Brief overview
- Symptoms: Diarrhea, bloating, abdominal pain, belching and nausea.
- Treatment: No or reduced intake of sorbitol in the diet
- Causes and risk factors: Incomplete utilization of sorbitol in the small intestine
- Investigation and diagnosis: By breath test (H2 breath test)
- Course of disease and prognosis: Not curable, symptoms can be prevented by dietary changes
What is sorbitol intolerance?
In sorbitol intolerance (sorbitol malabsorption), the absorption of the sugar alcohol sorbitol in the small intestine is impaired.
Naturally occurring sorbitol
Sorbitol is a so-called sugar alcohol – a sweet-tasting carbohydrate that occurs naturally mainly in fruits (peaches, plums, apples, pears) and concentrated in dried fruits.
Industrially produced sorbitol
So-called “sugar-free” light products in particular often contain sorbitol. This is because sorbitol has a lower sweetening power and calorie content than normal sugar.
Another product group that very often contains sorbitol is diabetic foods. The reason for this is that the body utilizes sorbitol (unlike normal sugar) even without insulin. This means that the cells absorb sorbitol from the blood without the help of insulin.
Because sorbitol also does not cause tooth decay and has a slightly cooling effect on the tongue, it is found in many toothpastes and dental chewing gums.
If you are affected by sorbitol intolerance or sorbitol intolerance, it is important to note that sorbitol is also used as a carrier in the pharmaceutical industry, for example for (effervescent) tablets, and in the cosmetics industry.
Sorbitol intolerance: frequency
In addition, people with pure fructose intolerance indirectly do not tolerate sorbitol: on the one hand, sorbitol additionally inhibits the absorption of fructose into the body; on the other hand, the body converts sorbitol into fructose.
Sorbitol intolerance: symptoms
Typical symptoms of sorbitol intolerance are diarrhea, flatulence, abdominal pain, nausea and belching. The amount of food consumed that causes symptoms varies from case to case. Some people, for example, react with symptoms of intolerance from 15 grams of sorbitol per day, while others experience symptoms from as little as five grams per day.
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. At this level of consumption, diarrhea usually occurs. However, people with sorbitol intolerance in particular experience discomfort even at lower doses.
Sorbitol intolerance: treatment
Then it is important to slowly test the personal tolerance limit of sorbitol by first eating small and then increasing amounts of sorbitol-containing foods (see list below). This tolerance limit often varies greatly with sorbitol intolerance.
Sorbitol content of selected foods
The following food list allows people with sorbitol intolerance to estimate the sorbitol content of selected foods.
|
Food |
Average sorbitol content in g/100g foodstuffs |
|
Diabetic sugar |
99 |
|
Diabetic candy |
90 |
|
Diabetic spreads |
27,3 |
|
Pear, dried |
10,5 |
|
Jam with fructose from citrus fruits |
9,2 |
|
Jam with fructose from stone fruit |
9,1 |
|
Jam/jam with fructose for diabetics |
9,1 |
|
Jam with fructose from soft fruits |
9 |
|
Plums, dried |
7,8 |
|
Plum jam |
6 |
|
Peach, dried |
5,4 |
|
Jam with sugar substitute and sweetener from soft fruits |
5,3 |
|
Apricots, dried |
4,7 |
|
Apple, peeled, dried |
3,2 |
|
Apple, dried |
2,8 |
|
2,2 |
|
|
Pear fruit juice |
2 |
|
Dried fruit, mixed |
1,8 |
|
Dried plum/pear compote |
1,5 |
|
Plums |
1,4 |
|
Plum fruit juice |
1,3 |
|
Pear, canned |
1,2 |
|
Plum compote |
1 |
|
Peaches |
0,9 |
|
Grapes, dried |
0,9 |
Those who are affected by sorbitol intolerance and cannot tolerate the foods on the list, even in small quantities, have the option of switching to varieties that contain very little or no sorbitol.
These include, for example, banana, orange, tangerine, lemon, pineapple, kiwi, watermelon and sugar melon. With ready-made products, it is advisable to read through the list of ingredients first.
If one suffers from sorbitol intolerance, it is advisable to also avoid products that contain other sugar substitutes such as mannitol, isomaltitol, maltitol and lactitol. They may also cause flatulence and diarrhea.
Sorbitol intolerance: causes and risk factors
It is unclear exactly how the utilization disorder occurs. In any case, it is not an allergic reaction – the colloquially used term “sorbitol allergy” is therefore incorrect. In an allergy, the immune system is directed against the supposed enemy, which is not the case with sorbitol intolerance.
Sorbitol intolerance: examinations and diagnosis
The doctor detects a sorbitol intolerance by means of a specific test, the so-called H2 breath test: If sorbitol tolerance is suspected, it is necessary to appear for the test on an empty stomach. Now the doctor first determines the hydrogen content of the exhaled air by having the patient blow into a breath test device.
Then the patient is given a sorbitol solution to drink (for example, five grams of sorbitol dissolved in 200 milliliters of water). The doctor then measures the hydrogen concentration in the exhaled air several times at specific intervals.
Sorbitol intolerance: course of the disease and prognosis.
Sorbitol intolerance is not curable. However, avoiding or limiting the consumption of sorbitol-rich foods can prevent symptoms.