Letzte Aktualisierung am 18. March 2025 von Dr. Michael Zechmann-Khreis
Causes, symptoms and current findings
Sorbitol, also known as sorbitol, is a sugar alcohol that occurs naturally in various fruits such as apples, pears and plums. In the food industry, sorbitol is often used as a sweetener and humectant and is known under the E number E420. In the case of sorbitol intolerance, also known as sorbitol malabsorption, the small intestine cannot absorb sorbitol sufficiently. The mechanism is similar to that of fructose malabsorption. And although we have known about sorbitol intolerance since the 1980s, not everything about this intolerance has been fully researched. We know that undigested sorbitol reaches the large intestine, where it is fermented by bacteria, which can lead to symptoms such as flatulence, abdominal pain and diarrhea.
Current research results
Recent studies have shown that the gut microbiome plays a crucial role in the processing of sorbitol. Research has identified changes in the gut microbiome that can lead to sorbitol no longer being effectively digested. In particular, a reduced number of Clostridia bacteria, which can break down sorbitol, has been observed. These changes may be caused by factors such as the intake of antibiotics in combination with a high-fat diet.
Diagnosis and therapy
Sorbitol tolerance is usually diagnosed using an H2 breath test. The affected person drinks a sorbitol-containing solution and the exhaled hydrogen (H2) is measured. An increase in the hydrogen content indicates malabsorption. As there is no specific therapy, treatment mainly consists of adjusting the diet. Those affected should avoid foods containing sorbitol or reduce their consumption.
Three-step plan for nutritional adaptation
1. elimination dietAvoid sorbitol-containing foods for about two weeks.
2nd test phase: Gradual reintroduction of small amounts of sorbitol-containing foods to determine the individual tolerance threshold. Duration 1-2 weeks.
3. permanent dietLong-term nutrition based on individual tolerance limits.
Tips for everyday life
Sorbitol is not only found in many types of fruit, but also in many processed foods, especially in ‘sugar-free’ products such as chewing gum and sweets. It is therefore important to read the ingredients lists carefully. Foods with a sorbitol content of more than 10% must be labeled ‘may have a laxative effect if consumed in excess’.
Sorbitol content
The following foods have relatively high sorbitol contents. These are examples, not a complete table. If you would like a more complete and interactive list, we recommend the “Ask ingrid” app.
Natural sources of sorbitol (fruits with a high sorbitol content)
- Apples
- Pears
- Plums / damsons
- Cherries
- Apricots
- Peaches
- Nectarines
- Berries (e.g. blackberries)
- Dried fruit (e.g. dried apples, plums, apricots, raisins)
Vegetables with sorbitol content
- Cauliflower
- Broccoli
- Brussels sprouts
- Paprika
- Mushrooms (e.g. button mushrooms)
Sugar-free and diet products (sorbitol as additive E 420)
- Sugar-free chewing gum
- Sweets & candies with sugar substitutes
- Diet or “light” confectionery
- Toothpaste and mouth rinses (e.g. with sorbitol as a humectant)
Processed foods with sorbitol as an additive
- Baked goods (e.g. “sugar-free” cookies)
- Ready-made desserts and ice cream
- Soft drinks and fruit juices (especially those labeled “sugar-free” or “light”)
- Some ready-made sauces & dressings
Sorbitol tolerance requires individual dietary adjustments. By understanding their personal tolerance level and being aware of sorbitol-containing foods, sufferers can effectively manage their symptoms and improve their quality of life.
Sources
Souci-Fachmann-Kraut, Lebensmitteltabelle für die Praxis, 3rd edition
“Ernährung. Physiologische Grundlagen, Prävention, Therapie”, WVG, 2016
Lee, J.-Y. e al. High fat intake sustains sorbitol intolerance after antibiotic-mediated Clostridia depletion from the gut microbiota. Cell 187, 1191-1205.e15 (2024).
Sorbitol intolerance: An overview’
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