Sweetener Side Effects: Case Histories

Jan. 10, 2008 -- Consuming sweets and chewing gum with sugar substitutes may help the weight-conscious slash calories, but excessive use of the sweetener sorbitol can cause extreme weight loss and other problems, according to a new report.

In this week's BMJ, Juergen Bauditz, MD, of the University of Berlin, and colleagues describe two patients with a sorbitol habit who had dramatic, unexplained weight loss until their excessive use of the sweetener was discovered.

(Do you include items with sorbitol in your diet? What foods and how often? Tell us about it on WebMD's Type 2 Diabetes Support Group board.)

Sugar-Free Sweeteners and Side Effects: Case Histories

One patient, a 21-year-old woman, had unexplained diarrhea and abdominal pain for eight months. She reported an unintended weight loss of 24 pounds, weighing in at about 90 pounds.

After she was asked about diet, she said she chewed sugar-free gum with sorbitol daily, taking in about 18 to 20 grams a day. One stick typically has 1.25 grams.

Once she eliminated sorbitol from her diet, the gastrointestinal problems stopped and she gained back more than 15 pounds.

The second patient, a 46-year-old man, had been hospitalized because of diarrhea and a weight loss of more than 48 pounds during the previous year. His blood work and other exams came back normal, but when asked about diet, he, too, reported excessive consumption of sorbitol. He chewed 20 sticks of sugar-free gum daily and also ate about 7 ounces of sweets daily, totaling about 30 grams of sorbitol.

When he cut out the sorbitol, he gained back 11 pounds within six months and his diarrhea problems disappeared.

The message for doctors, the authors conclude, is to inquire about dietary habits when a patient has unexplained weight loss.

Sugar-Free Sweeteners and Side Effects: A Food Scientist's View

Reports of side effects such as abdominal pain and diarrhea with high amounts of sorbitol consumption are nothing new, says Roger Clemens, DrPH, a spokesman for the Institute of Food Technologists and professor of pharmacology and pharmaceutical sciences at the University of Southern California, Los Angeles.

"The laxative effect is very well documented," Clemens tells WebMD. "It could be these individuals [in the case histories] were particularly sensitive." And they did consume excessive amounts, he notes. "We would not expect the average consumer to consume upwards of 20 sticks of gum a day."

"Sorbitol is not well absorbed," Clemens says. As a result, excess water enters the gastrointestinal tract and diarrhea can occur. Those who rely on artificially sweetened products to help manage their diabetes or to reduce overall calories, he says, should use a variety of such products and consume them in moderation. Sorbitol is found in toothpastes as well as chewing gum and sweets.