Another today, even more sick. Both bars contained maltitol. The pain adn bloating today was so severe I nearly went to the hospital—it even hurt to breathe. After throwing up and a few rounds in the bathroom, I feel much better. Never touching that garbage ever again. What about those of us who have no bad reaction to Maltitol? It solves my need for a treat and it has 20 grams of protein, plus CLA and white kidney bean in it. Being a vegetarian, this bar is really handy for me!
Avoid Sugar Alcohols at all costs. They give you diarrhea like none other! Try Agave Nectar or nothing at all! We came across this sugar free chocolate cream pie from walmart last week; bad idea. It made us so sick. She was sick for two days while I suffered for about four days. We decided, okay, no more sugar free pies. Now yesterday we picked up some sugar free chocolate chip cookies.
Again, bad idea. Had some last night, I felt fine, a lil gassy, but my mother felt sick. I decided to try some more today and yeah, the bathroom seems to be my new best friend.
Curious we looked at the ingredients and found malitol and sorbitol and a little description and warning for people with diabetes. Maltitol is plant based. It comes from corn and from wheat. The corn based maltitol is usually harsher on your system than the wheat based maltitol. Most products are made with the corn based but yo can find some products with the wheat based maltitol. However, as with any other food, maltitol effects different people different ways.
Just because fatty patty had some diarrhea after eating 5 pounds of sugar free chocolate, doesnt mean maltitol is bad. Just try some for yourself.
If it doesnt work for you, than move on. I eat chocolate made with maltitol on a frequent basis and have never had an experience like people claim to have on here. Fatty Patty? Your comments are rude and not from personal experience of others. I ate One. I have been sick for 4 hours. Non stop diarrhea and bubble guts. I do eat werthers originals sf and they do nothing to me. Of course one tiny candy c maybe 6 a day. But this Atkins bar is evil evil evil. Glycemic index is totally irrelevant to our line of questioning.
The question is not, how fast does maltitol spike blood sugar. The question is, to what extent should maltitol be considered a carbohydrate. That is the real concern. Glycemic index is a red herring. Glycemic load is the real concern. Shame on you Atkins corporation.
I just spent 8 hours in the emergency room yesterday due to diarrhea so bad it caused bleeding. I have eaten a particular semisweet chocolate with Maltitol for years, but this time it really got to me. I had similar, though not as severe incidents from other brands in the past.
Also I avoid sorbitol. It is a neurotoxin that has caused me permanent or at least 3 years now eye damage. I was so pleased, as I have been searching for something similar for years … without sugar or very little and without any of the sugar substitutes. Not a real great time to have this problem.
Made with maltitol. I came home to research maltitol and see what it is… not sure that I want to go back and buy any.. I may try the chocoperfection bars recommended on here, I found there website just by doing a quick search. But some of you have asked about other sugar substitutes….
It is really good and can be used in everything you would use sugar in baking, drinks, sauces, etc. I have been using it for over a year now. A but pricey, but everything good for you is, right! Good luck! I am sitting here in the worst pain from horrible gas and cramping. Last night I ate Sugar Free Jelly Bellys and like a moron did not pay attention to the warning label that you should only eat 8 at a time. They were so delicious I counsumed 4 times that. Today at lunchtime I doubled over in pain and have been suffering ever since.
I also got total body aches, headache and chills, felt like the flu! Has anyone else experienced this? Now I cant sleeep and I really feel like I was poisoned and my stonmach literally feels bruised from the massive cramps and gas. I am just going to treat myself to a tiny bit of real jelly bellys when I need them. The nutrition facts listed its dietary fiber 1g , the familiar sugar 0g and something I have never seen before, sugar alcohol 23g!
This phony come on verges on the criminal considering how much damage that long run much sugar can do to pre diabetes and diabetes 2 persons.
It could be imminently deadly to unwary diabetes 1 patients. They should package this as an alternative to Ex-Lax. I ate a package of malitol sweetened cherry vines — and I bloated up like a puffer fish, and then went to the bathroom for HOURS.
I was totally dehydrated. Two of my friends told me they had experienced the same thing. Adaptation to xylitol was observed. The general health of the participants in the above-mentioned Turku Sugar Studies [ 4 , 20 ] was reexamined four years following the final xylitol feeding [ 71 , 72 ]. This basal diet formula diet did not contain fiber and thus lacked the water-binding capacity of normal food. The subjects were investigated using versatile clinical, anthropometric, ophthalmological, and metabolic tests.
