Artwork for podcast Inside Knowledge
Ep 25 - Help I've had a FODMAP reaction to Sorbitol!
Episode 257th November 2023 • Inside Knowledge • Anna Mapson
00:00:00 00:10:48

Share Episode

Shownotes

This episode is part of my FODMAP mini-series looking at how to handle a negative reaction to the FODMAP diet reintroduction phase. Listen to them all.

Listen to hear how to retest after a positive FODMAP reaction to a challenge. I also share HOW sorbitol will affect your gut.

Foods turn to moderate or high FODMAP for sorbitol at these levels:

  • Apricot – 25g    
  • Avocado - 45g 
  • Blackberries – 7g (1 berry)
  • Cabbage (white) – 100g
  • Peaches – 30g       
  • Sweetcorn – 63g

If one of the high Sorbitol foods has affected you, you can retest this FODMAP with a different food.

For help managing your IBS diet, including the low FODMAP diet, join the 3 month Gut Reset.

Links

Transcripts

Speaker:

Why is it so hard to find

your IBS food triggers?

2

:

Even when you've eliminated FODMAPs

and identified a trigger during

3

:

the reintroduction phase, it can

be difficult to work out what

4

:

that means for day to day life.

5

:

Can you ever eat that food again?

6

:

That's exactly what I'll cover in

this episode of The Inside Knowledge.

7

:

This episode is part of a mini series

where I cover each of the FODMAPs in turn,

8

:

so you can either listen to them all, or

just the one that's most suited to you.

9

:

You'll learn in each episode what

foods fall into each FODMAP category,

10

:

how to tackle the rest of that

category once a food reaction has

11

:

been identified, and when should you

retest, and how to proceed day to day.

12

:

Welcome to episode 25.

13

:

Today I'm talking about sorbitol.

14

:

It's one of the FODMAP categories

and it's one I find people

15

:

tend to not expect to react to.

16

:

So what is a high sorbitol food?

17

:

Well, it includes things like

Apricots, avocados, blackberries,

18

:

white cabbage, peach and sweet corn.

19

:

And you'll also find it

as an additive in foods.

20

:

It's sometimes called E 420 and it's

in things like packaged cakes, cough

21

:

syrups, sometimes sweets and chocolates.

22

:

So it adds a little bit of

water to the food product.

23

:

So that is why they tend to

add it to processed foods.

24

:

I'm going to talk a little bit about how

sorbitol could affect your digestion,

25

:

then I'll go into some specifics on

those foods that I mentioned with the

26

:

exact amounts that increases them to a

moderate FODMAP or a high FODMAP, and

27

:

then we'll talk about how to reintroduce

the foods or how you can go about

28

:

adjusting to a high sorbitol reaction.

29

:

This is the first episode, I'm just

going to very quickly recap on the FODMAP

30

:

reintroduction process which is Once

you've been a low FODMAP diet for a couple

31

:

of weeks, you've found a good baseline,

your digestion has normalized, then you

32

:

try to do this challenge by reintroducing

each of the FODMAP categories.

33

:

And if you don't know what I mean by

FODMAPs, go back and listen to episodes

34

:

17 and 18 where I start from the

beginning with an explanation of the diet.

35

:

I'm assuming that you guys listening now

are fully up to date with what FODMAP Diet

36

:

is and the reintroduction process is where

we do very careful challenge to test your

37

:

tolerance to certain foods If when you

did your sorbitol rechallenge exercise

38

:

you chose Avocados and you reacted to them

then maybe you can try another sorbitol

39

:

food So what I suggest with my clients

is if one of the high sorbitol foods has

40

:

affected you You should wait till you

recover feel better and then retest with

41

:

a different food from that category.

42

:

So you can either choose to retest another

sorbitol food, or you can come back to

43

:

it at the end of your challenge process.

44

:

For example, you may have tested with

avocado, but actually blackberries

45

:

would be okay, and it's something

in the avocado that is the problem.

46

:

So for example, avocados have the

potential to raise histamine levels

47

:

in the gut which can, for some people,

cause pain or bloating or diarrhea.

48

:

The other thing you might

test with is cabbage.

49

:

That is a gas producer in some people,

so white cabbage, and maybe that was

50

:

the reason that you reacted not to

the sorbitol content of the food.

51

:

Sorbitol is one of the sorbitol

and mannitol and they work

52

:

in a very very similar way.

53

:

It's a naturally occurring sugar

alcohol in foods and it's even used

54

:

as a laxative in high doses which

is around 20 grams per portion.

55

:

So this gives you an

indication of what it can do.

56

:

It can draw water into the gut and as

it moves slowly through the intestine,

57

:

it osmotically draws water in.

58

:

So The longer it's there,

the more it draws water in.

59

:

It can cause a higher stool volume,

so like, cause you to want to go more.

60

:

Diarrhoea, obviously because you've

got more water in your intestines.

61

:

And also some bloating and gas.

62

:

When we eat foods with glucose in them,

glucose is normally absorbed in the...

63

:

upper part of our small intestine,

and polyols are normally only partly

64

:

absorbed, and then they are found

throughout the small intestine, so

65

:

it's normal to not digest all of

the polyol content of your food.

66

:

The non absorbed portion passes

to the large intestine where it

67

:

is fermented by our gut bacteria

into short chain fatty acids.

68

:

So you might have heard me

talk about these before.

69

:

They are really anti inflammatory,

beneficial molecules that are byproducts

70

:

of our gut bacteria fermenting food that

we eat, and it creates a bit of gas as

71

:

a by product as well, but also these

really beneficial short chain fatty acids.

72

:

So I don't want you to

think this is a bad process.

