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

• Group Gut Reset - https://www.goodnessme-nutrition.com/group-course-ibsc/
• 1:1 Gut Reset - https://www.goodnessme-nutrition.com/consultations/

Why is it so hard to find

your IBS food triggers?

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Even when you've eliminated FODMAPs

and identified a trigger during

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the reintroduction phase, it can

be difficult to work out what

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that means for day to day life.

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Can you ever eat that food again?

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That's exactly what I'll cover in

this episode of The Inside Knowledge.

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This episode is part of a mini series

where I cover each of the FODMAPs in turn,

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so you can either listen to them all, or

just the one that's most suited to you.

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You'll learn in each episode what

foods fall into each FODMAP category,

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how to tackle the rest of that

category once a food reaction has

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been identified, and when should you

retest, and how to proceed day to day.

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Welcome to episode 25.

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Today I'm talking about sorbitol.

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It's one of the FODMAP categories

and it's one I find people

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tend to not expect to react to.

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So what is a high sorbitol food?

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Well, it includes things like

Apricots, avocados, blackberries,

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white cabbage, peach and sweet corn.

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And you'll also find it

as an additive in foods.

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It's sometimes called E 420 and it's

in things like packaged cakes, cough

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syrups, sometimes sweets and chocolates.

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So it adds a little bit of

water to the food product.

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So that is why they tend to

add it to processed foods.

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I'm going to talk a little bit about how

sorbitol could affect your digestion,

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then I'll go into some specifics on

those foods that I mentioned with the

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exact amounts that increases them to a

moderate FODMAP or a high FODMAP, and

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then we'll talk about how to reintroduce

the foods or how you can go about

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adjusting to a high sorbitol reaction.

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This is the first episode, I'm just

going to very quickly recap on the FODMAP

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reintroduction process which is Once

you've been a low FODMAP diet for a couple

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of weeks, you've found a good baseline,

your digestion has normalized, then you

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try to do this challenge by reintroducing

each of the FODMAP categories.

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And if you don't know what I mean by

FODMAPs, go back and listen to episodes

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17 and 18 where I start from the

beginning with an explanation of the diet.

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I'm assuming that you guys listening now

are fully up to date with what FODMAP Diet

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is and the reintroduction process is where

we do very careful challenge to test your

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tolerance to certain foods If when you

did your sorbitol rechallenge exercise

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you chose Avocados and you reacted to them

then maybe you can try another sorbitol

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food So what I suggest with my clients

is if one of the high sorbitol foods has

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affected you You should wait till you

recover feel better and then retest with

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a different food from that category.

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So you can either choose to retest another

sorbitol food, or you can come back to

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it at the end of your challenge process.

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For example, you may have tested with

avocado, but actually blackberries

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would be okay, and it's something

in the avocado that is the problem.

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So for example, avocados have the

potential to raise histamine levels

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in the gut which can, for some people,

cause pain or bloating or diarrhea.

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The other thing you might

test with is cabbage.

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That is a gas producer in some people,

so white cabbage, and maybe that was

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the reason that you reacted not to

the sorbitol content of the food.

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Sorbitol is one of the sorbitol

and mannitol and they work

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in a very very similar way.

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It's a naturally occurring sugar

alcohol in foods and it's even used

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as a laxative in high doses which

is around 20 grams per portion.

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So this gives you an

indication of what it can do.

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It can draw water into the gut and as

it moves slowly through the intestine,

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it osmotically draws water in.

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So The longer it's there,

the more it draws water in.

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It can cause a higher stool volume,

so like, cause you to want to go more.

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Diarrhoea, obviously because you've

got more water in your intestines.

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And also some bloating and gas.

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When we eat foods with glucose in them,

glucose is normally absorbed in the...

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upper part of our small intestine,

and polyols are normally only partly

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absorbed, and then they are found

throughout the small intestine, so

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it's normal to not digest all of

the polyol content of your food.

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The non absorbed portion passes

to the large intestine where it

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is fermented by our gut bacteria

into short chain fatty acids.

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So you might have heard me

talk about these before.

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They are really anti inflammatory,

beneficial molecules that are byproducts

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of our gut bacteria fermenting food that

we eat, and it creates a bit of gas as

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a by product as well, but also these

really beneficial short chain fatty acids.

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So I don't want you to

think this is a bad process.

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Some people will find they get an

increase in hydrogen gas production,

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and that does depend a little bit

on the types of bacteria that are

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I looked at one study where in healthy

volunteers, people had an increase

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in hydrogen gas production after

only taking as little as 5 grams of

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sorbitol, and this is people who didn't

have IBS, but when they had 10 grams

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of sorbitol in one meal, they had

gastrointestinal distress, so gas and

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bloating, and then it got quite severe.