The xylitol loading tests were not found to result in any abnormal metabolic reactions. As expected, the sudden increase in the level of xylitol consumption from those to which the subjects were accustomed resulted in osmotic diarrhea in some subjects.
These symptoms disappeared in most cases in 3 to 4 days. No significant diarrhea was reported by subjects who consumed normal diet plus xylitol. Four instances of diarrhea in two subjects and six instances of flatus in three subjects were recorded during the basal sucrose diet and normal diet periods without xylitol.
Four of them have continued uninterrupted daily consumption of xylitol over 44 years. Xylitol was incorporated into the diet in the form of chocolate, chewing gum, wafers, crystalline xylitol, meringue candies, yoghurt, and ice cream. Gastrointestinal side effects were recorded daily during the day xylitol consumption, as well as during xylitol-free periods before and after the trial.
During the latter periods of high-level xylitol administration, an obvious adaptation to the substance was observed. With the exception of a few cases of diarrhea only at the start of the xylitol regimen, no other clinical signs indicated treatment-related side effects. This finding was considered remarkable, since the liquid nature of the formula diet consumed is devoid of fiber and hence lacks water-binding capacity and the subjects investigated had not been previously exposed to xylitol.
In the previous xylitol loading test of a similar nature [ 71 , 72 ], subjects were partially adapted to xylitol. For example, in a study carried out by Mellinghoff already in published in , xylitol was used as a substitute for sugar with diabetics.
Only one child withdrew prematurely from the sequence of experiments on account of diarrhea [ 68 ]. Diarrhea-associated data of 11 subjects, who had habitually used xylitol for 3. Four of the subjects had also participated in the above-mentioned xylitol loading test [ 72 ]. The group of 11 included three children who had used xylitol for most of their lives. Their ages at the commencement of the program were 1. Following the termination of the feeding study, that is, during the next 2.
Detailed paper diary and questionnaire performances showed that none of the subjects reported diarrhea during the entire study period the children's data were based on parental monitoring. Absence of gastrointestinal disturbances in the two youngest children was noticeable.
Their average daily frequency of xylitol intake varied from 3 to 7 during their 3. The group of Salminen [ 5 ] studied six healthy volunteers, aged 26—36 years, who were unaccustomed to xylitol. Two subjects experienced transient diarrhea and one complained of flatulence. An important observation was that this xylitol administration had no effect on the concentration of gastric inhibitory polypeptide or insulin in plasma.
After ingestion of xylitol, gastric emptying was markedly prolonged. Xylitol decreased food intake, causing the authors to suggest a role for xylitol as a potentially important agent in dietary control [ 75 ]. Salminen et al. During the entire course of the study, no problems were encountered with regard to the reported frequency of laxation or possibly associated abdominal discomfort [ 76 ].
All subjects experienced dose-dependent diarrhea. Adaptation was observed in most subjects. None of the subjects had abdominal pain or diarrhea during the study [ 54 ].
Lam's group at the University of Washington used xylitol-containing foods in xylitol feeding studies in young children aged 3 to 6 years [ 78 ]. The foods included popsicles, puddings, gum drops, gelatin dessert, cookies, and popcorn.
This experiment was not a loading test but measured children's acceptance of xylitol-based foods; the amount of xylitol presented to the children on a tray of xylitol foods was up to 2. These snack foods were generally well tolerated by children.
In another experiment xylitol-containing milk was well accepted by 4- to 7-year-old children [ 79 ]. In a kindergarten study carried out in South Korea in , 5-year-old children were divided into three groups of equal size. Two of the groups received, in the form of chewing gum, 4. None of the subjects had gastrointestinal problems, as reported by kindergarten personnel and parents. The children regarded the use of chewing gum as a pleasurable experience. These subjects can be regarded as unaccustomed to the polyols tested.
Gastrointestinal complaints, excessive gas, diarrhea, and vomiting were monitored. The noneffective dosage of three sugar alcohols not causing transitory diarrhea was investigated in 27 male and 28 female subjects in a Japanese study [ 82 ].
