Sugar alcohols

[plumbago]

Sabine Hassenfelder is a German science writer who has worked in the US and Sweden, among other places. She posts entertaining, funny videos about science, but recently did one on sugar alcohols, which I think is worth viewing. In it, she talks some about autoimmunity in general, and why symptoms often show up later in life (30s -40s, eg). ("I've probably had this my entire life," she says, but she didn't notice sooner, mostly due to age and food intolerance are mostly a threshold effect. But another part of the reason is that they're used much more so than ever, she says - even toothpaste!) She was having some post prandial digestive issues - cramps, pain, bloating - and went on a detailed search for the culprit. It turns out to have been sugar alcohols. Often called sorbitol or mannitol, it is added to things like soft cookies to keep them from drying out. There are many different sugar alcohols, with many different names, sigh. Intolerance to this food additive is something to consider (possibly) if you are still having symptoms after going gluten free for a number of months. Doctors gave her all manner of diagnoses including diverticula (nope). She cut sugar alcohols out of her diet and she says 95% of her problems disappeared.

"If you have an autoimmune problem, it will flare up along with it" she says. Whoa. She predicts diagnoses of sugar alcohol intolerance will skyrocket in the coming decade.

Sugar alcohols represent the "P" in the FODMAP diet (polyols). They are not technically an artificial sweetener, though they do have a sweet taste, so they do not have to be disclosed on food labels.

Search for her on youtube - it's worth a watch.

[trents]

Erythritol avoids many of the problems associated with other sugar alcohols and is safe unless used in large quantities.

[plumbago]

Yeah, but the point of the video was that sugar alcohols are often hidden. I know little about erythriol, and as far as I can tell, that's not what the video was talking about - ie, two different things?

Editing to add to my reply here...So erythritol is actually a polyol, which is a sugar alcohol, the topic of her video, though she does not specifically mention it in her video. She says that the body never completely breaks down this compound, and intolerance develops due to reaching a threshold. Again, she doesn't specifically mention it, but being a polyol, I would assume she considers it just as potent a future problem as those she does name.

Edited January 21, 2024 by plumbago

[RMJ]

I think sugar alcohols have to be listed on the ingredient portion of a food label.  They do NOT have to be included on the Nutrition Facts portion of the label unless certain claims are made about the food. 

[plumbago]

According to the video @RMJ -- They are not technically artificial sweeteners so they do not have to be disclosed. Labels often just say "less sugar" or "sugar substitute."

I encourage folks to watch it.

[trents]

Not sure what the FDA requirement is but I often see them listed in ingredient labels.

Most sugar alcohols are not broken down well before they reach the colon and therefore can cause a lot of flatus. Erythritol is different in that respect. It is broken down and 90% absorbed before it gets to the colon. The only knock on it that I am aware of is that when used in large quantities it can cause arrythmia. But the quantity required to cause that effect is not likely to be reached unintentionally.

It also needs to be kept in mind that sugar alcohols are naturally found in may fruits and vegetables and some of them have pretty high concentrations of sugar alcohols. Prunes, for instance.

Pears are also high in sugar alcohol.

Edited January 21, 2024 by trents

[plumbago]

4 minutes ago, trents said:

Not sure what the FDA requirement is but I often see them listed in ingredient labels.

They may be listed, but that doesn't mean they are required to be listed. (Again, I encourage people to watch the video)

4 minutes ago, trents said:

It also needs to be kept in mind that sugar alcohols are naturally found in may fruits and vegetables and some of them have pretty high concentrations of sugar alcohols.

So - again, in the video - she says she's 95% better, and that 5% is from the sugar alcohols found in fruits. Her point is that it is now added in more and more things, and we are getting overexposed.

[trents]

So, all the health experts tell us we eat way too much refined sugar and it causes obesity, diabetes and cardiac disease. All true. So, the food industry, in response to that, removed the refined sugar and replaced it with "0" calorie artificial sweeteners, some of which have cancer risk attached to them. So, the food industry responds to that issue and replaces artificial sweeteners with natural "0" calorie natural sweeteners like manitol, xylitol, sorbitol, ect. (i.e., the sugar alcohols). Really, the problem is we are addicted to sweet.

