Fructose-Restricted Diet
What is fructose? How long do I have to follow a low
Fructose is a natural sugar found in many fructose diet?
foods like fruits and honey. Fructose is also Some people will feel better quickly while
found in ‘table sugar.’ Long chains of others need more time. Once you have felt
fructose are called fructans and are found in better for 4-6 weeks, you can slowly add
certain vegetables, wheat, and other foods. foods back to your diet. Try to add only one
Fructose is very sweet and is often made food back to your diet at a time and wait 3-4
into high fructose corn syrup, used in soft days in between to see how you feel.
drinks and processed foods.
What foods or food groups do I need to
Why do I need to restrict (limit) fructose avoid?
in my diet? • Avoid foods and drinks with high
• Fructose malabsorption is when fructose corn syrup (candy, sodas,
your body does not digest or absorb sweetened juice).
fructose well. This can cause • Avoid packaged baked goods. Most
bloating, abdominal pain, nausea, of these contain high fructose corn
gas, and diarrhea. syrup.
• Hereditary fructose intolerance is • Avoid sorbitol (a sugar alcohol).
a very rare genetic disorder. This is Fructose combined with sorbitol can
when the liver is not able to help the make your symptoms worse. Sugar
body break down fructose. free candy and cough drops often
Symptoms can be more serious. This contain sorbitol.
disorder requires more than just • Limit fruit portions to ½ cup at a
limiting fructose. meal or snack.
• Limit sweets to small servings.
How do I follow a low fructose diet? Enjoy sweets with a meal not as a
People can tolerate different amounts of snack.
fructose. Most people have trouble with
large amounts of fructose like in high In healthy adults, less than 25-50 grams of
fructose corn syrup and honey rather than fructose can cause GI symptoms. A 16-
smaller amounts of fructose in fruit. You ounce bottle of apple juice may have more
will need to read food labels and learn which than 30 grams of fructose and a 20-ounce
foods are high in fructose. bottle of soda can have up to 40 grams.
Sweeteners
Limit or avoid: Choose these:
• Agave syrup • Barley malt syrup (about 2% fructose)
• Caramel • Brown rice syrup
• Fructose • Brown sugar
• High fructose corn syrup • Dextrin
• Honey • Dextrose—can find in specialty stores
• Invert sugar and online (binds free fructose in gut to
• Licorice absorb), can be used in recipes
• Molasses • Glucose or glucose syrups
• Pancake syrup • Lactose
• Palm sugar • Maltose, isomaltose
• Sugar alcohols: mannitol, sorbitol, • Polycose
xylitol (for some people) • Raw sugar or turbinado sugar
• Sorghum • Real maple syrup (limit to 1Tbsp)
• Sucrose (table sugar/cane sugar)
Always read ingredient labels to see if other • Sugar substitutes: aspartame*
sweeteners, like high fructose corn syrup are (Nutrasweet® or Equal®), Sugar Twin®,
added. Sweet One®, Stevia®, sucralose
(Splenda®)*
*Certain artificial sweeteners like sucralose or aspartame can upset your stomach.
Although some sweeteners are okay to use, some people may not handle large amounts at one
time.
Fruits
Eat small portions of fruit as part of a meal. Do not eat fruit separately as a snack. Avoid fruit
drinks, juices, jams, jellies, and chutneys.
Fructose Content of Common Fruits
Fructose is absorbed in the small intestine in a couple of ways. If glucose is present in equal
amounts with fructose, the body absorbs fructose better. Free fructose without matching glucose
is absorbed more slowly, which may cause upset stomach.
Start with small portions of easier to tolerate fruits at meals (see first table on next page). They
have a lower number of grams of fructose and are lower in “excess fructose” so will cause less
gas and other symptoms.
Lower Fructose - Easier to Tolerate Fruits
Fruit Serving Size Fructose (grams)
Apricot 1 fruit .33
Cantaloupe 1/2 cup diced 1.5
Raspberries ½ cup 1.5
Plum 1 fruit 2
Peach 1 medium 2
Nectarine 1 medium 2
Blackberries 1/2 cup 2
Grapefruit ½ fruit 2
Pineapple ½ cup chunks 2
Strawberries 1/2 cup sliced 2
Honeydew 1/2 cup diced 2.5
Orange 1 fruit 3
Cherries ½ cup 4
Blueberries ½ cup 4
Higher Fructose - Harder to Tolerate Fruits
Fruit Serving Size Fructose (grams)
Kiwi 1 fruit 4
Raisins 1 miniature box 4
(1 oz or 30 raisins)
Watermelon 1 cup diced 5
Banana 1 medium 6
Grapes ½ cup 6
Mango 1 whole 6
Orange juice 1 cup 6.4
Persimmon 1 whole 2 ½ inch 9.3
diameter
Apple 1 medium 10
Prunes ½ cup 11
Pear 1 medium 11
Apple juice 1 cup 14
Dates ½ cup 14
Figs, dry ½ cup 17
Adapted from USDA National Nutrient Database for Standard Reference, Release 28
Avoid these harder to tolerate fruits until you are feeling better (see table above). Once you are
symptom free, you may be able to slowly add 1-2 new fruits weekly. If side effects return,
decrease the amount of fruit in your diet (still avoid juices).
Tomatoes
Many people have problems eating tomato products. Sweetener is often added to spaghetti sauce.
