Conditions Low Fructose Diet

What is Fructose?

Fructose is a natural sugar found in fruit, fruit juice, honey, and agave syrup. It is also found in some vegetables and wheat products in another form called fructans (long chains of fructose sugars). High fructose corn syrup (HFCS) is another form of fructose that is added to many packaged and processed foods.

What is Fructose Intolerance?

Fructose intolerance (also called fructose malabsorption) happens when a person's body has trouble absorbing normal amounts of fructose. This is different from a rare condition called hereditary fructose intolerance, which is a serious genetic disorder. This handout is only about fructose malabsorption, which is common and much less serious.

What are Common Symptoms?

When fructose is not absorbed in the small intestine, it travels to the large intestine. There, bacteria break it down and make gas. This can cause:

Belly pain
Gas and bloating
Burping
Diarrhea (because unabsorbed fructose pulls water into the intestine)

Less common symptoms can include heartburn, tiredness, trouble thinking clearly ("brain fog"), headaches, weight loss, and sugar cravings.

How is Fructose Intolerance Diagnosed?

Anyone can develop fructose intolerance, but it is more common in people with irritable bowel syndrome (IBS) or other digestive problems. The simplest way to find out if fructose is causing symptoms is to try a low fructose diet for about 2 weeks. If symptoms get better, fructose was likely part of the problem.

If symptoms do not improve with diet changes alone, a Hydrogen Breath Test may be used. This test measures gases in the breath after drinking a fructose solution. A positive (abnormal) test supports the need for a low fructose diet. Talk to your doctor about which approach is right for you.

What is a Low Fructose Diet?

A low fructose diet means eating less fructose by limiting or avoiding:

Foods with more fructose than glucose
Foods high in fructose (more than 3 grams per serving)
Foods that are a big source of fructans (chains of fructose)

How Long Do You Need to Follow this Diet?

Follow a low fructose diet until symptoms get better. This usually takes 2 to 6 weeks. Some people feel better in just a few weeks, while others may need more time.

Once you feel better, slowly add back foods with higher fructose and fructans, one at a time. Wait 1 to 3 days between each new food. The goal is to eat the most varied diet you can while keeping fructose low enough to avoid major symptoms. Everyone's limit is different!

Other Important Sugars to Know About

Glucose: Glucose is a sugar that helps your body absorb fructose. Foods with equal or more glucose than fructose are usually easier to digest. Eating a glucose food along with a fructose food can help reduce symptoms.
Table Sugar (sucrose): Table sugar is half glucose and half fructose, so small amounts are usually okay. Large amounts can still cause problems.
Sugar alcohols: These are often found in "diet" and sugar-free foods like gum, mints, and cough drops. Common ones include erythritol, isomalt, maltitol, mannitol, sorbitol, and xylitol. They do not contain fructose, but they can make it harder for your body to absorb fructose, so they should be avoided or limited.
Sugar substitutes: Artificial sweeteners like aspartame, sucralose/Splenda, and stevia do not contain fructose, but some people may not tolerate them well.

