Ep.83 – Sugar and IBS

Can you eat sugary foods if you’ve got IBS? And if so, which type of sugars are okay? And what about artificial sweetness? This episode is all about sweet foods and how they affect your digestion. I’ll talk about low FODMAP sugars and which ones to focus on if you’re following the restrictive phase of the diet.

You’ll also learn about how sugars are digested and why certain types of sugars are harder for our body to handle than others. So if you hate the thought of giving up sweet foods, this episode could help you manage your symptoms without feeling too restricted.

Sugar and IBS

Welcome to episode 83 of the Inside Knowledge podcast. I’m Anna Mapson This week I’m talking about sweet foods and sugar because a lot of my clients have been told they need to cut out all sugary foods if they want to get control of their IBS symptoms. Now whilst eating healthily and obviously managing our sugar intake is important, you might be pleased to hear that you don’t need to eat omit all sugars. And you don’t need to avoid all sweet tasting foods.

 I’m gonna go into a little bit about the differences between the types of sugars some which are more easily digested than others, and then we can talk about how to make it work for you, like in a normal sort of diet. Give you some tips on how to. Eat those kind of foods without overwhelming your digestion.

Low FODMAP sweet foods

First off, in this episode, I’m going to talk about the FODMAP diet. And if you don’t know already, FODMAPs are groups of short chain carbohydrates and sugar alcohols that aren’t well digested in our small intestine. And in some people who have IBS, can lead to symptoms like bloating, gas, additional stomach pain, diarrhea.

You can hear more about the low FODMAP diet in episodes 17 and 18 if you want to understand more about those. But the key thing to note for today’s purpose is that these type of foods are highly fermentable in our gut, which can add to the bloating and the gas, and also, they can draw water in.

So these are the types of symptoms that you can get from some high FODMAP foods. And when I’m talking about the restriction phase of the FODMAP diet, we’re really only talking about a period of two to six weeks when you’re following this diet to cut out all the high FODMAP foods. It’s not a diet that you should be following long term, and I do keep trying to stress that because some people are on it for years.

Many of my clients have been low FODMAP and avoiding all of these foods for multiple years. And what we want to try and do is to reintroduce them and I hope that what you get from this podcast It’s one of my main messages is that eating a more varied diet. Eating more different types of fibre is in the long run much better for your gut health than cutting out all of these foods.

So this is where I want to try and encourage people to eat more variety and more foods. Now with sugar obviously, we don’t want to have a very high sugar diet.

It’s not great for our body, and it’s not great for all kinds of things to have a lot of sugar. But, the nuance is that you don’t have to eliminate all of it, and you don’t have to stay on this low FODMAP diet, cutting out many fermentable carbohydrates, in order to control sugar. your symptoms.

Digestion process – how sugars are absorbed

If we go back to a little recap on how digestion works, obviously in your mouth you chew up the food, you mash it up. Then it goes to your stomach where there is the start of the chemical digestion process as well as more mashing up. Your stomach is a bag of muscle which will also contract and squeeze the food together to mash it, but you’re also getting your first, tranche of chemical digestion. You’re getting the stomach acid, breaking foods down, then the food slowly moves into your small intestine where your digestive enzymes start to break down the carbohydrates.

To get the sugars absorbed, we have to break them down to their smallest molecule. Some sugars are two chemical molecules put together. For example, table sugar, which you think of as just sugar, is actually a combination of fructose and glucose, and they’re in equal parts. Sugar is 50 50 fructose and glucose.

These two I’m going to talk a little bit about today, and how they get digested because that has got an impact on how you might choose to eat them.

Table sugar and IBS

Table sugar is the most common sugar that you think about. That is actually low FODMAP. Obviously, you don’t want to have a huge amount of sugars in your diet, but you can eat normal table sugar on the low FODMAP diet, but high FODMAP foods are not the only trigger for IBS type symptoms.

We also have people who are very sensitive to fat digestion, and that could be down to the digestive enzymes that are breaking your food down, could be down to your bile flow. Could be down to a whole range of other things. People can be very sensitive to fats, you might also have an excess growth of bacteria in your small or large intestine that are really interfering with your normal digestive motility, the way you’re breaking your food down, like all kinds of things.

So the FODMAP sensitivity is not the only reason why you might have IBS. There is also the non digestive causes of IBS like medication you might be taking, your stress and emotional health. These things also play a really big role in how we digest our food and how we feel in our gut.

