Due to the rise in diabetes in the USA, for decades there has been a big marketing push to get people to use zero-calorie and low-glycemic sweeteners. I previously posted about health issues I connected to a zero-calorie sweetener, and noted that I also did better on a low-carb diet. Now I’m going to explain the simple science behind why certain sweeteners, including no-cal-sweeteners and even natural low-glycemic sweeteners like agave and honey, or even just the natural sugars in wheat, apples, and onions can cause major health issues for some people.
I only learned about all of this in 2011 when a podiatrist mentioned a study that found a connection between gout and fructose. I started researching the topic, and the information I found surprised me.
It turns out that around 30% of the population of Western countries and Africa have a condition known as Fructose Malabsorption. Asia has lower numbers, but it’s still around 10%. That’s a lot of people with a condition most of us have probably never heard of.
The condition exists when people do not produce enough of the enzymes needed to breakdown all the fructose in our modern diet. Undigested sugars end up in the intestines altering the profile of bacteria. While our digestive system needs probiotics, an overgrowth of even the good biotics can cause problems. It leads to fermentation and the production of hydrogen, carbon dioxide, and methane gases, leading to all kinds of digestive problems, nausea, fatigue, brain fog, and even gout. Many people with irritable bowel disease may simply have fructose malabsorption.
While it is called fructose malabsorption, because fructose is the main sugar that is not broken down, the lack of enzymes also keeps other sugars from being broken down, including sugar alcohols (any sugar that end in -ol, like sorbitol) along with fructans, which are found in grains like wheat.
Fructose is broken down in the liver by enzymes, but even average people can only properly absorb 25-50g of fructose per sitting. People are considered to have fructose malabsorption when they can absorb less than 25g. To put that into perspective, a 12 oz can of cola has about 22g, an apple has 13g, a tablespoon of honey or agave has about 8g. Someone with fructose malabsorption may not be able to properly digest even a single serving of one of those ingredients.
The two main forms of sugar we consume are glucose and fructose. Glucose is the sugar in our blood. Table sugar is sucrose, and sucrose is half glucose and half fructose. Interestingly, normal corn syrup is mostly glucose, but high-fructose corn syrup (HFCS) is corn sugar that has been processed so it’s around half fructose. Fruit juices also contain large amounts of fructose, especially apple and grape juices. Onions contain lots of fructose. It’s obvious that our modern diet, full of processed sugars and fruits year round, not to mention boxed fruit juices, contains much more fructose than humans ever consumed in the past, so fructose malabsorbtion is more of an issue.
Know anyone with irritable bowel or other mysterious digestive issues and fatigue? Along with lactose intolerance and gluten intolerance, two generally recognized digestive issues, people may also want to rule out fructose malabsorption.
From my research, it appears the study of fructose malabsorption was brought to the greater attention of scientists in Australia while doctors were trying to figure out why some people responded so well to a wheat free diet who were not genetically gluten-intolerant (Celiac). Turns out wheat contains Fructans, which is a form of fructose.
I originally went gluten-free on my own twenty years ago. Doing so put my diagnosed Crohns disease into total remission, and was declared a miracle by my doctor. I did this diet against the wishes of my gastrointerologist, who insisted diet did not play any role in Crohns. He told me to instead prepare to spend the rest of my life sickly and undergoing surgery after surgery. My digestion has been problematic, getting markedly worse over the past six years, but the more research and experimentation I do with dietary restrictions the better I feel. My current hypotheses, based on all this research, and realizing the number of connections I’ve found, is that it wasn’t cutting the gluten, but possibly cutting the fructans, that saved me from the miserable future this gastroenterologist predicted. This is conjecture, but founded on plenty of dietary experience and research.
Luckily, there is a diet outlined for people diagnosed with fructose malabsorption. It’s known as the FODMAPS diet. Look it up if you’re curious about the details.
Just last year a new gastroenterologist told me that he thought all his patients that claimed they did better on a gluten-free diet were only imagining that they felt better. Seems he was not only totally ignoring all the science that states that 1 out of every 133 people are genetically gluten intolerant, but also the stats that show a massively larger percentage of the population has some form of fructose malabsorption. Anyway, getting off wheat is probably the hardest part of the FODMAPS diet, and something I did long ago, so taking it a little further wasn’t all that difficult for me.