The noneffective dose level of xylitol was 0. Xylitol chewing gum was given to year-old preschoolers in a Japanese study [ 83 ]. This study was chosen for the present piece to represent another attempt at monitoring the occurrence of gastrointestinal side effects in a regular chewing gum study in young children.
The authors managed to monitor the occurrence of osmotic diarrhea in the children with the aid of parental participation. The required daily consumption of xylitol was planned to amount to 5. Reports are based on comprehensive literature reviews and the scientific opinions of knowledgeable investigators engaged in work in relevant areas of biology and medicine.
Inclusion of lactose in the scientific survey of sugar alcohol research can be regarded as a wise tactical decision. Authorities in various countries have, when necessary, referred to this FDA resolution. New information regarding the absorption and metabolism of xylitol and other sugar alcohols has become available after the publication of the joint FDA-LSRO resolution.
The new information, some of which was detailed in cases 1 — 20 above, has confirmed the historic knowledge [ 84 ] and is in congruence with the FDA-LSRO resolution regarding the occurrence of gastrointestinal effects associated with the consumption of xylitol and other sugar alcohols. By the mids, the advent of erythritol as a dietary sweetener had not yet occurred. Gastrointestinal side effects normally occur after consumption of excessive doses of slowly absorbed carbohydrates such as lactose and sugar alcohols apart from erythritol.
The severity of symptoms depends on the individual consumer, state of fasting, dose consumed, mode of ingestion, molecular characteristics of the test substance, composition and structure of the other food simultaneously consumed, and existence of any prior period of adaptation [ 86 ].
Protection of the consumer from polyol-induced diarrhea can best be achieved by providing appropriate instructions on food label. Children younger than 3 years should not use chewing gum owing to choking hazard.
The absoluteness of the above-mentioned age limit is understandable in view of the composition of SCF and because relatively few studies in infants have been carried out explicitly from the point of view of gastrointestinal polyol effects. Most likely, some of the SCF members lacked personal, long-term in-family experience in the use of xylitol. Long-term field experience obtained especially within Finnish families, kindergartens, and day-care centers strongly points to the role of families and public institutions in teaching children to use xylitol chewing gum properly as part of lunch programs and oral hygiene practices.
Accordingly, a large number of 2- and 3-year-old Finnish children have customarily received xylitol products under parental guidance. Virtually all energy for the uptake of xylitol from the intestinal lumen is offered by the concentration gradient [ 19 ].
If the absorption capacity of xylitol is exceeded, osmotically induced diarrhea may occur. It has been difficult to determine the proportion of orally administered xylitol that is absorbed from the intestinal lumen in each particular set of circumstances. This portion seems to depend, among other things, on whether direct oral intake or consumption in combination with solids is involved.
It has nevertheless been established that even when consumed in the most direct form in solution, a significant portion of xylitol will be absorbed, since the associated metabolic effects can only be interpreted in this way [ 4 , 19 ]. Success in caries prevention by xylitol also relies on general oral hygiene and dietary practices; xylitol may not compensate for serious neglect of oral hygiene.
In case of rampant caries and poor oral hygiene, the doses may be even larger. Naturally, several other precautionary steps must also be taken when planning a xylitol-based caries program [ 1 ]. These safety aspects include gastrointestinal effects of xylitol, such as its slow absorption and potential causing of osmotic diarrhea in situations where recommended upper consumption limits are exceeded by unaccustomed subjects.
Tolerance to xylitol is better when it is consumed as part of regular meals or snacks. Even when consumed in confectionery items, such as pastilles, troches, lozenges, chocolate, and chewing gum, the risk of osmotic diarrhea is not remarkable, since those items are normally used in smaller amounts.
Xylitol present in beverages normally causes diarrhea at lower xylitol levels than when present in solid items this also applies to d -glucitol. Experience from the Turku Sugar Studies [ 4 , 20 ] suggests that it may not be advisable to use xylitol as a sweetener in soft drinks.
Since use of coffee and tea is normally self-restricting, it is possible to use xylitol as a sweetener in coffee and tea without notable gastrointestinal symptoms. Simultaneous consumption of fiber-rich food will lessen the ability of xylitol to cause osmotic diarrhea.
