Fructose-free weekly menu: seven days and a shopping list

Who is this menu for, and who is it not for?

It is designed for an adult with fructose malabsorption. The intestine absorbs fructose up to a certain point; any excess ferments in the colon and causes gas, bloating or diarrhoea. If fruit does not agree with you and you have been cutting out foods at random for weeks, this describes you. The full explanation is in our fructose intolerance guide.

It is not suitable for hereditary fructose intolerance, which is a different condition. This is a rare metabolic disease present from birth that becomes apparent in childhood when fruit and sugar are introduced. It is managed by a metabolic disease unit with a lifelong diet free from fructose, sucrose and sorbitol [2]. If you have been diagnosed with this condition, consult a metabolic disease specialist; this menu is not for you.

It has also not been calculated for a person with diabetes treated with insulin, kidney disease, someone who is pregnant, or a child. And it is not an elimination diet. The European guideline on breath tests states that restrictive diets should be reserved for cases where the relationship between what you eat and your symptoms has been documented [3]. This is a week of meals to help you plan; your doctor makes the diagnosis.

The weekly menu, dish by dish

Seven days, from Monday to Sunday. Every dish uses foods from the two lowest fructose bands in the table: less than 1 g and 1 to 3 g per 100 g [1]. Fruit is spread out, never having two pieces one after the other. Extra virgin olive oil, salt, vinegar and herbs are the kitchen staples.

Two points to note about the table this menu is based on. First, plums appear in two different bands, and peaches are in the low band when fresh and the middle band when dried, so neither is included this week [1]. Second, the table places custard and flan in the lowest band [1], but they contain added sugar, and table sugar is half fructose and half glucose [2]. That is why Sunday’s dessert is cottage cheese.

The two snacks that are not shown in the table

The table has three meals, while the day has five. The two that are missing, mid-morning and afternoon snacks, help spread out the day’s fruit instead of concentrating it. When absorption is limited, this makes a difference.

Simply alternate between these four options: a handful of almonds or hazelnuts, a glass of milk, a piece of cheese with bread, or a piece of fruit from the low band that you did not have with a meal. The thing to avoid is ending up having two pieces one after the other.

This week’s shopping list

Approximate quantities for one person for seven days, organised in the order you will find them in the supermarket. Everything apart from the kitchen staples is in the two lowest bands of the table [1].

Fruit and vegetables

• Potatoes: 2 kg · Onions: 1 kg · Garlic: 1 bulb
• Carrots: 1 kg · Pumpkin: 1 kg · Leeks: 4 · Tomatoes: 1 kg
• Aubergines: 2 · Mushrooms: 500 g · Wild mushrooms: 250 g · Asparagus: 1 bunch
• Spinach: 400 g · Chard: 1 bunch · Lettuce: 2 · Escarole: 1 · Cucumbers: 2 · Radishes: 1 bunch
• Artichokes: 4 · Cauliflower: 1
• Fruit from the low band for seven days: 4 mandarins, 2 oranges, 1 small melon, 1 piece of watermelon, 2 nectarines, 1 grapefruit, 1 small papaya, half a pineapple
• Avocados: 2 · Limes: 2 · Apricots: 6

Fishmonger and butcher

• Hake: 300 g · Desalted cod: 250 g
• Chicken: 600 g · Stewing beef: 300 g · Minced meat: 300 g

Dairy and eggs

• Milk: 2 l · Cottage cheese: 4 tubs · Hard cheese: 200 g · Fresh cheese: 200 g · Grated cheese: 100 g
• Eggs: 12

Store cupboard

• Lentils: 250 g · Chickpeas: 250 g (or two jars of cooked chickpeas; check the ingredients) · Peas: 400 g
• Rice: 500 g · Macaroni: 250 g · Noodles: 250 g · Rolled oats: 500 g
• Bread for the whole week, sliced and frozen in portions
• Tuna in olive oil: 2 tins
• Almonds: 250 g · Ground almonds: 100 g · Hazelnuts: 150 g
• Unsweetened cocoa · Coffee · Herbal infusions
• Extra virgin olive oil, salt, vinegar and herbs

The list contains no honey, jam, juice, breakfast cereal or dried fruit. None of these fits into a week designed to lower total fructose intake for the day. How much of each you tolerate can be assessed later, without rushing.

Why does this menu not eliminate fruit?

Because symptoms are usually related to the amount of fructose, the type of fruit and eating it all at once. Everyone has a limited capacity to absorb fructose, including healthy people, and high amounts are incompletely absorbed by anyone [3]. What differs from person to person is the amount at which symptoms begin.

There is no single threshold that works for everyone. The minimum amount tolerated by most people has not been systematically assessed [3]. Even so, in healthy volunteers, including those who malabsorb fructose, amounts below 25 g have not caused abdominal symptoms [3]. For someone who already has symptoms, the threshold is individual and varies greatly between people, and even within the same person over time [3]. That is why a fixed menu is a starting point, and your record of what agrees with you is what helps adjust it.

This week, no food group is removed. It leaves out fruit from the high band, spreads out the rest, and keeps vegetables, pulses, grains, dairy and protein in place. If you tolerate it well, the next step is to start reintroducing pieces of fruit.

What if sorbitol also does not agree with you?

This happens often, and there is an explanation. Fructose and sorbitol are two of the FODMAPs, a group of sugars that are poorly absorbed and ferment in the colon [4]. The body can also convert sorbitol into fructose, so a “sugar-free” product sweetened with it ends up providing fructose all the same [2].

This menu does not include apples, pears, plums, dried fruit or “sugar-free” chewing gum, which may provide sorbitol. The exception is apricot, which is in the lowest fructose band, but our sorbitol guide includes it among the fruits that are best limited. The change is listed under “Changes that help”. If irritable bowel syndrome is involved, the relevant option is a low-FODMAP diet, followed temporarily and with guidance.

How can you tell whether a packaged product contains fructose?

Check the ingredients list. The menu is straightforward with home-cooked food; packaged products are where the problem arises. The nutrition table has no separate line for fructose. European food information regulations define “sugars” as all the mono- and disaccharides in a food, without listing them separately [5]. This figure does not tell you how much fructose it contains.

Look for four names in the ingredients: sugar, honey, glucose-fructose syrup and concentrated fruit juice. If any of them appears among the first three ingredients, that product does not fit this plan. This applies to sliced bread, fried tomato sauce and jars of cooked pulses.

What mistakes do we see in consultations?

Three stumbling blocks come up in consultations almost every week, and all three can be addressed.

• Trusting a commercial intolerance test. IgG, hair and bioresonance tests do not diagnose fructose malabsorption. The valid test is a breath test, and your doctor will decide whether to request it [3].
• Having all your fruit for the day at once. A fruit salad at breakfast or two pieces of fruit for dessert can add up at once to an amount that is better tolerated when spread out.
• Continuing to cut foods out when nothing changes. If a dish does not agree with you, swap it for the one in the same row on another day before removing anything. And if your symptoms do not change when you reduce fructose, this sugar is probably not the cause. Look into irritable bowel syndrome before cutting more from your shopping list.

If bloating is what you notice most, our abdominal bloating guide explains the mechanism. What is not absorbed draws in water and is fermented by bacteria in the colon.