My love of apples left me feeling rotten to the core
Sixty per cent of us can’t properly digest the sugar in fruit — and it can leave some, like this writer, in misery for YEARS . . .
Long before experts began parroting about getting ‘five a day’, an equally insidious mantra entered my head: ‘An apple a day keeps the doctor away.’ As a child, I followed this religiously — easy to do when growing up in Kent’s fruit-growing belt, where I spent summer holidays picking apples. I liked the taste of them and, on the farm, they were free.
How was I to know I was condemning myself to years of misery?
When I think back to my youth, one thing above all sticks in my memory: the bloating. While to everyone else, I looked thin, they weren’t seeing what I saw. I looked down at my expanded belly and felt enormous. How could I eat more when I felt stuffed to the gunwales?
When I was 14, my mother took me to a doctor, who got me to lie on a couch, squeezed around my midriff and decided that I didn’t have a blockage in my bowels. ‘Just a bit of colic,’ he suggested.
That ‘bit of colic’ stayed with me for years, until, in my 20s, I finally asked: ‘Why is it I feel worst after eating an apple?’ I had been having them nearly every day, and noticed on days I didn’t, there were no symptoms. Applying the logic, I gave them up and immediately felt less bloated. But things didn’t clear up completely.
Sometimes, I could eat all kinds of food without ill-effect; other times, it felt like my guts had turned into a microbrewery — one huge hissing, fermenting mass. At these times, I often felt a strange sense of gloom for several hours.
Always a bit of a hypochondriac, I developed an encyclopaedic knowledge of illnesses such as bowel cancer and coeliac disease.
Yet they all seemed to have serious symptoms I didn’t have: I never felt ill, just full of wind. I thought maybe I was eating too quickly, so avoided curry and gassy beers. I wondered about oranges, as they often had a slight laxative effect. But then, I didn’t have the same problem with grapefruit, which I thought of as pretty much the same fruit, only a bit less sweet.
It wasn’t until 18 months ago, aged 48, when I woke up in the night belching after a dinner of pasta and tomato sauce that I decided I must solve the problem once and for all.
After yet another trawl on the internet through the usual inflammatory bowel diseases I always found, on an American website there was a condition that even I, as a seasoned hypochondriac, had never come across: malabsorption of fructose.
What caught my eye was its association with apples. But it wasn’t just apples. fructose is a natural sugar that occurs in most fruit and vegetables.
The body will try to absorb the sugar in the small intestine — but while some people are capable of doing this, many others struggle.
U.S. studies show 50 per cent of the population is unable to absorb 25g of pure fructose in one go — the sort of quantity you would find in a couple of apples.
Meanwhile, 80 per cent are unable to absorb 50g. Any fructose not absorbed in the small intestine passes into the large intestine where it ferments, producing gas.
‘ fructose is poorly absorbed by most of us,’ says Peter Whorwell, a professor of medicine and gastroenterology at the University of Manchester. ‘Despite this, a lot of people can eat fruit without any problem — but if you have a particularly oversensitive gut, it will result in a lot of gurgling.’ This is due to wind moving in the gut.
The good news is that fructose is more easily absorbed when eaten with glucose. Peaches and grapes have a balance of 50 per cent fructose and 50 per cent glucose, and I can happily eat these. But others, such as melon and pineapple, like apples, contain more fructose than glucose and so cause me problems.
After finding a list of foods that contain more fructose than glucose, I decided to go a week without eating them. This included pears, mangoes, fruit juices, dried fruits — which have very high levels of fructose by weight — and honey. Some foods and sugary drinks use fructosebased sweeteners, but since I ate few processed foods anyway, I didn’t have to worry about these.
Sad though I was to give up various foods, including a 30-year currant bun habit, the change was remarkable. Currants might be tiny, but the sugars in them are very concentrated. Within 48 hours, I felt, for the first time in my adult life, that the bloating had gone entirely.
My stomach was flatter than I could ever remember it. I kept expecting to suffer from wind at any minute, but didn’t. gone, too, was the sense of gloom that had accompanied my bloating.
for a condition I had never heard of, malabsorption of fructose is very common.
‘About 60 per cent of people have been shown to have a problem absorbing fructose, but not all will suffer symptoms,’ says Dr Ayesha Akbar of the British Society of gastroenterology.
I also discovered why I felt so gloomy. Malabsorption of fructose can induce a low mood as it interferes with the body’s production of serotonin, a chemical that induces a sense of wellbeing.
‘Serotonin is produced from an essential amino acid called tryptophan,’ says Dr Akbar. ‘Too much fructose in the gut prevents the take-up of tryptophan by the body, and makes less serotonin as a result.’
A week later, I ate an orange as an experiment — with the same effect as before. I had some peas, and the wind returned.
Armed with knowledge of the fructose and glucose content of food from foodintolerances.org, I made a list of three groups of foods: those I could eat with impunity, those to eat only in small amounts and those to avoid.
In the latter group are apples. Their fructose to glucose ratio is higher than any other food commonly eaten in Britain — topped only by mango, also banned, along with orange juice and melon.
I can, however, eat small quantities of apple cooked with sugar, as it reduces the ratio.
now I see why I can eat grapefruit without any problem, but not oranges: the former has a better fructose to glucose ratio. Bananas are oK, but not every day.
Tomato juice has a higher fructose to glucose ratio. This explains why pasta sauce, with concentrated tomato juice, left me in agony. I can, however, eat the odd fresh tomato.
Some veg, too, can cause problems as they have high levels of fructans — sugars with a slightly different structure to fructose, but which have the same effect. Leeks, one of my favourites, I eat only in moderate quantities.
Ditto peas, green beans and cabbage. But I eat masses of salad with no problem, so I am not going to go short of vitamins.
So, where does this leave all the dogmatic advice telling us to eat more fruit and veg? ‘This is the issue with one-size-fits-all health advice — everyone’s guts are different,’ says Professor Whorwell.
‘for some people, eating five fruit and vegetables a day is a good thing; but for others, three a day might be better. I have seen people who are eating five a day and suffering, so they then start eating seven a day, thinking that will make them feel better — and it just makes the problem worse.
‘It’s a question of trial and error to see what affects you. If you have an uncomfortable tummy, it’s very important to have it checked out. But if nothing serious has been found, then it’s worth asking whether the problem is too many fruit and vegetables.’
It is sad that I will never bite into a Cox’s orange Pippin ever again. And before english Apples & Pears (the trade association to promote english growers) writes in to complain, there are, of course, millions of people who can enjoy apples without ill effects.
But I do wish I had discovered long ago what was causing my belly to swell up like a Zeppelin.