Put Down the... Eggs? The Truth about Chocolate and IBS this Easter

What is irritable bowel syndrome?

‍‍Irritable Bowel Syndrome (IBS) is a common gastrointestinal condition that affects an estimate of 1 in 7 people worldwide and is around twice as common in women as it is in men. Typical symptoms of IBS include constipation, diarrhea, pain, or gas.

For a diagnosis, a doctor will check if you’ve experienced recurrent abdominal pain for at least one day per week (over the past three months) plus two or more of the following symptoms:

• Changes in stool frequency

• Changes in stool appearance

• Pain or relief of pain associated with a bowel movement

How does chocolate affect IBS symptoms?

Just as some foods, like coffee or bread, are normally identified as potential IBS triggers, chocolate frequently makes it to the top of the “no-go” list. Many people associate chocolate with symptoms like pain, bloating, gas, and diarrhea.

Chocolate, particularly chocolate high in dairy, such as milk chocolate, can contain many ingredients known to disturb the inner-workings of your gut.

These include:

1. Chocolate sugars and IBS

Sucrose, a combination of two sugar molecules fructose and glucose, is commonly used in sweets like chocolate, particularly milk chocolate. However, this ingredient is commonly associated with the appearance or worsening of IBS symptoms.

As anyone who’s tried the FODMAP diet may know, there is a lot of research available showing that intolerance to poorly absorbed carbohydrates (sugars), such as fructose, lactose, sorbitol, and other sugar alcohols, is a major problem in IBS.‍

However, a 2019 study showed that reducing starch and sucrose in the diets of people with IBS not only reduced gastrointestinal symptoms but also reduced ‘extra-intestinal symptoms’ such as tiredness and sweet cravings. In fact, after four weeks on a starch-and sucrose-reduced diet, almost one-third of the study participants no longer fulfilled the Rome IV criteria for IBS.

If you’re looking to cut down on sugar for the sake of your gut, it’s important to remember that “sugar-free” candies often contain sorbitol or sucralose which is known to trigger gut symptoms in people with IBS (and can even cause digestion problems in people without gastrointestinal issues).

2. Chocolate lactose and IBS

Dairy products, like milk chocolate, contain lactose, a common FODMAP called a disaccharide, that is not well digested by many adults worldwide, even in people with IBS.

It’s believed that after eating milk products, undigested lactose is broken up by gut flora (microorganisms in your gut) into gas and short-chain fatty acids. These byproducts of lactose can lead to IBS symptoms like discomfort/pain, bloating, and/or loose stools.

What’s more, a recent study suggests that lactose intolerance is significantly higher in IBS-D patients than in members of the population without IBS. A lactose deficiency means that your body doesn't produce enough lactase, an enzyme produced in the small intestine, that helps the gut to digest lactose.

Like IBS, lactose intolerance can cause symptoms like diarrhea, stomach cramps, bloating

and gas 30 minutes to 2 hours after eating or drinking something that contains lactose. However, unlike IBS, lactose intolerance may also cause vomiting.

3. Chocolate fats and IBS

While a little bit of fat, in the form of a chocolate bunny or a plate of bacon, might sound delicious, fat is thought to be a major trigger of IBS symptoms. Fat in most forms stimulates colonic contractions. As such, foods that contain high levels of vegetable oils, butter, or other kinds of fat will need to be included in your diet with caution.

Additionally, fatty foods are frequently linked to IBS symptoms in scientific studies. For example, in a 2001 study of 400 people with IBS, 44% attributed fatty foods (like deep-fried goods, pizza, and cream) with the induction of symptoms. IBS symptoms most commonly linked with fatty food consumption and include abdominal pain, bloating, gas, and loose stools.

However, this doesn’t mean that you have to give-up fats altogether. “Good” fats can have a wide variety of health benefits, like helping absorb vitamins and reduce inflammation.

If you really want to indulge in a chocolate treat this year, try and choose chocolate made with heart-healthy monounsaturated fats (found in olive oil, avocados, and cocoa butter!), like this little bunny by Koko Black. Just remember to mind your portions, too!

4. Chocolate caffeine and IBS

Caffeine, like you would find in coffee or tea, is also commonly found in chocolate. The darker the chocolate the more caffeine it usually contains. For instance:

• Dark chocolate contains 43 milligrams of caffeine per 100 grams

• Milk chocolate contains 20 milligrams of caffeine per 100 grams

• White chocolate contains no caffeine (but is very high in lactose and sugar)

To put this into perspective, your average cup of coffee contains around 40 mg of caffeine per 100 grams, so if you prefer to indulge in darker chocolate around Easter, your tummy will be getting a buzz off the caffeine too.

