I’ve been noticing a trend in my practice… Seemingly erratic minor digestive ‘hickups’ that have nothing to do with food allergies or even sensitivities. They don’t seem to be tied to the ingestion of the usual suspects, like gluten or dairy. And although symptoms may be traced to eating a certain food on some days, on other days one may be able to tolerate the same foods without any issues. This seems to be happening more in middle-aged individuals. What is going on? The answer MAY lie in a collection of hard-to-digest carbohydrates called FODMAPs (an article on those will follow). The sneakiest of them all, and a frequent offender, is sorbitol.
What is sorbitol?
Sorbitol is a so-called sugar alcohol (even though it does not contain any alcohol). It naturally occurs in some fruit – although in small quantities. The food industry uses it as a bulk sweetener and sugar substitute in sugar free gum and candy, as well as a moistening agent in baked goods. Sorbitol is lower in calories than sugar, and is therefore a preferred sweetener for cough syrups, drugs and dental hygiene products. It is very likely that you consume sorbitol somewhat regularly.
What is the problem with sorbitol?
On the upside, sugar alcohols (also called polyols) are metabolized more slowly than sugar and do not cause spikes in blood sugar, which can be beneficial for diabetics. They also have fewer calories per gram than household sugar. However, do not get overexcited about sugar alcohols quite yet: when eaten or drank in large quantities, polyol-containing products have been linked to weight gain.
Unfortunately, polyols such as sorbitol, but also xylitol, mannitol, maltitol or erythriol, are not absorbed well by the small intestine. Consumed in excessive amounts – maybe even combined with fructose – they can have a laxative effect even on healthy individuals. For people with a compromised digestive tract, the symptoms triggered by even small amounts of sorbitol can range from merely unpleasant to limiting one’s ability to function in daily life.
How can I tell if I react negatively to sorbitol?
The two recommended diagnostic tools for sorbitol intolerance are
a) Keeping a diligent food journal in order to identify triggers of gastrointestinal symptoms
b) Having a breath test done, which measures the symptoms and the concentration of certain gases in your breath after you have drank some sorbitol dissolved in water. Make sure you do this under the counsel of a qualified physician or nutritionist.
What if I have been diagnosed with sorbitol intolerance?
Get into the habit of reading food labels, to make sure you consume real food with minimal additives and processing. Sadly, sometimes those labels can be tough to interpret. For instance, sorbitol is not always labeled as such. In Europe it frequently hides behind the E-number E-420 or the sorbitol-containing E432, E433, E434, E435 and E436. In the United States, the brand names Ora-Sweet SF, PCCA Sweet-SF, PCCA Syrup Vehicle, PCCA-Plus or Numoisyn are synonyms for the sugar-alcohol.
As mentioned, sorbitol occurs naturally in some fruits. All types of stone fruit, such as apples, pears, apricots, plums, dates and peaches, as well as grapes, contain significant amounts of sorbitol – even more so when they are dried. Beware of mixed fruit juices and store-bought smoothies, too, as they may be apple-juice based. However, berries, citrus fruit and exotic fruit are generally safe.
If your have a diagnosed intolerance, it is wise to forgo commercially produced cookies, cakes, pastries and sugar free products (which is a great idea for your health, anyways). Making your own treats instead is a fun and delicious alternative!
Finally, people with a diagnosed sorbitol intolerance may want to limit their intake of wine and beer. Also, carefully read labels of mouthwashes, toothpastes and cough syrups.
Any other tips?
Many individuals suffering from sorbitol intolerance may also be sensitive to larger amounts of fructose. If symptoms persist, try limiting the intake of high-fructose foods such as honey, jams, jellies, canned fruit, and anything with high fructose corn syrup in it.
Not ready to cut stone fruit out of your diet entirely? You may find that you can tolerate small amounts, such as one apple slice or a small plum. Be careful, though, as individual tolerable servings may add up over the course of a day or week and trigger symptoms.
Make sure to check the ingredient lists of your supplements and medications. Pills, syrups and even vaccinations may contain sorbitol – and cause adverse reactions.
Last but not least, work on your gut integrity and on a healthy digestive system. In time, this may improve your tolerance of sorbitol dramatically. I know it has for me.
References available upon request.