Some articles of potential interest:

CSPI Press Release
---------------------------------------------
For Immediate Release:
September 27, 1999

Consumer Group Petitions FDA to Require "Diarrhea" Notice on Foods that Contain Sorbitol

WASHINGTON - The Center for Science in the Public Interest today petitioned the Food and Drug Administration (FDA) to improve the existing warning label on processed foods that contain the sugar substitute sorbitol. Sorbitol is a sweet-tasting sugar alcohol used in many sugar-free or “dietetic” candies, cake mixes, syrups, and other foods, as well as in some medicines. It provides fewer calories than regular sugars, because it is poorly absorbed by the body.

Studies over the past fifteen years have proven that sorbitol can cause gastrointestinal symptoms, ranging from mild discomfort to severe diarrhea, when adults consume between 10 and 50 grams of the additive. Children, because of their small size, may be affected by even smaller amounts. Currently, the FDA requires a laxative notice only on the few products that may lead to the consumption of 50 grams or more of sorbitol daily, though some companies voluntarily label additional products.

“The FDA should require a better label notice on sorbitol-containing products,” said Michael F. Jacobson, Ph.D., executive director of CSPI. “The FDA has known for years that sorbitol can cause severe diarrhea. It’s high time that the Agency required a strong label notice on all products that might cause problems.”

“Since even small amounts of sorbitol can cause gastrointestinal symptoms it is important for the FDA to inform the public of this potential problem,” said Dr. Jeffrey S. Hyams, Head, Department of Digestive Diseases and Nutrition, Connecticut Children’s Medical Center, and Professor of Pediatrics, Connecticut University School of Medicine. “I know of people who have undergone extensive medical testing for abdominal pain and diarrhea when the problem was simply that they were ingesting excessive amounts of sorbitol.” Dr. Hyams conducted a clinical study in which five of seven adults experienced gastrointestinal symptoms after ingesting 10 grams of sorbitol.

Some products that contain more than 10 grams of sorbitol or similar sugar substitute per serving include: Brach’s Star Brites Fruity Candies, Life Savers Delites Hard Candy; Cumberland Packing Corp.’s Sweet ‘N Low Sugar Free, Low Fat Cake Mixes; Frutay Peppermint Drops; Cary’s Maple Syrup; Allen Wertz Simply Sugar Free Chocolate & Vanilla Caramels, Fruit Taffy
Whips, and Coffee Toffee.

“With Halloween coming up, people should be concerned about well-meaning families giving candy to children that could end up giving them severe diarrhea,” said Dr. Ray Breitenbach. Dr. Breitenbach is a practicing family physician and retired United States Air Force Lt. Colonel Flight Surgeon who has written about the risks of eating sorbitol-containing candy.

CSPI has petitioned the FDA to require foods containing one or more grams per serving of sorbitol or other sugar alcohol, such as mannitol, to carry a more informative notice. CSPI’s petition recommends that labels state: “NOTICE: This product contains sorbitol, which may cause diarrhea, bloating, and abdominal pain. Not suitable for consumption by children. To protect yourself, start by eating no more than one serving at a time.”


------------------------------------------------------------

Food & Nutrition Newsletter - June 1997 - Audiences

SORBITOL:

Sorbitol is found naturally in fruits and as an ingredient in many sugar-free gums, sugar-free breath mints, and dietetic candies. Sorbitol malabsorption includes gas, bloating, abdominal cramps, and osmotic diarrhea. 7.5 g sorbitol. the amount in 4 pieces sugar-free gum, 4 sugar-free breath mints, or 1 1/2 sugar-free lollipops could cause diarrhea in a 3 - year old child. All 3 year olds tested who reported greater than 0.5 g sorbitol per kilogram of body weight also reported episodes of afebrile diarrhea. Because significant numbers of preschoolers consume sugar-free products, adverse reactions may occur and questions about the use of sorbitol-containing products should be helpful. 

Payne JL,Winston,JC & Williams AC 

-----------------------------------------------------

Sorbitol, a polyol (sugar alcohol), is a bulk sweetener found in numerous food products. In addition to providing sweetness, it is an excellent humectant and texturizing agent. Sorbitol is about 60 percent as sweet as sucrose with one-third fewer calories. It has a smooth mouthfeel with a sweet, cool and pleasant taste. It is non-cariogenic and may be useful to people with diabetes. Sorbitol has been safely used in processed foods for almost half a century. It is also used in other products, such as pharmaceuticals and cosmetics.

A French chemist first discovered sorbitol in the berries of the mountain ash in 1872. It occurs naturally in a wide variety of fruits and berries. Today it is commercially produced by the hydrogenation of glucose and is available in both liquid and crystalline form.

Sorbitol has been affirmed as GRAS (Generally Recognized As Safe) by the U.S. Food and Drug Administration and is approved for use by the European Union and numerous countries around the world, including Australia, Canada and Japan.

