amounts of fructose or sucrose (table sugar).
I just saw my dietitian and then G.I. Doc in the last few weeks. Both had told me to avoid monk fruit. I was shocked by the honey, but I understand now. I am able to tolerate Stevia just fine, but it is the only sweetener I can tolerate other than cane sugar and moderation.
In the text there was mentioned a chart of safe sugar for fructose malabsorption, however, I couldn’t find a chart. Do you have a link to the chart?
Thank you.
Is there a difference between Brown sugar from molasses and brown sugar from cane sugar? I see Molasses on the “NOT” list.
Hello, Papaya: Monash University has lab tested ripe papaya and it contains no FODMAPs.
Scared me when I saw that you report to AVOID, so I double checked.
What about carob powder please?