Episode 7: Why Your Gut Reacts to “Healthy” Foods: Sugar Alcohols Explained

In this Team Gut Girls bloating series episode, Dr. Whitney Baxter with co-hosts Dr. Christina Carew and Dr. Dominique Vanier discuss sugar alcohols (polyols)—the “P” in FODMAP—as a sneaky cause of bloating, gas, loose stools, and abdominal discomfort. They explain these reduced-calorie sweeteners (e.g., xylitol, sorbitol, mannitol, erythritol, maltitol) occur naturally in some fruits and vegetables and are common in sugar-free gum, candy, baked goods, frozen desserts, jams, and some drinks; a practical label tip is to look for ingredients ending in “-ol.” Polyols are incompletely absorbed in the small intestine, reach the microbiome, and ferment, with tolerance varying by person and quantity, especially in IBS with visceral hypersensitivity. They note reasons for use (texture, moisture, reduced browning, cooling sensation, fewer cavities, lower sugar impact) and summarize that current evidence suggests no harmful microbiome effects and possible prebiotic benefits, advising symptom tracking and discussing concerns with a clinician or dietitian rather than automatically eliminating foods.

00:00 Introduction

02:20 Why Are They Used?

05:31 How Do They Cause Bloating?

10:51 Impact on the Microbiome

15:45 Practical Takeaways

17:11 Talking to Your Practitioner

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Why Your Gut Reacts to “Healthy” Foods_ Sugar Alcohols (Polyols) Explained  

Dr. Whitney Baxter, ND: Welcome back to another episode with Team Gut Girls on our series about bloating. This is Dr. Whitney Baxter. I’m joined by my co-host, Dr. Christina Carew, and Dr. Dominique Vanier. For this episode, we wanna talk to you about some sneaky causes of bloating that are found in the foods that you eat. So these can be found both naturally in , stone fruits, vegetables, like mushrooms, stone fruits like avocados,, peaches, but also in packaged foods like candy, gum, baked goods.

Dr. Christina Carew, ND: Mm.

Dr. Whitney Baxter, ND: So I’m talking about sugar alcohols, polyols. If you’ve heard of the FODMAP diet, that’s the P. So this is things like xylitol, mannitol, and other things that you might now recognize on that pack of gum. As always, we’re here to help you ask your doctor the right questions to determine, “Hey, could this be what’s causing my bloating?”

So today, we’re talking about [00:01:00] food that causes bloating, but if you’ve been listening to this podcast, you’ll know that we love food, and we try to not make it the victim when you present with bloating right away. There are so many causes of bloating and distension, and it’s not always just the food. And because of this, we’re not always recommending that you just eliminate food.

So if you’re listening to this podcast and you think this might be causing your bloating, still ask your doctor, still seek out a dietician for some support. But after listening to this, you might think, “Hey, yes, there are some good clues that this could be the cause.” So when it comes to these sugar alcohols or these polyols, they’re just simply not completely digested in our gut, so they hit the microbiome and cause lots of bloating and gas or loose stools, depending on your gut, depending how much you’re eating all at once, but I wanna talk to you about why that’s happening in a little bit.

So they can be commercially produced from sugars, starch, [00:02:00] starches. They’re used as reduced-calorie sweeteners and are found in many sugar-free or, diabetic candies, if you’ve seen those, sugar-free gums, that sort of thing. Okay, so why are they used in sugar-free items? Do one of you wanna talk about this one?

Why Are They Used?

Dr. Whitney Baxter, ND: Christina?

Dr. Christina Carew, ND: Sure. So they, often are used- Sort of alluding to the diabetics as a sweetener to fi- or a sweet taste kind of replacement for people that are trying to reduce their sugar intake, for instance, or, or have, limitations on sugar intake, so they’re often considered some of those artificial sweeteners.

They generally have fewer calories, and so that’s another, bonus, for them. They are full- often, found in foods that, need bulk or texture to retain their moisture or prevent them from browning, which occurs during heating. So they’re, like, [00:03:00] used sometimes in ways to preserve our food so that it looks the way that we want it to look.

And they also can make that cooling sensation in the mouth, so if you think about,, mint gums and some of those. And they are less, presumably less likely to cause ca- cavities, and they do not re- they do not interact with plaque bacteria in our mouths. So there’s, lots of reasons why they’re used, but maybe, we don’t know as much as we, we do about sugar about them yet.