In the United States, sorbitol is provided by a number of manufacturers, including Archer Daniels Midland, Lonza Inc., Roquette America, Inc. and SPI Polyols, Inc.

Functional Advantages

Sorbitol is used as a humectant in many types of products for protection against loss of moisture content. The moisture-stabilizing and textural properties of sorbitol are used in the production of confectionery, baked goods and chocolate where products tend to become dry or harden. Its
moisture-stabilizing action protects these products from drying and maintains their initial freshness during storage. 

Sorbitol is very stable and chemically unreactive. It can withstand high temperatures and does not participate in Maillard (browning) reactions. This is an advantage, for example, in the production of cookies where a fresh color with no appearance of browning is desired. Sorbitol also combines well with other food ingredients such as sugars, gelling agents, proteins and vegetable fats. It functions well in many food products such as chewing gums, candies, frozen desserts, cookies, cakes, icings and fillings as well as oral care products, including toothpaste and mouthwash.

Does Not Promote Tooth Decay

Polyols, including sorbitol, are resistant to metabolism by oral bacteria which break down sugars and starches to release acids that may lead to cavities or erode tooth enamel. They are, therefore, non-cariogenic. The usefulness of polyols as alternatives to sugars and as part of a comprehensive program including proper dental hygiene has been recognized by the American Dental Association.

Use In The Diets Of People With Diabetes

Control of blood glucose, lipids and weight are the three major goals of diabetes management today. Sorbitol is slowly absorbed. Therefore, when sorbitol is used, the rise in blood glucose and the insulin response associated with the ingestion of glucose is significantly reduced. The reduced caloric value (2.6 calories per gram versus 4.0 for sugar) of sorbitol is consistent with the objective of weight control. Products sweetened with sorbitol in place of sugar may be useful in providing a wider variety of reduced calorie and sugar free choices to people with diabetes.

Recognizing that diabetes is complex and requirements for its management may vary between individuals, the usefulness of sorbitol should be discussed between individuals and their health care providers. Foods sweetened with sorbitol may contain other ingredients which also contribute calories and other nutrients. These must be considered in meal planning.

Reduced Calorie Alternative To Sugar

Absorption of sorbitol by the human body is slow, allowing part of the ingested sorbitol to reach the large intestine where metabolism yields fewer calories. Therefore, unlike sugar which contributes four calories per gram, the caloric contribution of sorbitol is about 2.6 calories per gram. The U.S. Food and Drug Administration has stated it does not object to the use of this value. For a product to qualify as “reduced calorie” in the United States, it must have at least a 25 percent reduction in calories; to qualify as “light” it must have a one-third reduction. Sorbitol is, therefore, useful in formulating “reduced calorie” and “light” products.

The lower caloric value of sorbitol and other polyols is recognized in other countries as well. For example, the European Union has provided a Nutritional Labeling Directive stating that all polyols, including sorbitol, have a caloric value of 2.4 calories per gram.

Safety

Sorbitol’s safety is supported by numerous studies reported in the scientific literature. In developing the current U.S. food and drug regulation which affirms sorbitol as GRAS, the safety data were carefully evaluated by qualified scientists of the Select Committee on GRAS Substances selected by the Life Sciences Office of the Federation of American Societies for Experimental Biology (FASEB). In the opinion of the Select Committee, there was no evidence demonstrating a hazard where sorbitol was used at current levels or at levels that might be expected in the future. The U.S. Food and Drug Administration’s regulation for sorbitol requires the following label statement for foods whose reasonably foreseeable consumption may result in the daily ingestion of 50 grams of sorbitol: 

“Excess consumption may have a laxative effect.”

The Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (JECFA) has reviewed the safety data and concluded that sorbitol is safe. JECFA has established an acceptable daily intake (ADI) for sorbitol of “not specified,” meaning no limits are placed on its use. An ADI “not specified” is the safest category in which JECFA can place a food ingredient. JECFA’s decisions are often adopted by many small countries which do not have their own agencies to review food additive safety.

The Scientific Committee for Food of the European Union (EU) published a comprehensive assessment of sweeteners in 1985, concluding that sorbitol is acceptable for use, also without setting a limit on its use.

Multiple Ingredient Approach To Calorie Control

Americans continue to demand good tasting products with less calories and fat. The development and use of a variety of safe low-calorie sweeteners, bulking agents, fat replacers and other low-calorie ingredients help meet this consumer demand. The availability of several low-calorie ingredients allows food manufacturers to choose the most appropriate ingredient, or combination of ingredients, for a given product.

Sorbitol works well with other ingredients and may be synergistic with other sweeteners. This means the combination of the sweeteners is sweeter than the sum of the individual sweeteners and results in synergistic blends which provide taste, economic and stability advantages.

Copyright © 1999 Calorie Control Council