Polyols 101

Many of my clients tell me that even a few small pieces of sugar-free candy or gum cause diarrhea. Ditto for the well-know effect of prunes or cherries. What do these foods have in common? They contain polyols, also known as "sugar alcohols".

Technically, they are FODMAPS carbohydrates, and they are sweet! Most polyols are poorly absorbed, and wind up in the large intestine when they are consumed. In the large intestine, polyols are fermented by gut bacteria. They are also capable of drawing water into the large intestine. Together, the excess gas and excess fluid can cause distension of the colon, which cause bloating, flatulence and looser stools for the IBS sufferer. In a double whammy, eating or drinking sugar alcohols worsens fructose intolerance!

Some sugar alcohols, such as sorbitol, occur naturally in fruits such as apples, pears, and the "stone fruits," which include plums, prunes, apricots, peaches, cherries and so on. Sugar alcohols are often used to sweeten "sugar-free" foods (such as candy, gum, low-carb items, and bubbly water) and liquid medications. They can be recognized on the food label's list of ingredients by the ending "-ol". Examples are xylitol and maltitol.

Note that erythritol seems to be an exception. Studies have shown it is well absorbed and unlikely to cause GI symptoms.

Comments

[Candie Schaal]

Hi Patsy,

I just posted on the salad dressing post from last year but I wasn't sure if you would see it. I just bought your book and it has helped me so much. I have been on the elimination diet for 5 days and I was symptom free the first day. I did have a couple of questions:

1. What kind of yogurt is okay? Do you know what organic milled sugar is?
2. Is balsamic vinegar okay? I would love to mix it with some olive oil but I thought I read somwhere that it is not safe.
3. After being sick for three years and diagnosed a year ago this has been the best I have felt in three years so thank you. Can you recommed a dietician in the Denver area?

Thanks,
Candie

[Patsy Catsos]

Candie, thanks for writing! Glad you are feeling so much better. Thats the kind of comment Id love to see on Amazon.com if you feel so inclined!

Here is a link to a previous post about yogurt: http://www.ibsfree.net/ibsfree_at_last/2009/11/make-your-own-lactosefree-yogurt.html.  Another option would be to take a lactaid pill with a small serving of plain or sugar-only-sweetened yogurt, which will knock down the lactose somewhat.

Organically milled sugar is a healthier sounding version of table sugar, which is sucrose, and is FODMAPS friendly. Maybe Ill write a blog post about the many names of sugar.

Balsamic vinegar is OK.

[Candie Schaal]

Patsy,

Thanks so much for taking the time to respond. I was concerned about the acidophillus and other cultures in the yogurt. I read that they can be hard for FM'ers. I don't have a problem with lactose. I think a blog post about the different names for sugar would be great.

I tried the salad dressing Shittake Mushroom with sesame. I see that is has apple cider vinegar in it which I thought was not safe. It does taste good though.

Thanks for taking the time to help. You are a great person of help for me during this journey. Many thanks.

Candie

[Patsy Catsos]

Watch or subscribe to the blog for an upcoming article on vinegars!

[Sandy Farl]

What about apple cider vinegar, maple syrup, brown sugar and carmel color. On original list I've seen, these have been on the "don't eat" lists

[Sandy Farl]

What about onion powder? Why is that okay.

[Patsy Catsos]

Filtered apple cider vinegar has no carbs, therefore no FODMAPS. My sources show maple syrup does not contain excess fructose, so is OK on the elimination diet. Brown sugar is OK because the USDA data shows it does not contain excess fructose. (Updated 9/11/2011). Caramel color is often not gluten free (different issue) but I am not aware of any reason it is not FODMAPS friendly.
Sent from my Verizon Wireless BlackBerry

[Patsy Catsos]

I no longer recommend onion or garlic powder on the elimination phase of the diet.

Updated 9/11/2011
Sent from my Verizon Wireless BlackBerry

[Stephan Tobin, Ph.D.]

Hi Patsy,
The day before yesterday I went to Whole Foods and bought all the stuff on your shopping list and started the elimination phase yesterday. So far so good except that I experienced my usual bloating, gas and constipation last night before going to bed. I took a couple stool softeners but am concerned that I might be sabotaging the program. What's you reaction?

Also, I have always tried to buy high-fiber cereals (at least 5 grams per serving) but notice that Cheerios has only 3 grams/serving. (That's why I stopped buying Cheerios years ago; they used to have more fiber.) With the occasional lower amount, I would add oat bran. Is it okay to do that with the Cheerios?

Another issue: I have been used to eating about 3 prunes a day for my constipation. It hasn't been working at all lately and I notice prunes have polyols, one of the FODMAPS elimination groups. Does your program provide enough fiber for someone like me, IBS with constipation?
Stephan

[Patsy Catsos]

I will make some general comments, as I can't offer professional "advice" in this forum.

Stool softeners aren't FODMAPS themselves, so they won't sabotage the program in that sense. They may be useful in the smallest possible dose if stool is hard to pass.

Here are a couple of links to prior posts about fiber and constipation:

http://www.ibsfree.net/ibsfree_at_last/2010/05/getting-enough-fiber-on-the-fodmaps-elimination-diet.html

http://www.ibsfree.net/ibsfree_at_last/2010/05/getting-enough-fiber-on-the-fodmaps-elimination-diet.html

Hope these links work!

I know it seems counter-intuitive to limit certain fibers and sugar alcohols to manage constipation but I encourage readers to give it a chance. Ask yourself, if it was working that well to eat all that bran and all those prunes, would you still have a problem?

[Tanya]

Hi! Just got your book today. Noticed you suggest Cheerios for breakfast. I live in the UK and the only cheerios here seem full of wheat, grain, etc, you name it! (And it's Nestle, another big no-no!)I never buy prepared cereals, so are there alternatives? Porridge, made by me? Not about to start yet, as I need to do another coeliac test, in about 5 weeks. I am also spending the summer in Sweden and far from sure there are Cheerios there - what alternative? Preferably not pre-packaged!

[Patsy Catsos]

Suggestions for breakfast? How about oatmeal, corn or rice grits, polenta? Eggs?

[elise]

hey patsy - any update on the pectin? i am vegan and was using hemp protein to supplement during the elimination phase and was just wondering if the protein powder i have is fodmaps free. it is made with brown rice protein, hemp protein, stevia, xanthan gum and pectin. im not sure about the xanthan gum either, so if you have info on those id appreciate it. thanks

[Patsy Catsos]

Sorry, no new info on pectin. Xanthan gum--not sure its exact FODMAPs status but many of my clients do not tolerate it in large quantities.

[Annette]

I live in the UK and notice that Cheerios have whole grain wheat, brown sugar and wheat starch. Should Cheerios be avoided? Does that only leave oats for breakfast?

[Patsy Catsos]

Too bad about the whole grain wheat in the Cheerios in the UK. If it had been just wheat starch they still would have been OK. Another reminder of the importance of double checking ingredients, as they may change over time or vary from one location to the next. You can substitute any allowed grain you would like for the cheerios at breakfast. I'll try to avoid brand names due to the UK/US different manufacturer's problem, but how about these ideas: porridge made from (yes) oats, rice, quinoa flakes, buckwheat,or corn (grits U.S.), corn flakes, rice krispies/bubbles, puffed rice, corn or rice Chex. Then there are fried potatoes, corn tortillas, certain bread, buckwheat pancakes, eggs, omelettes, etc.