Now going back to the fructose and glucose thing, I wanted to just talk a little bit about about how glucose and fructose are digested, because this helps to set the scene for the rest of the sweeteners and foods I’m going to talk about.

Fructose and glucose sensitivity

So they’re both naturally occurring in fruits and vegetables, as well as processed foods. The key thing is though that fructose is only well digested when it is met in equal quantities to glucose. If you have a meal or a food that is higher in fructose than it is in glucose, then some of the fructose doesn’t get well digested and sits in the small intestine.

This is because glucose helps fructose to get into your cells and then it can be utilized and metabolized by your body. There’s a little transporter mechanism in your cell that kind of pulls the sugars in and glucose, you can imagine it like it holds the hand of fructose and pulls it into the cell, makes it accessible to be used as an energy source and as a nutrient in your body.

Now, when we have got a lot of fructose and not very much glucose. Then, not all the fructose can be pulled across by the glucose, which means that there’s excess fructose that’s undigested in your small intestine. When you get that, it can draw water in osmotically, so it pulls water from your surrounding tissues, into the small intestine. That can lead to bloating. It can also be fermented by bacteria The unabsorbed fructose is there and if you’ve got a lot of bacteria there, they can really get to work on it. The bacteria, when they’re eating, or you can imagine them like, consuming the fructose molecules, they then cause gas bubbles by their metabolism.

Fructose sensitivity

So, that is the way that excess fructose can interfere with your digestion. By adding excess water, like drawing it in making you feel bloated and sometimes causing diarrhoea and also the excess gas so that again bloating but sometimes pain as well as you’re getting big gas bubbles moving through your system.

Now if you’re constipated that will be much worse because the gas bubbles and the build up is stuck and you’ve got a slow moving transit time which means that gas is going to be sitting there for much longer.

High fructose sweeteners to avoid in fructose sensitivity

There are three common sweeteners, or sugar types, that are higher in fructose than glucose. And for this reason, they don’t meet the low FODMAP criteria and tend to be worse for getting some of those symptoms that I’ve just described.

Honey is a high fructose sweetener

The first one is honey, which many people think is healthier than sugar because it’s available in nature, honey should be better for me. However, honey is higher in fructose than glucose, and so If you have more than about one teaspoon during your restrictive phase, you’ll be going into a higher FODMAP meal. One tablespoon per sitting is considered high FODMAP. So if you have a tiny amount of it, that should be okay. And that’s probably because you’re eating it with other things.

So switching from honey to normal sugar, is actually better for you if you’re following the low FODMAP diet.

High fructose corn syrup

Secondly, when you think fructose is high fructose corn syrup. Processed foods like often fizzy drinks and sweets often have high fructose corn syrup in. Now what is quite interesting though, is that high fructose corn syrup is not very far off chemically from sugar. So remember I said table sugar, is 50 50 glucose and fructose, where actually high fructose corn syrup is somewhere like 57% percent fructose and only 43 percent glucose.

So it’s a slight difference, but not massively. Depending on the percentage of high fructose corn syrup in your product, you may or may not find that this is an issue. I would say, typically, when you’re trying to identify your triggers, if you don’t know whether fructose is a problem for you or not, it is best to remove foods that contain high fructose corn syrup, particularly if it means that then you’re cutting out things like fizzy drinks, sweets, and, you know, processed, baked goods, for example.

Agave syrup is a high FODMAP sweetener

A common sweetener that is often used in sugar free products would be agave syrup. Now this is very high in fructose and does not meet the low FODMAP guidelines. So if you’re someone who doesn’t have your triggers identified, then you might be want to be careful about agave syrup. You can have a very small amount, I think five grams per meal is considered low FODMAP. But it’s sometimes found in sugar free drinks and foods So it’s often used as a syrup in a cocktail for example, because it’s already a liquid sugar And so you may find that these liquid sugars are more quickly absorbed, because it’s in a liquid as well.

It’s not sitting in your stomach for two hours, it’ll go through you much quicker. Therefore, it’ll be hitting your small intestine a bit quicker. The high fructose, remember, doesn’t get absorbed as well, so that could lead to more problems for your IBS.

Low FODMAP sweeteners

Sweeteners that do work much better on the other hand are as follows:

Maple syrup

Maple syrup is actually low FODMAP. So having that as an alternative to honey or agave syrup is a really good swap. It sometimes is a little bit more expensive to be fair. when you look for it, Make sure that it is actually proper maple syrup rather than maple syrup, flavoured syrup, because sometimes it is actually purely high fructose corn syrup with maple syrup flavouring.