Store-bought spaghetti sauce has 11 grams of sugars. This is twice the amount of sugar that is in
plain tomato sauce. After you are symptom free, if you want spaghetti sauce, try to make your
own sauce. Use the simple recipe below, or you can also purchase “no sugar added” tomato
sauce. You will still need to limit your portion.
When the “Grams Excess Fructose” column says “Glucose,” the food has a good balance of
glucose and fructose to help the body digest the fructose.
When the “Grams Excess Fructose” column lists the grams of excess fructose, this means there is
no balance of glucose to help absorb the fructose in this food.
Fruit Serving Size Fructose (grams) Grams
Excess
Fructose
Fresh Tomato 1 whole 1.7 grams 0.15
Tomato Sauce ½ cup 2.03 grams Glucose*
Canned Tomatoes ½ cup 1.52 grams 0.2
Tomato Paste 1 Tablespoon 0.48 grams 0.01
*Note: “Glucose” means this fruit has more glucose than fructose
Spaghetti with Meat Sauce
½ pound hamburger, browned and drained 1 teaspoon oregano, or to taste
2 cloves fresh garlic, minced 1 teaspoon basil, or to taste
16 ounces tomato sauce salt and pepper to taste
After meat is browned and drained, add garlic, oregano, and basil. Add tomato sauce, salt and
pepper to taste and simmer for about 20-30 minutes while pasta is cooking. Do not eat more than
½ cup serving. Try having the sauce with gluten-free noodles. You may also add other herbs or
spices.
Vegetables
Some vegetables contain fructose but are well balanced with glucose. Half cup portions should
not be a problem. Eat vegetables as part of a meal. If you have diarrhea, avoid whole kernel corn.
It is hard to digest.
Vegetables that May Serving Size Fructan (Grams) Notes
Cause Problems
Asparagus 6 spears 2.6
Leeks ½ cup 5.6
Onions 2 Tbsp 2.1 (may cook with but
remove the chunks)
Jerusalem artichoke ½ cup 15
Garlic 1 Tbsp 0.5
Globe artichoke 1 globe 5.5
Dandelion greens ½ cup 3.1
Chicory roots ½ cup 15 Common additive in
high fiber products
Vegetables to Avoid
Avoid these if you have gas:
• Beets • Cauliflower • Mushrooms
• Broccoli • Legumes/baked • Sugar snap peas
• Brussels sprouts beans
• Cabbage • Green peppers
Dairy Products to Avoid
• Flavored or sweetened milks (chocolate and others)
• Flavored or sweetened yogurts
• Sweetened condensed milk
• Flavored coffee creamers
Drinks to Avoid
• Carbonated sweetened drinks, stay away from citrus flavors
• Fruit and vegetable juices, lemonade and other sweetened juice drinks
• Milkshakes and malts
• Beer, sherry, port and other fortified wines
Allowed Drinks
• Water, carbonated water
• Milk
• Glucose-sweetened energy and sports drinks
• Powdered drink, sugar-free (or with allowed sweetener)
• Coffee or tea
• Alcoholic drinks (limit to 1 ounce): gin, rum, vodka (from grain or potato), whiskey, dry
white wine, or red wine
Other Foods to Avoid or Limit
• Avoid chewing gum (both sugar and sugar-free).
• Avoid chocolate and most other desserts. Cocoa powder with allowed sweeteners is okay.
• Avoid condiments sweetened with fructose. For example: ketchup and soy sauce.
• Avoid coconut, coconut milk, coconut cream. These are high in sugars.
• For sandwiches and salads, chop up dill pickles instead of using sweet pickle relish.
• Check medicines and vitamins for hidden fructose and/or sorbitol.
Breads and Starches
If your symptoms do not improve after removing high fructose corn syrup and limiting the fruit
you eat, you may need to watch your intake of fructans in breads and starches. Wheat-based
foods contain fructans or high fructose corn syrup. These can increase symptoms. You may just
need to avoid breads with honey or high fructose corn syrup. You may then eat other breads as
desired.
Avoid: Choose these:
• Whole wheat bread • Rye bread, gluten-free breads
• Whole grain cereals • Gluten-free cereals
• Graham crackers • Rye, corn or rice crispbreads
• Wheat pasta • Rice noodles, gluten-free pasta, brown
• Store bought cakes, cookies or muffins rice (for fiber) or white rice
• Wheat flour • Gluten-free cookies and cakes
• Products with dried fruits, fruits, honey, • Rice flour, spelt flour, other gluten free
coconut or added sugar flours
• Instant flavored cereals & granola
Constipation
If you are constipated, talk to your doctor. When you are constipated, your gut has longer to feed
and ferment on the sugars in the gut from the foods you eat. As the sugars feed those bacteria,
the bacteria grow which causes gas and stomach pain.
Teach Back
What is the most important thing you learned from this handout?
What changes will you make in your diet/lifestyle, based on what you learned today?
If you are a UW Health patient and have more questions please contact UW Health at one of the
phone numbers listed below. You can also visit our website at [Link]/nutrition.
Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s
Hospital (AFCH) can be reached at: (608) 890-5500.
Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright 9/2019 University of Wisconsin Hospital and
Clinics Authority. All rights reserved. Produced by the Department of Nursing HF#376.