Category	High Fructose Foods (Avoid or Limit)	Low Fructose Alternatives (Good Choices)
Fruits Since all fruits contain some fructose, low fructose fruits should still be limited to 1-2 servings/day. Serving size is ½ cup or 1 small piece.	Apple (all forms) Ripe banana Boysenberry Canned fruits packed in apple or pear juice Cherries Dried fruits (apricots, dates, figs, goji berries, mango, pineapple, prunes, raisins) Fresh figs Fruit juices Grapefruit Guava Mango Nectarine Pear (all forms) Persimmon Plum Pomegranate Tamarillo Watermelon White peaches	Avocado Firm banana Blackberries Blueberries Cantaloupe Clementine Cranberries Coconut Grapes Honeydew Kiwi Lemon Lime Mandarin orange Orange Papaya Pineapple (fresh, small amounts) Raspberries Rhubarb Strawberries Tangelo
Vegetables	Artichoke (all types, including canned hearts) Asparagus Beetroot Brussels sprouts Garlic Leek bulb Onion Savoy cabbage Scallions/spring onions (white bulb part) Shallots Sugar snap peas Tomato paste and ketchup	Alfalfa sprouts Arugula Bamboo shoots Bean sprouts Bell peppers (all colors) Bok choy Broccoli (limit to ½ cup) Cabbage (common, red) Carrots Celery Chili pepper Chives Collard greens Corn Cucumber Eggplant Endive Fennel Ginger Green beans Kale Leek (green leaves only) Lettuce (all types) Olives Parsnip Potato Radish Rutabaga Scallions (green part only) Seaweed (nori) Spinach Summer squash Sweet potato Swiss chard Tomato (fresh) Turnips Water chestnuts Zucchini
Meats/Meat substitutes	Marinated, seasoned, breaded, or processed meats made with wheat, onion, garlic, or high fructose sweeteners	Plain, unprocessed meats prepared without breading or sweetened sauces Deli meats and processed meats made without honey or high fructose corn syrup Eggs Tofu (firm)
Grains/Starches Always check ingredient lists carefully for high fructose sweeteners!	Grains: wheat, rye, barley Bread: white, wheat, rye, multigrain Baked goods: made with white, wheat, rye or multigrain flour Cereal: cereals made with wheat, rye, or barley including bran flakes, shredded wheat; cereals with raisins or dried fruit Crackers: made with wheat or rye Flours: all-purpose, enriched, graham, rye, semolina, white, wheat Tortillas: flour tortillas Pasta: white or whole wheat Others: couscous High fiber: bread, cereal, and granola bars with chicory root/inulin	Wheat-free grains and flours: amaranth, arrowroot, buckwheat, cornmeal, millet, oat, rice, quinoa, sorghum, tapioca, teff Bread: cornbread, gluten-free bread, sourdough bread Cereal: corn-, rice-, or oat-based (such as plain Cheerios, Corn Chex, Rice Chex); oatmeal, grits, cream of rice Pasta: gluten-free noodles, rice noodles, corn or quinoa pasta Rice: all varieties Corn tortillas Crackers/snacks: corn or rice crackers, gluten-free crackers, tortilla chips, corn chips, popcorn, potato chips
Dairy/Dairy substitutes	Flavored or sweetened milks Coconut milk and cream Any dairy product or dairy-free alternative made with high fructose fruits, honey, high fructose corn syrup, chicory root/inulin, or fruit juice concentrates Be extra careful with flavored coffee creamers, yogurts, and ice creams	All dairy products, lactose-free products, and dairy-free alternatives made with low fructose ingredients and sweeteners
Fats and oils	Salad dressings made with onion, garlic, fructose, fruit juice concentrate, or high fructose corn syrup	All oils, butter, margarine Commercial salad dressings without fructose or high fructose corn syrup
Nuts and seeds	Cashews, Pistachios	All other nuts and seeds
Beverages	Fruit juices Soda and sweetened drinks with agave syrup, honey, fructose, high fructose corn syrup, or sorbitol Sports drinks made with fructose or high fructose corn syrup Coffee and teas with chicory root Fortified wines (sherry, port) Rum	Water, sparkling water Soda and drinks made with cane sugar Sports drinks made with glucose Coffee and tea (plain) Spirits (limit to 1 ounce): gin, vodka, whiskey, tequila Wine (limit to 4–6 ounces): white or red Beer (limit to 12 ounces)
Desserts	Dried fruit bars Baked products made with dried fruit or fruit juice concentrate. Desserts made with fructose, high fructose corn syrup, honey, or high fructose fruits Desserts made with wheat flour (all-purpose, whole wheat, or multigrain)	Desserts sweetened with sugar (sucrose) Wheat-free cakes, cookies, muffins made with safe sweeteners Sherbet and sorbet made with low fructose fruits
Sweeteners	Agave nectar, honey, fructose, HFCS, molasses Fruit juice concentrates Sugar alcohols: erythritol, isomalt, maltitol, mannitol, sorbitol, xylitol	Brown rice syrup Brown sugar Cane sugar/syrup Confectioner's sugar Corn syrup (not high fructose) Corn syrup solids Dextrin Dextrose Glucose and glucose syrups Lactose Maltose Pure maple syrup Raw sugar Sucrose (table sugar) Stevia
Condiments, seasoning other ingredients	Chicory root extract or fiber Fructooligosaccharides (FOS) Garlic salt/powder Inulin Onion salt/powder Sweetened sauces made with fructose: BBQ sauce, ketchup, jam, marmalade, pancake syrup, relish, sweet and sour sauce	All herbs and seasoning blends (without onion/garlic) Baking powder Baking soda Condiments and sauces with low fructose sweeteners

Sample Meal and Snack Ideas

Breakfast

Oatmeal topped with ½ cup fresh berries, chopped nuts, cinnamon, and brown sugar
Egg omelet with baby spinach, red pepper, and cheddar cheese
Scrambled eggs, 2 slices of bacon, and 1 slice sourdough toast with butter
Gluten-free or sourdough toast with 2 tablespoons peanut butter
Plain cereal (like Cheerios) with milk and ½ cup blueberries
Banana walnut pancakes: Use gluten-free pancake mix with ½ mashed firm banana and 1 tablespoon chopped walnuts. Top with pure maple syrup
Plain Greek yogurt with granola (check ingredients) and ½ cup berries
Smoothie: ½ cup frozen blueberries blended with 3–4 ounces plain Greek yogurt

Lunch and Dinner

Rice bowl: rice, grilled chicken or shrimp, lettuce, fresh tomato, scallion greens, and cheddar cheese with lime juice and olive oil
Tuna salad: tuna mixed with mayonnaise, lemon juice, chopped celery, and fresh dill, served on sourdough bread or in lettuce wraps
Grilled ham and cheese on gluten-free or sourdough bread
Gluten-free pasta with fresh chopped tomatoes, garlic-infused oil, and fresh basil
Stuffed peppers: cooked ground turkey or beef mixed with rice or quinoa, feta cheese, chives, and parsley, stuffed into bell peppers and baked

Snacks

Gluten-free pretzels and cheddar cheese
Rice cake with peanut butter
Rice crackers, Swiss cheese, and ½ cup grapes
Hard-boiled egg
String cheese with a handful of almonds
Vanilla yogurt (check ingredients) with ½ cup blueberries
½ sandwich on gluten-free or sourdough bread with sliced chicken, lettuce, and tomato
Rice chips, a handful of peanuts, and baby carrots
Gluten-free crackers, string cheese, and an orange
Cottage cheese with ½ cup pineapple
Baby carrots and cucumber with dill dip (blend ½ cup cottage cheese with fresh dill, salt, and pepper)
Firm banana slices with almond butter or peanut butter
Popcorn (plain or lightly salted)