Dietary Fructose Intolerance

Department of Food and Nutrition Services,
University of Iowa Hospitals and Clinics
Peer Review Status: Internally Peer Reviewed
Creation Date: May 2004
Last Revision Date: May 2004

Restaurant Survival

Eating away from home is one of the most challenging parts of staying on your fructose- restricted diet. It can be done successfully, however.

Success in fructose-restricted dining is determined by a number of factors, with the first factor being the type of restaurant you choose. The average food service worker will not easily understand your dietary restrictions. The more time you spend with the food service personnel explaining your dietary limitations, the more chance you will have of success. Personnel with the least time to spend checking ingredients will be at fast-food chain establishments. Even in the less frantic atmosphere of a sit-down restaurant, employees will have little time to check food ingredients from labels. Upscale restaurants offer a less harried atmosphere. It is in this atmosphere that you are likely to find wait staff willing to take the time to aid in food selection.

The second factor in successful restaurant dining is speaking to the right people. They are:

The wait-staff:

Enlisting the interest and cooperation of your wait-staff is essential. They can be your best ally or your biggest stumbling block. Even cooperative wait-staff will not be able to take the time you need during rush hour. Time your meals so the restaurant will not be busy, and you will have access to the personnel necessary to help with your selections.

Be as clear and explicit as possible when talking with the wait staff. State: I need your help. I have a food intolerance where I must avoid fructose, a sugar found in processed foods, soda, fruits and vegetables. If I eat any foods containing fructose I will experience pain, bloating and diarrhea. I know the diet is complex, and I will try to order simple foods. I cannot have foods containing fructose, High Fructose Corn Syrup, Sorbitol, honey, molasses, maple syrup, or caramel. I can use sugar substitutes with the exception of Splenda. I cannot have carrots, tomatoes, beets, onions, peas or corn. I can have plain green leafy vegetables, potatoes and rice. I can have small amounts of asparagus, green beans, broccoli, cauliflower, leeks, cucumbers, lettuce, green pepper, and cabbage without added sugars or sauces. I cannot have fruit or fruit juice, sweet wines or vegetable juices. I can have unbreaded meat, chicken and fish (without added sweeteners), shellfish, crab, or crayfish. I need to avoid spicy foods, since there are spices I cant tolerate. I can have milk and milk products as long as there is no added sugar. Even small amounts of fructose in my food will cause symptoms.

Order specifically. I would like a steak, broiled on a piece of aluminum foil with no seasonings, a baked potato with butter, a lettuce-only salad with a small slice of lemon and oil on the side, plain steamed spinach (green beans, etc.), and coffee/tea/milk. Since this is a complex problem, maybe it would be easier if I spoke to the chef so that s/he will understand my concerns and be able to prepare my food appropriately. Could you show me the way to the kitchen and introduce me

The Chef:

The person who knows the ingredients in the food is the person who prepares it. The chef is often not the person doing the cooking, but is in charge of supervising the kitchen, ordering supplies and checking recipes for standardization. Two levels of cooks and kitchen assistants work under the chef. Ask the chef who prepares a particular food and talk to that person. Even though basic recipes should be standardized, each cook has his/her own way of preparing foods. A menu item that was fructose free yesterday may not be today.

The third factor to consider when eating away from home is choosing a specific food. Consider:

Salads:

Small amounts of salad greens should not be a problem unless the greens have been treated to increase shelf life. If you have doubts, ask the chef, or bring a portion of salad greens from home.

Salad dressings:

Commercial companies make most, if not all, salad dressing bases. Determine ingredients by reading the label on the original container. It may be safer to order a lemon wedge and oil on the side, or to bring a small container of dressing from home. House dressings are usually made from a commercial base with other ingredients added to make it unique to a particular restaurant. Read the label and talk to the person who made the dressing to determine if it is safe to eat.

Soup:

Except for selected restaurants, most soups are canned. Read the label. If the soup is made at the restaurant it may contain ingredients not compatible with your diet. Obtain specific ingredient information from the person who made the soup.

Main courses:

Prime Rib and other meats. Whether grilled or broiled, seasoning is routinely used in meat preparation. Specify no seasonings. Many establishments keep a pot of hot au jus in the kitchen for preparing prime rib. Au jus is a sauce used for flavor and appearance, and usually contains hydrolyzed vegetable protein, a soy product that may not be tolerated. Request no au jus onyour meat. Additionally, meat and poultry is frequently marinated using untolerated ingredients. When making reservations, request no marinade. Emphasize the meat must be cooked on aluminum foil to avoid contamination from sauce used on other orders.

Sauces:

In many fine restaurants, one person is in charge of all sauces. Often the sauce ingredients are a closely guarded secret. If the purpose of your inquiry is clear, the chef will help determine if the sauce has fructose containing ingredients. Canned sauces are also available in restaurants. Request to check the ingredient list. To avoid questionable sauces, bring your own.

French Fried Foods:

In most restaurants, the same hot oil is used to cook breaded foods and french fries. The batter may contain an untolerated ingredient. There is a possibility of contaminating your french fries with small bits of batter from what has been in the fryer earlier. In large chains where french fries are cooked in separate fryers, there is less chance of contamination.

Hash browns:

Few restaurants make fresh hash browns. Most hash browns are potatoes, dextrose and salt, but read the label to be certain. Ask the person cooking the hash browns what other ingredients have been added.

