I believe I have dietary fructose intolerance, aka fructose malabsorption.

Here is the Univ. of Iowa's description:

http://www.uihealthcare.com/topics/.../whatisdfi.html

and symptoms:

Bloating
Abdominal pain
Diarrhea
Headache
Weight loss
Fatigue

http://www.uihealthcare.com/topics/...i/symptoms.html

I'm struggling to figure out what to eat! I have found a great table at the Paleo Diet website that lists fructose/sucrose/glucose content of fruit

http://www.thepaleodiet.com/nutriti...uits_table.html

but I'm wondering about other foods. Vegetables and nuts, in particular. I keep reading that some vegetables and all nuts have fructose, but I can't find anything that lists which vegetables have fructose and how much.

I've discovered I can eat bananas, at least in small amounts, but definitely NOT apples. This is all very new to me, so any help would be appreciated.

Since I've stopped eating fruit my rheumatoid arthritis symptoms have decreased dramatically, and some chronic stomach pain, which I had erroneously attributed to NSAIDs, has disappeared as well.

I wouldn't think nuts have much sugars in them, they're very low carb. Look at the carb content on them and that'll indicate how much sugar they've got.

Could your problem be more specific than sugar? What about pectin? Apples have a lot more pectin than bananas (I think). I remember on SCD they would have you peeling apples and cooking them, because they're easier to digest that way.

This says there are traces of glucose and fructose in nuts: http://pubs.acs.org/cgi-bin/abstrac...f?sessid=6006l3

If you're trying to scrounge out every bit of fructose out of your diet you might have to stop eating any plant based food at all. Although some people here do that, I personally wouldn't.

Also, if you've got a doctor you trust you might be able to get them to test you and they might actually have enzymes you can take to help you digest fructose.

You're right about pectin and bananas. According to PDR Health, pectin is found in citrus fruit and apples. I have been eating some of these fruits but not on a regular basis. I have, however, been eating a number of fruits (especially dried) that have very high fructose content.



NancyLC your link goes to the reference page only. Is there a different link to the whole document?

I found another link on the Paleo Diet website to the USDA's food nutrient analyzer, which includes fructose, glucose, and tons of other info:

http://www.ars.usda.gov/main/site_m...decode=12354500

I thought this would work well to compare non-fruit foods that have fructose to the fruits listed in the Paleo Diet website's table. However, when I compare apples to apples (literally!) in the fruit database to the USDA's database the figures don't match. So I don't know if Cordain's table is wrong or if I don't know how to read the USDA table correctly.

I can't eliminate every bit of fructose in my diet, but I'd sure like to know what non-obvious foods will give me a whopper of a stomach ache shortly after eating plus joint pain the next day.

This was what Google found:

Does trace amounts give you problems?

How about keeping a food journal for awhile?

Nancy LC your link was correct the first time you posted it. Sorry -- It starts with references then has the info lower on the page, and I didn't scroll down. I'm glad to learn that at least some of the nuts I eat every day have only trace amounts of fructose. I suppose at some point I'll have to eliminate them from my diet altogether and see if there's any change, but for right now they're such a staple I'm not willing to give them up.

I don't know what amounts give me problems. I'm going to try cranberry juice one day soon (very low fructose) and see if that is tolerable.

I've been keeping a food diary for about a week, and that's helpful. I've stayed away from fructose pretty faithfully, but have been adding in more dairy and I seem to be reacting to that. Today is my worst arthritis day since stopping fruit. I don't know if it's because of my reduced prednisone dosage, or if I'm reacting to very small amounts of fructose, or if I'm reacting to lactose now also. Or all three. Going shopping for food is very depressing right now, with all that I'm trying to avoid.

I remember reading in Protein Power Lifeplan their description of dairy foods moving through the digestive system. They said it looks like glue. That's pretty much what it feels like to me right now, after not eating any for several weeks!

Yeah, casein is super gluey stuff, like gluten is. I had some pure casein once and it was incredibly hard to mix with anything because it was so gluey. And anything you used to clean the container... you had to throw it away it created such an uncleanable gluey mess!

Have you looked into arthritis diets? I know Dr. Fine thinks oxalates are potential problems. He likes the Paleo diet but thinks nightshades and oxalates are possible problems especially for arthritis.

What are oxalates exactly? Haven't heard of those. I've been testing nightshades a bit. Tomatoes seem to be a slight problem. I had no trouble a couple weeks ago eating green peppers, but that's part of what I ate yesterday, so now I'm not sure.

I I need to be a lot more scientific about my testing, and I have tried to be, but some days I'm just tired of it all and I eat stuff that I know will muddy the waters. Yesterday's bad bad bad lunch was tortilla chips (corn is probably not a good idea), lots of shredded cheese, green peppers, onions, and a tiny bit of salsa. I'm paying for it today!!

Next week I see a nutritionist for the first time, and I have high hopes that he'll be able to get me on the right road.

There's an intestinal bacteria that can digest oxalates, but a lot of us are missing it due to antibiotic use.

Here's what WHFoods says about oxalates: http://www.whfoods.com/genpage.php?tname=george&dbid=48

Thanks for the link to info on oxalates. I certainly eat them every day in the form of almonds and cashews.

