The People's Perspective on Medicine

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?
Toilet constipation

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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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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I don’t know if my stomach issues are caused by diabetes medication or taking of sweeteners for many years. I had an incident after eating chocolate that was diabetic and had Stevia in it also. Though I’m told Stevia has no side effects. Now it’s a case of elimination which could take a long time as these episodes thankfully don’t happen very often but when they happen it’s very very bad and totally uncontrollable. I could be sitting on bus next time which would be absolutely devastating.
I’m going to the docs after the fourth incident in nine months. It’s depressing and embarrassing.

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.

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.

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.

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

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!

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!

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.

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.

Quite right. I’ll add it now.

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

I have switched to organic whipping cream in my coffee to
avoid the milk in half and half, which seemed to contain
more milk than cream plus chemicals. Mixed with plain,
unsweetened coconut milk from the refrigerator section
at some markets, it is as natural as one can get. So delish
and fat is better than sugars or substitutes in my book.
In Germany, people use a coffee cream with 12% cream
which tastes great. I have loved cream all my life and have
never been fat, but sugar and substitutes cause me problems.

Why does’nt anyone talk about or use monk fruit, also called
lo han? It is the best sweetener I have used. NOT the
commercially available Nutresse in the orange packets in
the supermarket which is adulterated just like Truvia, a stevia
knockoff. Lo han is very sweet, I use a very small amount in
baking, i.e. Paleo brownies.
Almost every protein powder, probiotic drink, protein bar, etc.
contains stevia and some of the other “ol” sweeteners. I cannot
stand the taste, get gas and avoid them.

Years ago I had problems with Splenda in diet sodas. I switched back to Diet Pepsi with aspartame. I know the warnings on it but it never caused problems for me. Recently during a hot spell I was downing a lot of this drink and didn’t drink much water. I became really ill with urgent diarrhea that would wake me up. I just read that Pepsi was going back to their aspartame formula. I rushed to look at the ingredients on my current stash of soda and sure enough they had switched to sucralose which I understand is one main ingredient in Splenda. I stopped drinking it immediately and am slowly recovering. I have decided to stay off the soda completlely this time and encourage everyone to keep reading the labels.

Monk fruit (or lan ho) is still mixed with erythritol, which some people still react to, especially if they mix it with fruit.

I’m very sensitive to artificial sweeteners. At one point, I had diarrhea for a month straight. Then I learned the lemonade my wife was making – crystal light – was made with artificial sweeteners. I jokingly accuse her of trying to poison me like the people do on ID channel. Normally I can detect it as diet products taste very off to me, and I reject them immediately.

hank you all for sharing. I recently started drinking a drink with sucralose and have had much diarrhea. good to know the pink bismuth has this in it. to get rid of the diarrhea I mix four cups of boiled water with 6 teaspoons of sugar and a half a teaspoon of salt. let it cool and drink all of it and you will definitely not have diarrhea afterwards. I think this also explains the bloating that I have had the past couple years not knowing why.

I have used artificial sweetener, Splenda, for 20 years and it has not affected my health in any way. Being fat from sugar is the real threat to your health.

Just an fyi, in the 18 mos I used Splenda I had 3 kidney stones. That was the only new thing I had added to my diet. Stopped the Splenda, again the only change to my diet was deleting it, and haven’t had a kidney stone since…it’s been 10 and a 1/2 years. If you consume Splenda regularly, add lemon in your diet and drink plenty of water. This was advice given to me from my urologist.

Can diarrhea caused by sugar free candy, eaten daily in excessive amount therefore diarrhea on a daily basis, harm the kidneys?

Well, after reading all these thoughts, I don’t feel stupid anymore. I can’t use any of the artificial sweeteners! Not even Stevia. I have found that most Stevia sweeteners have some kind of additive that also sends you to the bathroom. Sugar alcohols are also a problem. Somewhere I read that if you get raw Stevia, it is okay for those who have problems with other sweeteners. Has anyone tried it? I’m leery of trying anything else, and going through all the agony associated with the other stuff. Thanks to everyone for their thoughts.

On two separate occasions I purchased some “sugar-free” brownies from the ever popular and super-expensive supermarket chain known as Whole Foods here in the U.S. I didn’t pay much attention to the ingredients.

The first time, I ate four small brownie ‘bites’ and became ill after a few hours. I spent the entire night suffering from diarrhea, extreme bloating, and gas. Because I wasn’t able to say with certainty that the problem was the brownies (I only suspected), I decided to get a few more the following week (a fresh batch of brownies) and see if the problem reoccurred.

This time I only had two brownie bites, but the results were pretty much the same. Horrible stomach pains that lasted three days and made me afraid to eat anything for fear of further upsetting my stomach.

Today I went in to the bakery department and asked one of the employees working there for a list of the ingredients. I was familiar with all the ingredients (eggs, butter, milk, cocoa powder, etc.) EXCEPT the first one–maltitol. The employee mentioned to me that she has heard of several customers having issues with this ingredient. Never again. It was such a horrible experience. I’m sticking to sweeteners that the my body will digest more easily such as honey, dates, and coconut.

Oh my God!!!! My husband and I are having the same problem from eating the same brownies!!!!! They need to use Stevia — not Maltitol.

I’m definetly going back over there to express my concerns. Thank you for sharing this.

Please suggest sweeteners that are safe to take. Thank you

Yeah any time I drink sugar free stuff with sucrose it causes literally explosive diarrhea, stevia is the only way to go, if you can stand the bitter aftertaste.

How can I find a coffee creamer without Sorbitol?

Stevia is also natural and I don’t think it has those symptoms. You can try that. There are several brands, try different one to see which one you like more (I only like one).

