Fructose Intolerance in Children
or fructose malabsorption disorder is actually a genetic metabolic disorder in which the intestines cannot sufficiently break down the fructose sugar enzyme. It is the sister of lactose, and the symptoms will often be very similar.
Lactose and fructose are sugars that must be broken down in the stomach. The stomach has special enzymes it produces to tear down the sugars. If those enzymes are not present, or present in insufficient numbers, you have an intolerance.
Food For Thought
Interestingly enough, the problem of fructose intolerance was once termed obscure or unusual. It wasn’t seen a lot unless it was severe. However, it has been growing enormously, and GI doctors are seeing more and more of this in children every day!
Fructose Intolerance is diagnosed mostly in the North America (specifically the United States) and in Northern European Countries. These two areas consume a lot more refined sugar, including high fructose corn syrup, than the rest of the world.
You connect the dots. I have been told by pediatric gastrointestinal doctors (GI docs) that children simply cannot process the huge amounts of sugar found in the American diet.
The main culprit is high fructose corn syrup, which is much sweeter and denser than regular sugar. The main villains are the processed food manufacturers who add in this nice, cheap, flavor enhancer to reduce the bottom line.
The Gold Star Test
The gold star test for fructose intolerance is the hydrogen breath test, or the balloon test.
The child is given a strong drink of either lactose or fructose. Then, at regular intervals, the child blows into what looks like a Mylar balloon. They are checking for the presence of hydrogen in the breath. If your body produces the enzyme that breaks down the sugars (hydrogen’s), then hydrogen will not be present
Living with Fructose Intolerance
Getting the diagnosis of fructose intolerance can be overwhelming, simply because there is sugar everywhere! After getting our diagnosis, I did a lot of crying; simply because I was so overwhelmed. But then I pulled myself together, started reading labels, and got busy in the kitchen.
The keys to success are learning to read labels, finding appropriate alternatives, and learning how to grocery shop all over again.
Reading labels is good for everyone to do, but is a necessity when dealing with fructose intolerance. You’re not just looking for high fructose corn syrup. You are looking for anything that is a derivative of sugar.
The recommendation from our nutritionist was to avoid anything that ended in –ose. Even the new diet supplements that are chemically derived can cause problems. Here’s why: the body breaks down sugar as sugar. It doesn’t recognize the new twists on diet sweeteners. The exceptions to the rule have been Splenda, and Strevia.
I found that when I fed my daughter sugar-free cookies and pastries she still got sick.
You want serving sizes to contain as few sugars as possible. At our house, I have learned that my daughter can tolerate a serving with up 10 ten grams of sugar… total. So, when I read labels, I ask myself two questions:
1. Is there sugar in the first three ingredients?
2. Does it contain 10 grams or less of sugar?
If the answers are yes, then we are probably ok.
A Word About Fruit
Fruit is supposed to be wonderful for your child! It contains so many nutrients and vitamins… and sugar. The bad news is that fruit contains sugar. If you have fructose intolerance, ALL fruit sugar is an issue. The good news is that it isn’t refined and processed sugar so your chances of dietary success are greater.
There is a wonderful website called
the fruit pages
that breaks down the sugars found in the different kinds of fruit. You will be surprised!
Start with the lower sugars first, then begin experimenting. I strongly urge you to keep a food diary to keep track of fruits and reactions, because your child will have many. With us, it was hit and miss. She can’t tolerate melons, but apples are ok. You will have to experiment to see which fruits, if any, your child can have.
Finding Appropriate Alternatives
You need to find new foods to replace the old ones. This is true for every meal and snack that is given throughout the day. Thanks to diabetes, there are many lower sugar alternatives out there. And remember, your child can have milk sugars (lactose), so puddings and milk are still in; just look for the sugar free label. Once again, be aware of how your child reacts to the “sugar-free”. Here are some suggestions based on the favorites of my daughter:
Breakfast: cereal (Rice Chex or Cheerios) with milk, toast (check your labels) with peanut butter
Lunch: Sandwiches, nuts, olives, graham crackers, tortillas, and saltines
Snacks: tortilla chips and salsa, peanut butter apples, crackers and milk
Dinner: bean burritos are our favorite! Most meats without sauces, rice, potatoes, beans, and most vegetables.
Rethinking Grocery Shopping
At first, the grocery store can reduce you to tears, and a trip to the store may take a couple of hours because you have to read EVERY SINGLE LABEL!
Trust me, it get’s better!
This is what happens: for the first month, it will take you a long time to plan your menu’s and shop for groceries. Give yourself a break because it’s like learning how to play a new game. There are new rules and there’s no cheat sheet. Or is there?
Some grocery stores have lists that contain items tailored to your dietary needs. Ask them if they have a list for foods that are fructose free or diabetic friendly. That will help a lot.
The second thing that happens is that you begin to learn which foods will work for you. For example, I know that Italian bread is our go-to. I don’t have to read every single bread loaf anymore. I go straight to the one that works for us and move on.
You will learn where your “new foods” live at the grocery store, shopping becomes a lot easier. It’s never as easy as it was before, but it becomes manageable.
Searching for Silver Linings
No one wants a diagnosis of fructose malabsorption or fructose intolerance, but there is a silver lining. It could be a lot worse. And secondly, everyone will benefit from the new diet. Our entire society eats too much sugar.
I spend a lot of time in the kitchen. It’s made me a better cook, wife and mother. I know exactly what my family is eating, and I can relax knowing that my daughter isn’t going to be sick and miserable because of food.