[i]. The number of children diagnosed with IBS has not been evaluated extensively in the US, but a study of 5403 children in China ages 6-18 years old showed that 13 percent had IBS. A Canadian study of 315 patients ages 4 to 18 with digestive symptoms showed that 22-35% had IBS[ii]
I grew up in a typical American home where we had access to far too many sugars and starches. I remember routinely having cramps and other ghoulish symptoms almost every morning before school, thanks to a bowl of cereal with milk, English muffins or pancakes. If your child suffers from frequent diarrhea, constipation or both, or other symptoms including abdominal pain, bloating or cramps, they could have IBS. For kids with IBS, these carbohydrates discussed in my book series, Fast Tract Digestion, can trigger symptoms and should be avoided:
- Resistant starch
- Sugar alcohols (with the exception of erythritol).
IBS has been definitively linked to the overgrowth of bacteria in the gut[iii]. During small intestinal bacterial overgrowth (called SIBO for short), bacteria produce gas, toxins and overstimulate the immune system giving rise to IBS symptoms and negatively impacting digestion and nutrition. Although several factors can contribute to SIBO, the growth itself is fueled by undigested carbohydrates. The more difficult –to-digest carbs, listed above, are the ones most likely to give rise to SIBO and IBS symptoms.
The biggest culprit in Halloween candy is sucrose (which is half fructose), but many diet candies contain sugar alcohols. Other junk foods such as potato chips, and other carb laden crispy snacks have significant amounts of resistant starch and gluten from wheat (which can affect many people who are gluten intolerant).
Back in the day, most sweeteners were sugar based, but many non-sugar sweeteners have since been introduced giving us more options, but also more questions. As I have learned more about the overall health and digestive problems linked to many sweeteners, I am less enthusiastic about sweets in general but also interested in finding sweeteners that satisfy our sweet tooth but don’t disturb our gut. Let’s have a look at sweeteners in use today.
The most common natural sweetener is sucrose or table sugar. Sucrose is a disaccharide (meaning it’s composed of two sugar molecules stuck together) containing equal amounts of glucose and fructose. Sucrose may cause IBS symptoms because it contains 50 percent fructose, which can be difficult for some people to absorb. The same goes for high fructose corn syrup, which generally contains more fructose than glucose, and honey, which has approximately the same ratio of glucose to fructose as sucrose. Most people can tolerate small amounts of sucrose and honey, but moderation is the key.
Fructose itself is also used as a common sweetener in many foods, snacks and desserts and is almost twice as sweet as sucrose or honey. I would advise strictly limiting fructose as it is very difficult to absorb, particularly in the absence of glucose. This can be challenging given the widespread use of this sweetener.
Stevia marketed as SweetLeaf, Truvia and Stevia Blend, is a natural sweetener that comes from the leaves of the South American plant Stevia rebaudiana. This sweetener has been used for decades in other countries but only recently has found its way into the US market. I haven’t used this sweetener myself, but the sources I checked seem to indicate it has a relatively good safety record. Stevia is heat stable and can be used in cooking.
There is only one problem with stevia: All of the brands I checked, including Stevia Blend, SweetLeaf and Truvia, also contain sugar alcohol and, in the case of Stevia Blend, fructose oligosaccharide as ingredients. Both of these substances are not absorbed by the small intestine and are highly fermentable by gut bacteria. For this reason, these sweeteners should be avoided completely unless you can find brands that don’t add sugar alcohols. Jimmy Moore of “Livin’ La Vida Low-Carb Blog” fame recently told me that there are sugar alcohol-free forms of Stevia available which might be an acceptable alternative if you are interested in using this sweetener.
There are several artificial sweeteners on the market that provide alternatives for people who want to avoid sweeteners that contain fructose. Artificial sweeteners generally have no carbohydrates and zero calories but simply taste sweet. Sucralose (Splenda) is the most popular followed by aspartame (Equal and NutraSweet) and saccharin.
Sucralose (Splenda) was approved for use in the US in 1998. Sucralose is similar in many ways to sucrose, but has been chemically modified so that it is not digestible — by people or bacteria. This property makes it ideal for people with digestive problems including IBS. Sucralose is also stable when heated, so can be used for baking or in other hot recipes. Sucralose has an excellent overall safety record. Several people have told me they have concerns about the safety of Splenda, but no one has thus far has provided a scientific basis for these claims. If you have one, I will read it. Just leave the reference in the comment section.
Equal and NutraSweet both contain aspartame which was approved by the FDA in 1981. The sweetener can break down when exposed to heat so is not good for baking. Aspartame may also cause mild headaches and other side effects in some people. In general, I would avoid this sweetener. Also, people who have the rare genetic condition known as phenylketonuria must avoid aspartame because it contains the amino acid phenylalanine.
Saccharin (Sweet’N Low) is another artificial sweetener that contains just under one gram of dextrose (glucose) as one of its ingredients. Based on testing in rats in the sixties, the sweetener was thought to cause cancer, leading the FDA to require a warning on the product, the cancer fears were determined to be unfounded in humans and the warnings were removed in 2001. Despite its bitter aftertaste, many people prefer it to other sweeteners. Like aspartame, saccharin is not stable when heated and cannot be used for baking.
Sugar alcohols, also known as polyols, represent a group of non-carbohydrate sweeteners. Sugar alcohols include sorbitol, mannitol, xylitol, lactitol, isomalt, erythritol, and maltitol. In general, sugar alcohols are poorly absorbed, so they don’t raise insulin levels much, but can be fermented by gut bacteria, potentially causing diarrhea, gas, bloating, reflux and other IBS symptoms. For this reason, most sugar alcohols should be avoided.
One sugar alcohol, erythritol, has some unique properties which makes it a good choice as an alternative sweetener (it’s not an artificial sweetener since it’s produced by yeast). Unlike the other sugar alcohols, erythritol is mostly (90%) absorbed in the small intestine. Even the 10% that remains in the intestine may not be a problem as at least one study showed gut bacteria may not be able to metabolize it[iv]. It’s also not metabolized much by the body as most of it can be recovered in urine[v]. Safety studies in animals and humans suggest that erythritol is very safe as well[vi]. Thanks to Lauren Benning for writing to me about the benefits or erythritol and Kris Gunnars for his excellent article on erythritol.
To read more, check out the Fast Tract Digestion books. What are your favorite gut friendly sweets? Please share because I have a sweet tooth.
[i] Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-721.e4. doi: 10.1016/j.cgh.2012.02.029.
[ii] Caplan A, Walker L, Rasquin A. Validation of the pediatric Rome II criteria for functional gastrointestinal disorders using the questionnaire on pediatric gastrointestinal symptoms. J Pediatr Gastroenterol Nutr. 2005 Sep;41(3):305-16.
[iii]Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, Koussoulas V, Barbatzas C, Pimentel M. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome. Dig Dis Sci. 2012 May;57(5):1321-9.
[iv]Arrigoni E, Brouns F, Amadò R. Human gut microbiota does not ferment erythritol. Br J Nutr. 2005 Nov;94(5):643-6.
[v]Hiele M, Ghoos Y, Rutgeerts P, Vantrappen G. Metabolism of erythritol in humans: comparison with glucose and lactitol. Br J Nutr. 1993 Jan;69(1):169-76.
[vi]Munro IC, Berndt WO, Borzelleca JF, Flamm G, Lynch BS, Kennepohl E, Bär EA, Modderman J. Erythritol: an interpretive summary of biochemical, metabolic, toxicological and clinical data. Food Chem Toxicol. 1998 Dec;36(12):1139-74.