Can you eat sugary foods if you have IBS? And if so which types of sugars are ok? What about artificial sweeteners? This episode is all about sweet foods and how they affect your digestion.

• low FODMAP sugars and which ones to focus on if you’re following the low FODMAP diet
• how sugars are digested, and why certain types of sugars are harder for the body to handle than others.
• are artificial sweeteners ok for people with IBS?

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Can you eat sugary

foods if you've got IBS?

2

And if so, which type of sugars are okay?

3

And what about artificial sweetness?

4

This episode is all about sweet foods

and how they affect your digestion.

5

I'll talk about low FODMAP sugars and

which ones to focus on if you're following

6

the restrictive phase of the diet.

7

You'll also learn about how sugars

are digested and why certain

8

types of sugars are harder for

our body to handle than others.

9

So if you hate the thought of

giving up sweet foods, this episode

10

could help you manage your symptoms

without feeling too restricted.

11

Welcome to episode 83 of the

Inside Knowledge podcast.

12

I'm Anna Ma pson This week I'm talking

about sweet foods and sugar because a lot

13

of my clients have been told they need

to cut out all sugary foods if they want

14

to get control of their IBS symptoms.

15

Now whilst eating healthily and obviously

managing our sugar intake is important,

16

you might be pleased to hear that you

don't need to eat omit all sugars.

17

And you don't need to avoid

all sweet tasting foods.

18

I'm gonna go into a little bit about

the differences between the types

19

of sugars some which are more easily

digested than others, and then we can

20

talk about how to make it work for

you, like in a normal sort of diet.

21

Give you some tips on how to.

22

Eat those kind of foods without

overwhelming your digestion.

23

First off, in this episode, I'm

going to talk about the FODMAP diet.

24

And if you don't know already, FODMAPs

are groups of short chain carbohydrates

25

and sugar alcohols that aren't well

digested in our small intestine.

26

And in some people who have IBS, can

lead to symptoms like bloating, gas,

27

additional stomach pain, diarrhea.

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You can hear more about the low FODMAP

diet in episodes 17 and 18 if you

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want to understand more about those.

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But the key thing to note for today's

purpose is that these type of foods

31

are highly fermentable in our gut,

which can add to the bloating and the

32

gas, and also, they can draw water in.

33

So these are the types of symptoms that

you can get from some high FODMAP foods.

34

And when I'm talking about the restriction

phase of the FODMAP diet, we're really

35

only talking about a period of two to

six weeks when you're following this diet

36

to cut out all the high FODMAP foods.

37

It's not a diet that you should

be following long term, and I do

38

keep trying to stress that because

some people are on it for years.

39

Many of my clients have been

low FODMAP and avoiding all of

40

these foods for multiple years.

41

And what we want to try and do is to

reintroduce them and I hope that what

42

you get from this podcast It's one of

my main messages is that eating a more

43

varied diet Eating more different types

of fibre is in the long run much better

44

for your gut health than cutting out

all of these foods So this is where

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I want to try and encourage people to

eat more variety and more foods now

46

with sugar You Obviously, we don't

want to have a very high sugar diet.

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It's not great for our body, and

it's not great for all kinds of

48

things to have a lot of sugar.

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But, the nuance is that you don't

have to eliminate all of it, and you

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don't have to stay on this low FODMAP

diet, cutting out many fermentable

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carbohydrates, in order to control sugar.

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your symptoms.

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If we go back to a little recap on how

digestion works, obviously in your mouth

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you chew up the food, you mash it up, then

it goes to your stomach where there is the

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start of the chemical digestion process.

56

as well as more mashing up.

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So your stomach is a bag of muscle

which will also contract and squeeze

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the food together to mash it, but

you're also getting your first,

59

tranche of chemical digestion.

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So you're getting the stomach acid,

breaking foods down, then the food

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slowly moves into your small intestine

where your digestive enzymes start

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to break down the carbohydrates.