Make sure that it’s actual maple syrup that you are buying. I have tasted one of those fake maple syrups before, and it’s really not very nice. It’s not the same at all.

Sugar is low FODMAP

I also mentioned sugar, like table sugar or sometimes called sucrose. So that is, as we’ve discussed, like it’s okay on the low FODMAP diet. Now some people with IBS will still have a problem digesting glucose or sucrose. You can have a problem with the enzymes that break down sucrose, the table sugar, from sucrose into its individual molecules, which is fructose and glucose. So some people will have a problem with this digestive enzyme and may still be sensitive to sugar even though sugar, sucrose itself, is considered low FODMAP.

This is what I meant by the fact that high FODMAP foods are not the only trigger. Some people can still be sensitive to table sugar, even though it’s considered low FODMAP. The reason that you can get an issue with digesting sugar is because is that you can either have damage to the mucosal lining of your gut, so that’s like a kind of layer of mucus that surrounds your intestines and helps to protect it.

That’s where some of the digestive enzymes sit, your brush border enzymes, where they help you do that digestion process, breaking the sugars down. If you’ve got some damage to it, and it could be through, surgery, maybe you have got some patches of inflammation, perhaps you have got some bacteria which are upsetting the mucosa in the small or large intestine.

 These can also play a part in stopping digestion being as effective as it should be. So perhaps there could be an imbalance in your sugar digestion because you’ve got some overgrowth of bacteria, for example, like SIBO. that can interfere with your digestive enzymes.

Sugar and starch sensitivity

There is also something called congenital sucrose isomaltase deficiency, which is a genetic condition where people just don’t have the enzyme to break down sucrose, or isomaltase, and maltase is another enzyme that helps to break down maltose, another one of the kind of carbohydrate components.

 That is quite rare, but variations of the genetic mutation are also possible. It’s thought that these are more common as well in people who have IBS than in the general population. And that makes sense. You know, if you’ve got uncontrolled IBS, it’s possible that there are small things that like small differences in the way that you break down certain sugars and although we’ve got the low FODMAP diet which is really well tested and researched in terms of its benefits, there are other things that could be causing your symptoms and sucrose breakdown could be one of them.

Stevia is a low FODMAP sweetener

Another sweetener I want to talk a little bit about, haven’t mentioned yet so far, is Stevia. Stevia is a natural sweetener that is derived from a plant. It’s calorie free, it doesn’t contain any FODMAPs, which means it’s good for a lot of people who have IBS. It could be, a good low FODMAP sweetener for some people who are managing IBS.

It does have a slight aftertaste from it, and I don’t really like it. However, some people don’t notice that and feel okay drinking it. If you find stevia in certain products, like I know that there’s like a Coke that is sweetened with stevia, for example, and it’s like a natural Coke, What you’ll find is that that product has got a lot of other things in it that aren’t as easy to digest, perhaps.

They’re also maybe still fizzy. So there are other things that might also set off your digestion that’s not necessarily down to the stevia. But you can use it in baking, it comes in a kind of powder form, and it’s often in some products as a sweetener. Generally, if you don’t mind the taste of it, it’s well tolerated.

Then we’ve also got the artificial sweeteners or non nutritive sweeteners as they’re sometimes called just because there’s literally no nutrition in them. They’re just sweeteners. So things like aspartame, these are in a lot of sugar free products. It’s really hard nowadays, because of the sugar tax, to actually find things like squash and, fizzy drinks like lemonades that actually are just purely sugar. Most of them have had half the sugar removed and they’ve also got these non nutritive sweeteners in.

Artificial sweeteners

There is some concern about the long term health impacts of artificial sweeteners on our gut microbiome, but I would really stress here that these studies are nearly always done on rats and animals and they are using more than a hundred times the safe level for humans that they show a potential increased risk.

What they show is like a potential disruption to your gut microbiome or irritation, but that is a hundred times the amount that is classed as safe for humans to drink. If you’re just having one soda per day, or every now and again, that is probably not going to be giving you significant long term health effects.

However, if you are drinking five litres of fizzy drink a day. I would say that’s something that you need to work on anyway and try to move to drinking more water and other liquids that are more beneficial to your health. So it’s all about proportion How much of this are you having in proportion to the rest of your healthy balanced diet?

