Four foods which can cause bloating and abdominal pain

Bloating and abdominal pain after eating?  Think back over your diet for the last few days. Do you frequently eat any of these foods?
– apples (including apple juice)
– pears (including pear juice)
– high fructose corn syrup
– agave nectar

bloating from fructose
Too much free fructose?

Many people suspect that bloating and pain might be caused by an unidentified food sensitivity.  But they may actually have trouble digesting certain carbohydrates, not a sensitivity to particular foods. Slow absorption of fructose, in particular, is quite common.  Although we may call it “fructose malabsorption,” it is not truly a disorder, just part of the range of normal human digestion.  Some people simply have fewer transport molecules in their intestine to pull fructose through their intestinal lining, or have transporters which act more slowly. In this situation, a person can develop discomfort after eating foods which have high “free” fructose, meaning that the fructose molecules outnumber the glucose molecules in the same food.  Fructose molecules are then left lingering in the intestine, where normal intestinal bacteria digest them, producing gas and other substances which can cause bloating and discomfort.  (This is not the same as hereditary fructose intolerance, which is a dangerous condition, present from birth, which leads to seizures and developmental delay.)

In the American diet, the foods highest in free fructose are apples, pears, high fructose corn syrup, and agave nectar. This doesn’t mean that people with fructose malabsorption can’t ever eat these foods.  After all, apples and pears are a normal part of a healthy diet, and agave nectar leads to less blood sugar increase then many other sweeteners.  But for people who absorb fructose slowly, smaller quantities or less frequent use may be better.  Even high- fructose corn syrup, although not an ingredient I generally recommend, shouldn’t cause problems in small quantities.

Do you have questions about nutrition and digestive symptoms in children and teenagers?  Rebecca Cherry, MD, MPH, is a specialist in Pediatric Gastroenterology and Nutrition. She is in private practice in San Diego, at Pediatric Specialty Partners.  You can reach the office at 858-625-0809 or at