Download Low sucrose and fructose diet for children

Low sucrose and fructose
diet for children
Fructose and Sucrose
Fructose and sucrose are sugars found in our diet.
Sucrose
Sucrose is the sugar from sugar cane – also known as table sugar. There are
three main sources of sucrose in our diets:
> Table sugar we add ourselves (eg. sprinkled on cereal or added in cooking)
> Sucrose (table sugar) added by manufacturers to processed foods (eg. to
cakes, biscuits and drinks)
> Natural sucrose found in fruits and vegetables
Fructose
Fructose (sometimes called fruit sugar) is a natural sugar that is mainly found in
fruits and honey, with smaller amounts found in some vegetables. It is also
present in some processed foods.
What is fructose and sucrose intolerance?
Sucrose and fructose intolerance occurs when the body is unable to absorb fructose and
sucrose well. A common symptom of fructose and sucrose intolerance is diarrhoea. Some
children also experience abdominal pain, bloating, wind and irritability.
The diagnosis of fructose and sucrose intolerance should be confirmed by Breath Hydrogen
Tests.
Sucrose intolerance should not be confused with Sucrose-Isomaltase deficiency. SucroseIsomaltase deficiency is a rare inherited disorder that requires almost complete elimination of
sucrose from the diet and other dietary modifications. This information sheet is not intended
for children with Sucrose-Isomaltase deficiency.
Fructose intolerance should not be confused with ‘Hereditary Fructose Intolerance’ - a much
more serious condition caused by a liver defect. This information sheet is not intended for
children with Hereditary Fructose Intolerance.
Treatment
Fructose and sucrose intolerance is treated by lowering the amount of fructose and sucrose
in the diet.
Fructose and sucrose do not need to be completely removed from the diet - every child is
different and will tolerate different amounts of fructose and sucrose.
Fructose and sucrose content of commercial foods
The following tables sort foods according to how much fructose and sucrose they contain. There are two groups:
Eat freely
Limit
These foods are low in sucrose and fructose and can be eaten freely
These foods are high in sucrose or fructose or both. Initially they should be limited. Once
symptoms resolve you can challenge with small amounts of these foods.
Tolerance of the ‘limit’ group of foods will vary greatly between children. Many children will tolerate small amounts
of high fructose and sucrose foods without symptoms however if large amounts are eaten symptoms may
reappear.
Dairy &
dairy
alternatives
Breads and
Cereals
Biscuits and
cakes
Drinks
Meat / eggs
Margarine,
butter, fats
and oils
Eat freely
Limit
> breastmilk
> sweetened condensed milk
> standard infant formulas and soy formulas
> S26 Soy formula
except S26 Soy (check with your dietitian)
> flavoured milks (added sugar) – eg. chocolate
> cow’s milk (plain, unflavoured)
milk
milk flavourings – eg. Milo, Aktavite
yoghurts sweetened with sugar
yoghurts with fruit
ice cream and ice-blocks
sorbet
frozen yoghurt
custard
flavoured or sweetened soy milk
all desserts and puddings made with sugar
jelly
sweetened breads
cereals with added fruit, honey or sugar
> rice milk (plain, unflavoured)
>
> soy milk (plain, unflavoured)
> lactose free cows milk
> cheese (including cream cheese)
> natural yoghurt (plain)
> diet yoghurt (plain)
> cream
> evaporated milk
> sugar free custards
> diet jelly
> plain breads
> pasta
> noodles
> flour
> cereals with no added sugar– eg. rice
cereal, puffed wheat, Vita Brits, Weeties,
rolled oats
> homemade low fructose and sucrose
biscuits and cakes
> plain dry biscuits – eg. SAO, Jatz, Ryvita,
Vitaweat, rice cakes, Salada, water
crackers)
> tea and coffee
> cocoa
> diet cordial and soft drinks
> diet milk flavourings eg. diet chocolate
topping
> unflavoured mineral and soda water
no restrictions
>
> margarine and butter
> imitation cream (sweetened)
> all oils
> sour cream
>
>
>
>
>
>
>
>
>
>
> commercial biscuits and cakes with added
sugar (eg. chocolate biscuits)
> commercial sweetened pastries
> biscuits with added fruit
> juice
> regular cordial
> milk shakes
> milk flavourings – eg. Milo, Quick, Ovaltine,
> flavoured mineral water
> regular soft drink
Spreads
Eat freely (continued from previous page)
Limit (continued from previous page)
> Vegemite
> jam – including 100% fruit jam
> Marmite
> marmalade
> Promite (small amounts – thin spread)
> chocolate spreads
> cream cheese
> peanut butter (including no added sugar
> cheese spread
>
>
Sweets
>
>
>
Sauces
> gravy (without added sugar)
>
> cream based pasta sauces
> cheese sauces
>
varieties)
honey
lollies, chocolate, toffees, liquorice
other confectionary based on sugar or fruit
100’s and 1000’s
sugar free confectionary (often contain sugar
alcohols – see ‘sugars’ section)
asian sauces such as sweet and sour, bbq,
sweet chilli, hoi sin and plum.
concentrated tomato products (eg. tomato
paste, tomato pasta sauces, tomato sauce)
Fructose and sucrose content of fruits, vegetables and legumes
The following tables sort fruits and vegetables into three groups:
Eat freely
Fruits and vegetables with a low fructose and sucrose content. Can be eaten freely.