Dr. Whitney Baxter, ND: Mm-hmm. Mm-hmm. Yeah. And we’ll learn that they’re not inherently harmful, but, just something to keep in mind of how they get digested in our gut. Mm-hmm. So let’s get more specific so you can start to recognize them on food labels and maybe if something you’re consuming on a daily basis. Dominique, what are some examples?

Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. I… When, I’m educating patients, I’m telling them to look out for the end of the word, ending in O-L. Okay? So O-L, and if you could think back to chemistry in high school, your alcohol. Mm-hmm. \ So we’ve got [00:04:00] erythritol, sorbitol, mannitol, maltitol, and xylitol. There may be others, but those are the main ones.

And you also wanna think about kind of, like, broadly where we would find them. We’ve started to talk about, the sugar-free gums, candies, mints, as well as diabetic diet and keto foods. They are typically not as sweet as artificial sweeteners like aspartame, for example. When you’re having that type of food, you’re still gonna, you’re still gonna taste some sort of sweetness.

They still are sweet. And you know, like, they’re also gonna be found in baked goods often. Cakes, cookies, pies, things like frozen desserts. Sometimes ice cream, sometimes not. Flavored jam. So and even sometimes we can find them in, fruits and vegetables. So sometimes they’re found in things like prunes, cauliflower, and button mushrooms, which was a bit of surprise to me when I- when we were looking into this.

You can find sorbitol naturally in some foods like apples, pears, peaches, apricots, in some [00:05:00] vegetables. Like, there’s a lot. There’s a really big list. Fermented foods such as wine and soy sauce. You you know, when you wanna … When you’re reading the package of gum, ice cream, cookies, you’ll likely find that there’s more than one type.

So there- we find them pretty broadly in a diverse diet.

Dr. Whitney Baxter, ND: Yeah, and I like what you said. Just keep it simple. Look at the word, that O-L, ’cause yeah, you’ll, you’ll start to recognize some things, on the things you’re grabbing during the day.

How Do They Cause Bloating?

Dr. Whitney Baxter, ND: Okay, so why and how do they cause bloating, gas, diarrhea?

Those are some symptoms that they can cause. Essentially when they hit your gut, your small intestine, sometimes things are selectively absorbed or they have mechanisms to help it into our bloodstream, but these are just passively diffused. They just kind of sift on through. So if there’s a large quantity, they’re not all getting through our gut.

So that’s left to be a [00:06:00] whole, and then this incomplete absorption of these foods are getting to our gut microbiome and literally getting fermented and producing gas. So for some people, it can just be a tolerance thing, kind of like lactose intolerance, so some people can tolerate more. But for this reason, sometimes you’ll notice different countries that they ha- and even in some packaged foods, they’ll have to say excess consumption could have a laxative effect.

Handy to know. But this is why. Yeah. So just, yeah, if you’re noticing like, hey, I do actually grab a muffin or a cookie more days than I’m realizing, or I’m having these, like, mints throughout the day after my coffee if I have to be in a lot of- speaking to a lot of people, and you’re noticing a lot of gas and bloating, like, after lunch or things it’s nice when you start to track your symptoms to put these clues together [00:07:00]

Dr. Christina Carew, ND: These are also in a lot of drinks, so lots of- Yeah

like, those, alternative bubbly waters and alternative, soda options. So sometimes when people are choosing that option because it’s, more natural, it may actually, especially if your consumption rate is high, could be a place where you’re accumulating them- Mm-hmm … that you’re not even realizing.

Dr. Dominique Vanier, ND: Yeah, that’s a good point.

Dr. Whitney Baxter, ND: Mm-hmm.

Dr. Dominique Vanier, ND: Yep.

Dr. Whitney Baxter, ND: Yeah. Sneaky. Okay. So over the years, I’ve had a lot of patients ask me these things, or I’ve read about some questions that if they’re causing these symptoms, why are we consuming them? Are they harmful? Do they impact our gut microbiome? So I wanna break these down.

Why are they being used as sweeteners if they trigger these gas, bloating, diarrheas?

Dr. Christina Carew, ND: I guess marketing is part of it, right? People are looking for alternatives to sugar because sugar became sort of a villain in the marketing world. And so and then people switched to aspartame, and then [00:08:00] aspartame became a villain, and so xylitol or something from, birch tree seems like maybe it’s more natural.

