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Sorbitol and xylitol (polyol) intolerances

 

Causes

Sorbitol intolerance

Sorbitol is a sugar alcohol (polyol) commonly used as a sweetener in sugar-free sweets and chewing gum, diet and diabetic foods, amongst other products. It is produced by the human body, occurs in fruit, beer and berries, is also contained in some medicines (e.g. mouth washes, cough syrups and laxatives) and cosmetics. Sorbitol has fewer calories and is less likely to cause dental caries than normal household table sugar, sucrose. Absorption in the small intestine occurs passively and is much slower than other sugars. This allows even moderate doses to be malabsorbed, reaching the colon for fermentation, especially in individuals with a rapid intestinal transit. A high proportion of healthy individuals develop abdominal bloating, gas, cramps and diarrhea at doses of 5 g and above.

Fructose and sorbitol intolerance often co-exist and mutually aggravate intestinal symptoms (see Fructose intolerance). The concurrence of lactose and sorbitol is less clear, although there is some supporting evidence (see Lactose intolerance).

Frequency in population

  • More than 50% of adults experience significant symptoms following ingestion of more than 10 g.
  • Intolerance appears more common in Asians and American blacks than in whites. Overall, 30 to 75% of adults malabsorbed 10g of sorbitol.
  • Present in up to 70% of patients with Irritable Bowel Syndrome

Symptoms

These include bloating, abdominal cramps and pain, diarrhea, increased intestinal sounds and gas production, and nausea. These symptoms resemble those of functional bowel disease. Up to 70% of patients with irritable bowel syndrome are sorbitol intolerant.

Little is known about long term effects of sorbitol intolerance, although severe weight loss has been reported. In diabetics high concentrations of sorbitol secondary to high blood glucose concentrations have been associated with nerve (small nerve fiber neuropathy) as well as eye damage.

Testing and diagnosis

See Tests

Management

Reduction of the intake of sorbitol to individually tolerated levels will rapidly lead to symptom relief in most individuals. Sorbitol is frequently encountered in diet, i.e. low calorie, foods and beverages, in high concentrations in sugar-free chewing gum and sweets / candies, in stone fruit (e.g. sweet cherries, plums) and dried fruit. Liquid medicines may contain sorbitol.

Fructose intolerance should be excluded by appropriate testing, due to the high degree of concurrent intolerance and symptom exacerbation (see Fructose intolerance).

See Food tables for a listing of sorbitol and fructose food content.

Information nuggets

  • Xylitol, another sugar alcohol, can produce similar intolerance symptoms as sorbitol. It is as sweet as sucrose, but with less calories, and has unique antibacterial activity evidenced by protection against dental plaque and caries, ear and upper respiratory infections, and may help control oral Candida infections. It exists naturally in many fruit, mushrooms, vegetables, oats, corn and birch trees. It is used extensively in sugar-free sweets / candies, as well as chewing gum.
  • Mannitol: a sugar alcohol (polyols), is mainly found in mushrooms, pumpkin, seaweed, celery, candies and chewing gum.
  • Sorbitol and fructose intolerance very commonly co-exist and may exacerbate each other (see Fructose intolerance).
  • The dissolving of the polyols produces a cooling sensation on the tongue.

 
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