The FODMAPS diet is very close in many respects to the Primal Diet. That’s why I went on a mostly Primal diet last year. You primarily eat vegetables and meat. This removes most of the right foods, but not all. I was also careful about using coconut flour and coconut milk, which are popular with the Primal Diet, as they contain fructose. You also have to cut out a few other foods from the Primal Diet, including onions, which was a big loss. Apples and other high-fructose fruits also must be removed. The diet automatically cuts out a lot the hard to digest food groups, like dairy, sugars, and grains. I started by eating too many nuts, as that allowed me to create baked goods using nut flours, which made the transition easier.
As I mentioned in a prior post, six weeks after going on the diet I had blood work done. My numbers were better than they’d been in ages. My triglycerides and cholesterol plummeted to excellent levels. My stamina when exercising increased. I started sleeping better. My blood pressure lowered. My uric acid stabilized at a lower level. Consuming TruVia and Inulin caused major problems for me, and they apparently require the same enzymes that breakdown fructose. Changing my diet, reducing carbs and sugar, cutting out Truvia and inulin, together corrected my digestive system and lifted bad cases of brain fog and fatigue.
While a case of mild food poisoning, which alone further lowers enzyme activity, interrupted my investigation into this, I did just test myself by first going on a no lactose and low fructose diet. When my digestion was acting normal I made a lemonade using 12g of pure fructose as the sweetener and drank it. Because the sugar has to pass through the digestive system, enter the intestines, and multiply the gut biotics, it took 24 hours for the reaction to run its full course. The effects lasted a few days and slowly returned to normal. Repeat.
So, my theory as of today is that I appear to be in the large group of people who genetically have enzyme production too low for our modern diet. This means poor fructose, fructan, sugar alcohol, and Inulin tolerance.
As for the gout connection I mentioned at the beginning of this post: A couple of years ago my gout was acting up badly, so I bought a uric acid monitor. Uric acid monitors are like those glucose monitors used by diabetics. You prick your finger and feed a drop of blood onto a device that gives you real-time measurements. I found that when my levels went above 9 I was at an increased risk for a gout attack. My levels sometimes went as high as 11. While on this diet, my levels stabilized around 8. I went on enzyme pills for a few weeks. Doing this brought my uric acid blood levels down to 5. Sadly, when I mentioned this the gastroenterologist I saw last year said that gout is not a digestive issue and dismissed my findings. I had a piece of gluten-free apple pie at a family dinner. That night I could feel the pain buildup in my foot. My blood pressure also became elevated. In the morning I tested my uric acid levels. It was at 10 for the first time in months. Apples are a very high fructose fruit. My recent bout of food poisoning, which totally wiped out my enzyme production, also raised my uric acid levels. Sorry, but I now totally believe the study that showed a link between gout and fructose malabsorption, and I have no doubt that gout is a digestive issue. I love the empowerment of science and technology.
If you ever try a low-carb diet and find you do better on it, this may be why. If you have any digestive problems, you may want to give the FODMAPS diet a try for a few weeks to see if it helps, and maybe do a fructose challenge (using the fructose sweetened lemonade I mentioned above) to prove it further. And even if you do not have fructose malabsorption, do keep in mind your body can only tolerate so much fructose in one sitting. Drinking a large carbonated beverage or fruit juice, with more sugar or diet sugar alcohols or onions or fruit, may just be way more than your body can handle even with normal enzyme levels.
More Articles on Fructose:
Two Common Sweeteners Have Different Effects On the Body, Study Suggests
Fructose Consumption Increases Risk Factors for Heart Disease: Study Suggests US Dietary Guideline for Upper Limit of Sugar Consumption Is Too High
This Is Your Brain On Sugar: Study Shows High-Fructose Diet Sabotages Learning, Memory
Fructose-Sweetened Drinks Increase Nonfasting Triglycerides In Obese Adults