Sorbitol intolerance

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

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In the case of sorbitol intolerance, the sugar alcohol sorbitol (sorbitol) cannot or only partially be used in the small intestine. Instead, bacteria in the colon metabolize it. This can cause stomach pain, gas, and diarrhea. Read more about sorbitol intolerance here: What is sorbitol? Where is it in? What happens in the body if I am intolerant to sorbitol? What can those affected do about the symptoms?

Avoid buying light and sugar-free products, as well as food for diabetics, as these mostly contain sorbitol.

Dr. med. Mira Seidel

Sorbitol intolerance: description

In the case of sorbitol intolerance (sorbitol intolerance, sorbitol malabsorption), the absorption (absorption) of the sugar alcohol sorbitol in the small intestine is impaired, so that it is metabolized by bacteria in the large intestine. This can lead to unpleasant digestive problems.

Where is sorbitol contained?

Sorbitol is a so-called sugar alcohol - a sweet-tasting carbohydrate that occurs naturally mainly in fruits (apricots, plums, apples, pears, etc.) and in concentrated form in dried fruit.

Sorbitol is also produced industrially and can be added to certain foods as a food additive E420 in any amount. It can be found as a sugar substitute or as a humectant in products such as mustard, mayonnaise, ketchup, salad dressing, toast, biscuits, cakes, muesli, muffins, candies, chewing gum, chocolate and praline fillings.

So-called “sugar-free” light products in particular often contain sorbitol. Because compared to normal sugar, sorbitol has a lower sweetening power and a lower calorie content.

Another product group that very often contains sorbitol is food for diabetics. The reason for this is that the body can use sorbitol (as opposed to normal sugar) even without insulin. This means that the cells can absorb sorbitol from the blood even without the help of insulin.

Because sorbitol also does not cause tooth decay and has a slightly cooling effect on the tongue, it can also be found in many toothpastes and dental care chewing gums.

In addition, sorbitol is used as a carrier in the pharmaceutical industry (e.g. for effervescent tablets) and the cosmetics industry.

Sorbitol intolerance: frequency

So far there are no reliable figures on how many people in the population are intolerant to sorbitol. It is known, however, that sorbitol intolerance often occurs in combination with fructose intolerance (fructose intolerance) and / or lactose intolerance (milk sugar intolerance).

In addition, people with a pure fructose intolerance do not indirectly tolerate sorbitol: On the one hand, sorbitol also inhibits the absorption of fructose into the body; on the other hand, sorbitol is converted into fructose in the body.

Sorbitol intolerance: symptoms

Above a certain amount (20 to 50 grams per day) sorbitol is intolerable for everyone because the absorption capacity for the sugar alcohol in the small intestine is limited. This amount of consumption leads to diarrhea. Especially people with a sorbitol intolerance have symptoms such as flatulence, abdominal pain, belching and nausea even with lower doses.

From what consumption level such symptoms of sorbitol intolerance appear in individual cases varies. For example, some people react with symptoms of intolerance from 15 grams of sorbitol per day, while others react from five grams per day.

Sorbitol intolerance: causes and risk factors

In the case of sorbitol intolerance, the sorbitol ingested with food cannot be used in the small intestine, or only incompletely. It then reaches the large intestine with the leftover food, where it is metabolized by the bacteria that live here. This creates gases and waste products that lead to digestive problems.

It is unclear exactly how the utilization disorder occurs. In any case, it is not an allergic reaction - the colloquial term sorbitol allergy is therefore wrong. In the case of an allergy, the immune system becomes active against the supposed enemy, which is not the case with sorbitol intolerance.

Sorbitol intolerance: examinations and diagnosis

Sorbitol intolerance can be demonstrated using an H2 breath test:

The patient must appear sober for the test. First, the hydrogen content of the exhaled is determined by the patient blowing into a breath test device. Then he has to drink a sorbitol solution (for example five grams of sorbitol dissolved in 200 milliliters of water). The hydrogen concentration in the exhaled air is then measured several times at certain time intervals.

In the case of sorbitol intolerance, this concentration increases significantly (compared to the fasting value): when the bacteria metabolize the undigested sorbitol in the large intestine, a lot of hydrogen is produced, which is released via the exhaled air after it has been absorbed into the body.

Sorbitol intolerance: treatment

The symptoms of sorbitol intolerance can only be avoided by not consuming any or only as much sorbitol as one can personally tolerate. It can be helpful to refrain from using sorbitol-containing products for some time after the diagnosis has been made, until the symptoms have completely subsided.Then it is important to slowly test your personal tolerance limit for sorbitol by first consuming small and then increasing amounts of sorbitol-containing foods (see list below). This tolerance limit often varies considerably in the case of sorbitol intolerance.

Food list: sorbitol content of selected foods

Food	Sorbitol content in grams per 100 grams of food
Diabetic sugar	99
Diabetic sweets	90,0
Diabetic spreads	27,3
Pear, dried	10,5
Jam with fructose made from citrus fruits	9,2
Jam with fruit sugar made from stone fruit	9,1
Jam / jam with fructose for diabetics	9,1
Fruit sugar jam made from soft fruit	9,0
Plums, dried	7,8
Plum jam	6,0
Peach, dried	5,4
Jam with sugar substitute and sweetener made from berries	5,3
Apricots, dried	4,7
Apple, peeled, dried	3,2
Apple, dried	2,8
pear	2,2
Pear fear juice	2,0
Dried fruits, mixed	1,8
Prune / pear compote	1,5
Plums	1,4
Plum fruit juice	1,3
Pear, canned food	1,2
Plum compote	1,0
Peaches	0,9
Grapes, dried	0,9

Those who cannot tolerate the foods mentioned in the list, even in small quantities, can switch to varieties that contain very little or no sorbitol. These include, for example, banana, orange, tangerine, lemon, pineapple, kiwi, watermelon and sugar melon. In the case of finished products, you should always read the list of ingredients first.

By the way: If you suffer from sorbitol intolerance, you should avoid products that contain other sugar substitutes such as mannitol, isomaltitol, maltitol and lactitol. They can also cause gas and diarrhea.