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Sorbitol occurs naturally in fruits (1) and is manufactured for purposes that include the sweetening of dietetic foods (2). Although its energy value continues to be the subject of research (3,4), sorbitol is an ingredient found in many sugar-free gums, sugar-free breath mints, and dietetic candies. Sorbitol is commonly consumed but apparently not widely recognized; for example, one study showed that 54% of college students had never heard of sorbitol (5).
The gastrointestinal effects of sorbitol malabsorption can include gas, bloating, abdominal cramps, and osmotic diarrhea (6-21). A study comparing sorbitol and lactulose as medications to treat constipation discovered no clinically important differences in their laxative effect (22). In addition, the Federal Register describes sorbitol as a hyperosmotic laxative ingredient (23). According to documented case and clinical studies, the effects of sorbitol on gastrointestinal function appear to be dose responsive. If ingestion of greater than or equal to 0.5 g sorbitol per kilogram of body weight can induce diarrhea (8,10,18), then a 3year-old child weighing 15 kg could develop diarrhea after ingesting only 7.5 g sorbitol, an amount contained in about 4 pieces of sugar-free gum, 4 sugar-free breath mints, or 1-1/2 sugar-free lollipops.
In a clinical trial, Smith et al (21) found that more carbohydrate malabsorption occurred after the ingestion of apple juice than after white grape juice in healthy 6and 18-month-old infants. Although no single factor was identified as the causative agent, one compositional difference the researchers noted was the notable presence of sorbitol in apple juice, whereas white grape juice contains none (21). Whether sorbitol-containing gums and candies pose a similar risk for young children has not been evaluated in clinical studies.
The purpose of this study was, first, to determine the age at which young children might begin to have access to sugarfree gums and candies. Second, the maximum amount of sorbitol potentially available when these products were ingested was of interest. Although the study design did not allow us to search for a cause-and-effect relationship, we did explore the possible relationship between diarrhea in young children and the intake of sorbitol-containing gums, breath mints, and candies.
METHODS
Manufacturers of sugar-free gums, sugarfree breath mints, and dietetic candies were asked about the amounts of sorbitol in their products. The Table lists...