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Fructose Malabsorption

Fructose malabsorption is a digestive disorder in which the body is unable to break down fructose (the sugar in fruit), and it may cause bloating, stomach pain, heartburn, diarrhea and gas.


  • Fructose is a type of sugar that is naturally found in fruits, some veggies and honey. It is also used as a sweetener in some soft drinks and fruit drinks.
  • Fructose malabsorption is when the body doesn’t take in fructose the right way, meaning the body is not able to break it down during digestion.
  • When undigested fructose reaches the bowels, it reacts with naturally occurring bacteria, which can cause the common symptoms of fructose malabsorption.
Note: Fructose malabsorption should not be confused with hereditary fructose intolerance, which is a condition diagnosed very early in life, when a baby starts eating food or formula.

Common symptoms

Symptoms of fructose malabsorption often come about two hours after consuming fructose, though it varies from person to person.
  • Bloating
  • Belly pain
  • Heartburn
  • Diarrhea (loose stool)
  • Gas
Getting Tested

Getting Tested

To prove fructose intolerance, your doctor can order a breath test that checks for hydrogen.
Fructose breath test
  • Given to older children as well as adults.*
  • This test measures the amount of hydrogen in the breath. This test is very accurate.
  • In the test, the patient drinks a fructose-loaded drink, and the breath is tested at routine intervals.
  • Hydrogen in the breath means improper digestion of fructose.
  • Certain foods, medications and smoking can change the test’s accuracy and may need to be skipped before the test.
* Hydrogen breath tests are not given to infants and young children, because giving these patients a fructose load can result in diarrhea (loose stool), which can cause dehydration.
Controlling Symptoms

Controlling Symptoms

Being told you have a food intolerance or malabsorption issue and needing to change how you eat, can feel like a lot to take on. While it is not as severe as having a food allergy, a food intolerance or malabsorption issue can impact your life.  You might be scared to eat for fear of having a reaction. You may not want to join your family and friends when they go out, because you’re worried about cross-contamination. These feelings are normal and can be handled by talking to your gastroenterologist and a registered dietician or nutritionist.  Not eating fructose and eating a low-sugar diet is the best way to put off the painful symptoms linked to fructose malabsorption. However, many people with fructose malabsorption can eat some amount of fructose without problems. By keeping a food diary, you can find out how much fructose is too much for you. Limit your intake of:
  • Fruit, fruit juices and dried fruit.
  • Honey.
  • Sodas and other drinks that have high-fructose corn syrup.
  • Alcohol.
You should know that high-fructose corn sweetener is often added to prepared foods and is found in high concentrations in non-diet soft drinks and most fruit juices. Be sure to read nutrition labels before eating or drinking things you may think have fructose. 

Foods with excess fructose (to avoid)

  • Agave
  • Apples
  • Asparagus
  • Boysenberries
  • Cherries
  • Fresh figs
  • High-fructose corn syrup
  • Honey
  • Mango
  • Pears
  • Rum
  • Sugar snap peas
  • Sun-dried tomatoes
  • Tomato paste
  • Tamarillo
  • Watermelon

Still having symptoms?

It can be scary to keep having symptoms, even after changing to a low-fructose or fructose-free diet. If this is the case for you, perhaps you are eating hidden fructose. A dietician can help you find out if you are unintentionally consuming fructose through such things as medications, supplements or other sources. If you determine you are not consuming hidden fructose, it is time to meet again with your gastroenterologist to find out if more tests or treatment options are needed. Try the MyGIHealth® app to better note your symptoms and when they happen.

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