Non-Dairy products:

Non-dairy products are often used in restaurants, and may contain untolerated ingredients. Three frequently used non-dairy products are non-dairy creamer, non-dairy potato topping, and non-dairy whipped topping. Ask to read the label.

The fourth and final factor to consider when dining out involves your budget. If a quality restaurant is beyond your budget and you desire the social aspects of dining out, eat something at home before going out, and then order only a baked potato and salad from the restaurant. Use a potato topping and salad dressing from home. If you are able to fit a quality restaurant into your budget, and you have had a good dining experience, show your gratitude to the wait-staff and chef for making your dining experience enjoyable, give a generous tip. For that extra touch, leave a complimentary note with the tip. Compliments are appreciated. Bon appt!

Travel Survival

To put it bluntly, travel is a pain in the gut.

Travel may be defined in two ways; mode of transportation and destination objectives - work or play. Each provokes challenges to be overcome if the travel experience is to be enjoyed, and the flat-on-your-back-in-bed or the in-the-bathroom-all-day scenarios avoided.

Traveling by car takes more time, but has certain advantages. Depending on the length of the trip and the season of the year, food from home may be taken and enjoyed along the way. Warm weather picnic lunches packed with carefully selected foods eaten at rest stops provide freedom from symptoms when you arrive at the destination. Several days before the expected trip; freeze bottled water to use as the coolant in the cooler. There is no water mess from ice, and bottled water is refreshing to drink as it melts. It is advisable to loosen the lid and remove 1/2 inch of water from the bottle before freezing to avoid over expansion of the bottle. Retighten the lid. Keeping a heavy blanket and/or a reflecting blanket over the cooler prolongs the life of the frozen bottled water. If care is taken, the cooler may stay cool for up to 3 4 days. The return trip home may require more thought, unless you can find a place to replace your frozen water and more food for the return trip, too.

Travel by plane can be tricky, depending on the duration of the flight. Dont eat much, but drink a lot. Often only pretzels are available on flights within the continental U.S., particularly on flights with connections. Passengers are expected to make food purchases from airport venders or bring their own. Nibbling slowly on plain sesame seed or poppy seed bagels sold at most airports may be tolerated, but the safest food to eat remains food you bringfrom home. There are a lot of small snacks available for easy carry on: individually wrapped string cheese, pistachio nuts, Baby Bell cheese, crackers and cheese (use a plastic spoon), beef jerky. Include protein foods plus carbohydrate containing foods. Eating protein at every meal makes you feel better. Try sesame rice crackers, homemade bread spread with tahini, or a hard-boiled egg kept cool with a small blue ice tucked into purse or pocket. Stay hydrated. Drink one of these two re-hydrating solutions before a flight, if dehydration is a problem, and then drink more water on the flight.

Cruise travel may be easier than you think. Cruises are known for lush food creations and sparkling, delicious temptations; but because of the large selection, it is usually possible to choose food that will not limit your good time. It is better to eat less and enjoy other activities onboard than to spend all of your time in the stateroom recovering from a bad food choice. Each meal menu gives the passenger several selections and will usually include acceptable foods. European based cruises do not have food with added fructose. Pick your cruise line wisely.

Attending a conference, with set lunch menus, presents a major challenge. If possible, contact the conference centers meal supervisor and/or chef in advance. Explain your food restrictions. Ask if meat without sauce or marinade is available. Avoid cooked vegetables; unknown flavor enhancing ingredients are often added. Eat simple foods. Baked potatoes are a safe choice. Use your favorite dressings, such as sour cream and butter. Equally as good as sour cream is topping your potato with cottage cheese for flavor as well as protein. For the lactose intolerant drizzle olive oil, Parmesan cheese, and a little vinegar over the potato. If a salad bar is available, add chickpeas, sesame seeds, and/or olives to the greens.

As a backup, buy vacuum-sealed packets of chunk light tuna packed in spring water. Tuna is tasty when spread on rice crackers or plain bagels. A sweet snack to consider is a sesame seed cookie. The seeds provide fiber and protein, and the recipe includes dextrose. Try the following recipe:

Sesame Cookies

1 cup butter, softened
2 1/2 cups all purpose flour
1/4 cup sugar
2 egg whites, slightly beaten
1/2 cup dextrose
2 teaspoons baking powder
1 teaspoon cardamom, ground
1 cup sesame seeds

In large mixing bowl, beat butter with an electric mixer on medium to high speed for 30 seconds. Add sugar and beat well, scraping sides of bowl. Beat in egg yolks, ground cardamom, and baking powder until well combined. Beat in as much flour as possible with mixer. Work any remaining flour in by hand. Cover and chill 1 hour until easy to handle.

Shape dough into 1-inch balls. Roll in egg whites and then in sesame seeds. Place balls one inch apart on greased cookie sheets. Flatten slightly with bottom of a glass. Bake at 375oF for 15 minutes or until lightly browned. Cool.

Basic advice in a nutshell for happiness and health when traveling is:
1) Practice care when making food selections.
2) When in doubt about available food, dont take a chance.
3) Explain your dietary requirements.
4) Ask questions about ingredients and preparation methods.
5) Bring food you have already prepared from home.
6) Drink a lot of water.

You will feel better, have more energy, and return home refreshed and looking forward to the next trip.
Happy travels!

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