Limit
Fruits and vegetables that contain moderate amounts of fructose and/or sucrose. Initially when
starting a low fructose and sucrose diet this group should be avoided. Once symptoms resolve
you can then challenge with small amounts from this group.
Avoid
Fruits and vegetables that contain high or very high amounts of fructose and/or sucrose. Initially
when starting a low fructose and sucrose diet this group should be avoided. Once symptoms
resolve you can then challenge with small amounts from this group.
Tolerance of fruit and vegetables will vary greatly between children. Many children will tolerate small amounts of
moderate to high fructose and sucrose fruit and vegetables without symptoms however if large amounts are eaten
symptoms may reappear.
Vegetables
Eat freely
Limit
Avoid
> all other vegetables not listed in
> brussels sprouts
> beetroot
> carrots
> creamed sweetcorn
>
> gherkin – pickled
“limit” or “avoid” groups
>
>
>
>
celeriac
onion
pumpkin – queensland blue
red cabbage
sweetcorn kernels
> green peas
> parsnip
> pumpkin – butternut
> sweet potato
> sweetcorn – fresh on the cob
Fruit
Eat freely
Limit
Avoid
> avocado
> grapefruit
> apples – all
> lemon
> passionfruit
> apricot
> lime
> raspberries
> banana
> rhubarb
> strawberries
> blackberries
> watermelon
> blueberry
> brown pears
> cherries
> currants
> custard apple
> dried apple
> dried apricot
> honeydew melon
> kiwi fruit
> lychee
> mandarin
> mango
> nashi pear
> nectarine
> orange
> peach
> pears
> pineapple
> quince
> rockmelon (cantelope)
> sultanas
Onion, leek, garlic and legumes
Onion, leek, garlic and most legumes contain low to moderate amounts of fructose and sucrose but often can
cause bloating and discomfort in children with fructose and sucrose intolerance. These foods are best avoided
initially when starting a low fructose and sucrose diet. Once symptoms (eg. bloating, diarrhoea) have improved
they can then be reintroduced in small amounts as tolerated.
Sugars
The following tables sorts sugars into two groups:
Eat freely
This list contains sugars with a low fructose and sucrose content
Limit
This list contains sugars that are high in fructose and/or sucrose. Initially when starting a low
fructose and sucrose diet this group should be avoided. Once symptoms resolve you can then
challenge with small amounts from this group.
Eat freely
Limit
> glucose (powder, liquid)
> table sugar – white, brown, raw, icing
> brown sugar
> honey
> 100% maple syrup
> imitation maple syrup
> caramel
> fructose
> palm sugar
> high fructose corn syrup
> Karo light corn syrup
> Splenda
Sugar alcohols
Sugar alcohols are food additives used as artificial sweeteners in some products. Sometimes children with
sucrose and fructose intolerance can’t tolerate sugar alcohols. If sugar alcohols do cause problems your child
(eg. bloating, diarrhoea, abdominal pain) they may need to avoid them.
Sugar alcohols that may cause symptoms:
> Erithitol
> Mannitol
> Lactatol
> Sorbitol
> Isomalt
> Lactitol
> Maltitol
> Xylitol
Sugar substitutes in cooking
The following substitutes are available to use instead of table sugar (sucrose) in food preparation and cooking:
Glucose (dextrose)
> Available from supermarkets and pharmacies (glucose powder)
> In cooking use the following conversions for your recipes:
o
1 cup sugar = 1 ½ cups glucose powder
o
½ cup sugar = ¾ cup glucose powder
o
1 tablespoon sugar = 1 ½ tablespoons glucose powder
Artificial sweeteners
> Available from supermarkets (eg. Equal)
> Used in some diet products to sweeten food (eg. diet soft drink, diet cordial)
> Safe to use in normal amounts – individual families have preferences about use in children
Label reading
To limit sucrose in the diet:
Your child may need to avoid packaged foods with large amounts of added sugars.
Ingredients on the food label are listed from the largest ingredient in the product to the
smallest. Try to avoid large amounts of foods which include sugar (eg. ‘sugar’ or ‘raw sugar’)
listed as one of the first three ingredients (Weetbix is an exception). Speak to your dietitian
for more information on label reading.
e.g. Big M Strawberry Milk – Ingredients: Skim Milk, milk, sugar, emulsifier (471), flavour,
natural colour (120).
High sucrose food - sugar is one of
the first three ingredients listed
To limit fructose in the diet:
Some commercial foods will contain large amounts of fructose due to ingredients used.
Your child may need to avoid packaged foods with large amounts of high fructose ingredients
for example:
> Foods with added dried fruit (eg. breakfast cereals, muesli bars)
> Foods with added sugar alcohols
> Drinks based on fruit (eg. cordials with added fruit juice)
> Foods with large amounts of added honey (eg. honey coated breakfast cereals)
> Concentrated tomato products (eg. tomato paste, tomato pasta sauces, tomato sauce) may
need to be avoided initially – this is because large amounts of tomatoes are used to make
these products making them very high in fructose
o
Use these products sparingly or use fresh tomato or canned chopped tomatoes in
small amounts instead.
o
Choose cream based pasta sauces instead of tomato based
More information
For more information on the low fructose and sucrose diet speak to your dietitian.
Food product information contained in this resource was up to date at the time of revision. If
you are not sure about a food, check with the manufacturer.
Produced by
Women’s and Children’s Health Network
Nutrition Department
72 King William Road
North Adelaide SA 5006
Telephone: (08) 8161 7233
© Department of Health, Government of South Australia. All rights reserved.
Revised January 2012. Printed February 2012..