Breathing techniques for IBS

Welcome to episode 54 of the Inside Knowledge podcast for people with IBS. I’m Anna Mapson. This episode is going to highlight a couple of things that you might be seeing in your food ingredient listings that could be contributing to your IBS flares. Now, definitely the emphasis is on could be, because not all of these things will be a problem for everybody.

Just the same as when we go through the FODMAP triggers, looking at different sorts of things that could potentially cause your bloating, discomfort, diarrhoea, constipation, et cetera. The same thing applies to these. They won’t be a problem for everybody.

So the other thing I wanted to make sure, just thinking about the actual amount of this ingredients. in the food that you eat. So what I mean by that is, if you eat a product that has got a tiny amount of this kind of food additive in it, is it really going to give you a problem or not?

Like, we need to look at the quantity that is in the food. When you’re reading food ingredient listings, They have to put the ingredients with the largest amount in the product first, and it goes in descending order. So, if there is an ingredient listed in your food product right at the end, it’s probably going to be a very small amount.

Now, it doesn’t necessarily mean it won’t affect you, but the likelihood decreases as the ingredient that you’re worried about goes further down the list. If it’s right at the top, and it’s like the second ingredient listings then maybe it’s going to be more of an issue for you. I’ve got five I’m going to go through today, but there are lots of other things that could potentially be a problem for you as well, so this is not an exhaustive list.

Firstly, I want to start off with high fructose corn syrup. So fructose, as you may well know, is a FODMAP. This means it can cause irritation and IBS symptoms. In people who are sensitive, so not in everyone, but some people who are sensitive who have IBS, fructose can be a problem. The reason it’s a problem is because it draws water into the small intestine.

It’s all down to the way that fructose is absorbed in our digestive system. We’re actually not that good at absorbing fructose. It gets best absorbed when it is in conjunction with glucose. So most people don’t absorb huge amounts of fructose because it’s not a very efficient way to absorb it.

Like there’s a transporter that kind of holds the fructose and takes it into your cell there’s not very many of these transporters available. So what happens is when there’s glucose as well, the glucose, you can think about it, is holding the hand of fructose and it kind of drags the fructose in.

Whilst it’s getting in through the glucose gate into our cells and then it can be used. So what’s important to know though is that we don’t really eat fructose often on its own. Fructose is nearly always with glucose even in high fructose corn syrup. which you might think is mostly just fructose, there’s actually a lot of glucose.

in high fructose corn syrup as well. There is two types of high fructose corn syrup, one of which is 55 percent fructose and 42 percent glucose, and then there’s another sort which is actually 55 percent glucose and 42 percent fructose. So both of these are actually pretty close to 50 50, which is the same as Sucrose, normal table sugar that we have. So it’s not very far off. High fructose corn syrup is not actually that much higher in fructose than normal sugar.

But there’s quite a lot of hoo ha about it in, um, whether it’s a good additive, to have in our foods. When you do have fructose that’s higher than the glucose, there is more chance for that little bit of extra fructose to cause problems in your digestive tract.

The one I wanted to highlight today is agave syrup.

Now, a lot of people will think, oh, that’s much more healthy than normal sugar because it is more natural. I mean, there’s lots of things you can unpack about that because generally when it comes down to the molecular structure, sugar is sugar, whether it’s coconut sugar or brown sugar or white sugar, there’s really relatively little difference in how they actually Absorb.

But the one thing that is interesting though is agave syrup is very high in fructose, and this is more like 80% of the sugars are from fructose. So that is why agave syrup is a very high FODMAP sweetener and may be a trigger for you. And this is the trap that some people fall into. Like you’re trying to be healthy, you’re trying to go for alternative things that aren’t sugar.

But. it can be a issue. The other thing to look at is high fructose corn syrup as an additive to foods is normally in things like processed snacks, like ultra processed foods, basically sweetened yogurts, maybe breakfast cereals, as well as soft drinks. So a lot of fizzy drinks will include high fructose corn syrup, but it’s also in things like cereal bars, biscuits, cakes, like any sort of packaged ultra processed sweet food.

The next one to move on to looking in your ingredients listings is all the sugar alcohols. So these might have names like sorbitol, mannitol, and xylitol. They will be found in things that are classified sugar free often, so sugar free chewing gum, sugar free sweets, diet foods as well, especially because they’re sugar free, like low Calorie and some kind of medications as well, actually. So, again, similar to fructose, but these sugar alcohols are not fully absorbed in your small intestine, leading to fermentation by gut bacteria and also gas production by the gut bacteria. I have actually got some podcast episodes specifically about these sugars.

So there’s episode 25 about sorbitol, 26 about mannitol, and episode 28 about fructose. So if you’re interested in learning a little bit more about how these all affect your digestion, those specific podcast episodes really dive into those in a detailed way.

