Fructose Elimination Diet: What, How, Why?

What is an elimination diet? Why should I try it?

When you’re having gut issues, a common strategy is to try an elimination diet. Basically, you eliminate whatever you think your triggers might be until your symptoms are gone or significantly reduced. Then, you try introducing very small portions of things back into your diet while closely monitoring your symptoms to figure out what you can tolerate. Everyone is different, and food variety is important for your overall gut health, so it’s important to experiment and find what works for you. Please note: I am not saying everyone needs to do an elimination diet. However, it was strongly recommended by both my GI and my nutritionist and it helped me a lot as I navigated my new diagnosis.

Click here to read an article from Monash University about the low-FODMAP elimination diet (note that it involves restricting things beyond fructose and fructans, but it provides an overview of the process).

How do I do an elimination diet?

Step 1 : Identify

Identify potential triggers. This might come from a doctor’s advice, your own noticings, or an official diagnosis, like fructose malabsorption. For me, I knew I needed to eliminate both fructose and fructans (made of complex chains of fructose). Read more about fructose intolerance, including the diagnosis process, here.

Step 2 : Plan

Carefully plan your meals to limit the eliminated items as much as possible. Because fructose is found in so many foods, eliminating all fructose is nearly impossible. My nutritionist recommended trying to stay below 5 total grams of fructose per day during the elimination phase.

Step 3 : Monitor Symptoms

Keep some kind of log of your symptoms. It isn’t overly important to track everything you are eating right away, as it will likely take a while for your symptoms to abate. After receiving my fructose intolerance diagnosis, it took at least 3-4 weeks of strictly limiting my fructose intake before my permanent bloating and other symptoms started to resolve. This process often ranges from two to six weeks, and it has to do with how much of what you can’t digest is built up in your system.

Step 4 : Small Reintroduction

Once you start to feel better, you can begin a slow and strategic reintroduction. For example, if I felt good all weekend, on Monday morning I might try a small portion of 2 strawberries alongside my breakfast. At this stage, you’ll want your tracker to become more detailed. Note the date, the meal, and what you tried, including the portion size. Then, pay attention to your body the rest of the day. Everything else you eat should follow the elimination diet rules. Sometimes, you might need to give yourself a day or two to see how you react.

Step 5 : Expanded Reintroduction

If you tolerated the two strawberries without symptoms, a couple days later, you might try four strawberries, etc. until you work up to a full serving. It is important to pay extra attention to any reactions you might have.

Step 6 : Reset & Try Again

Here is the tough part. If you tolerated the strawberries (hooray for you!) or if you didn’t, you now cut them back out. Make a note of what serving size worked for you. Make sure you are back to a no-symptom or limited symptom baseline, and then try reintroducing a small portion of something else (perhaps some cherry tomatoes). All the while, keep taking notes in your food log.

Step 7 : Find Your Balance

Eventually, you will get a feel for what your body can tolerate and what will send you to bloat city. Many people with fructose intolerance can ultimately tolerate 10-15 grams of fructose per day once their guts are back on track. Taking notes in some kind of food log really helps. Maybe you figure out that you can have 2-3 berries with breakfast and a handful of cherry tomatoes at lunch without issue, or maybe you need to choose one or the other on a given day. You can also keep track of recipes you’ve tried and whether or not they triggered your symptoms. That’s the main reason I started this blog—so I can keep track of everything for myself!

So, what can I eat, and what should I avoid?

If you’re doing a fructose/fructan elimination diet, the chart below is a great starting place. During the elimination, you should strictly avoid everything on the “high fructose” side. I even limited many of the lower fructose fruits and vegetables for the first week or two to try to support my body in dealing with the reserve of fructose in my system.

During the elimination phase, you should also try to avoid all kinds of sugar, natural or refined. Once you begin reintroducing things, you can see how you handle potentially safer sweeteners like brown rice syrup, maple syrup, Stevia, or brown sugar. First, however, you need to let your gut heal. Learn more about sweeteners in this blog from Nutrition Over Easy.

Protein and dairy were my go-to food groups during the early stages of my elimination diet. I also ate a good deal of rice, carrots, spinach, and potatoes. Many of the recipes on my blog should be safe for the elimination phase or easy to modify, and most of them also include a “fructose forward” section if you are trying to introduce new foods. Finally, you can read up on how to balance fructose and glucose to support your digestion.

References & Resources

• Fedewa & Rowe (2014): Dietary Fructose Intolerance, Fructan Intolerance and FODMAPs

• Reinagel (2015): Safe sweeteners for those with fructose malabsorption (ignore until after the elimination diet)

• University of Virginia (2017): Low Fructose Diet (detailed chart of foods to avoid, limit, or include during the elimination diet)