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Sugar Substitutes Cause Diarrhea

Could the sugar substitutes found in foods for people with diabetes be causing uncomfortable gas and diarrhea? Which ones should you avoid?

My 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 increases in blood sugar from sucrose. non-nutritive sweeteners can cause digestive symptoms in some people. Here are a few testimonials:

Xylitol for Dry Mouth Caused Diarrhea:

Q. The dentist recommended xylitol for my dry mouth. Wow, diarrhea city!

A. Xylitol is a sugar substitute that is frequently found in dry mouth products and sugarless gum. It can cause diarrhea.

Another reader reported that Biotène Gel was helpful for the dry mouth caused by a CPAP machine. She suffered no adverse effects. Biotene contains both sorbitol and xylitol. This suggests some people are less susceptible to GI complaints, but many other report problems.

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. My sugar-free pancake syrup is 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, mannitol and xylitol 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 somewhat less likely to cause bloating, gas and diarrhea (International Journal of Dentistry, online Oct. 20, 2016). As noted above, some people do react badly to it. 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.

Recent research has uncovered other concerns, however. People with elevated levels of erythritol in their blood are more prone to blood clots. Consequently, they are more likely to experience cardiovascular complications.


Another sweetener that is becoming popular, steviol, does not appear to cause diarrhea or other difficulties often (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, however (Molecular and Cellular Endocrinology, May 15, 2016). In general, non-sugar sweeteners are linked to increased inflammation. As a result, you might want to moderate your consumption of any sugar substitutes so that you eat only the minimum needed to make food palatable.

Don’t Count Too Much on Sugar Substitutes:

An analysis of randomized trials found “no to minimal benefit” in switching to non-nutritive sweeteners for long-term weight control (Endocrine Practice, Oct. 2021). Use for dry mouth or to protect teeth from cavities might not always require long-term use. There are hints that some sugar substitutes can change the balance of microbes in the digestive tract towards a more inflammatory pattern.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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  • Mäkinen KK, "Gastrointestinal disturbances associated with the consumption of sugar alcohols with special consideration of xylitol: Scientific review and instructions for dentists and other health-care professionals." International Journal of Dentistry, online Oct. 20, 2016. DOI: 10.1155/2016/5967907
  • Momtazi-Borojeni AA et al, "A review on the pharmacology and toxicology of steviol glycosides extracted from Stevia rebaudiana." Current Pharmaceutical Design, online Oct. 21, 2016. DOI: 10.2174/1381612822666161021142835
  • Shannon M et al, "In vitro bioassay investigations of the endocrine disrupting potential of steviol glycosides and their metabolite steviol, components of the natural sweetener Stevia." Molecular and Cellular Endocrinology, May 15, 2016. DOI: 10.1016/j.mce.2016.03.005
  • Christofides EA, "POINT: Artificial sweeteners and obesity-Not the solution and potentially a problem." Endocrine Practice, Oct. 2021. DOI: 10.1016/j.eprac.2021.08.001
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