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To get the sugars absorbed,

we have to break them down

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to their smallest molecule.

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Some sugars are two chemical

molecules put together.

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For example, table sugar, which you

think of as just sugar, is actually

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a combination of fructose and

glucose, and they're in equal parts.

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Sugar is 50 50 fructose and glucose.

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These two I'm going to talk a little

bit about today, and how they get

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digested because that has got an impact

on how you might choose to eat them.

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So table sugar is the most common

sugar that you think about.

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That is actually low FODMAP.

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Obviously, you don't want to have a huge

amount of sugars in your diet, but you

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can eat normal table sugar on the low

FODMAP diet, but high FODMAP foods are not

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the only trigger for IBS type symptoms.

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We also have people who are

very sensitive to fat digestion,

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and that could be down to the.

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Digestive enzymes that are breaking

your food down, could be down to

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your bile flow, could be down to

a whole range of other things.

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People can be very sensitive to fats,

you might also have an excess growth

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of bacteria in your small or large

intestine that are really interfering

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with your normal digestive motility,

the way you're breaking your food

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down, like all kinds of things.

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So the FODMAP, Sensitivity is not the

only reason why you might have IBS and

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there is also the non digestive causes

of IBS like medication you might be

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taking, your stress and emotional health.

87

These things also play a really

big role in how we digest our

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food and how we feel in our gut.

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Now going back to the fructose and glucose

thing, I wanted to just talk a little

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bit about about how glucose and fructose

are digested, because this helps to set

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the scene for the rest of the sweeteners

and foods I'm going to talk about.

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So they're both naturally

occurring in fruits and vegetables,

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as well as processed foods.

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The key thing is though that fructose

is only well digested when it is

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met in equal quantities to glucose.

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If you have a meal or a food That is

higher in fructose than it is in glucose,

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then some of the fructose doesn't get well

digested and sits in the small intestine.

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This is because glucose helps fructose

to get into your cells and then it can

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be utilized and metabolized by your body.

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There's a little transporter mechanism

in your cell that kind of pulls the

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sugars in and glucose, you can imagine

it like it holds the hand of fructose

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and pulls it into the cell, makes it

accessible to be used as an energy

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source and as a nutrient in your body.

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Now, when We have got a lot of

fructose and not very much glucose.

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Then, not all the fructose can be pulled

across by the glucose, which means

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that there's excess fructose that's

undigested in your small intestine.

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When you get that, it can draw

water in osmotically, so it pulls

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water from your surrounding tissues.

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into the small intestine

That can lead to bloating.

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It can also be fermented by bacteria

The unabsorbed fructose is there and

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if you've got a lot of bacteria there,

they can really get to work on it And

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the bacteria, when they're eating, or

you can imagine them like, consuming

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the fructose molecules, they then

cause gas bubbles by their metabolism.

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So, that is the way that excess fructose

can interfere with Your digestion.

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By adding excess water, like drawing it

in making you feel bloated and sometimes

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causing diarrhoea and also the excess

gas so that again bloating but sometimes

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pain as well as you're getting big gas

bubbles moving through your system.

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Now if you're constipated that

will be much worse because the gas

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bubbles and the buildup is stuck

and you've got a slow moving transit

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time which means that gas is going

to be sitting there for much longer.

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There are three common sweeteners,

or sugar types, that are higher

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in fructose than glucose.

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And for this reason, they don't meet

the low FODMAP criteria and tend to

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be worse for getting some of those

symptoms that I've just described.

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The first one is honey, which many

people think is healthier than sugar

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because it's available in nature,

honey should be better for me.

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However, honey is higher in fructose

than glucose, and so If you have

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more than about one teaspoon during

your restrictive phase, you'll be

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going into a higher FODMAP meal.

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One tablespoon per sitting

is considered high FODMAP.

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So if you have a tiny amount

of it, that should be okay.

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And that's probably because you're

eating it with other things.

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So switching from honey to normal

sugar, is actually better for you if

134

you're following the low FODMAP diet.