[plumbago]

Very much so. Two things can be true at once - sugar can lead to chronic disease (including cancer BTW), and sugar alcohols (again, technically not an artificial sweetener, according to the video), can lead to intolerance, causing bloating, gas, and pain.

If you ask me, and you didn't, we should be regulating sugar, high fructose corn syrup, and I guess artificial sweeteners and possibly sugar alcohols, as well. But alas, we don't. We just have to clean up the enormous problems they cause on the daily. It's a huge pain. I work in "healthcare."

[RMJ]

I don’t disagree that sugar alcohols can cause digestive problems, or that Americans eat too much sugar/sweeteners.  I just disagree with the labeling (mis)information. 

Maybe it’s different in Germany where the Sabine Hassenfelder is from, but I don’t find anything in FDA laws or regulations exempting sugar alcohols from the ingredient lists of foods. They don’t meet the requirements for an exemption.

Unless health claims about sugar alcohols or sugar are made on the package, where they do not have to be listed is in the nutrition facts total sugars area - which is a bit deceptive.

If mannitol or sorbitol are present at a level where more than 20 grams (mannitol) or 50 grams (sorbitol) is expected to be ingested there has to be a warning: Excess consumption may have a laxative effect.

[plumbago]

Here's what the FDA says - and again, please do watch the video.

Food manufacturers may voluntarily list the amount in grams (g) per serving of sugar alcohols on the Nutrition Facts label (under Total Carbohydrate). They may also list the name of a specific sugar
alcohol if only one is added to the food. But, food manufacturers are required to list sugar alcohols if
a statement is made on the package labeling about the health effects of sugar alcohols or sugars
(when sugar alcohols are present in the food)

https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/assets/InteractiveNFL_SugarAlcohols_October2021.pdf

[plumbago]

Anyway, I feel like maybe the forest is being missed, here, for the trees.

There's a higher percentage of the stuff that's been added to foods, than occurs naturally in fruit. That's one. Two, and this was my main point - if people with celiac disease are still having issues, it is certainly worth considering that it could be these sugar alcohols. I found the video impressive, and can only add for the thousandth time, that I think people should watch it.

[RMJ]

22 minutes ago, plumbago said:

Here's what the FDA says - and again, please do watch the video.

Food manufacturers may voluntarily list the amount in grams (g) per serving of sugar alcohols on the Nutrition Facts label (under Total Carbohydrate). They may also list the name of a specific sugar
alcohol if only one is added to the food. But, food manufacturers are required to list sugar alcohols if
a statement is made on the package labeling about the health effects of sugar alcohols or sugars
(when sugar alcohols are present in the food)

https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/assets/InteractiveNFL_SugarAlcohols_October2021.pdf

That is for the nutrition facts label which is separate from the ingredient list. I tried to make that clear in each of my posts.  I give up.

[knitty kitty]

Great video, @plumbago!  

I agree wholeheartedly that sugar alcohols cause problems!  I avoid them like the plague.  

I've had problems with candies, mints, toothpaste, and lots of gluten free processed foods which contain one sugar alcohol or another.  The consequences just are not worth it!  

Found some interesting articles...

https://www.nih.gov/news-events/nih-research-matters/erythritol-cardiovascular-events

And...Sorbitol malabsorption in normal volunteers and in patients with coeliac disease

https://pubmed.ncbi.nlm.nih.gov/3343011/

And...A Systematic Review of the Effects of Polyols on Gastrointestinal Health and Irritable Bowel Syndrome

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508768/

[Scott Adams]

On 1/20/2024 at 7:15 PM, plumbago said:

Anyway, I feel like maybe the forest is being missed, here, for the trees.

There's a higher percentage of the stuff that's been added to foods, than occurs naturally in fruit. That's one. Two, and this was my main point - if people with celiac disease are still having issues, it is certainly worth considering that it could be these sugar alcohols. I found the video impressive, and can only add for the thousandth time, that I think people should watch it.

I think this is a great topic for a Celiac.com article. I’ve always had issues with, and have avoided sugar alcohols and artificial sweeteners.