Digestive Disorders > Intolerances > Sorbitol Intolerance

Sorbitol intolerance: All you need to know

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Almost everyone has heard of digestive problems due to lactose or gluten intolerance, yet sorbitol intolerance is far less known. This is despite surveys suggesting around 80 percent of people do not tolerate the sugar substitute well in large quantities.

Sorbitol malabsorption occurs when sorbitol can be partially absorbed or not absorbed at all into the blood in the small intestine. When this causes digestive problems, it’s referred to as sorbitol intolerance. However, sorbitol intolerance rarely occurs alone: A combined fructose-sorbitol intolerance is often the cause.


**Do you have an intolerance? **Try our free online tests for lactose intolerance, gluten intolerance, fructose intolerance, or histamine intolerance.


What are common sorbitol intolerance symptoms?

Sorbitol intolerance symptoms are the same as those of other intolerances (lactose and fructose intolerance, wheat sensitivity). This makes diagnosis purely by recording the symptoms impossible. The typical symptoms of food intolerance are:

  • Diarrhea
  • Flatulence
  • Burping
  • Cramping stomach pain
  • Nausea
  • Fatty stool
  • Bad breath (halitosis)

How can sorbitol intolerance be diagnosed?

If typical gastrointestinal symptoms often occur after eating, a food intolerance test should be carried out by a gastroenterologist. As with testing for fructose or lactose intolerance, the H2 breath test is also carried out if sorbitol intolerance is suspected. A symptom and food diary can also provide information about which foods you cannot tolerate. Tracking can be done easily on your mobile phone using the Cara Care app.


**Did you know...**

Sorbitol is a FODMAP! FODMAPs are a group of food ingredients that people with a sensitive gastrointestinal tract often cannot tolerate.


Which foods contain high amounts of sorbitol (E 420)?

Sorbitol occurs naturally in pome fruit (apples and pears) and stone fruit. However, sorbitol’s versatile properties mean it and its chemical compounds (e.g. sorbitan monostearate) are added to numerous industrially manufactured products. The following table gives you an overview. In particular, diabetic products or foods advertised as sugar-free contain large amounts of sorbitol. Since the total sorbitol content depends on maturation and production methods, the sorbitol content of various foods cannot be clearly stated.

Fruits containing sorbitol Processed foods containing sorbitol
  • Apples
  • Pears
  • Apricots
  • Plumbs
  • Peaches
  • Cherries
  • Dried fruit
  • Sugar-free chewing gum and candies
  • Baked goods, desserts, cake, pastries
  • Ice cream
  • Medication
  • Marmalade
  • Products for diabetics
  • Chocolate
  • Fruit juices
  • “Sugar-free” diet products
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Which foods should I avoid if I can’t tolerate sorbitol?

The foods listed in the table generally contain a higher proportion of sorbitol. You should therefore enjoy them carefully. Unlike with an allergy, certain amounts of the trigger can be handled with an intolerance: It’s the amount that does the harm.

With the help of a food diary, you can find out your individual tolerance limit. Unfortunately, sorbitol is not only hidden in the foods listed. Many processed food products contain the additive. It is therefore important to take a look at the additives list and the E numbers when shopping. Sorbitol is listed as E 420. Sorbitol chemical compounds have their own numbers. In our article on sorbitol, you will find a list of the relevant E numbers.


**Did you know?**

As little as** five grams of sorbitol **can cause digestive problems in some people? That corresponds to four to five “sugar-free” candies!


Which foods can I safely eat if I am sorbitol intolerant?

If you have a sorbitol intolerance, care should be taken to ensure that your diet is low in sorbitol and low in fructose. All processed food products that don’t contain sorbitol as an ingredient are also suitable.

