The widespread use of sweeteners in many foods means that more and more people are finding that some processed products do not agree with them. This is when you start to think about sorbitol intolerance.
Sorbitol, a very useful sweetener for the industry
Before addressing sorbitol intolerance, it is worth knowing what we are referring to. he sorbitol is a type of sugar which is obtained from glucose through a chemical process known as hydrogenation. It is also produced naturally in our body from excess glucose. Finally, it is also found naturally in some foods, especially in fruit.
It is mainly characterized because “it provides sweetness without contributing to the formation of dental cavities. It is a sweetener highly appreciated by the food industry for its ability to retain moisture, which helps maintain the freshness and texture of processed products.. That is why it is such an interesting additive for the cosmetic and pharmaceutical industries as well,” declares Rocío Práxedes, dietitian-nutritionist specialized in clinical nutrition and member of the Spanish Academy of Nutrition and Dietetics.
Malabsorption or intolerance, what difference does it make?
The intolerance food is defined as a adverse response of the body to a specific food or some of its components without the immune system intervening. It can lead to digestive discomfort and intestinal malabsorption, although not all cases of intestinal malabsorption are related to food intolerance.
Práxedes adds that «intolerance can be caused by various causes: toxic, pharmacological, metabolic, digestive, psychological or idiopathic reactions (that is, of unknown origin) to certain foods or to some chemical substance they contain.»
Although diet-related sorbitol intolerance is common, there are other possible causes of sorbitol intolerance or sensitivity that are not directly linked to food intake. In certain Metabolic diseasesSorbitol produced within the body can accumulate in amounts that can cause intolerance symptoms.
Causes and types of sorbitol intolerance
Excess sweets
To know the types of sorbitol intolerance, we must know the causes. The most common is, according to the dietitian-nutritionist, “the excessive consumption of foods sweetened with sorbitol. This excess causes the transport mechanisms involved in the intestinal absorption of carbohydrates to become saturated.”
The intestine’s ability to absorb sorbitol is limited and depends on transporters specific ones that have a maximum transport capacity. “When sorbitol is consumed in quantities that exceed the capacity of these transporters, Not all ingested sorbitol can be absorbed efficiently.causing a laxative effect, gas and abdominal distension.”
If large amounts of fructose are also consumed (for example from sugary drinks) together with sorbitol, both sugars will compete for the same transporter, which can reduce the absorption efficiency of both.
gastrointestinal diseases
Sorbitol intolerance “can also be secondary to a gastrointestinal disease, such as celiac disease, inflammatory bowel disease, or gastroenteritis. These disorders can damage the lining of the small intestinewhich hinders the body’s ability to absorb sorbitol properly,” says Práxedes.
Metabolism alterations
Only in some cases, the origin of intolerance can come from “inborn errors of metabolism.” This disorder affects the genes that code for proteins and are necessary to metabolize the sorbitol that is produced within our body.
Symptoms of sorbitol intolerance.
When sorbitol or other sugars are not completely absorbed in the small intestine, they pass into the large intestine, where “they are fermented by intestinal bacteria. The bacterial fermentation of carbohydrates in the colon produces gases (hydrogen, carbon dioxide and methane),” explains the dietitian-nutritionist.
Rocío Práxedes states that the most common symptoms of sorbitol intolerance are exaggerated, abdominal distension, cramps, gas, abdominal cramps and diarrhea. These are, therefore, very common symptoms common to “other gastrointestinal conditions.” To obtain an accurate diagnosis and an appropriate treatment plan, you must go to the gastroenterologist and proceed with the appropriate diagnostic tests.
How to know if I have sorbitol intolerance
Diagnosing sorbitol intolerance will be key to understanding the causes of the problem and attacking the symptoms. The first thing the specialist team needs to know is the patient’s dietary habits, which is why it is common to request a dietary diary. so that I can point out everything that comes
If sorbitol intolerance is suspected, the digestive specialist will request one of the following tests to confirm the diagnosis: the expired hydrogen test or the blood glucose curve.
