Irritable Bowel Syndrome (IBS) is a condition that affects many people worldwide affecting the quality of life by preventing enjoyment from favorite activities. Constipation, diarrhea, or a mixture of both along with abdominal pain are predominant symptoms of IBS sufferers. Eating certain foods is one of the possible triggers, so finding out which foods are causing the adverse reactions is a key to a symptom-free life.
Low FODMAP diet has been a savior for many people with IBS reducing or eliminating the symptoms. It involves elimination and re-introduction of fermentable carbohydrates with the goal of finding individual food triggers. There are five groups that need to be avoided and challenged on a low FODMAP diet and I am not going to describe all of them now (you can read about the low FODMAP diet here), but I will talk about one group of carbohydrates that maybe a culprit of symptoms in people with IBS, and this group is POLYOLS. So, what the heck are the polyols? It sounds like a scientific and complicated term but let me tell you that you’ve come across these carbohydrates many times in the past.
Polyols are the letter “P” in FODMAP acronym and include sorbitol and mannitol. They are malabsorbed in the GI tract and, when they reach the large intestine, they attract water and get fermented by intestinal bacteria which produces gas. All people, with and without IBS, may be sensitive to these compounds and mostly experience bloating, abdominal distention, and diarrhea. However, people with IBS have a hypersensitive gut; therefore, when the belly distends from bacterial gas production, some people may experience abdominal pain compared to people without IBS who would simply have excessive gas or diarrhea without the pain.
Sorbitol and mannitol are naturally occurring polyols that are mostly found in stone fruits and some vegetables. Below are examples:
Polyols are also called sugar alcohols and there are other polyols present in foods besides mannitol and sorbitol. Remember seeing a commercial about a chewing gum when they said it contains xylitol? That’s it! Xylitol is a polyol. Most sugar alcohols end in “-ol”, which makes it easy to spot them in the ingredient list. Other sugar alcohols are erythritol, lactitol and isomalt. These polyols are added to foods because they provide fewer calories than regular carbohydrates. Normally, carbohydrates provide 4kcal per 1 g, but sugar alcohols are 2-3kcal per 1 g, which makes it a great alternative to sugar in low calorie and sugar-free products, such as chewing gums, bakery goods and confectionery.
When you see the words “sugar free”, “zero sugar”, or “no sugar added” on the package, it may indicate that other forms of sweeteners were used instead of sugar, such as sugar alcohols.
Polyols are not only added to foods, but also to medication, supplements (vitamins, minerals, herbal remedies or probiotics), cough syrups, cough drops and personal care items (toothpaste, mouthwash) to give a sweet taste. Sounds interesting? Check your medicine cabinet and I am sure you will find some supplements or medications that contain sorbitol or isomalt.
Unfortunately, there are no tests to check for sorbitol or mannitol intolerance, and the best way to know if you are sensitive to these sugar alcohols is to do an elimination diet.
Keeping a food and symptom journal will help to understand if your symptoms are from ingesting sugar alcohols aka polyols. Eliminating them completely for some time and testing the tolerance later will help to identify your personal tolerance level. I recommend working with a dietitian who can guide you through the process and help to create a plan, so that you can still include some polyols and not going to restrict your diet.