If you’re wondering about fructose malabsorption, it’s a condition where the body ferments excess fructose, fructans, and certain other sugars that aren’t absorbed properly. This causes gastrointestinal distress and the only solution is to limit the problematic sugars by following a low-FODMAP diet. The acronym stands for Fermentable (rapidly digested by bacteria in the intestines), Oligosaccharides (fructans and galacto-oligosaccharides), Disaccarides (lactose), Monosaccharides (fructose), And Polyols (sugar alchohols such as sorbitol, mannitol, xylitol and maltitol).
A lot of foods have fructose in them, but only the ones that contain more fructose than glucose are a problem. Glucose helps transport fructose across the gut barrier, so only the extra fructose causes problems in people with fructose malabsorption. The body can’t absorb the extra fructose and other sugars, which sit in the gut and ferment. Fructose malabsorption is also load dependent, in other words, it’s the total amount you consume in a day that matters. That means you might get away with eating a particular food one day, but not the next because everything else you ate added to the total amount and the food in question pushed you over the limit your body can handle.
Fructans can also bind with tryptophan, the precursor of melatonin and serotonin, which causes insomnia. I’ve struggled with insomnia for ten years and nothing I did helped. No matter how many articles I read on sleep hygiene and covering up the light from the alarm clock, I still woke up at 3:30 in the morning. Some nights I never fell asleep. At times, I’ve been more sleep deprived than when my children were infants. I was able to get my gastrointestinal symptoms under control fairly easily once I started the low-FODMAP diet, but it’s been a struggle to restore natural sleep patterns. Slowly, my sleep is improving, but if I eat something I shouldn’t, I don’t sleep well for a week or more. Now when I look at something I used to love eating, I think about not sleeping and I pass it up. It’s just not worth it, because no matter how much I’d like to sink my teeth into a crunchy baguette or a creamy chocolate eclair, I’d far rather sink into a deep, deep sleep.
Unlike some people with fructose malabsorption, only fructose and fructans bother me. But they are in a lot of plants including asparagus, leeks, beans, cabbage, artichokes, onions, garlic, wheat, barley, and rye. When I first realized that I had to give up so many foods, I wasn’t sure what I would do. Saying goodbye to apples, pears and watermelon wasn’t that hard, and I made peace with the fact that my favorite vegetables are forbidden. Substituting other grains for wheat wasn’t difficult either, especially since there are so many excellent gluten-free recipes out there.
Replacing onions and garlic was the biggest challenge because they are one of the easiest ways a cook has to build flavor, and they’re in almost every Italian recipe. My favorite food is Italian and I own stacks of Italian cookbooks. When I ask my kids what they want for Thanksgiving dinner, they say homemade ravioli. So I was sad when I realized that many of my old favorites were off the menu. But then I had an epiphany. I sat down at the kitchen table one Saturday with a couple of my favorite cookbooks and I started compiling a list of recipes that worked for me. Before I knew it, I filled twelve single-spaced pages. I own hundreds of cookbooks and even if only a few of the recipes in each cookbook are low-FODMAP friendly, added together there are hundreds of recipes that are perfect as is. And if you include the ones that only need a little tweaking, the number of suitable recipes soars higher.
I wouldn’t choose to have this condition, but it’s an effective filter for sorting through the cookbooks that fill my workspace and the floor in front of the crammed bookshelves. No one could cook all of those recipes, but now I have parameters that make it easy to read through a cookbook and not get lost. Either it works or it doesn’t and on I go, looking for delicious things to experiment with in the kitchen.