Everybody heard the common adage "an apple a day keeps the doctor away," but for some, apples can actually cause a lot of unpleasant gastrointestinal symptoms, including bloating, cramping and diarrhea. If you are trying to eat healthy by eating more fruits but find yourself feeling tight in your jeans a few hours later, you may have a condition called fructose malabsorption.
Fructose Malabsorption
Fructose malabsorption is still poorly understood and under-diagnosed by most doctors, but it is a common problem in people with irritable bowel syndrome or other gut disorders and can affect just about anyone. Fructose malabsorbers do not have enough of the transporter responsible for absorbing fructose, which is found in apples and other fruits, in your intestines. As a result, the unabsorbed fructose attracts a lot of water from other part of your body into your intestines by a process called osmosis, which contributes to your bloating. Moreover, bacteria in your gastrointestinal tract ferment this fructose, producing gas and further worsening your bloating issue.
Apples
Fructose is the natural sugar found in fruit, but is especially problematic for fructose malabsorbers in present in greater amount compared to glucose. Apples contain more fructose than glucose and are therefore responsible not only for causing bloating in fructose malabsorbers, but can also induce abdominal pain, cramping, flatulence, constipation or diarrhea. Other fruits containing an unfavorable ratio of fructose to glucose can induce the same bloating and other gastrointestinal problems: pears, cherries, mangoes, watermelon as well as most dried fruits and fruit juices. Sweeteners such as honey, agave syrup and high-fructose corn syrup can also be problematic. If apples are the cause of your bloating, you should avoid other high-fructose foods.
Get Tested
Fructose malabsorption is diagnosed with a test called hydrogen breath test, which is the same diagnostic test used to identify lactose intolerance. Ask your doctor to be referred if you believe you may have a fructose malabsorption problem. When starting the test, the lab technicians will give you a specific amount of fructose and a sample of your breath will be taken every 30 minutes for two to three hours. If high levels of hydrogen are detected in your breath, you will be diagnosed with fructose malabsorption. The test is quite simple and can help you single out other foods that may be responsible for your bloating, apart from apples.
Swap Apple
If you have fructose malabsorption or simply notice that you are bloated after eating apples, swap your apples for a fruit that contain more glucose than fructose. Glucose stimulates the absorption of fructose, which makes foods with a high glucose to fructose ratio better tolerated for most people. For example, you could have banana, blueberries, kiwifruits, honeydew melon, pineapple, orange, mandarins, grapes, grapefruit or cantaloupe. Although most of these fruits are usually better tolerated because of their lower fructose content, it is best to not have more than a small serving at a time to avoid overloading your limited capacity of absorbing fructose.
References
- Shepherd Works: Fructose Malabsorption
- "Journal of Gastroenterology & Hepatology"; Evidence-Based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach; Peter R Gibson and Susan J Shepherd; 2010
- "Journal of the American Dietetic Association"; Fructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for Effective Dietary Management; Susan J. Shepherd and Peter R. Gibson; 2006
- Shepherd Works: Hydrogen Breath Testing
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