Sorbitol intolerance perhaps

[Emaych61]

Anyone on here been found to have this via testing, and if so, can I ask where you managed to find a place that tested for it? Thus far I’ve been checked - by means of hydrogen breath testing - for SIBO, lactose intolerance and fructose intolerance, all of which have come back fine, but the hospital I went to for them does not test for for sorbitol intolerance. Coeliac disease has also been ruled out (by blood test). I have (or rather - had) a lifelong history of a tendency towards constipation (under consultant led care for it as a child) which, now that I’m in my 60s, has suddenly gone to a tendency towards loose bowel motions which at times verges on diarrhoea. All tests thus far have failed to find a cause (including a colonoscopy). I’ve been told that I’m not unique; the consultant I’m seeing for it has encountered other cases, but that’s of small consolation. I have found a way to help control it - it’s amazing what a banana on the edge of being unripe (so still showing some green) can do: such bananas used to bung me up completely, now they’re giving me some sort of normality - well, for some of the time, though for best results one needs to be eaten after supper in the early evening. I also know that certain fruits will cause an issue, and eating raspberries (a fruit which is usually safe) after a vegetarian meal is likely to result in problems but not immediately - they start several (usually between 12 and 24) hours later. But the “why” is still proving elusive. Sorbitol intolerance is the one thing that hasn’t been tested for.

Any thoughts anyone?

[Fybogellover]

no but soritol is in listerine mouthwash!

[Emaych61 in reply to Fybogellover]

I don’t use the stuff.

Sorbitol is naturally present in a number of foods (fruits and vegetables) as well as being used in many convenience foods and commercially available baked goods. We tend to prepare our food from fresh ingredients though so it’s really only the fruit and vegetables which contain it that are likely to cause a problem if that’s what is causing the issue.

[Fybogellover in reply to Emaych61]

The amount of illegal pesticides being intercepted is on the rise, we don’t know what we’re eating really, hope you find out, best of luck Ireland

[xjrs]

The best way to find out about specific food intolerances is by FODMAP elimination and reintrodution i.e. try out 1/3 of portion size of a small amount of sorbitol containing food on day 1, increase by 1/3 on day 2, another 1/3 on day 3 and record symptoms each day and up to 4 days after.

High sorbitol containing foods here:

ibsresearcher.com/constipat...

However, some of these foods may also contain other FODMAPs. You can download the Monash University FODMAP app to find all the FODMAPs in these foods.

More on food sensitivities and elimination & reintroduction here:

ibsresearcher.com/microbiom...

ibsresearcher.com/fodmap-el...

If you want to do full FODMAP elimination and reintroduction, this is best done under the guidance of a dieitian from a GP referral. However, I'd always recommend trying Alflorex probiotic, which has been studied for IBS on a 3 month trial first, since it can increase food tolerance and you want to eat as many FODMAPs as you can since they are good for your overall gut health as they feed good bacteria in the gut. Alforex may also help control any bad bugs that may be causing your symptoms, hopefully helping them to calm down. My symptoms have been far better since being on Alflorex, although I still have some remaining food intolerances, it is not as many as before. Although everything is trial and error with IBS and it may not work in all cases depending on the root cause of your IBS (which is still all under research).

[tomdickharry]

No idea on testing, but I do not take many fruits or cakes. Fruits often contain salicylates, to which I have a reaction. Most shop-bought cakes and pastries have sorbates, sorbitol, mannitol, xylitol or similar, all known culprits for diarrhoea.

[Emaych61 in reply to tomdickharry]

Most of our food (including cakes/biscuits - a very occasional treat - and puddings once a week on Sunday) are cooked at home. That includes bread.

[jbrking]

Too may artificial sweeteners can cause diarrhoea. Have you been tested for bile acid diarrhoea? I’ve had lots of bloods, stools and a colonoscopy, all showed nothing. Had a sehcat scan which confirmed it. Lots of food triggers. Bile is released to digest food, some foods need more bile like fat, leaves, skins, seeds. Too much bile then reaches the colon and because it shouldn’t be there and the body thinks it’s poison, it will flush it out, hence the diarrhoea. I take a prescribed medication called colesevelam. Its original use is for reducing cholesterol but is also prescribed for people with this condition as it helps bind the excess bile so you can pass it in a stool. Have a look at bad-uk.org website. I suffered for many years being told it’s IBS and finally got referred to Gastro who did the tests.

[Emaych61 in reply to jbrking]

I’ve not heard of bile acid diarrhoea before. One to ask the cons when I next see him.

[so_blue in reply to Emaych61]

I haven't had a formal diagnosis or a sehcat scan, but a registrar prescribed me colestyramine light at a low dose as a sort of test for bile acid diarrhoea.

I only started having issues with diarrhoea regularly about three years ago and a GP initially suggested it could be IBS-D, but it didn't seem to be that to me. It took until late last year for me to be referred to a department of the hospital that seemed to have better answers, after testing negative for coeliacs (for the third time in my life, as I've also struggled with B12 anaemia/deficiency due to being vegetarian since 1993), a colonoscopy, etc. (To be fair, a newer GP and the registrar both agreed with me that it didn't seem to be IBS).

I've been aware of having a low tolerance to sorbitol for a long time (I discovered the warning on packets of Extra chewing gum were accurate when I was in my teens and chewed a whole packet (7 sticks) in a day. And I can drink large volumes of apple cider, but I can't safely drink more than 1-2 pints of pear cider or perry without catastrophic results), but nothing else used to set me off.

Even though I'm only having one sachet a day of colestyramine light (the average dosage is 3-6 sachets, I think), it seems to have settled things for me to the point that I'm hoping to eat normally on a trip away next week (usually I don't eat until the evening when I have to go out any distance from home, and I try to eat early enough in the evening that I have a movement in the morning before I leave for a day of sightseeing. That's been the only way I can avoid panic attacks).

Colestyramine light can cause some people to become constipated, but at the low dose I'm on, it seems to have returned me to where I used to be, so I haven't asked for my prescription to be increased.

Alongside taking the cholestyramine, I've also cut back my alcohol intake, swapping some of my ciders for low or no alcohol versions, so it could be a combination of the two things (bile acid diarrhoea can be triggered by drinking habits) that has settled things for me.

As a bonus, my cholesterol was ever so slightly high, and the two actions (the medication and reducing my alcohol intake) have helped that too. I was tested after about a month on the medication and my cholesterol was down to the top edge of the acceptable range.

It's definitely worth speaking to your consultant about BAD, in case that's the cause.

And, just to clarify and ensure I don't cause offence, I've only shared regarding the alcohol triggering BAD because that would be likely to be what triggered mine. Obviously, I have no idea of your drinking habits!

Good luck!

[RickyW]

I thought Sorbitol was a pretty well known trigger. I try and avoid it as much as possible!

[Emaych61 in reply to RickyW]

The problem is I was absolutely fine with it in moderation (that is in naturally occurring sorbitol and maybe the occasional biscuit) until twenty months ago and then suddenly, even though my diet didn’t change, my bowel habit did, virtually going from one extreme to the other for no apparent reason.