Diarrhea in diabetics: the role of sorbitol.

Diabetics often consume dietetic foods with sorbitol as the sweetener. Sorbitol, in amounts as little as 10 g. may produce diarrhea in healthy individuals. Sorbitol intolerance was studied in 12 diabetics and 23 nondiabetics. Similar numbers of diabetics (n = 10, 83.3%) and nondiabetics (n = 18, 78.3%) were found intolerant as judged by a greater than or equal to 20 ppm rise in postprandial breath hydrogen levels. Six diabetics (50%) and 13 nondiabetics (56.5%) developed abdominal symptoms after sorbitol ingestion. Subsequently, 100 diabetics and 100 nondiabetics were interviewed to determine the relationship between regular sorbitol consumption and abdominal symptoms. The interview revealed that (1) most individuals consuming sorbitol were unaware of its presence in their diet and (2) diarrhea was significantly (p less than 0.001) more prevalent in diabetics consuming sorbitol than diabetics not consuming it. We conclude that (1) many diabetics are intolerant to sorbitol and (2) regular sorbitol consumption may explain the "idiopathic" diarrhea in some diabetics.