Suitable fruits Other suitable foods
  • Berries: Raspberries, blueberries, blackberries, gooseberries, sea buckthorn, currants
  • Melon: Watermelon, honeydew melon
  • Citrus fruits: Lemon, lime, orange, grapefruit
  • Kiwi
  • Bananas
  • Quince
  • Pineapple
  • Unprocessed meat
  • Fish, eggs
  • Oil
  • Vinegar
  • Salt, pepper
  • Fresh herbs
  • Vegetables such as eggplant, bell pepper, leafy salads, spinach, parsnips, radishes, broccoli, peas, fennel, kale, kohlrabi, Swiss chard, okra, asparagus, onions
  • Grain, rice
  • Potatoes

How are sorbitol intolerance and fructose intolerance related?

Sorbitol and fructose are often found in large quantities in the same foods (dried fruit, stone fruit, pome fruit). Since sorbitol in the intestine inhibits fructose uptake, the symptoms of sorbitol consumption can worsen if there is a fructose intolerance. In addition, the body converts sorbitol to fructose.

But what is bad for people with fructose intolerance is great for diabetics. Since sorbitol is not broken down into glucose, it has no negative impact on blood sugar levels.


**Did you know?**

Because of its water-binding properties, sorbitol has a laxative effect on everyone after a certain amount. With a daily dose of between 20-50 grams of sorbitol, diarrhea occurs.


If I have a sorbitol intolerance can I tolerate other sugar substitutes?

If the sugar substitute is also a sugar alcohol such as sorbitol, they are unfortunately also not well tolerated. These include:

  • E 954: Isomalt
  • E 421: Mannitol
  • E 966: Lactitol
  • E 965: Maltitol and maltitol syrup
  • E 967: Xylitol (may be tolerated in moderation)
  • E 968: Erythritol (may be tolerated in moderation)

However, artificial sweeteners such as aspartame and saccharin are well tolerated if you have a sorbitol intolerance.

Why are more and more people suffering from sorbitol intolerance?

Our eating habits have changed a lot in recent decades. Due to high demands in the working world, there is less time to provide yourself with healthy and fresh food.

Industrially manufactured foods are not only cheap, quick, and easy to prepare – they are also tasty thanks to their high salt and fat content. The food industry achieves longer shelf life and optimizes the texture and taste by adding additives.

Today, sorbitol (E 420) is not just absorbed through its natural sources but it’s contained in all baked goods, low-calorie soft drinks, chewing gum, and many other industrially manufactured products. So the tolerance limit is often exceeded. Transporters in the intestine are too busy and can no longer absorb sorbitol into the blood, and typical digestive problems are the result.

Does sorbitol intolerance come with skin symptoms?

No, sorbitol intolerance does not manifest with skin symptoms. If you have rashes and gastrointestinal symptoms combined, this may be due to a food allergy. You can find out more in our specialist article on food allergies.


Helpful everyday tips:

  • Instead of vinegar, use lemon juice for the dressing.
  • **Bread **that is still moist after days contains sorbitol with a high degree of certainty. It is better to buy fresh bread from the bakery and do without industrial bulk goods!
  • Beer and wine also contain small amounts of sorbitol! If you have a sorbitol intolerance, alcoholic beverages should therefore be avoided.
  • Children's sweets usually do not contain sorbitol.
  • Toothpaste containing sorbitol does not cause any discomfort because it is spit out again.

Ledochowski, M. (2009). Wegweiser Nahrungsmittel-Intoleranzen: wie Sie Ihre Unverträglichkeiten erkennen und gut damit leben. Georg Thieme Verlag. Can be downloaded under this Link.

Rabast, U. (2008). Gibt es noch sinnvolle diätetische Maßnahmen in der Gastroenterologie?. Ernährungsumschau, 9, 540-546. Online: https://www.ernaehrungs-umschau.de/fileadmin/Ernaehrungs-Umschau/pdfs/pdf2008/0908/EU09540546.qxd.pdf

Perets, T.T., Hamouda, D., Layfer, O., Ashorov, O., Boltin, D., Levy, S., Niv, Y. and Dickman, R., 2017. Small Intestinal Bacterial Overgrowth May Increase the Likelihood of Lactose and Sorbitol but not Fructose Intolerance False Positive Diagnosis. Annals of Clinical & Laboratory Science, 47(4), pp.447-451. Online: http://www.annclinlabsci.org/content/47/4/447.short

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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