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with Elaine Magee, MPH, RD

Elaine Magee's blog has now been retired. We appreciate all the wisdom and support she has brought to the WebMD community throughout the years. For more information on nutrition and eating well, visit our Real Life Nutrition and Tasty. Easy. Healthy. blogs

Monday, March 1, 2010

The Dirty Little Secret of Sugar-Free Products

“The truth about sugar alcohols and the people who are sensitive to them…”

I know that sounds like the teaser advertisement for an upcoming talk show but the truth is there are a few things you should know before consuming sugar alcohols (often used in sugar-free products) with reckless abandon.

Oh I know all about the side effect of sugar alcohols. I can’t touch them without some intestinal side effects. Several of my friends have recently experienced bad times in the bathroom – and it may have been due to consuming these sugar alcohols.

A Primer on Sugar Alcohols
Sorbitol, and other sugar alcohols can be found naturally in some fruits and plants and they are used as low-calorie sweeteners in various food products because they aren’t easily digested. This group of sugar replacers (which includes sorbitol, xylitol, mannitol, and isomalt, in addition to maltitol) is touted as being particularly helpful to people with diabetes because only a portion of it is digested and absorbed. And the part that is absorbed through the intestinal tract is absorbed slowly, so there is little rise in blood sugar and little need for insulin.

But, the fact that these sugar alternatives aren’t easily digested helps explain why they have been known to produce gas, bloating, cramping and diarrhea in some people. This is thanks to the part of the sugar alcohol that isn’t digested or absorbed. It goes through the intestinal tract and starts to ferment and attract water into the intestinal tract. A certain, individualized amount of discomfort, ranging from gas to diarrhea can result, depending on the amount consumed and each person’s intestinal tract.

Anyone with Irritable Bowel Syndrome (IBS) or other intestinal sensitivities is perhaps most at risk for these not so subtle side effects. That said, what do gastroenterologists have to say about sugar alcohols- are they seeing problems with their patients tolerating them?

A Gastroenterologist Weighs in on Sugar Alcohols
Gastroenterologist and author, Shekhar Challa, MD agrees that these symptoms arise due to sugar alcohol not being absorbed or partially absorbed. He believes the side effects can be worse in patients with IBS, but wanted to clarify that people can have symptoms even if they do not have IBS. Most of the time Dr Challa’s patients don’t know that these sugar alcohols are making their IBS or intestinal symptoms worse.

One theory which is getting more traction is this, around 20% of people with IBS may have SIBO (small intestinal bacterial overgrowth),” explains Dr. Challa. “These patients perhaps have more symptoms as any non absorbable sugars are actually broken down by the small bowel bacteria causing symptoms of IBS…the bacteria essentially “feast” on these sugars.

A Dietitian Weighs in on Sugar Alcohols
I wanted to know if dietitians have found these sugar alcohols (and sugar-free products) to be helpful for their clients with diabetes or those wanting to lose weight. Susan Dopart, MS, RD, a dietitian in private practice and author of A Recipe for Life, has found that most everyone she works with has had the same experience. She doesn’t recommend them to anyone, but especially cautions diabetics who tend to have sensitive systems in general. One sugar free chocolate may be okay, she explains, but more than that leads to severe stomach cramping and crisis in the bathroom.

I can speak from personal experience that cramping commences about an hour or two after consuming a dose of sugar alcohols, apparently due to gas that is forming in the intestines. So for some of us, along with the uncomfortable cramping, smelly gas is also likely to ensue.

The American Dietetic Association advises that more than 50 grams of sorbitol or 20 grams of mannitol per day can cause diarrhea. You can see the total amount of sugar alcohol in a serving of each sugar-free product by reading the nutrition information label. For example, the Dove Mint Crème product has 17 grams of “sugar alcohols” per 5 pieces or 40 grams of chocolate.

You’ll find sugar alcohols in sugar-free chocolates and other sugar-free confections, including gum and mints, and some lower calorie frozen desserts. They are popping up though in all sorts of reduced calorie products, so check that label if you think you are sensitive to them!

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Posted by: Elaine Magee, RD at 7:00 am

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