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Now the other thing you probably

think about when you think fructose

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is high fructose corn syrup.

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Processed foods like often

fizzy drinks and sweets.

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They often have high fructose corn syrup

in . Now what is quite interesting though,

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is that high fructose corn syrup is

not very far off chemically from sugar.

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So remember I said table sugar,

is 50 50 glucose and fructose,

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where actually high fructose corn

syrup is somewhere like 57% percent

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fructose and only 43 percent glucose.

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So it's a slight difference,

but not massively.

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Depending on the percentage of high

fructose corn syrup in your product, you

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may or may not find That this is an issue.

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I would say, typically, when you're

trying to identify your triggers, if

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you don't know whether fructose is a

problem for you or not, it is best to

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remove foods that contain high fructose

corn syrup, particularly if it means

149

that then you're cutting out things like

fizzy drinks, sweets, and, you know,

150

processed, baked goods, for example.

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A common sweetener that is often used in

sugar free products would be agave syrup.

152

Now this is very high in fructose and

does not meet the low FODMAP guidelines.

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So if you're someone who doesn't have

your triggers identified, then you might

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be want to be careful about agave syrup.

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You can have a very small

amount, I think five grams per

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meal is considered low FODMAP.

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But it's sometimes found in sugar free

drinks and foods So it's often used as

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a syrup in a cocktail for example,

because it's already a liquid sugar

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And so you may find that these liquid

sugars are more quickly absorbed,

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because it's in a liquid as well.

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It's not sitting in your stomach for two

hours, it'll go through you much quicker.

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Therefore, it'll be hitting your

small intestine a bit quicker.

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The high fructose, remember, doesn't

get absorbed as well, so that could

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lead to more problems for your IBS.

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Sweeteners that do work much better

on the other hand include maple syrup.

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Maple syrup is actually low FODMAP.

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So having that as an alternative to honey

or agave syrup is a really good swap.

168

It sometimes is a little bit

more expensive to be fair.

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when you look for it, Make sure that

it is actually proper maple syrup

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rather than maple syrup, flavored

syrup, because sometimes it is

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actually purely high fructose corn

syrup with maple syrup flavoring.

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So make sure that it's actual

maple syrup that you are buying.

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And I have tasted one of those

fake maple syrups before, and

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it's really not very nice.

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It's not the same at all.

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. I also mentioned sugar, like table

sugar or sometimes called sucrose.

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So that is, as we've discussed, like

it's okay on the low FODMAP diet.

178

Now some people with IBS will still have

a problem digesting glucose or sucrose.

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You can have a problem with the enzymes

that break down sucrose, the table

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sugar, from sucrose into its individual

molecules, which is fructose and glucose.

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So some people will have a problem with

this digestive enzyme and may still be

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sensitive to sugar even though sugar,

sucrose itself, is considered low FODMAP.

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This is what I meant by the fact that high

FODMAP foods are not the only trigger.

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Some people can still be sensitive

to table sugar, even though

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it's considered low FODMAP.

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The reason that you can get an issue with

digesting sugar is because is that you

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can either have damage to the mucosal

lining of your gut, so that's like a

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kind of layer of mucus that surrounds

your intestines and helps to protect it.

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That's where some of the digestive

enzymes sit, your brush border enzymes,

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where they help you do that digestion

process, breaking the sugars down.

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If you've got some damage to it,

and it could be through, surgery,

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maybe you have got some patches of

inflammation, perhaps you have got

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some bacteria which are upsetting the

mucosa in the small or large intestine.

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These can also play a part

in stopping digestion being

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as effective as it should be.

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So perhaps there could be an

imbalance in your sugar digestion

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because you've got some overgrowth

of bacteria, for example, like SIBO.

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that can interfere with

your digestive enzymes.

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There is also something called congenital

sucrose isomaltase deficiency, which

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is a genetic condition where people

just don't have the enzyme to break

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down sucrose, or isomaltase, and

maltase is another enzyme that helps

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to break down maltose, another one of

the kind of carbohydrate components.

