man on toilet with a help sign, poop pills

Do you ever become frustrated when you discover that something you’ve done to improve your health has caused trouble instead? Many people have encountered problems with sugar substitutes, whether they are using them to prevent dental caries or to avoid unwelcome blood sugar effects from ordinary sweeteners. These compounds can cause digestive symptoms.

Diarrhea from Sugar Substitutes:

Q. I am a diabetic and used to have diarrhea all the time. Then I read that sorbitol can cause diarrhea. I had been using sugar-free pancake syrup sweetened with sorbitol.

I stopped using it and immediately had no more diarrhea. I told my doctor about this and he agreed that sorbitol can cause diarrhea. Others may be suffering from this same problem.

A. You are not the only one to pinpoint non-sugar sweeteners as a potential cause of diarrhea. Here is a message from another reader:

“I read a question from a reader suffering from diarrhea and stomach pain. The reader wondered if the diabetes meds were causing this.

“Was that person eating sugar-free products with the sweetener maltitol? This sweetener can also cause digestive problems. Sensitive individuals should check the list of ingredients.”

Sweeteners like sorbitol, maltitol and mannitol are frequently used in foods for people restricting sugar. They have calories but are absorbed much more slowly than table sugar. Because they can reach the large intestine without being absorbed, they may cause diarrhea.

Other Options Less Likely to Cause Trouble:


Xylitol, also known as birch sugar, is a small molecule that seems less likely to cause bloating, gas and diarrhea (International Journal of Dentistry, online Oct. 20, 2016). It is similar to the other sugar substitutes because it is a sugar alcohol. In this case, the term alcohol does not refer to something you drink. It is a chemical term describing the chemical structure of the compound.

Xylitol is a fermentable polyol and should be avoided as part of a low-FODMAP diet. FODMAP stands for fermentable oligo-, di- and monosaccharides and polyols. The low-FODMAP is often recommended for the treatment of IBS.

Be very careful to keep xylitol and any xylitol-containing foods such as chewing gum, mints or peanut butter away from dogs. It is very toxic to canines.


Erythritol is another sugar substitute. People tolerate it even better than xylitol, perhaps because the microbes in our digestive tracts are not able to ferment erythritol. Most people do not develop diarrhea or stomach rumbles after consuming erythritol, although taking it with fructose could trigger those reactions.


Another sweetener that is becoming popular, steviol, does not appear to cause diarrhea or other difficulties (Current Pharmaceutical Design, online Oct. 21, 2016). Stevia is derived from a South American plant, Stevia rebaudiana. Steviol might act as an endocrine disrupter at high doses (Molecular and Cellular Endocrinology, May 15, 2016). As a result, you might want to moderate your consumption of any non-sugar sweetener so that you eat only the minimum needed to make food palatable.

Revised 1/16/17

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  1. Donna

    Years ago I started getting nauseous from drinking big diet sodas at movie theaters and found it was the aspartame. Now I find that all of the “-itol” sweeteners give me diarrhea. ICK. I stay away from all of the artificials now. I like my coffee sweetened and kept trying different types of Stevia until I discovered NuNatural Liquid. Most Stevia has an aftertaste – a bit like licorice – which tastes horrible in coffee. The liquid works well.

  2. Suzy

    I couldn’t understand what caused my diarrhea. I was puzzeling as I was about to add a packet of Tea to my quart of water. Read the ingredients to see aspartame. I decided to skip it. Wow, no afternoon diahrrea! A little bit of Stevia works as sweetener for me.
    Was glad to learn online that I wasn’t the Lone Ranger.

  3. D
    Springfield, Virginia

    I have not read in any articles, websites or in my searches been able to find out: what amount of Splenda causes problems? Sure it is different for all according to product digested but I wish someone did a controlled scientific study to let us know what is the most a person can consume. ??? If anyone has any info like this, is it banned in other countries, etc. please share info AND source. Thanks.

    • D
      Springfield, Virginia

      Hi D here,
      I meant most that can be consumed that will not cause diarrhea, affect gut flora or cause IBS.

  4. Cindy M. Black
    Seattle, WA

    A long time ago I found out that Sorbitol and all those other “itol’s” not only cause diarrhea but also cause massive flatulence! I cannot understand why ANYONE wouldn’t just go straight for the stevia. I use stevia in absolutely everything (even cooking and baking), and I simply love it. Tastes exactly like sugar, and few side effects. As for the bitter aftertaste: Yes, some stevia does that. But not all! I just shopped around to find the right one. (Though I’m not affiliated with Trader Joe’s, I have to say, their liquid stevia has NO bitter aftertaste). Cheers!

  5. Rick

    There are several reasons for diarrhea, the most obvious being that you have just ingested a toxic substance into your bowel and your body wants to get rid of it. Your gag re-flux works on the same principle and with the same or similar mechanics. How many of you throw up after ingesting too much alcohol or any other toxic substance like rotten food only to have that fine wine end up in your lap. It may have saved your life!

  6. JAS

    I was trying to lose weight so I switched from regular soda (coke) to diet soda (diet coke) with artificial sweetener. I drank huge amounts (at least one to one and one half giant liter bottle a day); also, the diet soda made me even thirstier than the regular soda. About a year after I started the diet coke, I started having unusual symptoms: vertigo, extreme weakness & tiredness, unable to start urination. A friend (and then a dietician) advised me that the artificial sweetener in the diet soda gets metabolized in the body and turns into formaldehyde…. Doctors tested me for MS but all tests were negative. I dropped all artificial sweeteners plus all soda cold turkey & limited my regular cane sugar consumption in other foods. Coincidentally, I was also using a toothpaste that had artificial sweetener in it so I stopped that too… These man-made substances are not meant to be in our bodies.

  7. Susan

    Xylitol is an excellent sugar substitute and is found in an increasing number of products, including some chewing gum and peanut butter. Please, Joe and Terry: Any mention of xylitol should include its toxicity to dogs because so many of us routinely give peanut butter as a dog treat or to disguise pills.

  8. Sally

    I’ve been using Truvia without any side effects. Is this considered a more favorable substitute for sugar?

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