Sorbitol and diabetes risk:

mrsD · 09-12-2008, 07:30 AM

Well, I have returned from my vacation. And what happened there to me? Well, I had a very adverse experience with Sorbitol which I discovered is now added to some non-dietetic candies by Hershey's (and it is also being found in other foods more commonly). Sorbitol is a sweetener and also provides a soluble vehicle to other chemicals. In this instance it was in the filling in the new Cherry Cordial Kisses. Because I did not read the label-- I had purchased these before-- I didn't know it.
They were reformulated to have a longer shelf life, and caused me huge inconvenience with unexpected diarrhea.

So now I am looking to see how much Sorbitol is absorbed from the GI tract... and this is not a happy subject.

http://journals.cambridge.org/downlo...fb4dfe7e2a40f0

12% estimate of absorption from the GI tract in this paper.

This paper says 3%
http://www.inchem.org/documents/jecf...no/v05je91.htm

Well, sorbitol is involved in the expression of neuropathy in diabetics:

http://www.inchem.org/documents/jecf...no/v05je91.htm
It is called the polyol pathway.

edit--I forgot the link to this quote:
http://en.wikipedia.org/wiki/Diabetic_neuropathy

Quote:

Furthermore, the high levels of sorbitol are believed to reduce the cellular uptake of another alcohol, myoinsitol, decreasing the activity of the plasma membrane Na+/K+ ATPase pump required for nerve function, further contributing to the neuropathy.

In summary, excessive activation of the Polyol pathway leads to increased levels of sorbitol and reactive oxygen molecules and decreased levels of nitric oxide and glutathione, as well as increased osmotic stresses on the cell membrane. Any one of these elements alone can promote cell damage, but here we have several acting together.

Experimental evidence has yet to confirm that the polyol pathway actually is responsible for microvasculature damage in the retina, kidney and/or neurons of the body. However, physiologists are fairly certain that it plays some role in neuropathy.

Well, the Hershey's company told me they do not have to warn on the label for amounts below 50grams per serving.
I had 9 kisses one day (one serving) and 6 the next a few days later. Both were enough to give me diarrhea. The person I talked to, would not disclose how much sorbitol was in each candy Kiss.

Some of my concern is two fold... Will time show that sorbitol consumed by normal people, may lead to nerve damage?
When non diabetic people consume a laxative like sorbitol regularly, and experience GI upsets, will this be diagnosed as IBS or colitis?
http://www.foodintol.com/food_intolerance/hot_ibs.htm

So at this time, I strongly urge readers here to read their labels. Do not consume food products with sorbitol in them.
One other factor is the rise in drug products that are Liqui-gels. I myself have used Aleve liquigels with great success. But they have sorbitol in them too. Only not as much.
For Aleve..it is listed LAST in the inert ingredients. But as liquigels increase in popularity, this may become a factor too.
NatureMade vitamins just introduced a whole line of new liquigel vitamins. So is it possible to take several of these, and get a significant dose of sorbitol? (I will be calling them later today, to see if sorbitol is in them-- I suspect it is).
I also suspect they buy their liquigels from a specific manufacturer.. Banner.
http://www.pharmcast.com/BuyersGuide...nerComInfo.htm
this is one example.

It is also ironic...most the diabetic dietetic candies marketed to diabetics contain significant
amounts of sorbitol...enough to have a warning on the label!
Please read this:
http://findarticles.com/p/articles/m...26/ai_56027491

mrsD · 09-12-2008, 10:30 AM

this morning.

1) they do not put sorbitol in their new vitamin softgels.

2) They make their own, and do not subcontract out to other
manufacturers.

So this is nice to know.

So the bottom line now? Check your labels, foods, vitamins etc.
You do not want hidden laxatives in your foods (unless you are a person with severe constipation issues).

Next on my agenda is the new emulsifier PGPR:
http://en.wikipedia.org/wiki/Pgpr

Both of these items are in Hershey's Cherry Cordials.
sorbitol + PGPR

The candy bars only have PGPR so far that I can see.
This site lists it as "possibly causing hyperactivity in children"...
http://www.msreversed.com/toxicingredients.html

I did find ricinolate esters linked to and sometimes used as bowel cleansing surfactants for prep for colonoscopy/other tests of the bowel.