Such fibers include cellulose and xylans a group of so-called hemicelluloses which impute water-holding properties, resulting in considerable bulking of digesta. Cereals, among other plant-derived foods, are rich in xylans. Long-term field experience has shown that even health-conscious consumers may be unable to differentiate between mild gastrointestinal effects occasioned by such common dietary items as legumes, lactose, and d -glucitol, if these are consumed together with xylitol.
Furthermore, several xylitol-containing confectionery items also contain glucose syrups and maltose syrups or polydextrose—popular bulking agents and sugar replacers which are slowly absorbed and may cause similar effects as polyols.
Although polydextrose has been claimed to provide physiological effects similar to those of other fibers and to be better tolerated than most other low digestible carbohydrates such as polyols , excessive consumption of polydextrose can lead to osmotic diarrhea [ 88 ]. Finally, it may always be justifiable to contemplate the possibility that humans may to a certain extent have addled our nutrition by continuous introduction of partly or fully synthetic food ingredients to replace the traditional ones that have constituted our evolutionary environment.
The four-carbon erythritol is a tetritol that shares many of the functional and physicochemical properties of the sugar alcohol family [ 1 , 15 , 89 , 90 ]. Erythritol has gained an increasing number of applications in food manufacturing and in medical and other uses.
Owing to the advent of erythritol as a sweetener in foods, attention was directed at the gastrointestinal reactions associated with erythritol consumption. Following extensive safety evaluations reviewed in [ 15 ] , it has been concluded that erythritol is well tolerated in humans and does not cause any toxicologically relevant effects even following ingestion of larger quantities. No laxation was observed when adults consumed a single bolus of erythritol in a beverage; 0.
No laxation was observed in 4- to 6-year-old children either. These consumption figures indicate the safety of erythritol use, especially when it has been estimated that the exposure to erythritol via oral health-care products such as chewing gums and troches will be very low, that is, approximately 0.
The observation that erythritol at doses of up to 0. The human intestinal microflora does not ferment erythritol [ 94 ]. Erythritol is normally better tolerated than xylitol by humans. A study carried out in nondiabetic adults at the Louisiana Technical University showed, however, that a combination of The authors concluded that coingestion of equimolar concentrations of fructose and erythritol may increase carbohydrate malabsorption; that is, paracellular absorption of erythritol could also enhance paracellular absorption of fructose in healthy adults.
The results of Kim et al. Combinations of erythritol-fructose and erythritol-glucose may also cause untoward effects in dental plaque. Recent studies suggested that erythritol can have utility value in caries prevention [ 97 , 98 ]. In some experimental animals erythritol may also react different. Guinea pigs were given erythritol with or without the addition of pectin. The feces were muddy in all animals with the uptake of erythritol alone, while muddy or very soft feces were not observed in animals fed a mixture of pectin and erythritol.
Various gastrointestinal discomforts have been known to humans for thousands of years. Osmotic diarrhea, catharsis, meteorism, flatulence, and borborygmi borborygmus are terms that frequently appear in this context. Osmotic diarrhea may result from the consumption of too-large doses of dietary sugar alcohols such as xylitol, d -glucitol, d -mannitol, maltitol, lactitol, and isomalt. Also other related substances, such as the GOS and lactose, may cause similar effects. GOS-type substances are normal constituents in the seeds of leguminous plants, such as soya beans and peas.
Sugar alcohols, along with some oligosaccharides, have also received attention in food and nutrition research owing to their prebiotic properties and other health benefits. IBS and functional constipation serve as examples of common gastrointestinal disorders whose treatment may benefit from the application of sugar alcohols and certain GOSs.
Osmotic diarrhea occasioned by excessive consumption of these substances is not a disease, but a simple osmotic response to the presence of slowly absorbed carbohydrates in the gut lumen. The presence of these solutes in the lumen will draw water from surrounding tissues.
The capacity of the common alditols to cause osmotic diarrhea depends on their molar mass, symmetry of the molecule, and, thus, the detailed configuration of the molecule. However, significant variation may occur. Consumption of disaccharide sugar alcohols maltitol, lactitol, and isomalt may also lead to similar gastrointestinal disturbances. Researchers have not always paid attention to study conditions, such as comparing administration of sugar alcohol in plain water versus as part of regular fiber-containing meals or snacks.
For example, tolerance to xylitol present in beverages such as lemonades, fizzes, and still drinks normally causes diarrhea at lower xylitol levels than when present in solid food. Use of xylitol in a beverage apart from as a sweetener in tea of coffee cannot be recommended. Adaptation to tolerate increasing quantities of xylitol has been observed in long-term feeding trials.