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That is quite rare, but variations of

the genetic mutation are also possible.

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It's thought that these are more

common as well in people who have

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IBS than in the general population.

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And that makes sense.

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You know, if you've got uncontrolled

IBS, it's possible that there are small

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things that like small differences in

the way that you break down certain

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sugars and although we've got the

low FODMAP diet which is really well

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tested and researched in terms of its

benefits, there are other things that

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could be causing your symptoms and

sucrose breakdown could be one of them.

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Another sweetener I want to

talk a little bit about, haven't

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mentioned yet so far, is Stevia.

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Stevia is a natural sweetener

that is derived from a plant.

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It's calorie free, it doesn't contain

any FODMAPs, which means it's good

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for a lot of people who have IBS.

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It could be, a good low FODMAP sweetener

for some people who are managing IBS.

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It's It does have a slight aftertaste

from it, and I don't really like it.

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However, some people don't notice

that and feel okay drinking it.

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If you find stevia in certain products,

like I know that there's like a Coke

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that is sweetened with stevia, for

example, and it's like a natural Coke,

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What you'll find is that that product

has got a lot of other things in it

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that aren't as easy to digest, perhaps.

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They're also maybe still fizzy.

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So there are other things that might

also set off your digestion that's

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not necessarily down to the stevia.

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But you can use it in baking, it comes

in a kind of powder form, and it's

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often in some products as a sweetener.

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Generally, if you don't mind the

taste of it, it's well tolerated.

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Then we've also got the artificial

sweeteners or non nutritive sweeteners

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as they're sometimes called just because

there's literally no nutrition in them.

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They're just sweeteners.

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So things like aspartame, these

are in a lot of sugar free products.

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It's really hard nowadays, because of the

sugar tax, to actually find things like

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squash and, fizzy drinks like lemonades.

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that actually are just purely sugar.

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Most of them have had half the

sugar removed and they've also got

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these non nutritive sweeteners in.

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Now there is some concern about the

long term health impacts of artificial

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sweeteners on our gut microbiome, but

I would really stress here that these

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studies are nearly always done on rats

and animals and they are using more than

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a hundred times the safe level for humans

that they show a potential increased risk.

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And what they show is like a

potential disruption to your gut

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microbiome or irritation, but that

is a hundred times the amount that is

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classed as safe for humans to drink.

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If you're just having one soda per

day, or every now and again, that is

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probably not going to be giving you

significant long term health effects.

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However, if you are drinking

five litres of fizzy Drink a day.

249

I would say that's something that you

need to work on anyway and try to move

250

to drinking more water And other liquids

that are more beneficial to your health.

251

So it's all about proportion How much

of this are you having in proportion to

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the rest of your healthy balanced diet?

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If your diet is only made up

of foods containing a lot of

254

artificial sweeteners Then you

probably need a bigger shift anyway.

255

These are only in, obviously,

processed, produced foods.

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They're not in whole foods that

we want to try and encourage

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everyone to eat more of anyway.

258

So that's why having a can of Coke

every now and again is not going to

259

be the end of your gut microbiome.

260

It's not going to be . a massive problem.

261

If you're having five a day, then

I would say that is a problem

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maybe for other reasons anyway.

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Other sweeteners I wanted to just

mention, so sucralose, which is often

264

used as an artificial sweetener.

265

It's in products like

Splenda, for example.

266

There is again some concern over

sucralose affecting your gut

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microbiome and gut motility.

268

But again, there isn't much strong

evidence in humans that this is

269

the effect that you might get.

270

Most of the sucralose is

excreted, it doesn't get into

271

our cells, it just comes out.

272

And I think the best thing to do would be,

if you're worried about these artificial

273

sweeteners, is take them out, get to a

good place with your diet, and then trial

274

putting them back in again, if you don't

want to have sugar in your coffee, for

275

example, and you use little sweeteners.