Caffeine stimulates alertness and mental focus but can also have negative impacts on the gut and the digestive system. Caffeine can speed up the movement of our bowels (one study showed coffee can help you evacuate your bowels within 4 minutes of consumption!), increase stomach acid production, and increase your body’s stress response.
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Results from a questionnaire in Sweden suggested that two-thirds of IBS patients drink coffee, and of those, 39% reported worsened gut symptoms after coffee, including diarrhea and stomach pain.

Can I eat chocolate with IBS?

As with any common IBS trigger, it’s important to listen to your body and figure out what works best for you. While several key ingredients in chocolate are known to trigger digestive discomfort, some people may find that smaller portion sizes or dairy-free options might be easier on their gut. And, as with most good things in life, moderation is key!

How much chocolate can I eat in one sitting?

According to Monash University research into FODMAPs, sugars that are not completely digested or absorbed in our intestines, you can still eat small amounts of potentially triggering foods without affecting your gut health. For instance:

• Dark chocolate: 0.5 - 3 ounces (~15 grams -85 grams) of dark chocolate is considered low FODMAP

• Milk chocolate: 0.5 an ounce (~15 grams) is considered low FODMAP

However, while small potions like this are enough to minimize reactions to chocolate FODMAPs, sucrose (monosaccharides), and lactose (disaccharides), you may find that the fat content or the caffeine content is still enough to upset your digestion, particularly if you are very sensitive to these kinds of triggers.

Enjoying a flare-free Easter break

There are many special ways you can celebrate the season that won’t send your symptoms into a flare. Some fun ideas to get into the holiday spirit include:

• Sticking to dark chocolate and small servings

• Painting/decorating eggs

• Planning an Easter egg hunt with small gifts instead of candy

• Making a fresh (low FODMAP) spring fruits platter

• Splurging on a bunch of spring flowers for yourself

• Putting up seasonal decorations

The wrap-up

While Easter may be a time for friends and family, it’s also often a time where you can easily overindulge in chocolate treats. Chocolate contains four main ingredients that can irritate your gut, including sucrose, lactose, caffeine, and fats. To help you avoid a potential flare-up, remember to enjoy chocolate in moderation: stick to small servings and choose dark chocolate options where possible.

References

1. Low FODMAP Diet App | Monash FODMAP - Monash Fodmap. Monashfodmap.com. https://www.monashfodmap.com/ibs-central/i-have-ibs/get-the-app/. Published 2021. Accessed March 26, 2021.

2. Boekema PJ, Samsom M, van Berge Henegouwen GP, Smout AJ. Coffee and gastrointestinal function: facts and fiction. A review. Scand J Gastroenterol Suppl. 1999;230:35-39. doi:10.1080/003655299750025525

3. Rao SS, Kavelock R, Beaty J, Ackerson K, Stumbo P. Effects of fat and carbohydrate meals on colonic motor response. Gut. 2000;46(2):205-211. doi:10.1136/gut.46.2.205

4. Lactose intolerance - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lactose-intolerance/symptoms-causes/syc-20374232. Published 2021. Accessed March 25, 2021.

5. Xiong L, Wang Y, Gong X, Chen M. Prevalence of lactose intolerance in patients with diarrhea-predominant irritable bowel syndrome: data from a tertiary center in southern China. J Health Popul Nutr. 2017;36(1):38. Published 2017 Nov 21. doi:10.1186/s41043-017-0113-1

6. Hayes PA, Fraher MH, Quigley EM. Irritable bowel syndrome: the role of food in pathogenesis and management. Gastroenterol Hepatol (N Y). 2014;10(3):164-174.Barišić V, Kopjar M, Jozinović A, et al. The Chemistry behind Chocolate Production. Molecules. 2019;24(17):3163. Published 2019 Aug 30. doi:10.3390/molecules24173163

7. Bommelaer G, Poynard T, Le Pen C, et al. Prevalence of irritable bowel syndrome (IBS) and variability of diagnostic criteria. Gastroenterol Clin Biol. 2004;28(6-7 Pt 1):554-561. doi:10.1016/s0399-8320(04)95011-7

8. Nilholm C, Roth B, Ohlsson B. A Dietary Intervention with Reduction of Starch and Sucrose Leads to Reduced Gastrointestinal and Extra-Intestinal Symptoms in IBS Patients. Nutrients. 2019;11(7):1662. Published 2019 Jul 20. doi:10.3390/nu11071662

9. Lactose intolerance - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lactose-intolerance/symptoms-causes/syc-20374232. Published 2021. Accessed March 25, 2021.