Sorbitol Research and Safety - News-Medical.Net

Sorbitol is a naturally occurring sweetener synthetically extracted from glucose. Owing to its low calorific value, it is used in pharmaceutical products, sugar-free foods, and oral care products such as mouth fresheners and toothpastes. It is prescribed for use by diabetes patients as it has a lesser tendency to increase the sugar level in the blood.

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Consumption of sorbitol gives a cooling sensation in the mouth with almost no aftertaste.  It helps to maintain the high quality of food products by retaining moisture, improving the texture, and acts as a crystallization modifier, a softening agent, and a viscosity controller. It is an important ingredient in confectionery items and food that need to be stored for some time. Sorbitol is a natural constituent of fruits such as apples and pears; dry fruits such as prunes and raisins; stoned fruits like apricots and peaches, and berries of the family of the Sorbus tree.

Research on Sorbitol

In , a report by the European Union’s Scientific Committee on food stated that intake of above 50 g of sorbitol per day may result in diarrhea. It also stated that food containing greater than 10% of sorbitol may be harmful to health and can have a laxative effect. Polyols are alcohol sugars and sorbitol is a type of polyol. In Europe, polyols are banned in soft drinks because of their laxative effects.

In , the European Food Safety Authority submitted a health report on polyols such as sorbitol and concluded that they could be used for improving dental health and for repairing teeth enamel. EFSA has no fixed safety margin for the daily intake of sorbitol.

Sorbitol was first used in the USA by the food industry in . The Generally Recognized as Safe (GRAS) list of Food and Drug Administration (FDA) suggests a tolerance of 7% of sorbitol in foods. FDA studies have found no toxicity and determine the normal level of consumption of sorbitol to be 25 g daily in two doses. No carcinogenic effects were found in experiments on sorbitol. Animal studies involving rats injected with sorbitol showed no tumor incidences at the injection site.

Safety

Sorbitol has been declared safe for use by a number of scientific studies. The Joint Food and Agriculture Organization (JECFA) has categorized the acceptable daily intake (ADI) of sorbitol as “not specified,” which is actually the safest category for any food ingredient. There is no fixed upper margin for the intake level of sorbitol. However, FDA suggests that if the daily intake level of sorbitol exceeds 30 g per day, it may result in serious symptoms. People suffering from nausea, vomiting, or abdominal pain should avoid sweeteners like sorbitol, while pregnant and breast-feeding women should consult their physician before use.

Sorbitol is best used when stored at the normal atmospheric temperature (15°C to 30°C). Temperatures below this level may lead to thickening of sorbitol, and it should not be allowed to freeze.

Side Effects

The side effects of consumption of sorbitol are mild; the main health concern faced is gastrointestinal disturbances, as sorbitol does not get completely digested in the small intestine.

The small intestine absorbs sorbitol in small amounts, which are then converted to fructose. The presence of the excess amount of the remaining sorbitol may result in diarrhea. Excessive sorbitol usage may result in gastrointestinal complexities such as flatulence, bloating, cramping, and other abdominal discomforts. Sorbitol intake may cause serious problems in people who are highly sensitive to laxative effects caused by it.

Other side effects that may arise due to sorbitol usage are listed below:

• In diabetic patients, it may lead to injury of blood vessels and nerves.
• Damage to the eyes with formation of cataract and increased risk to the kidneys.
• In rare cases, people may have skin allergies like itching and blisters on the surface of the skin.
• Some people may suffer from anal and rectal itching.
• Possibility of tarry stools.
• Difficulty in breathing.
• Excessive thirst.
• Decrease in urine output.

Consultation with the physician is suggested if any of the above symptoms arise.

Effects on children

Cavities

Generally, sorbitol does not lead to tooth decay. Starches and sugars in foods are split up by oral bacteria and these bacteria release acids. Such acids gradually destroy tooth enamel if they are not rinsed properly. Sorbitol and other sugar acids or polyols react against bacterial metabolism and hence there is no decay in the enamel.

Diabetes

Diabetic children are suggested to manage their blood lipids, glucose, and weight. As sorbitol is absorbed gradually and partially, the reaction of blood glucose and combined insulin is decreased. Also, the calorific value of sorbitol is two-thirds of normal sugar, so it is helpful in managing the body mass index among children.

However, the excess intake of this sweetener might have a negative impact on children.

Further Reading

What Is Sorbitol and How Does It Work?

Sorbitol is used to relieve occasional constipation and irregularity. Sorbitol generally produces bowel movement in 1/4 to 1 hour when used rectally.

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• Sorbitol is also used as a pharmaceutical aide (sweetener).
• For other uses of sorbitol, ask your doctor.

What Are Dosages of Sorbitol?

Dosages of Sorbitol:

Adult and Pediatric Dosage Forms and Strengths

Irrigation solution

• 3 g/100mL (3%)

Oral solution

• 70%

Dosage Considerations – Should be Given as Follows:

Constipation

• Adult, Oral: 30-150 mL (70% solution) once
• Adult, Rectal enema: 120 mL of 25-30% solution once
• Children under 2 years: Safety and efficacy not established
• Children 2-11 years:
  • Oral: 2 mL/kg (as 70% solution) once
  • Rectal enema: 30-60 mL as 25-30% solution
• Children 12 years and older:
  • Oral: 30-150 mL (70% solution) once
  • Rectal enema: 120 mL of 25-30% solution once

Sodium Polystyrene Sulfonate Adjunct

• Adult: 15 mL of 70% solution or 10-20 mL/2 hours orally until diarrhea occurs
• Children under 12 years: Safety and efficacy not established
• Children 12 years and older: 15 mL of 70% solution or 10-20 mL/2 hours orally until diarrhea occurs

Transurethral Surgical Procedures

• 3-3.3% as surgical procedure irrigation

What Are Side Effects Associated with Using Sorbitol?

Common side effects of sorbitol include:

• Abdominal discomfort
• Dehydration
• Diarrhea
• Dry mouth
• Excessive bowel activity
• Fluid and electrolyte losses
• High blood sugar (hyperglycemia)
• Lactic acidosis
• Nausea
• Swelling (edema)
• Vomiting

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Sorbitol?

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Sorbitol has no known severe interactions with other drugs.
• Serious Interactions of sorbitol include:
  • sodium polystyrene sulfonate
• Moderate Interactions of sorbitol include:
  • deflazacort
  • dichlorphenamide
• Sorbitol has no known mild interactions with other drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

What Are Warnings and Precautions for Sorbitol?

Warnings

• This medication contains sorbitol. Do not take sorbitol if you are allergic to sorbitol or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Anuria, acute abdominal pain, nausea, vomiting, or other symptoms of appendicitis or undiagnosed abdominal pain

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Sorbitol?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Sorbitol?"

Cautions

• Patients with severe cardiopulmonary or renal impairment.
• Dehydration, electrolyte abnormalities.
• Patients are unable to metabolize sorbitol.

Pregnancy and Lactation

For more information, please visit Sorbitol Solution.

• Use sorbitol with caution during pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
• Use caution with the use of sorbitol if breastfeeding. Consult your doctor.

References Medscape. Sorbitol.
https://reference.medscape.com/drug/sorbitol-
DailyMed. Sorbitol.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=16cc9d47---ab84-f22cfe2e