The third ingredient I want to talk about is inulin.

This is a type of fiber that is highly fermentable and can cause bloating and gas and a lot of discomfort in people when you eat a lot of it. One of the ways you might see it written down on an ingredients listing is chicory root or chicory because inulin, when it’s taken from The chicory root is very, very sweet, and so it’s sometimes used as a sugar free way to add prebiotic fiber to the product and reduce down the sugar. So, Overall, it sounds great, but then for people with IBS, sometimes it can be a real trigger. You might also see fructo-oligosaccharides, or FOS for short. FOS and inulin are quite similar, but inulin has got a longer chain of different carbohydrates stuck together, whereas FOS, the fructo-oligosaccharides is like short chain carbohydrates, so molecular.

structure of them is a little bit different, but they’re used in a similar way, often to add prebiotic fibers and to sweeten your foods. Now the types of foods they’re most commonly seen in is things like cereal bars, protein bars sometimes as well, any low carb I quite often see them in like a sugar free Granola or things like that, and you may also see them in, like yogurt products or dairy alternatives, that sort of thing.

Because of the way it is a prebiotic, inulin has been studied quite a lot for increasing the good gut bacteria, protecting the gut. Specifically, bifidobacteria, and there’s also lots of studies, really, showing that people who take high doses of fructooligosaccharides or inulin, may be able to reduce down body fat, so it’s thought that by increasing these good bacteria, that’s the bifidobacterium, it might then increase the products that these bacteria make.

So when our gut bacteria come into contact with fibres and foods that we can’t digest as humans, then it will come to the large intestine, and these bacteria make something called short chain fatty acids. Now these are beneficial for our gut health, they help to fuel the colon cells and they’re also anti inflammatory and they can travel around the body just doing their good, so we want good amounts of short chain fatty acids, and they may, in some of them, reduce appetite, which may be why people who are taking a lot of these prebiotics may have an impact on their weight, because they’re just eating a little bit less, because they are less hungry.

This is one of the ways where eating a high fibre diet can help with weight management. So just again, the reminder though, that if the inulin is a very, very small part of a product that you absolutely love and you’re not sure whether it’s causing your problems, then it might still be worth just omitting it from your diet for a week or two and see if you have any change in your symptoms by removing out this highly fermentable type of fibre.

Like I’ve said before, it’s not that this is bad for you, this is a prebiotic, Helping the beneficial gut bacteria. It’s a good thing to include in your diet. But, if you’re someone who’s very, very sensitive to these things, it may be increasing the amount of, gas and bloating and maybe like sensitivity in your digestive system because the gut bacteria are increasing, eating away at this inulin.

Another consideration is that maybe the increase in this prebiotic fibres is feeding the bad bacteria as well. And that is potentially why you might feel your symptoms worsen when you increase fibre but over time it’s more likely that you will feed up more of the good bacteria and crowd out these bad bacteria.

Obviously each individual dietary change, you know, has to be managed within your symptoms, what you’re finding tolerable, and what works for you. But it is worth thinking about gradually increasing up these fibers.

The fourth additive that you might want to pay attention to is emulsifiers. So these are commonly found in dairy alternatives to make the product taste creamy thick when it doesn’t have any dairy in it.

It’s also found in low fat products where they’ve taken out a lot of the fat that gives it that sort of nice mouth feel of having more creamy element to your food. So you might find it in, , your soya milk, your almond milk, maybe even in oat milks. It’s also found in things like ice cream, mayonnaise, or sometimes also in like packaged baked goods like biscuits or cakes that you might buy in the shop.

Now there are different types of emulsifiers and thickeners and they’re used for different reasons, but some of these might trigger a little bit of inflammation in your digestive tract. Now, I want to be careful around this because there is quite mixed evidence, or there is a sort of a lack of evidence, I would say, in people.

It’s these particular elements of the processed food that is causing problems. So where we have, a difference, I suppose, in the way we’ve eaten. You know, the change in our diets over the years, say a hundred years ago, people were just not consuming this high level of processed packaged foods. So we’ve seen a massive increase in additives in our foods over the last hundred years.

And we’ve also seen a real rise in problems like IBS. But doesn’t necessarily mean that it is down to these particular elements of your food. It could be around our change in lifestyle, you know, with change in our eating habits, so many things about the way we live. For example, we rarely now sit down and have three family mealtimes around the kitchen table.

We eat, like I said, a lot less fruits and vegetables, a lot less variety. We eat a lot of the foods on repeat. We tend to have much more time together. stressful lives in terms of we’re always on, we don’t have much downtime. And a lot less time in nature.