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They got to 20 grams and that is the level

that is sometimes used as a laxative.

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The reason why you might be very

sensitive to this process of additional

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water coming in to the gut and

additional gas is the hypersensitivity.

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So something that's really common in

people who have IBS is this excessive

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sensitivity to pressure in the gut.

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So every time it stretches and pulls

or you get a little bit of gas moving

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through you, that's really uncomfortable.

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Your pain receptors may be a lot

more sensitive than somebody else

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who doesn't have IBS and it's

down to that gut brain connection.

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So your nervous system in your gut is

on high alert and is sending significant

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pain messages back to your gut.

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

it's just that you're receiving a lot

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more pain messages for the same passage

of food that somebody else might have

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that doesn't really cause them pain

and that is a hallmark of having IBS.

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To give you a bit of a comparison

with those metrics that I mentioned

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in the study, so that from 10 grams of

sorbitol they started getting symptoms.

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If we look at the FODMAP ratio of

sorbitol foods, it's actually only 0.

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2 grams of sorbitol per portion or like

per meal that makes something high FODMAP.

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So what does this mean?

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What does it look like?

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Well, 80 grams of avocado has 0.

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52 of sorbitol.

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Now I'm saying all these numbers,

of course You'll have heard me

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say before that there is regional

differences, seasonal differences,

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with this FODMAP content of food.

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So you can try and be as

specific as you like with 0.

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52 of a gram, but actually there

is a little bit of leeway in this.

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So there's a bit of give and take,

but just to give you an example,

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the levels that people were getting

Gastrointestinal distress, it was called,

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so bloating and gas, was at 5 grams.

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Now this is only one

tenth of that level, 0.

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52 of sorbitol in 80 grams of an avocado.

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Not very much sorbitol.

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However, in people who have IBS,

it can cause a reaction, and that's

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why they've made that level of 0.

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2g sorbitol the cutoff for

a FODMAP moderate portion.

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In comparison, apples, like 100

grams of a pink lady apple, has 0.

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75 grams of sorbitol.

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So, more.

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sorbitol content than an avocado.

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And remember, apples will also

have a high fructose content, which

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is why they are very high FODMAP.

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So, I just wanted to put that into

proportion that there is a tiny amount

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of sorbitol, but for some people

who have IBS, that tiny amount is

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enough to trigger off your symptoms.

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And that is why we need to know how much.

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of a portion of food is

considered high and low FODMAP.

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I'll just run down the numbers, you

can write these down or come back to

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it if you want to, because it's quite

hard to find these numbers laid out.

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So this is all taken off the Monash

University FODMAP app, and it's November

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2023, so they do sometimes update their

numbers, so it's correct as of now.

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These foods turn to high or moderate

FODMAP at the following levels, so

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apricot is only 25 grams, avocado,

45 grams, blackberries, just 7 grams,

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that's one berry, cabbage, white cabbage,

that's like the hard cabbage, is 100

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grams, so a lot more cabbage for your

sorbitol content than one blackberry, and

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peaches, 30 grams, sweet corn, 63 grams.

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So, That's just a little rundown

of some of the most common foods.

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And if you eat more than that, like

if you have two blackberries, for

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example, that would be considered

then moderate to high FODMAPs.

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So if you stay at the levels

that I mentioned, you will be

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staying at a low FODMAP level.

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Now the final thing to be

aware of is FODMAP stacking.

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So if you tend to eat a couple of

different fruits and vegetables in the

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same meal, you may find that you're

having more sorbitol than you think.

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For example, if you have, um, some

avocado, a quarter of an avocado,

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followed by half a peach, that

could lead to a higher sorbitol meal

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without you realizing, because you've

had two low to moderate portions of

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sorbitol foods in one meal and then

added together, it becomes higher.

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Remember with FODMAPS you can move

on to another meal later in the day

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and you can still have a bit more

sorbitol later on and it won't add up.

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Ideally you want to just

do it by meal, not by day.

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So just to finish up, if you had a

problem with sorbitol, there is no need

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to stay away from these foods forever.

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What you do is you remember the

foods that I've mentioned, you stay

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at low levels of sorbitol for those.

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If you have a smaller...

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Portion than the amounts I mentioned

you should be fine and you should

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always try to include small portions of

Low FODMAP foods just to get a bit of

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diversity Now what you can do is to try

to eat them maybe On alternate days.

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So instead of like the challenge

you're doing three consecutive days

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with increasing amounts Maybe you're

okay with just one day a week.

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Maybe you're okay In a couple of

months time and that is why I suggest

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trying another sorbital challenge

in around six months because your

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tolerance can change over time.

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Listen in to the rest of this

little mini series about FODMAP

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reintroductions and what to do if

you've reacted to a FODMAP group.