Tokyo Food Safety Information Center » Tokyo Metropolitan Government food safety FAQ »I get diarrhea when I eat and drink non-sugar and low calorie foods and drinks; why?

I get diarrhea when I eat and drink non-sugar and low calorie foods and drinks; why?

I get diarrhea when I eat and drink non-sugar and low calorie foods and drinks; is this dangerous? I’m particularly worried whether such foods are safe to give to children.

Sugar free and low calorie foods and drinks use reduced sugar syrup or sugar alcohols such as xylitol in place of regular sugar.

Some sugar alcohols are classified as foods and some as food additives, but all those currently used are approved for use in foods and drinks.
As sugar alcohols not only taste sweet but can also create a cool sensation, some are used not just as sweeteners but also to give snacks and drinks a refreshing, cool feeling. In addition, as sugar alcohols contain almost no calories and are believed to prevent tooth decay, they are widely used in diet foods and tooth decay prevention products.

Conversely, however, in some individuals sugar alcohols can temporarily cause loose bowels after being eaten.
Most food makers investigate how much of a given sugar alcohol may be consumed without causing this problem and label their products to indicate they can cause loose bowels in some people.
Unlike diarrhea caused by illness, sugar alcohol-induced loose bowels do not last for long and thus are nothing to worry about too much. However, the effect does vary by individual and it is believed best to avoid sugar alcohols if you have problems with them. If you are concerned, please consult with a doctor.

In recent years, many parents have begun giving their children low calorie foods made with sugar alcohols to prevent tooth decay and obesity. However, the health effects of sugar alcohols on small children and infants may be different from the effects on an adult. In addition, children cannot choose the foods they are fed.
It is best to focus on given children a balanced diet and give them foods with sugar alcohols as appropriate to their physical condition.

More information

Sugar alcohols are made by adding hydrogen to carbohydrates and chemically stabilizing the resulting product. Although some may be found occurring naturally in food (such as in apples), in general they are produced via industrial enzyme reactions and similar means. Unlike regular sugar, they do not brown when heated. When overconsumed, they can cause loose bowels (diarrhea). However, as they do not pose any safety problems as long as they are not consumed in large doses at one time, most sugar alcohols are treated as foods in Japan. Even those that are listed as food additives have no restrictions on their usage amounts and sugar alcohols in Japan are used as a common food ingredient.
Most food makers make use of sugar alcohols while taking into consideration a maximum no effect level determined for adult subjects. In addition, most voluntarily note on food labels that they can cause loose bowels in some people.

◆Sugar alcohols handled as foods in Japan
Erythritol, maltitol, lactitol, reduced sugar syrup, reduced palatinose

◆Sugar alcohols handled as food additives in Japan
Xylitol (xylite), D-sorbitol (D-sorbite), D-mannitol (D-mannite)

◆Maximum no effect level (reference values)
The amount per kilogram of body weight of a single dose under which no effect is observed
Erythritol: Male 0.66 g/kg body weight Female 0.8 g/kg body weight
Maltitol: Male 0.3 g/kg body weight Female 0.3 g/kg body weight
Lactitol: Male 0.075 g/kg body weight Female 0.15 g/kg body weight
Xylitol: Male 0.3 g/kg body weight Female 0.3 g/kg body weight
Sorbitol: Male 0.15 g/kg body weight Female 0.3 g/kg body weight

◆Main foods and food additives used as sweeteners
　(Those marked with an asterisk are sugar alcohols)

Foods
Sugar, dextrose, maltose, fructose, starch syrup, isomerized sugar, oligosaccharide,
lactose, raffinose, trehalose, erythritol*, maltitol*, lactitol*, reduced sugar syrup*, reduced palatinose*

Food additives
・Designated additives (no limits concerning usage or amount)
　Asparatme, xylitol (xylite)*, D-sorbitol (D-sorbite)*, neotame
・Designated additives (limits concerning usage or amount)
　Acesulfame potassium, disodium glycyrrhizinate, saccharin, calcium saccharate, sodium saccharin, sucralose (trichlorogalactosucrose), D-mannitol (mannite)*

・Main Existing Food Additives used as sweeteners
Glycyrrhiza extract, licorice oil extract, D-xylose, stevia extract, stevia shoot, trehalose
●At the 35th Planned Expert Examination Committee held September 28, 2010, there was no evaluation by the Food Safety Commission and it is handled as a food.
●D-sorbitol (a food additive) has caused diarrhea in health foods in the past due to excessive usage.

Outside Japan
Erythritol
・The European Food Safety Authority conducted a reevaluation in 2010 and concluded that there were concerns over the safety of this substance depending on amount consumed.
・In the EU, research was conducted on children between the ages of four and six to set a maximum no effect level for this substance whose use is approved in foods and drinks around the world. The research determined a relationship between an estimated daily intake of 2.5% erythritol in drinks and diarrhea. Based on these results, there is concern of the safety of this substance with young children with drinks containing 2.5% erythritol given the possibility of intake from other foods as well.
・The US Food and Drug Administration has approved this substance for use as an additive excluding in drinks. Consumption of 1 gram per kilogram of body weight per day shows no significant effects on the digestive tract (2006).
・The Joint FAO/WHO Expert Committee on Food Additives conducted a reevaluation of the substance and chose not to specify an ADI (2009).