Life has changed massively over the last hundred years. And so it’s not necessarily just down to the inclusion of thickeners in your food. However, there is some kind of evidence this is not something that’s massively been replicated in people, but when they have given rats very high doses of some of these thickeners, then they have had Irritation to their gut lining, and when they have done it in a Petri dish, so just looking at these cells or they’ve used a model of the gut that’s not actually related to a person, then you can see a breakdown in the cells and irritation to the gut lining.

Some of these emulsifiers I’m talking about, you might see them listed as things like polysorbate, carboxymethylcellulose, or carrageenan. Carrageenan is actually an interesting one as well. It is made from seaweed derivative, and some of the confusion around this lies that in Some trials, in order to induce gut inflammation, they use a type of carrageenan in rat models.

So sometimes they will give them very, very high doses of carrageenan in order to simulate a gut that’s got inflammation in it, so they can do some tests on it. That doesn’t necessarily mean that the food grade carrageenan that might be in your gut Soya milk, for example, is going to have the same effects.

And also just remembering the quantity of that product that you have, and the quantity of the overall ingredient in that product, makes a difference. So if there is a very small amount of carrageenan in, say, your almond milk, and you only have almond milk in your tea, a small amount, the actual amount of carrageenan that you’re going to be ingesting is very, very small.

Now, if you were downing, like, two litres of this almond milk a day, then maybe you might start to notice more of an a pattern, but I would also say that’s probably not healthy, and no one’s suggesting anything. You should go ahead and drink two litres of almond milk a day anyway, because there are also other reasons why that might not be so good for you.

So, putting it into context is really important. Now, the very final one is artificial sweeteners, and you might see these listed As aspartame or sucralose. These are the most common ones that people worry about. Now there has been quite a lot of research into whether these artificial sweeteners will disrupt the gut microbiome.

And that is the main concern that people have around ingestion. So it’s not necessarily that it will give you an upset stomach and it would kick off your IBS. It’s just that more over time, there is sort of one train of thought that potentially these artificial sweeteners could cause an upset stomach.

upset to our gut microbes that is not beneficial, that is, you know, encouraging the bad bacteria. The thing is there isn’t really enough evidence in people that shows us that this definitely happens and this is where it always falls down. The studies that have shown some negative responses from very large amounts of artificial sweeteners to rats just might not be transferable to people and the doses that they give them are like over a hundred times the safety maximum limit for people to ingest.

So if you’re worried about artificial sweeteners, I would say don’t drink, liters of fizzy drinks that have got loads of artificial sweeteners in them. However, drinking one every now and again you is not going to upset your microbiome.

There is some evidence sort of worry that drinking sucralose could potentially speed up your gut motility. And I suppose as an anecdote, I do have a client who was drinking, a fizzy drink with one of these in every day. And when she cut it out, things radically improved in terms of diarrhoea, cramps, and just general gut sensitivity. So she did have a definite sensitivity to sucralose.

This is not a FODMAP as well, so we’d already done the FODMAP diet with her, and then we were talking about what else she was drinking or eating that could have potentially caused the problem she was still getting, and it didn’t. Probably came down to this two types of drinks that she was having that had sucralose in them and she was having them regularly.

These artificial sweeteners are generally quite new to humans and we don’t have masses of studies that show that there isn’t an impact on IBS. We do have some that show that there might be in rats at huge doses. So, depending on your sensitivity level, the way that you digest things, it’s possible that you will react to them as an individual, but for the majority of people, having a small amount of artificial sweetness should be manageable.

I wanted to just close out this episode by talking overall about our percentage of ultra processed foods that we have in our diet, and how if you’re eating a diet that’s mostly food that you’ve cooked yourself., that is, based on vegetables, fruits, whole grains, proteins, then it’s unlikely that small exposures to these kinds of foods that I’ve been talking about will be a problem for you.

Your overall dietary pattern is much, much more important than whether you have an ice cream once or twice a week, or whether you do enjoy a fizzy drink every now and again. These things can be okay as part of a balanced diet, but what’s really helpful to know is just, What the things are in the different ingredients that could trip people up.

And what I’ve also had before with clients is that they’ve been taking supplements that include some of these things and haven’t realized. So they’ve been taking supplements that they thought would be good for them and once we remove them from their diet, made their symptoms go away.

So it’s not always just food. These are the things to watch out for in anything that you take. If you’ve enjoyed this episode, I would love it if you could do a review for me, or please leave me, a good rating. It really helps me to get my podcast out there. If you’re interested in working with me one to one on your diet and digestion, I run a three month Gut Reset Program that You can do from wherever you are in the world because it’s online and I give you loads of education about gut health and diet and digestion as well as individual one to one calls so we can tailor all of that education to you and your position and make sure that you are getting control of unpredictable and painful gut symptoms that are so common with IBS.

Okay, that’s it for this week. Thank you very much for listening to this episode of the Inside Knowledge. Better digestion for everyone.