Fructose

Food rich in fructose includes many types of sweetened beverages and snacks, fruit, especially when in concentrated form such as juices or dried, and honey (see table below). Chains of fructose molecules, fructo-oligosaccharides or fructans, are present in high concentrations in some vegetables and cereal products and often lead to symptoms in individuals with fructose intolerance.

Many healthy foods contain fructose or fructans and it is important to maintain a healthy diet despite the reduction in fructose necessary to control symptoms.

To achieve this, expert assistance from a dietician knowledgeable in fructose intolerance is advised. Vitamin supplements are often useful.

In the case of a hereditary fructose intolerance (HFI), exclusion of sucrose (which when digested produces fructose and glucose) as well as fructose is required. 

The sweetener, tagatose, is metabolized to fructose and is found in beverages (soft drinks, instant drink preparations, teas, fruit or vegetable juices / drinks), breakfast cereals and cereal bars, confectionery and chewing gum, fondants and fillings, jams and marmalades, and diet foods. Levulose and invert sugar on food labels signifies fructose content.

Fructose is better tolerated in the presence of glucose. This means food containing at least as much glucose at fructose is often well tolerated (in the tables this is the F/G value, which should be smaller than 1).

Irrespective of glucose content, some foods naturally contain a high load of fructose, i.e. over 3g per serving, or of fructans, i.e. over 0.5g/serving.

These are the two criteria considered most useful in the selection of food to avoid.

Based on these criteria, the following foods are likely to be poorly tolerated and should be consumed in reduced quantities or avoided:

• Fruit and fruit juices: apple, cherry, grape, guava, litchi, mango, melon (honeydew and watermelon), orange, papaya, pear, persimmon, pineapple, quince, star fruit. Cooked fruit generally has lower fructose content than uncooked fruit.
• Most dried fruit, including currant, dates, dried fruit or health bars, figs, raisins.
• Processed fruit: barbecue / braai sauce, chutney, fruit from cans / tins (often in pear juice), plum sauce, sweet and sour sauce, tomato paste.
• Berries in larger quantities: blueberry, raspberry.
• Sweets, food and drinks with very high sucrose (table sugar) content and with high fructose corn syrup (HFCS).
• Honey, maple syrup.
• Vegetables in larger quantities (fructans or inulin content): artichoke, asparagus, beans, broccoli, cabbage, chicory, dandelion leaves, garlic, leek, onion, peanuts, tomato, zuccini.
• Sweet wines: e.g. dessert wines, muscatel, port, sherry.
• Wheat and rye-based products (fructan content): flour, pasta, bread, wheat bran, whole-grain breakfast cereals.
• Whole-meal products in large amounts.
• As sorbitol (E420 additive number) and xylitol (E967 additive number) are poorly tolerated in most individuals with fructose intolerance, it is advisable to assess whether the following induce symptoms: diet / ‘light’ and diabetic drinks, sugar-free chewing gum and sweets / candies, stone fruit (e.g. apricots, cherries, quinces, prunes, and peaches), pears, dried fruit (e.g. apple, apricot, date, fig, nectarine, peach, plum, raisin). Beer may be a problem in large amounts

Examples of generally well-tolerated fruit and vegetables are:

Aubergine, banana, Brussels sprouts, carrots, clementine / mandarine, corn, cucumber, fennel, grapefruit, lemon, potato, pumpkin, radishes, red currents, rhubarb, sauerkraut, spinach and sweet potato / yam.

In case of multiple carbohydrate / sugar intolerances a FODMAP (fermentable oligo-, di-, monosaccharide and polyol) intolerance may exist, warranting a general reduction of FODMAP content at least for a trial period of 4-6 weeks and under dietary supervision. This may, however, not be necessary in a substantial group of patients, as individual intolerances appear to be common.

The following information will give you details on how to specifically reduce fructose in your diet. However, dietary assistance is advised, to ensure you maintain a healthy and balanced diet.

The table below shows the fructose and glucose content, as well as the fructose / glucose ratio of common foods. The figures are rounded, hence the discrepancies between F, G and F/G. Bear in mind that when comparing tables of different sources some variation is expected. This is due to differences in measurement techniques, in actual sugar content of various fruit types as well as ripeness and growth conditions. These tables are therefore always to be considered as rough guidelines.

First step: observe F/G value, which should be smaller than 1 (i.e. less fructose than glucose in food).

Second step: absolute fructose content of food product should not be over 3g per serving. Small portions of borderline foods can be tried, especially when your stomach is not empty.

See links below for more extensive food lists.

Content in gram / 100g product:

First step: observe F/G value, which should be smaller than 1 (i.e. less fructose than glucose in food).

Second step: absolute fructose content of food product should not be over 3g per serving. Small portions of borderline foods can be tried, especially when your stomach is not empty.

See links below for more extensive food lists.

Content in gram / 100g product:

First step: observe F/G value, which should be smaller than 1 (i.e. less fructose than glucose in food).

Second step: absolute fructose content of food product should not be over 3g per serving. Small portions of borderline foods can be tried, especially when your stomach is not empty.

See links below for more extensive food lists.

Content in gram / 100g product:

First step: observe F/G value, which should be smaller than 1 (i.e. less fructose than glucose in food).

Second step: absolute fructose content of food product should not be over 3g per serving. Small portions of borderline foods can be tried, especially when your stomach is not empty.

See links below for more extensive food lists.

Content in gram / 100g product:

• Sweeteners: aspartame, acesulfame K, saccharin, cyclamate, stevia and thaumatin are no problem for HFI or fructose-intolerant individuals.
• Sorbitol decreases and glucose increase fructose tolerance. Glucose (e.g. glucose / dextrose-containing tablets, drinks, syrup) can be eaten together with fructose-containing foods to increase tolerability.
• Fructose-containing foods are better tolerated in several smaller servings throughout the day and not on en empty stomach.
• About 30% of fructose-intolerant individuals are also lactose intolerant. They are the most likely to from a general reduction of FODMAPs.
  Also see food tables for fructans, galactans and sorbitol, and food intolerance pages for fructose, fructans, galactans and sorbitol.

Enter food you are interested in checking sugar content of, e.g. apple, and click on “full report (all nutrients”)

Wilder-Smith CH et al.

Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders.

Aliment Pharmacol Ther 2013

Wilder-Smith CH, Olesen SS, Materna A, Drewes,A.. Predictors of response to a low-FODMAP diet in patients with functional gastrointestinal disorders and lactose or fructose intolerance. Aliment Pharmacol Ther 2017; 45: 1094-1106.