73

:

Some people will find they get an

increase in hydrogen gas production,

74

:

and that does depend a little bit

on the types of bacteria that are

75

:

I looked at one study where in healthy

volunteers, people had an increase

76

:

in hydrogen gas production after

only taking as little as 5 grams of

77

:

sorbitol, and this is people who didn't

have IBS, but when they had 10 grams

78

:

of sorbitol in one meal, they had

gastrointestinal distress, so gas and

79

:

bloating, and then it got quite severe.

80

:

They got to 20 grams and that is the level

that is sometimes used as a laxative.

81

:

The reason why you might be very

sensitive to this process of additional

82

:

water coming in to the gut and

additional gas is the hypersensitivity.

83

:

So something that's really common in

people who have IBS is this excessive

84

:

sensitivity to pressure in the gut.

85

:

So every time it stretches and pulls

or you get a little bit of gas moving

86

:

through you, that's really uncomfortable.

87

:

Your pain receptors may be a lot

more sensitive than somebody else

88

:

who doesn't have IBS and it's

down to that gut brain connection.

89

:

So your nervous system in your gut is

on high alert and is sending significant

90

:

pain messages back to your gut.

91

:

I don't mean that it's not real pain,

it's just that you're receiving a lot

92

:

more pain messages for the same passage

of food that somebody else might have

93

:

that doesn't really cause them pain

and that is a hallmark of having IBS.

94

:

To give you a bit of a comparison

with those metrics that I mentioned

95

:

in the study, so that from 10 grams of

sorbitol they started getting symptoms.

96

:

If we look at the FODMAP ratio of

sorbitol foods, it's actually only 0.

97

:

2 grams of sorbitol per portion or like

per meal that makes something high FODMAP.

98

:

So what does this mean?

99

:

What does it look like?

100

:

Well, 80 grams of avocado has 0.

101

:

52 of sorbitol.

102

:

Now I'm saying all these numbers,

of course You'll have heard me

103

:

say before that there is regional

differences, seasonal differences,

104

:

with this FODMAP content of food.

105

:

So you can try and be as

specific as you like with 0.

106

:

52 of a gram, but actually there

is a little bit of leeway in this.

107

:

So there's a bit of give and take,

but just to give you an example,

108

:

the levels that people were getting

Gastrointestinal distress, it was called,

109

:

so bloating and gas, was at 5 grams.

110

:

Now this is only one

tenth of that level, 0.

111

:

52 of sorbitol in 80 grams of an avocado.

112

:

Not very much sorbitol.

113

:

However, in people who have IBS,

it can cause a reaction, and that's

114

:

why they've made that level of 0.

115

:

2g sorbitol the cutoff for

a FODMAP moderate portion.

116

:

In comparison, apples, like 100

grams of a pink lady apple, has 0.

117

:

75 grams of sorbitol.

118

:

So, more.

119

:

sorbitol content than an avocado.

120

:

And remember, apples will also

have a high fructose content, which

121

:

is why they are very high FODMAP.

122

:

So, I just wanted to put that into

proportion that there is a tiny amount

123

:

of sorbitol, but for some people

who have IBS, that tiny amount is

124

:

enough to trigger off your symptoms.

125

:

And that is why we need to know how much.

126

:

of a portion of food is

considered high and low FODMAP.

127

:

I'll just run down the numbers, you

can write these down or come back to

128

:

it if you want to, because it's quite

hard to find these numbers laid out.

129

:

So this is all taken off the Monash

University FODMAP app, and it's November

130

:

2023, so they do sometimes update their

numbers, so it's correct as of now.

131

:

These foods turn to high or moderate

FODMAP at the following levels, so

132

:

apricot is only 25 grams, avocado,

45 grams, blackberries, just 7 grams,

133

:

that's one berry, cabbage, white cabbage,

that's like the hard cabbage, is 100

134

:

grams, so a lot more cabbage for your

sorbitol content than one blackberry, and

135

:

peaches, 30 grams, sweet corn, 63 grams.

136

:

So, That's just a little rundown

of some of the most common foods.

137

:

And if you eat more than that, like

if you have two blackberries, for

138

:

example, that would be considered

then moderate to high FODMAPs.

139

:

So if you stay at the levels

that I mentioned, you will be

140

:

staying at a low FODMAP level.

141

:

Now the final thing to be

aware of is FODMAP stacking.

142

:

So if you tend to eat a couple of

different fruits and vegetables in the

143

:

same meal, you may find that you're

having more sorbitol than you think.

144

:

For example, if you have, um, some

avocado, a quarter of an avocado,

145

:

followed by half a peach, that

could lead to a higher sorbitol meal

146

:

without you realizing, because you've

had two low to moderate portions of

147

:

sorbitol foods in one meal and then

added together, it becomes higher.

148

:

Remember with FODMAPS you can move

on to another meal later in the day

149

:

and you can still have a bit more

sorbitol later on and it won't add up.

150

:

Ideally you want to just

do it by meal, not by day.

151

:

So just to finish up, if you had a

problem with sorbitol, there is no need

152

:

to stay away from these foods forever.

153

:

What you do is you remember the

foods that I've mentioned, you stay

154

:

at low levels of sorbitol for those.

155

:

If you have a smaller...

156

:

Portion than the amounts I mentioned

you should be fine and you should

157

:

always try to include small portions of

Low FODMAP foods just to get a bit of

158

:

diversity Now what you can do is to try

to eat them maybe On alternate days.

159

:

So instead of like the challenge

you're doing three consecutive days

160

:

with increasing amounts Maybe you're

okay with just one day a week.

161

:

Maybe you're okay In a couple of

months time and that is why I suggest

162

:

trying another sorbital challenge

in around six months because your

163

:

tolerance can change over time.

164

:

Listen in to the rest of this

little mini series about FODMAP

165

:

reintroductions and what to do if

you've reacted to a FODMAP group.

Links

Chapters

Video

More from YouTube