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Sorbitol intolerance: definition, symptoms

by Josephine Andrews
Published: Last Updated on 321 views

Sorbitol intolerance is when the absorption of the sugar alcohol sorbitol in the small intestine is disturbed. Among other things, this leads to abdominal pain, flatulence and diarrhea in those affected. Sorbitol intolerance is treated by reducing sorbitol intake through food. Read more about sorbitol intolerance here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

T78

Avoid buying light and sugar-free products as well as diabetic foods as these usually contain sorbitol.

quick overview

  • Symptoms: diarrhea, bloating, abdominal pain, belching and nausea
  • Treatment: No or reduced dietary intake of sorbitol
  • Causes and risk factors: Incomplete utilization of sorbitol in the small intestine
  • Diagnostics: Using a breath test (H2 breath test)
  • Course of the disease and prognosis: Not curable, symptoms can be prevented by changing your diet

What is sorbitol intolerance?

In the case of sorbitol intolerance (sorbitol intolerance, sorbitol malabsorption), the uptake (absorption) of the sugar alcohol sorbitol in the small intestine is impaired.

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

Industrially produced sorbitol may be contained in certain foods as a food additive E420 in any amount. It is found, for example, 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.

Especially so-called “sugar-free” light products 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 diabetic foods. This is because the body uses sorbitol (unlike regular sugar) without insulin . That is, the cells take up sorbitol from the blood without the help of insulin.

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

If you are affected by sorbitol intolerance, it is important to note that sorbitol is also used as a carrier in pharmaceuticals (eg for effervescent tablets) and the cosmetics industry.

Sorbitol intolerance: frequency

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

In addition, people with pure fructose intolerance indirectly cannot tolerate sorbitol either: on the one hand, sorbitol also inhibits the absorption of fructose into the body; on the other hand, the body converts sorbitol into fructose.

What are the symptoms?

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

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

How is sorbitol intolerance treated?

The symptoms of sorbitol intolerance can only be avoided by not consuming any or only as much sorbitol as is personally tolerated. It may be helpful here if, after the diagnosis has been made, you first avoid products containing sorbitol for a while until the symptoms have completely subsided.

Then it is important to slowly test your personal tolerance level for sorbitol by first consuming small and then increasing amounts of foods containing sorbitol (see list below). This tolerance limit often varies quite strongly in the case of sorbitol intolerance.

Food list: sorbitol content of selected foods

The following food list enables people with a sorbitol intolerance to get an overview of the sorbitol content of selected foods.

foods 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 from citrus fruits 9.2
Jam with fructose from stone fruit 9.1
Jam/marmalade with fructose for diabetics 9.1
Jam with fructose from berries 9.0
Prunes, 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
Mixed dried fruit 1.8
Prune/pear compote 1.5
plump 1.4
plum fruit juice 1.3
Pear, canned 1.2
plum compote 1.0
peaches 0.9
grapes, dried 0.9

Anyone who is affected by sorbitol intolerance (sorbitol intolerance) and cannot tolerate even small amounts of the foods mentioned in the list has the option of switching to varieties that contain very little or no sorbitol at all.

These include, for example, banana, orange, tangerine, lemon , pineapple, kiwi, watermelon and cantaloupe. For ready-made products, it is advisable to read the list of ingredients first.

If you suffer 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 bloating and diarrhea.

Causes and risk factors

In the case of sorbitol intolerance, the sorbitol ingested with food is not or only partially utilized in the small intestine. It then travels with the leftover food into the large intestine, where it is metabolized by the bacteria that live there. 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 incorrect. In the case of an allergy, the immune system is directed against the supposed enemy, which is not the case with a sorbitol intolerance.

diagnosis

A sorbitol intolerance is proven by the doctor using a specific test, the so-called H2 breath test: If a sorbitol intolerance is suspected, it is necessary to appear sober for the test. The doctor first determines the hydrogen content of the exhaled air by having the patient blow into a breath test device.

Then the patient gets a sorbitol solution to drink (e.g. 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 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 escapes through the exhaled air after being absorbed by the body .

Sorbitol intolerance: disease course and prognosis

Sorbitol intolerance cannot be cured. However, if you avoid or limit the consumption of foods rich in sorbitol, symptoms can be prevented. 

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