Exhaled Hydrogen Test
Also called hydrogen breath test. “It is used to diagnose intolerances to certain sugars. Analyze the presence and amount of hydrogen and methane in the patient’s breath. These gases are produced by intestinal bacteria during the fermentation of unabsorbed sugars in the small intestine and that reach the colon.”
Blood glucose curve test
It is less used because it is less specific and more expensive. It requires several blood draws before and after ingesting sips or fructose. Its use is normally intended for other purposes such as glucose intolerance and other disorders related to glucose metabolism.
How to treat sorbitol intolerance
Treatment for sorbitol intolerance is based on a controlled diet. “The objective is to limit its contribution to concentrations that allow the patient’s symptoms to be reduced,” explains Práxedes.
For this you have to limit, rather than completely eliminate, certain foods:
- Fruits, such as apples, pears, plums, cherries, peaches, and apricots.
- Juices and jams in general Dehydrated fruits, especially all of the above
Fruits provide a variety of beneficial nutrients to the patient, such as vitamins, minerals, fiber and bioactive substances. Hence we always talk about limitation instead of exclusion. That is why it is also suggested to replace these fruits with others with lower levels of sorbitol and, therefore, may be better tolerated. “This is the case of berries such as strawberries, raspberries and blueberries.”
Only in certain genetic disorders, which are very rare, will sorbitol be completely eliminated from the diet.
Which professional treats sorbitol intolerance?
Although it is the doctor who diagnoses the intolerance, the dietitian-nutritionist is the indicated professional to propose the dietary treatment that best suits the personal circumstances of each patient. His job is to identify the foods with sorbitol that the patient usually consumes, evaluate the severity of the symptoms, prioritize the elimination or reduction of those foods with lower nutritional value and monitor the results of nutritional therapy.
Foods to restrict
Although to simplify things, we often talk about prohibited foods for sorbitol intolerance, in reality, as we have seen, it is about restricting their consumption. Prohibiting foods such as fruits and vegetables to a patient with sorbitol intolerance is a measure that is only taken in very extreme cases that have an obvious cost-benefit. In this case, in addition, the dietitian-nutritionist will be in charge of prescribing the necessary supplements to ensure adequate nutritional status during this period.
Some of the measures we can adopt are:
- Check for the possible presence of sorbitol in foods labeled ‘sugar-free’, low-calorie, processed foods, canned and dried fruits, syrups and liquid sweeteners, including gum and candies with sorbitol (E-420)
- Read food ingredients and see if sorbitol is listed as such, or as E-420.
- Avoid consuming juices and jams made from certain fruits (apples, pears, plums, cherries, peaches and apricots), as they have higher concentrations of sorbitol, as do dehydrated products derived from them.
- The most effective indication is base the diet on fresh and minimally processed foods, where you only need to limit the amount of fruits with higher sorbitol content. In many cases, symptoms improve considerably by reducing portion size and/or adjusting the timing of consumption of foods with more fructose and sorbitol.
The ALDI Council
Replacing table sugar with sweeteners, such as saccharin, cyclamate or erythritol, helps reduce caloric intake at the end of the day, but it is not advisable to overdo it. Reduce the dose little by little and you will recover the taste for natural foods.
Rocío Praxedes. CODiNuCoVa Corresponding Member. Diploma in Human Nutrition and CAP Dietetics, diploma in Nutrition in obesity surgery, diploma in nutrition in kidney disease, diploma in clinical nutrition. Intensive courses specialized in obesity and artificial nutritional therapy Currently an official Master’s student in project management and completing an intensive course specialized in nutrition and cancer. Since 2008 she has worked in private practice and since 2010 at Hospital Quirón Valencia. She has been secretary of CODiNuCoVa between 2009 and 2017. And secretary of the General Council of Official Colleges of DN 2013-2016. Between 2008 and 2010 she was secretary of ADDECOVA. INSTAGRAM: rocaopraxedesgomez. FACEBOOK: @rociodiethas. WEB: https://diethas.es/