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The recommended daily intake limit for

things like sucralose is 15 milligrams for

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every kilo of body weight that you have

per day, which is actually quite a lot.

278

And again, if you're having lots and lots

of artificial sweetness in your food,

279

then you might want to think about, you

know, where is all this coming from?

280

How can you switch your diet to be

eating more of a whole food based diet.

281

Sucralose is considered low

FODMAP though, so in terms of

282

meeting the FODMAP diet it's okay.

283

The same is with saccharin, another

artificial sweetener that's found in

284

diet drinks and sugar free products.

285

It seems to be safe if you've got IBS,

but again it's probably worth testing

286

your individual tolerance to some of

these things and not just assuming that

287

just because it's low FODMAP that you're

not going to have a reaction to it.

288

The thing with sucralose and

saccharin is that they're not

289

getting digested in the same way

that glucose based sweeteners are.

290

So they're not going through that

process that I mentioned of sitting

291

in the gut, drawing in water and

being fermented because they're not

292

getting broken down to fructose and

glucose and other FODMAP type sugars.

293

But they are sweetening the taste

in your mouth, and then they're just

294

kind of moving through your body.

295

Another reason for having the non

nutritive sweeteners, so things like

296

aspartame, sucralose, is that they don't

raise your blood . glucose levels like

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your blood sugars so if that's something

you're worried about like maybe you have

298

diabetes or pre diabetic and you need to

stay on top of your blood sugars, then

299

using those kind of artificial sweeteners

instead of glucose based sugars is going

300

to be helpful in terms of managing your

301

overall exposure to glucose in the diet.

302

The other type of sweeteners that you

will need to be careful of if you're

303

on the low FODMAP diet are things that

are advertised on sugar free sweets.

304

Like, for example, sugar free mints quite

often have things like xylitol in them.

305

You might get spreads like,

chocolate spread that's based

306

on mannitol, for example.

307

So I'm talking about the polyols.

308

These are sorbitol, mannitol, xylitol.

309

These are known to draw the water into

your gut and are considered high FODMAP.

310

So look out for those when you're

looking at ingredient listings.

311

The other thing that is sometimes put

in as a sweetener, which will be on

312

low BMI, Sugar or sugar free products,

particularly things like granola or cereal

313

bars will be inulin or chicory root.

314

This is a fibre that is very sweet,

but it is very high in FODMAP.

315

So for some people when they're

choosing a sugar free product will

316

actually unknowingly be really

increasing the FODMAP content and

317

causing themselves digestive issues.

318

Not everyone, but a

lot of people with IBS.

319

Could be sensitive to inulin

when it is in high amounts.

320

When you're reading the ingredient

listings, it's good to look

321

at where the ingredient sits.

322

The higher up it is in the ingredient

listing, the more percentage of the

323

product that you're I guess my main

message from this episode would be

324

you can have foods that contain sweet

things but if you're making choices

325

about which sweeteners to use because

you want to try and minimise the impact

326

on your symptoms Then generally normal

table sugar is the easiest and maple

327

syrup is another good liquid sweetener.

328

But try to avoid things like honey and

agave syrup on the low FODMAP diet Then

329

in terms of other processed foods, like

if you're someone who loves sweets or

330

chocolates fizzy drinks Just try to

reduce your Intake of those into a small

331

amount per day and think about how that

fits in your overall diet Where does

332

it sit in terms of proportion of foods

that are whole foods, home cooked foods

333

that you've made yourself compared to

foods that are They come in a little

334

wrapper and are purely created for the

pleasure of eating, rather than they're

335

going to give you some nutrient value.

336

Okay, please send me some

questions that you'd like me to

337

investigate and understand more

about in relation to your IBS.

338

I've got a couple of ideas for

339

love to hear from you if you've got

questions you want me to explore, but

340

I'll leave it there for this week.

341

Thanks very much for listening to

this episode of the Inside Knowledge.

342

Better digestion for everyone.