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Where FODMAPs Hide: Sorbitol

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Where do FODMAPs hide?

FODMAPs can be tricky because they're found in common foods that can be good for our health, like fruits, vegetables, grains, nuts, and seeds. FODMAPs can also be hiding in products like granola bars, yogurt, tortillas, and candy. Even supplements and medications may contain FODMAPs! Our new series, “Where FODMAPs Hide” will break down each of the individual FODMAPs and focus on where you can find them. First up, sorbitol.

 

Before we jump into sorbitol, what are FODMAPs?

Though you’ve likely heard of FODMAPs and how they impact your health if you've found your way here, let's review a short breakdown, just in case it's a new concept for you... 

FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. FODMAPs are fermentable carbohydrates that are not completely digested in our intestines. FODMAPs aren't inherently bad, but they might cause uncomfortable digestive issues like gas, bloating, abdominal distention or pain, diarrhea, and/or constipation, especially in people who have Irritable Bowel Syndrome (IBS). Find out more about FODMAPs here.

 

What is Sorbitol?

Sorbitol falls under the “P” in FODMAP, as a polyol, or sugar alcohol. It’s most commonly referred to as sorbitol, but you may also see it listed on a food label as glucitol or D-glucitol. Like other sugar alcohols, sorbitol is slowly absorbed in the small intestine and then malabsorbs once it reaches the colon. It has an osmotic laxative effect which means that it will pull water into the colon. Bacteria ferment it in the colon, which can then cause gas. Side effects for some people can include bloating, gas, abdominal pain, and altered bowel habits. 

 

Where can it be found?

Sorbitol is naturally occurring in some fruits and vegetables, but it is also artificially produced for some products. It is calorie-free and has 60% of the sweetness of white sugar (aka table sugar). Foods that naturally contain sorbitol are stone fruits (i.e. peaches, plums, apricots, nectarines, and cherries), avocado, blackberries, coconut, prunes, bok choy, green bell peppers, sweet corn, eggplant, and turnips. Some fruits and vegetables, like apples and pears, contain sorbitol plus another FODMAP type (ex: sorbitol and fructose). You’ll find this sugar alcohol added as an artificial sweetener in some products that are labeled “sugar-free” or “diet”. Examples of these products include soft drinks, ice cream, candy, or chewing gum. 

Not everyone needs to avoid sorbitol. It may even be beneficial for some IBS sufferers who are not affected by side effects like bloating, gas, or distention, as it aids in constipation and can be found in many nutritious foods. If you are sensitive to sorbitol, it can be easy to avoid the whole food products that contain them, like certain fruits and vegetables to confirm your sensitivity level. However, it can be much harder to avoid the hidden sources of sorbitol! The following are products and/or ingredients that contain sorbitol and that you should look out for:

 

Flour:

  • Coconut flour: This contains sorbitol and is frequently used in products that are labeled “gluten-free” or marketed as Paleo. Examples of products that may contain coconut flour include pancake mix, protein and/or energy bars, crackers, cookies, or baking mixes.

Beverages: 

  • Coconut milk: Coconut milk contains sorbitol and may be found in non-dairy milk blends, yogurts, or cheese.
  • Coconut water: This contains sorbitol and is sometimes found in non-dairy drink mixes or smoothies.
  • Aloe juice: Also containing high sorbitol, aloe juice is often marketed for hydration or used as a smoothie mix-in.
  • Apple juice: This, along with pear juice concentrate, contains sorbitol and is often used as a sweetener in products. Examples include bread, energy bars, pre-made smoothies, juices, candy, or cereal. 

Flavorings: 

  • Wasabi paste: While wasabi powder is sorbitol free, wasabi paste contains sorbitol and may be used to flavor nuts, crackers, or your favorite sushi.

Medications and supplements:

  • Sorbitol is often found in liquid medications, gummy vitamins, or fiber supplements. Remember to check labels to see if they contain sorbitol, glucitol, or D-glucitol.
  • Sodium polystyrene sulfonate (used to treat hyperkalemia in those with kidney disease) is often paired with sorbitol because of the laxative effect. However, recent studies have shown some adverse effects. Talk with your healthcare provider if you’re concerned. 


Should I avoid it? Where do I start?

Curious to know if you should be avoiding sorbitol? Talk with your healthcare provider to see if doing a trial elimination of sorbitol may be the right option for you. There are a couple of different ways you could eliminate it. The first is by completing all three phases of the Low FODMAP diet: elimination, reintroduction, and personalization. A second option that may be less restrictive, is just eliminating foods/products that contain sorbitol. Both options require you to add sorbitol back in to confirm that it is a trigger for you.

If you do find out that sorbitol is the cause of your digestive woes, you do have some options. Like the other FODMAPs, tolerance is often dose-dependent. This will vary from person to person, but you may find that you’re able to tolerate smaller portion sizes of sorbitol. You may also just need to adjust the frequency of how often you eat products that contain it. Many medications and supplements may just require a brand change or there may be another product that your healthcare provider recommends instead. 

Again, if you do not react to sorbitol, then there is no need to restrict it!  Sorbitol is naturally occurring in many fruits and vegetables that are an important part of a varied diet. The more variety in your diet, the more variety in your gut bacteria! If you do not experience gas, bloating, or abdominal distention, then you might consider using fruits or veggies that are rich in sorbitol to help with constipation. Fruits and veggies that are high in sorbitol help to soften stool and may speed up gut transit time. One very popular option: prunes! Be sure to play around with different fruits and vegetables to test your sorbitol sensitivity and find out what works best for you.

 

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About Author

Liz McMahon, RDN, LDN
Liz McMahon, RDN, LDN

Liz is a Registered Dietitian who focuses on digestive health. She has completed FODMAP training through Monash University and loves seeing the benefit her IBS patients have with this diet! Liz has been in the nutrition field for over 10 years, working at a top hospital in Philadelphia as a Clinical Dietitian for the past 5 years. She also runs her own private practice, Liz McMahon Nutrition, where she provides virtual nutrition counseling to clients with a range of gastrointestinal disorders.

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