The low FODMAP diet is an elimination diet that helps to identify if your gut is sensitive to foods high in FODMAPs (carbohydrates that are poorly absorbed).
FODMAPs = fructose (some fruits such as mango), lactose (such as milk), oligosaccharides (think wheat and onion) and polyols (some fruits such as most stone fruit and vegetables such as most mushrooms).
As part of avoiding high amounts of FODMAPs in the diet, a small number of food additives also need to be avoided.
Additives to Avoid on the Low FODMAP Diet
Polyols such as sorbitol and mannitol are found naturally in foods such as apples, cherries, pears and apricots.
Polyols are not absorbed well in the gut and consequently stay in the gut and draw water into the gut. This causes distension leading to bloating and/or pain. The polyols then reach the large intestine where they are eagerly devoured by the gut bacteria resulting in the production of gas which also adds to the gut distension.
Sorbitol and other polyols can often be used as food additives. They are useful as a sweetener for foods designed to be low in calories or 'diet products' as give the sweetness without the calories due to the fact that they are poorly absorbed.
Sugar free lollies, and sugar free chewing gum often contain sorbitol. These diet products high in polyols are often accompanied by a warning: 'excessive consumption has a laxative effect' and indeed they do- from the polyols!!
The food additives which need to be avoided or be cautious with as part of the low FODMAP diet are only the the food additives which are actually polyols. Other additives are considered to be suitable for the low FODMAP diet.
Polyol additives can be listed by their name or number or both but most commonly the name is used. The number E in front of the number is not used in Australia, but signifies that the additive has been passed by the European Community.
Sorbitol: 420 or E420
Mannitol: 421 or E421
Isomalt: 953 or E953
Lactitol: 966 or E966
Maltitol: 965 or E965
Xylitol: 967 or E967
These additives need to be specified on the ingredient list of any foods if they have been added. If present in a food that is not a 'diet' product then it may be in small enough amounts which comes under the Monash University low FODMAP diet cut off amount of .2g per serve and less likely to cause an issue.
Watch out for Liquid Medications!
Take care! Medications are different to food in terms of what has to be listed. With foods, all the ingredients need to be listed.
With medications, only active ingredients needs to be listed and not the inactive ingredients. Some medications may include polyols such as sorbitol as an inactive ingredient.
This is especially the case for liquid medications such as cough mixtures, with sorbitol added to provide sweetness to help mask the bitter taste of the medication.
Speak to the pharmacist to help determine if any of the polyol additives form part of the inactive ingredients and see if you can find a polyol free alternative or perhaps look at getting a compounded version without polyols .
When checking food ingredient lists, be aware of any polyol ingredients, with sorbitol being the common one to look out for although others such as mannitol are sometimes used.
If the product is not being sold as a sugar free alternative, and if the polyol is listed towards the end of the ingredient list it may be acceptable.
Be extra mindful with liquid medications such as cough mixtures which are at risk of containing polyol (likely sorbitol).