Can I have diet fizzy drinks if I have IBS?

If your diet is only made up of foods containing a lot of artificial sweeteners then you probably need a bigger shift anyway. These are only in, obviously, processed, produced foods. They’re not in whole foods that we want to try and encourage everyone to eat more of anyway. So that’s why having a can of Coke every now and again is not going to be the end of your gut microbiome, it’s not going to be a massive problem.

If you’re having five cans a day, then I would say that is a problem maybe for other reasons anyway.

Sucralose and gut health issues

Other sweeteners I wanted to just mention, so sucralose, which is often used as an artificial sweetener. It’s in products like Splenda, for example. There is again some concern over sucralose affecting your gut microbiome and gut motility. But again, there isn’t much strong evidence in humans that this is the effect that you might get. Most of the sucralose is excreted, it doesn’t get into our cells, it just comes out. And I think the best thing to do would be, if you’re worried about these artificial sweeteners, is take them out, get to a good place with your diet, and then trial putting them back in again, if you don’t want to have sugar in your coffee, for example, and you use little sweeteners.

The recommended daily intake limit for things like sucralose is 15 milligrams for every kilo of body weight that you have per day, which is actually quite a lot. And again, if you’re having lots and lots of artificial sweetness in your food, then you might want to think about, you know, where is all this coming from?

How can you switch your diet to be eating more of a whole food based diet. Sucralose is considered low FODMAP though, so in terms of meeting the FODMAP diet it’s okay. The same is with saccharin, another artificial sweetener that’s found in diet drinks and sugar free products.

It seems to be safe if you’ve got IBS, but again it’s probably worth testing your individual tolerance to some of these things and not just assuming that just because it’s low FODMAP that you’re not going to have a reaction to it. The thing with sucralose and saccharin is that they’re not getting digested in the same way that glucose based sweeteners are.

So they’re not going through that process that I mentioned of sitting in the gut, drawing in water and being fermented because they’re not getting broken down to fructose and glucose and other FODMAP type sugars. But they are sweetening the taste in your mouth, and then they’re just kind of moving through your body.

Another reason for having the non nutritive sweeteners, so things like aspartame, sucralose, is that they don’t raise your blood glucose levels like your blood sugars so if that’s something you’re worried about like maybe you have diabetes or pre diabetic and you need to stay on top of your blood sugars, then using those kind of artificial sweeteners instead of glucose based sugars is going to be helpful in terms of managing your overall exposure to glucose in the diet. The other type of sweeteners that you will need to be careful of if you’re on the low FODMAP diet are things that are advertised on sugar free sweets. Like, for example, sugar free mints quite often have things like xylitol in them. You might get spreads like, chocolate spread that’s based on mannitol, for example.

High FODMAP sweeteners

So I’m talking about the polyols. These are sorbitol, mannitol, xylitol. These are known to draw the water into your gut and are considered high FODMAP. So look out for those when you’re looking at ingredient listings. The other thing that is sometimes put in as a sweetener, which will be on low sugar or sugar free products, particularly things like granola or cereal bars will be inulin or chicory root.

This is a fibre that is very sweet, but it is very high in FODMAP. So for some people when they’re choosing a sugar free product will actually unknowingly be really increasing the FODMAP content and causing themselves digestive issues. Not everyone, but a lot of people with IBS could be sensitive to inulin when it is in high amounts. When you’re reading the ingredient listings, it’s good to look at where the ingredient sits. The higher up it is in the ingredient listing, the more percentage of the product that you’re I guess my main message from this episode would be you can have foods that contain sweet things.

But if you’re making choices about which sweeteners to use because you want to try and minimise the impact on your symptoms then generally normal table sugar is the easiest and maple syrup is another good liquid sweetener.

But try to avoid things like honey and agave syrup on the low FODMAP diet Then in terms of other processed foods, like if you’re someone who loves sweets or chocolates fizzy drinks Just try to reduce your Intake of those into a small amount per day and think about how that fits in your overall diet Where does it sit in terms of proportion of foods that are whole foods, home cooked foods that you’ve made yourself compared to foods that are They come in a little wrapper and are purely created for the pleasure of eating, rather than they’re going to give you some nutrient value.

Okay, please send me some questions that you’d like me to investigate and understand more about in relation to your IBS. I’ll leave it there for this week. Thanks very much for listening to this episode of the Inside Knowledge.

Better digestion for everyone.