Fruit is nature's sweet treat that you can enjoy without guilt. But if you get stomach pain after eating fruit, that's not so sweet. The most likely explanation is that you have a sensitivity to fructose, the most abundant type of sugar in fruit.
Fructose Intolerance Symptoms
About 40 percent of people worldwide have trouble digesting fructose, according to the National Institutes of Health Genetics Home Reference. Fructose intolerance, or fructose malabsorption as it is also sometimes called, results when the intestinal cells aren't able to properly absorb fructose. When the fructose reaches the bowel, it interacts with naturally occurring bacteria. This can cause several symptoms, the most common of which include:
- Abdominal pain
Hereditary Fructose Intolerance
Fructose intolerance or malabsorption should not be confused with another condition called hereditary fructose intolerance. Although they share similar symptoms, hereditary fructose intolerance is a more serious disorder that commonly develops in infancy when fruits and fruit juices are initially consumed. In addition to the symptoms of fructose intolerance, people with the hereditary condition may also experience:
- Low blood sugar
Repeated ingestion of fructose can have more damaging effects, including kidney and liver damage. Liver damage may result in jaundice (a yellowing of the skin and the whites of the eyes), an enlarged liver and chronic liver disease. Continuing to consume fruits and other fructose-containing foods can lead to seizures, coma and death from liver and kidney failure.
Avoiding Fructose In Fruits
If you have hereditary fructose intolerance, you're likely already aware of it. In addition, you probably avoid fruits anyway, as people with the condition typically develop a distaste for fruits, fruit juices and other fructose-containing foods, according to Genetics Home Reference.
If you have the milder, non-hereditary fructose intolerance, your ability to include fruit in your diet will depend on a few factors:
- Your individual level of sensitivity
- The types of fruits you eat
- The other foods — or lack of — consumed with fruit
Not all people will react to fructose in the same way. You may be able to tolerate only a small amount, while another individual with the condition might tolerate a larger dose. It takes some experimentation to determine how much fruit, if any, can be a part of your diet.
Fruits that are more "intestine-friendly" include:
- Passion fruit
These fruits contain more glucose, another sugar found in fruit that helps provide energy. For example, a mango and a banana have the same amount of fructose, but the banana contains more glucose, therefore it causes fewer digestive problems.
UVA recommends avoiding any fruits that are not listed above. In addition, you will also likely need to avoid dried fruits, fruit juices, juice concentrates, syrups made from fruits, fruit juices, jams and jellies and canned fruit in heavy syrup.
Tips for Tolerating Fruit
If you're not sure which of these fruits and foods will cause problems for you, try eating small amounts to begin with. If you have no symptoms, gradually increase the amounts you eat. In addition, you can take steps to minimize your risk of digestive distress by doing the following:
- Avoid eating large amounts of any fruit at one time.
- Stick to one to two servings of fruit each day. One serving of fruit is one-half cup or one medium, baseball-sized, whole fruit.
- Choose fresh or frozen fruit over canned fruit.
- Don't eat fruit by itself. Other foods can help mitigate the effects of fructose in the bowels.
Other Foods to Avoid
Fructose isn't just found in fruit. It's also in vegetables and honey. The combination of fructose and glucose creates sucrose, or table sugar. It may also be used on its own as a sweetener in foods. High fructose corn syrup is also a concentrated source of fructose.
So, in addition to some fruits, you may also need to avoid:
- Products listing fructose or crystalline fructose in the ingredients list
- Products containing high fructose corn syrup, including candy, desserts and soda
- Honey and products made with honey
- Sugar snap peas
- Sweet corn
- Tomato paste and tomato sauce
- Agave syrup
- Invert sugar
- Pancake syrup
- Palm sugar
If you repeatedly experience stomach pain after eating fruit, it's a good idea to schedule an appointment with your doctor who can tell you if fructose intolerance is the cause, or if there is another reason for your stomach cramps after eating fruit.
Fiber and Acid Reflux
Stomach pain after eating fruit is most commonly related to fructose malabsorption; however, there are other possible explanations. Fruits are rich sources of dietary fiber, which comes from the cell walls of plant foods. Your body can't digest dietary fiber, so it moves through the digestive system mainly intact.
This provides many benefits for your health, including improved bowel function and lower cholesterol. However, for some people, eating too much fiber at once can cause digestive problems, potentially including stomach cramps after eating fruit. Fruits that are particularly high in fiber include raspberries, pears, apples and bananas.
How much fruit do you typically eat in one sitting? Eating a lot of fruit at one time — especially high-fiber fruits — can cause you to get too much fiber which, according to Duke University Student Health, can cause bloating, constipation, gas, abdominal cramping and diarrhea.
Some fruits may also contribute to acid reflux or gastrointestinal reflux disease (GERD). In both cases, the stomach's contents back up into the esophagus and cause the characteristic burning sensation known as heartburn. It can also cause pain in the upper abdomen. Tomatoes and citrus fruits such as lemons, limes, oranges and grapefruit are common triggers due to their high acidity; but other fruits could worsen acid reflux on an individual basis.
- Genetics Home Reference: "Hereditary Fructose Intolerance"
- American Gastroenterological Association: "Fructose Malabsorption"
- University of Virginia Health System: "Low Fructose Diet"
- Mayo Clinic: "Dietary Fiber: Essential for a Healthy Diet"
- Duke University Student Health: "Fiber-How"
- Mayo Clinic: "Chart of High-Fiber Foods"
- Cleveland Clinic: "Lifestyle Guidelines for the Treatment of GERD"