I have found that Xylitol is causing constant diarrhea. I had not noticed that on the package it warns that it can cause diarrhea with excessive consumption. Since I do not tolerate sugar, I have gone from one sugar substitute to another for coffee and tea (many of you have listed them here), and though some of these sugar substitute products advertise as being natural like Xylitol, I have stomach/intestinal negative reaction to all of them.
I just wanted to share what is happening to me with the product Xylitol. Tastes good, but not good for me. Once I go off Xylitol, I am back to normal.
Also, if Xylitol is toxic to animals (primarily dogs mentioned), then what in the world is it doing to a human? I don’t trust products on the shelves, today, to inform the buyers truthfully.
Hope this little missive helps.

I am a diabetic and I have IBS-D and I am trying to transition to diet pop, well I noticed that when I drink diet pop I go more often. I can’t go all the time, it’s depressing to go because of the IBS and then because I’m drinking diet pop. This is crazy, but I’m glad I found other who have the same issue.

My whole life non-sugar sweeteners have given me the worst stomach pains I’ve ever had followed with diarrhea. Every single type I’ve ever had, including ones like Splenda, which is made with sugar tears me apart. When I had my kidney stone a number of years back, the pain was only a more drawn out version of the same exact pain I get from non-sugar sweeteners. Intensity, location, all of it the same, the only difference between my kidney stone and my reaction to non-sugar sweeteners is that one passes more quickly than the other.
What is this condition called? I’ve been in the hospital a couple of times, (not from this, but from appendicitis, and my kidney stone) and both times when they went to get me food, they asked about allergies, and I brought this up with them, calling it an allergy. They kind of rolled their eyes and brought bad food anyways, which I didn’t eat.
FYI Diet soda of any kind is bad. I’d really like to know what to tell the school my 8 year old son goes to, because it appears he’s having the same problems when he eats the school lunch.

for the diarrhea the only thing it works for me is coconut… water/milk/cookie/fresh etc…

I started using STEVIA… it doesn’t taste like sugar but it is sweet and is natural (from a trees leaves).

I also have a problem with artificial sweeteners and diarrhea. However, I find that if I limit the amount of artificial sweeteners it does not happen. It is only when I over do it that I have a problem.

Last year I was tested for and diagnosed with “Fructose Intolerance”. Also known as “Fructose Malabsorption”. The list is lengthy for sweeteners and foods to avoid or be wary of. This new way of life and eating is very challenging. But being true to the necessary diet means comfort for the body.

I am not diabetic but I do use sugar substitutes. When Splenda hit the market I was delighted. Of course, all the hype in their ads made it sound like a wonderful natural product. Well, it is far from that. I started perspiring profusely at certain times during the day. Hot flashes increased in intensity and I was going nuts.
The doctors couldn’t find anything wrong with me so I started keeping a diary of what I ate/time of flashes, etc. It turned out that Splenda (used in my tea, on my cereal, etc.) was the cause of my misery. As soon as I stopped using it, I went back to normal. I have run across five other women with the same experiences. Their doctors prescribed meds that only made them worse. Once they stopped Splenda, they were just fine.

Also avoid xylitol. It can cause diarrhea.

I regularly eat a candy bar with “sorbitan” in it. Is this a form of sorbitol? I have recently developed persistent diarrhea.

I’m not diabetic but I know these artificial sugars cause me ibs diarrhea. I cannot and will not use aspartame or splenda because cause me to have ibs d. I suspect a lot of people are sensitive to artificial sugars but aren’t connecting the dots.
Of course, there are other triggers for this ibs but I won’t go there, I’d have to write a book. :-)

I am not diabetic, but I have this same problem. I also unable to tolerate sucralose (brand name Splenda), which is sad because it now shows up everywhere from coffee creamer to candy to Special K protein shakes.
Sucralose and just about everything that ends in a ‘tol’ makes me violently sick. Which is sad. Most store bought stevia extracts contain something like erythritol, which makes me just as miserable as Splenda. The reason for this, as explained to me by a biochemist who was consulted before the fat-substitute Olestra hit the market is that companies DO NOT CARE what happens when something isn’t absorbed by your body.
All they care is that they can stick “fat free” or “sugar free” on the label! Some people’s digestive systems are more sensitive than others and decide to quickly shed what cannot be absorbed… in other cases, sugar alcohols can be used by intestinal flora as a carbon source, leading to cramping, bloating and diarrhea.
Warning… if sugar substitutes are one of your triggers, be VERY careful before purchasing or taking PeptoBismol to combat your diarrhea. It always has at least one sugar substitute, from aspartame to mannitol to sucralose. I have a horrible time convincing them to give me the ingredient list because their product makes things worse.
If you must take something for diarrhea relief, Kaopectate never uses artificial sweeteners.

Can you suggest something those of us who have diabetes can use? I am reading and hearing that it is dangerous to use sugar substitutes! What do we do?

many medications -specially diabetic, like metformin- can cause diarrhea and other side effects.

in a fit of conscientiousness about calories, I used sugar free syrup at a restaurant one time. The diarrhea from it lasted two days. Never again!

I have experienced the same problem. One has to be careful with so many products. These sugar substitutes can show up in a large number of food, e.g., diet soda, diet ice cream, non-sugar muffins all of which have caused large problems before I learned to be more careful.

I am also bothered by the sugar alcohols causing bloating and gas. I found years ago that Beano liquid works great for the gas from beans, but couldn’t find it recently, except in tablet form. So I bought it and used it a few times, but found that the bloating and gas was WORSE when using this Beano. I checked the ingredients and found mannitol is one of the ingredients!

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