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Dietary Fructose Intolerance: why eating mangoes can cause gas

Q: It seems that every time mangoes are in season, I get lots of digestive symptoms - like intestinal gas, bloating, and a change in my bowel habits. Do mangoes cause this condition?

A:Mangoes can cause the symptoms you describe if you have Dietary Fructose Intolerance, or DFI. The condition is a common cause of irritable bowel syndrome (IBS), which is characterized by intestinal gas, bloating, abdominal pain and cramping, nausea, and diarrhea or constipation. People with DFI can also have indigestion and excessive belching. Mangoes are one of many foods that can increase symptoms of IBS because they are higher in fructose, or fruit sugar, than they are in glucose. In fact, a number of foods can aggravate IBS because of their fructose-to-glucose content.

The fructose in mangoes is problematic for some people because of the way it's absorbed. In those suffering from DFI, fructose is absorbed poorly; as a consequence, it gets transported to the large intestine where it's broken down by bacteria in the colon, resulting in the production of methane and hydrogen gas. The end result: a noticeable increase in intestinal gas. This uncomfortable state can be avoided by reducing your consumption of foods with higher fructose-to-glucose ratios. Unfortunately, this category includes many of our favorite fruits grown in Hawaii. The good news, however, is that researchers have found that you can enjoy them if you limit your intake to small amounts.

In addition to intestinal discomfort, the long-term consequences for those with DFI can include an increased risk for nutritional deficiencies - such as low levels of folic acid, zinc, and the amino acid L-tryptophan. Activities of the antioxidants vitamins C, E, and glutathione have also been found to be lower in those with DFI.

If you have DFI, avoid the following foods because of their high fructose-to-glucose ratios: apples, pears, mangoes, pineapples, peaches, oranges (including mandarin oranges), honeydew melons, watermelon, lychees, and grapes. Dried fruits, including raisins and figs, can also aggravate the condition. Avoid exposure to fruit juices, coconut milk, honey, high fructose corn syrup, and alcohol sugars including sorbitol (which is found in sugar-free cough drops and gums, diet drinks, and some medications), xylitol, and mannitol. Other foods that can aggravate the condition include artichokes, asparagus, leeks, onions, and wheat. Supplements containing inulin and fructo-oligosaccharides (often found in probiotic formulas) should be avoided as well.

A hydrogen breath test can be done to evaluate if you have DFI. However, it is more cost effective to simply avoid the foods listed above for at least a month to determine if your symptoms are due to this condition.

Dr. Laurie Steelsmith is a naturopathic physician and licensed acupuncturist in Honolulu, as well as author of the best-selling new book Natural Choices for Women's Health, published by Random House. You can reach her and read her past columns at www.DrSteelsmith.com. This column is for information only. Consult your health provider for medical advice.

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