Given in high enough doses, it apparently is a laxative. (similar to colace) It works like a surfactant.
So far I am finding no other toxicity on PubMed for PGPR.

Mixed with ANOTHER laxative (in this case sorbitol), I would expect some additive actions.

Mars M & M's darks don't have EITHER product!

Vowel Lady · 09-12-2008, 10:42 AM

I am VERY concerned. I believe I might know someone who has used products with this in it and has been losing weigh too fast.
Once again...the info. you provide is wonderfully helpful! Thank you.

kalamity_jane · 09-12-2008, 01:19 PM

my late husband was insulin dependant and his doctor told him not to use diabetic food products, explaining they all use sorbitol in place of sugar. what confused me about that is the first pharmacy we walked into after that had an entire range of diabetic food products. and what is worrying is the number of diabetic folks i have met since who have no idea.

GregB77777 · 12-12-2008, 07:49 AM

Hi There--

If sorbitol affects the Na/K pump and the polyol pathway, and this affects the nerves in neuropathy, could sorbitol ALSO affect BRAIN neurons?

What I am getting at is this: My elderly grandmother (87) has been put on tablespoons of sorbitol every day by her doc in order to control constipation. However, since she has started taking this stuff, her mind has deteriorated rapidly--- she has gone loopy, hallucinating and talking gibberish, where she was relatively sharp before. The docs say this is just because she is old.

HOWEVER...

Last week we ran out of sorbitol for a few days. Within a day of her stopping this stuff, suddenly she was basically herself again after being totally out of her mind for several months! Now, OK, dementia sometimes works this way (ups and downs), but I am very suspicious this may have been the SORBITOL.

Does anyone have further information about this? I mean, if sorbitol affects neurons in the legs and hands of diabetics, then SURELY it must affect ALL neurons, right?

I could find no research on this though.

Any thoughts?

-Greg B

mrsD · 12-12-2008, 09:33 AM

The closest I can come to a warning about sorbitol is this:

http://www.corexcel.com/rw/html/body...tion_page1.htm

Mannitol and mannitol/sorbitol mixtures are used to reduce
cerebral edema, clinically.( following stroke or head injuries).

But I cannot find if sorbitol crosses the blood brain barrier, yet.

I will still look around when I get a chance, and post it here.

Typically with drugs, if you withdraw the suspected agent, allow time (say 2 weeks to wash out) and reintroduce it, that should tell you. So if you reintroduce sorbitol and keep a log, and she gets ill again, you will know definitely. You are forwarned so stopping it quickly at first sign of problems, won't be as bad as the first time.

Another thing to look out for are drugs for cholesterol treatment. In the elderly they cause confusion and loss of memory. The elderly can also get hyponatremia (from drugs, including SSRI antidepressants), and with hyponatremia the
delerium is similar to Alzheimer's.

I found this older article about sorbitol metabolism. I can't find a url for it in adobe (adobe drives me nuts sometimes)...so this is a copy of the Google search with link:

Quote:

[PDF]
The Metabolism of Sorbitol in the Human Subject
File Format: PDF/Adobe Acrobat - View as HTML
of the metabolism of sorbitol in. man. Our initial. experiments. were. with- unlabelled sorbitol,. and. showed that after. an. oral dose of ...
www.biochemj.org/bj/065/0554/0650554.pdf - Similar pages

What I am thinking, is that we know that the blood brain barrier in the elderly DOES change.
We know that common drugs that in younger people do NOT cross the blood brain barrier, DO in the elderly. This accounts for some of the delirium seen with drugs. For example: Zantac and Pepcid, two common OTC acid blocking drugs can cause serious issues with the elderly.

