Risk of Habituation of Chewing Gum & other Sorbitol Containing Food

Risk of Habituation of Chewing Gum & other Sorbitol Containing Food

Sorbitol is a naturally-occurring hexahydric alcohol that is found in various fruits and plants. Because it is sweet-tasting, non-cariogenic (low causing dental caries), and less caloric than sugars, sorbitol is produced commercially and commonly used as a sugar substitute in such dietetic food products as sugar-free candies, breakfast syrups, and cake mixes. Such products are popular among diabetics and others who seek to limit their consumption of sugar.


Certain people are unable to digest lactose, a sugar found in most dairy products, and thus develop severe diarrhea after eating such foods. Some food additives such as nutmeg and sorbitol have also been shown to cause diarrhea in susceptible people. In addition, some foods labeled "sugar-free" — such as sugar-free cookies and chocolates — may contain sweeteners such as sorbitol or mannitol that contain calories and can affect your blood sugar level. Some sugar-free products may also contain flour, which will raise blood sugar levels.

Some foods contain sugars that are absorbed slowly, such as fructose in fruit juice or sorbitol in dietetic confectionery. Through a process called osmosis, these unabsorbed sugars hold onto water in the intestines, sometimes leading to diarrhea. By reading labels, people with chronic non-infectious diarrhea can easily avoid fruit juice, fructose, and sorbitol to see if this eliminates the problem.

All artificial sweeteners don't necessarily offer a free pass for sweets. Such type of reduced-calorie sweetener (commonly used isomalt, maltitol, mannitol, sorbitol and xylitol) often used in sugar-free candies, chewing gum and desserts. Although those sugar alcohols are lower in calories than is sugar, sugar-free foods containing sugar alcohols still have calories.

Your digestive system may not tolerate the artificial sweeteners sorbitol and mannitol found in some sugar-free foods, gums and candies. Many healthy people develop gas and diarrhea when they consume these sweeteners.

Since the term “sugar alcohol” will probably only appear on the food label when a nutrient claim such as “sugar-free” is made, the consumer may indeed be confused when the term “sugar alcohol” also appears on the label. A nationally projectable consumer survey found that 78 percent of those surveyed think the term “sugar alcohol” indicates a product contains some sugar even when the product is labeled “sugar-free.” Sixty-nine percent believe the product contains some alcohol. A petition has been submitted to the FDA to allow use of the term polyols in lieu of sugar alcohols on the food label.

Hartford Hospital and University of Connecticut warned in 1983 at a study that sorbitol causes gastro-intestinal distress in amounts as little as 10g per day. Another study published at the Lancet suggested that sorbitol might be a cause of Irritable Bowel Syndrome for habitual use of sugar-free chewing gum containing sorbitol.

As many as 4 percent of cases of chronic diarrhea are due to medications and food additives; including alcohol and caffeine. Sorbitol (used as a nonabsorbable sweetener in diet foods) and fructose in corn syrup are osmotically active and can cause diarrhea. In a study of volunteers, 48 percent had diarrhea, abdominal pain, and bloating with ingestion of 10 g of sorbitol (equivalent to the ingestion of four to five sugar-free mints).

Medications and food additives are commonly antibiotics, antihypertensive drugs, antiarrhythmic agents, antineoplastic agents, antacids (magnesium-containing), sweeteners (sorbitol, fructose), ethanol, and caffeine. Sorbitol, one of the so-called polyols listed on sugar-free packs and used frequently as a softener and sweetener in confectionery.

Popular sugar-free fruit pastilles, mints and chewing gum contain sorbitol in rather large amounts (42% - 50%) (5,6). This means a single tiny 25g purse-pack of fruit pastilles contains easily enough Sorbitol to cause gastro-intestinal distress and diarrhea and Irritable Bowel Syndrome.

Study found that children who chewed gum that included 60 percent sucrose and 20 percent glucose between meals twice daily had percent greater dental caries incidence than did children who did not chew the gum under study.

Mechanism behind habituation of sorbitol containing sticks of chewing gum:

Sorbitol, however, should be considered a lowcariogenic sweetener rather than a noncariogenic one because consumption of larger amounts (more than two sticks of chewing gum per day) increases both the acid production in
plaque and the number of sorbitol-fermenting microorganisms. Sorbitol in a solution (such as in a soft drink) can be fermented, though slowly, by mutans streptococci.

Cariogenic microorganisms can “learn” to metabolize sorbitol when their sugar supply is restricted. Study suggested that this adaptation could have occurred owing to selection by sorbitol-fermenting bacteria or induction by sorbitol specific metabolizing enzymes. Chewing sorbitol-sweetened gum for about five minutes after receiving a sucrose rinse has been shown to substantially reduce demineralization. Salivary stimulation from sorbitol-sweetened gum also is thought to promote remineralization.

A comperative study between xylitol/ sorbitol gum and only sorbitol gum shown that the combined average of the plaque regrowth scores for the subjects chewing the xylitol/ sorbitol gum was significantly better than that for the sorbitol gum alone. The final trial evaluated two regimens in two forms (stick and pellet) of a xylitol gum versus a sorbitol gum. Both xylitol-containing gum forms were statistically superior to the sorbitol gum in retarding plaque regrowth. This study was recorded at PUB MED.

"Most children experience some stomach cramping, gas and even mild diarrhea after consuming too much juice containing sorbitol, said Dr. Carlos Lifschitz, a pediatric gastroenterologist with the USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine in Houston. According to Lifschitz, the most common sorbitol-containing juices to cause problems in children are apple, pear, peach and cherry.

Many sugar-free chewing gums contain a sweetener called sorbitol. Sorbitol is a laxative which is poorly absorbed by the small intestine. Most recently an article in the British Medical Journal (BMJ) warns of the dangers of excess sorbitol intake.

The warning comes after doctors came across two patients who had chronic diarrhea, abdominal pain and dangerously excessive weight loss. After lengthy investigations which could not identify why the patients were losing so much weight and had chronic diarrhea and pains, a detailed analysis of eating habits put the problem down to eating too much chewing gum with sorbitol.

One of the patients, a 21-year-old woman, had been eating the equivalent of 18-20g of sorbitol each day. The average stick of gum has about 1.25g sorbitol - so, she was chewing through 15-18 sticks of gum each day. The other patient, a 46-year-old man, was chewing about 20 sticks of sorbitol-containing gum plus approximately 200g of sweets (candy) each day - his total sorbitol daily intake was about 30g, the authors wrote.

As soon as sorbitol intake was stopped, both patients started having normal bowel movements (diarrhea subsided) and normal weight gain was achieved.

The authors say consumers are generally unaware of the possible side-effects of sorbitol, even though details are included in the small print of foods containing it. When consumers have gastronomical problems they are unaware that they may be caused by the laxative effects of sorbitol.

The authors conclude that sorbitol consumption may not only cause chronic diarrhea and functional bowel complaints, but also significant unplanned weight loss of about 20% of body weight. Any investigation of unexplained weight loss should include a detailed dietary history with regard to sorbitol-containing foods.

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