I'm reading a book called The Self-Help Way to Treat Colitis and Other IBS Conditions, 2nd ed., by De Lamar Gibbons. He blames most bowel disorders on dietary fructose intolerance, and says that many people surprisingly find that arthritis symptoms disappear once they begin eating a fructose-free diet. He doesn't go into much detail about the "arthritis" -- doesn't even distinguish between RA and osteo, at least in the first half of the book -- but has very clear explanations of the results of intestinal damage from food intolerances, including failure to produce enzymes to break down other, previously non-problematic foods (such as dairy), malabsorption, and so on.

I definitely think autoimmune conditions are linked to bad stuff happening in the intestines. Someday do a google search on Zonulin, it is a hormone that was recently discovered to open up the tight junctions in the intestines (brain and skin too!) but it has been found that some foods trigger this action in many humans, notably wheat but I bet there are others too.

Nancy LC, you must be prescient. 5 days after you introduced me to the word "oxalate," I ended up in the emergency room with calcium oxalate kidney stones! The ER doctor told me that diet has nothing to do with it, but the nutritionist I saw the next day said there is considerable debate over this, and he suggested I limit my consumption of oxalate-containing foods. Which I am doing.

The nutritionist also told me to take CompleteGest, which contains "vegetarian enzymes that help completely digest all foods," and Probiotic Pearls, which contain "L. acidophilus and B. longum to increase healthy intestinal flora." Not for the kidney stones, but for my ongoing intestinal problems, which have been pretty calm for 4 days now. I stopped eating everything except brown rice and protein (eggs, pork, beef, chicken) because none of these cause trouble. I added in rice milk yesterday and seem to be doing well with that, along with quinoa and buckwheat. I know it's non-Paleo, but choices are slim for me these days.

It was nice to talk to a professional who, when I mentioned the term "leaky gut," did not tell me that that's an interesting theory. In fact, he told me that I very likely do have a leaky gut, and that probably a lot more than lectins are passing through it and causing autoimmune reactions.

Meanwhile, I've been home for 2 days trying to flush out the stones with huge amounts of water, clutching my heating pad in one hand and Vicadin in the other....

Wow! Well, I'm so sorry this is happening to you! I wonder if avoiding the oxalates will help with your arthritis? My rhuematologist also believes leaky gut is connected to autoimmune diseases. Not that he does anything about it...

I've noticed an improvement in my arthritis since Sunday, when I started eating brown rice and protein and not much else. I stopped eating the tons of nuts I was eating because I was desperate to get my intestinal problems under control. I don't know if my improved intestinal health has made a difference or specifically the elimination of nuts (and their high oxalate content). I suspected the nuts were not a good idea because they are high in omega-6 fatty acids, and thus inflammatory, but I didn't want to give them up just yet because I have relied on them heavily as a high protein snack.

I am amazed at how well my joints feel. Even with all the drugs I've been on in the past 4.5 years, my hands have always given me trouble. It's not that they hurt all the time if they weren't being used (although sometimes that's been the case), but any kind of turning or twisting (doorknobs, jar lids, lifting tops off plastic storage containers) or anything that required even a small amount of force on my fingers has been difficult and painful. Now they are about 98% normal, which I wasn't sure would ever happen again.

So that's the good news. The bad news is that now I'm down to eating meat, non-gluten grains, some rice-derived products such as rice milk, and the small handful of vegetables that are low in oxalates. And protein powder. I tried cheese today and I'm not so sure that's going well through my digestive system. The nutritionist did say that he thinks once my gut issues are resolved I'll be able to eat a couple pieces of fruit each day, so that gives me some hope for expanded food choices in the future.

I wonder if you can maybe work on restoring your gut a bit. I'm a fanatic for kefir. I got my own grains and I've brewed some in coconut milk, but I love the goat milk the best.

Here's a nice chart you might find useful: http://www.branwen.com/rowan/oxalate.htm

Here is something about that oxalate absorbing microbe: http://www.csa.com/discoveryguides/...tic/review4.php

Wish we could get our hands on this stuff now!
http://news.ufl.edu/2001/10/24/stone-bacteria/

Giving rats high doses of a naturally occurring intestinal bacterium called Oxalobacter formigenes safely lowers chronically high levels of oxalate - a byproduct of digestion that is a major cause of kidney stones - to near normal, the scientists reported in the October issue of The Journal of Urology.

Scientists at UF and other institutions previously linked kidney stone formation to a lack of O. formigenes in the body, but the article provides the first published evidence that supplementation with the bacteria may help prevent stone formation. The research was conducted in collaboration with scientists at Ixion Biotechnology, a UF technology licensee located in Alachua, Fla.

Check this out, do you takes lots of ascorbic acid? http://www.urologystone.com/CH18WhatsNew/2001AUA.html

Nancy, thanks so much for all the links. I've been off the air for awhile but finally had a chance to follow up this morning.

Is the kefir that is sold in stores all soy-based? I'll have to read the labels more carefully. I looked at some kefir a couple weeks ago at Whole Foods and it had something in it I'm avoiding, but I didn't look at each brand. I see there are plenty of websites about how to make it yourself, so maybe I'll try that route.

I see my urologist again next week and I'll definitely ask her about the status of research on O. formigenes. One long-term study is concluding in March 2007.

I've been eating some dairy (cheese plus milk-containing processed foods) in the last few days and seem to be doing o.k. with it. I've been trying to avoid high-oxalate foods but that's pretty hard, given all my other food restrictions. The kidney stone problem comes and goes--no pain in the last 6 days, but I know there are more stones lodged in my kidney just waiting to travel south!

I don't think I consume too much ascorbic acid. I take a multi every day and that's probably my biggest source. I'll check with the urologist about that as well next week.

Thanks again for all your help!