So while I cannot find proof that sorbitol crosses the blood brain barrier, I am wondering if it does, especially in the elderly.
While searching for this I found a new PubMed paper on MS...which indicates that increased sorbitol occurs in the spinal fluid of people with MS...
This is the article:

Quote:

J Neurol Sci. 2008 Dec 15;275(1-2):106-12. Epub 2008 Sep 9.Click here to read Links
Cerebrospinal fluid evidence of increased extra-mitochondrial glucose metabolism implicates mitochondrial dysfunction in multiple sclerosis disease progression.
Regenold WT, Phatak P, Makley MJ, Stone RD, Kling MA.

University of Maryland School of Medicine, Department of Psychiatry, Division of Geriatric Psychiatry, Baltimore, MD 21201, USA; Baltimore Veterans Affairs Medical Center, Research Service, Baltimore, MD 21201, USA.

In contrast to relapse, the mechanisms of multiple sclerosis (MS) disease progression are less understood and appear not to be exclusively inflammatory in nature. In this pilot study we investigated the relationship between disturbed CNS energy metabolism and MS disease progression. We tested the hypothesis that cerebrospinal fluid (CSF) concentrations of sorbitol, fructose, and lactate, all metabolites of extra-mitochondrial glucose metabolism, would be elevated in secondary progressive (SP) MS patients and would be associated with worsening neurologic disability. We measured metabolite concentrations by gas chromatographic/mass spectrometric and enzymatic methods in archived CSF samples from 85 MS patients [31 relapsing-remitting (RR) and 54 SP patients] and 18 healthy controls. We found that concentrations of all three metabolites, but not concentrations of glucose or myoinositol, were significantly increased in CSF from SP and, to a lesser degree, RR patients, compared to controls. Furthermore, CSF concentrations of sorbitol and fructose (polyol pathway metabolites), but not lactate (anaerobic glycolysis metabolite), correlated positively and significantly with Expanded Disability Status Scale (EDSS) score, an index of neurologic disability in MS patients. We conclude that extra-mitochondrial glucose metabolism is increased in MS patients and is associated with disease progression evidenced by increasing EDSS score. As extra-mitochondrial glucose metabolism increases with impaired mitochondrial metabolism of glucose, these findings implicate mitochondrial dysfunction in the pathogenesis of MS disease progression. CSF metabolic profiling may be useful in clarifying the role of mitochondrial pathology in progression and in targeting and monitoring therapies for disease progression that aim to preserve or boost mitochondrial glucose metabolism.

PMID: 18783801 [PubMed - in process]

When glucose is metabolized by the cells in the body, a small amount of sorbitol is made as a byproduct. This is called the polyol pathway. It is possible that larger amounts ingested orally may compound this issue, especially in an elderly patient. And even more especially in a diabetic.
In that PDF on metabolism it states that the body rapidly metabolizes sorbitol away as carbon dioxide.

So while I know this seems complex... I do think you have some issues with sorbitol. And also keep in mind in the elderly drugs do not work as they do in younger patients. I have not found concrete papers on sorbitol and dementia or delirium. But I will keep on looking.

This site which I have used many times...and think is very complete..does not include mental
status changes with sorbitol:
http://www.umm.edu/altmed/drugs/sorb...ental%20Status

However, if your mother was developing some METABOLIC change due to the sorbitol, that could
induce some delirium. Sort of a second hand effect.

EarthGirl · 07-01-2010, 08:39 PM

Many Thanks for this information!
Yes it is horribly ironic that sorbitol is marketed to diabetics mad:

Worse maybe that those who suffer arthritic pain are often also advised to control weight too and use these low cal sugar alcohol products!

I am concerned as a family member using dietary measures for Type 2 diabetes and cardiovascular disease, also has IBS and recent diagnosis of CREST - a multi - inflammatory auto-immune disease with neuropathy does use sweets with maltilol / sorbitol frequently.

Stevia products with erythritol are becoming popular, can you provide any info on these with regard to neuropathy and also to fatty liver?
Many Thanks for your time and info.

mrsD · 07-02-2010, 07:16 AM

I'm sorry, I don't have any negative info yet on Stevia.

darlindeb25 · 07-02-2010, 06:24 PM

I buy my Stevia pure, no erythritol, so I can't help. I was worried about using the product with erythritol, simply because I'm not sure my body will tolerate it. I did find this:

http://abouterythritol.homestead.com/