The adaptive changes take place in the gut flora and possibly by enzyme induction in the liver. Xylitol, other alditols, and disaccharide sugar alcohols possess undeniable utility value in dietary and medical applications. Therefore, health-care professionals should be aware of restrictions and recommendations regarding their safe and appropriate use. National Center for Biotechnology Information , U. Journal List Int J Dent v. Int J Dent. Published online Oct Kauko K. Author information Article notes Copyright and License information Disclaimer.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
Abstract Sugar alcohols polyols are used in food manufacturing and in medical tests and examinations. Introduction The use of sugar alcohols polyols in the manufacturing of foods, medicines, and oral hygiene products has increased considerably during the past decades. Open in a separate window. Table 2 Maximum bolus doses of some dietary sugar alcohols not causing catharsis. The Pivotal Role of d -Glucitol and d -Mannitol Older literature is cited here on purpose in order to emphasize the existence of gradually growing clinical interest in this area of research.
Main Features of Xylitol Metabolism in Humans Glucose and galactose which are common dietary carbohydrates can be concentrated against a tenfold gradient by an active transport mechanism that assures their early absorption in the intestinal tract [ 6 , 13 , 19 , 20 , 60 , 61 ]. Figure 1. True Loading Tests of Xylitol in Humans: A Historical Perspective Few research papers have reported on gastrointestinal changes during xylitol consumption.
Figure 2. The Positive Erythritol Response The four-carbon erythritol is a tetritol that shares many of the functional and physicochemical properties of the sugar alcohol family [ 1 , 15 , 89 , 90 ]. Conclusions and Instructions Various gastrointestinal discomforts have been known to humans for thousands of years. References 1. Sugar alcohol sweeteners as alternatives to sugar with special consideration of xylitol.
Medical Principles and Practice. Oral care gum products. In: Wilson M. Food Constituents and Oral Health. Oxford, UK: Woodhead; Dubach U. Oral tolerance of Xylit in subjects with normal metabolism. Schweizerische medizinische Wochenschrift. Turku sugar studies VI. The administration of the trial and the control of the dietary regimen.
Acta Odontologica Scandinavica. Salminen S. The effects of xylitol on the secretion of insulin and gastric inhibitory polypeptide in man and rats. Gut microflora interactions with xylitol in the mouse, rat and man. Food and Chemical Toxicology. The tolerance of increasing amounts of dietary xylitol in children. These alternatives will also still help when you need to limit your sugar intake for either weight loss or diabetes. The stevia plant grows in South America. The stevia plant is also a source of fiber and iron.
This is also a sugar alcohol. Agave nectar is considered a natural sweetener, but it can still be processed to some degree. Table sugar contains about 50 percent refined fructose.
Refined fructose consumption is associated with:. Honey, maple syrup, and molasses are also natural sweeteners. They all contain varying amounts of refined fructose. Most of these, including honey, are very similar to sugar, including their calorie content. They should be used primarily for their taste and not to save on calories. Artificial sweeteners are manufactured and usually much sweeter than sugar. However, recent research shows that these sweeteners have an impact on gut bacteria and can indirectly affect insulin sensitivity and blood sugar levels over time.
While some artificial sweeteners contain a warning label that they may negatively affect your health, most health agencies agree that there are not enough studies to support that. Many people are trying to reduce their sugar intake , for reasons such as weight loss and diabetes. Maltitol and other sugar alcohols can be appropriate alternatives.
They can also help you figure out the best amount to consume to help you avoid the unpleasant side effects. It also can be found in gelatin capsules, and so can be an ingredient in many supplements. Although it has half the glycemic index of table sugar, maltitol can raise blood sugar if eaten in large amounts over time. While this artificial sweetener does have some advantages over table sugar, such as a lower caloric value and glycemic index maltitol has a glycemic index of 35, while table sugar has a high glycemic index , it is not completely safe to consume in large amounts.
Consumption is associated with a variety of digestive disturbances. One study compared products containing regular sugar and those containing maltitol.
They found that after eating the products with maltitol, participants in the study reported significantly higher gastrointestinal symptoms like abdominal discomfort, flatulence gas , and bloating.
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