And so I think that’s part of it. We also know that there’s, less calories, so certainly that’s a draw for a lot of people who are looking for a calorie reduction but still getting, some sweetness tasting. And, maybe they have less impact on insulin concentrations or blood glucose response.

It kind of depends on, what is it in, right? And, what is it replacing? So is it, in a food that already has a lot of calories and this just takes some out, or avoids some of the package labeling because it doesn’t have as much sugar in it, but splits it in between these, alcohol sugars is a possibility as well.

And then, the GI symptoms aren’t something that everyone experiences. And so just like any other food, not everyone is allergic to peanuts, not everyone is allergic to or sensitive to, certain foods, and so we don’t [00:09:00] restrict them in diet. We just say, “Here are options that are available to you consumers.

You know, choose what you want, what fits your diet and your lifestyle best.”

Dr. Dominique Vanier, ND: That, that’s a good point, right? Which is, when we’re going down that, the journey of determining what foods we’re sensitive to, sometimes we can think about, oh, it must be gluten or it must be dairy. But I think the sugar alcohols really represent this group where, it’s not necessarily the first thing that we think about and it’s so spread out in our diet.

So it’s it’s definitely something to pay attention to if somebody is having sensitivities to what feels like every time they go out and they eat food or they purchase something packaged or they’ve had certain drinks. Something to think about.

Dr. Christina Carew, ND: And it’s not that you’re, like, consciously adding it in.

It’s in a food, so you’re not obv- necessarily recognizing it.

Dr. Dominique Vanier, ND: Good point. Mm-hmm.

Dr. Christina Carew, ND: Yeah.

Dr. Dominique Vanier, ND: Um,

Dr. Whitney Baxter, ND: okay, Dominique, how do they trigger that gut pain?

Dr. Dominique Vanier, ND: Mm-hmm. That’s a good question, yeah. So it has to do with what you mentioned, Whitney, like that passive diffusion, um, through the gut [00:10:00] walls. So they can be, you know, a laxative if taken in high enough quantities.

Um, this may induce gas, bloating, abdominal discomfort in healthy people. And as well, w- and that’s where, where it can be a bit tricky, ’cause we can see this in a normal, like, healthy, non-digestive issue population as well as in the IBS population due to what we’ve gone over many times before in other podcasts is it’s this visceral hypersensitivity mechanism.

Um, uh, as well, the sugar alcohols will, like, have a slow and incomplete absorption, so that’s an important point, too. And everyone’s gut is different, and everyone’s threshold of polyol ingestion, um, to laxative or bloating discomfort is different.

Dr. Whitney Baxter, ND: Yeah. Yeah. So it’s, that’s where tracking really comes in handy- Mm-hmm … starting to pick up clues. Um, yeah, ’cause this- So

Impact on the Microbiome

Dr. Christina Carew, ND: Whitney, do they impact the microbiome?

Dr. Whitney Baxter, ND: Well, I went down some rabbit holes- Uh-huh … with this question because I was [00:11:00] also curious about this, too. Um, so some of them, kind of like the FODMAP world, when we put someone on a low-FODMAP diet, they’re o- not, not every category of the FODMAP is built the same.

They’re different structures. So just even, like, in this category of the FODMAP diet, these polyols are all kind of absorbed differently. So studies show that isomaltose, maltitol, lactitol, xylitol can reach the large bowel and increase the good numbers of our bifidobacteria in humans. So that’s something to keep in mind, ’cause they are also found in, like, they’re naturally occurring.

So it, it’s cool that there is some, some benefits. Um, so, so they’re thinking that these could have some prebiotic action, so they’re actually fueling the healthy species of the microbiome. And then different clinical trials show that lactitol may decrease [00:12:00] populations of other things, bacteroides, clostridium.

Um, so there are some studies in human trials. The majority are always in mice, so we can’t always say, yes, that’s the same for us. They have different makeups. They’re gonna digest things differently than we do. Um, their little guts probably have never seen a candy before, where ours probably already has, so we’re like, we can manage it a little differently.

Um- But there was an interesting study in mice, and I’ll just talk about this ’cause maybe this can happen in humans too, where they essentially put them on an antibiotic round and then fed them a high-fat diet, and they found that they had more intolerance to these polyols. And, and again, that’s just showing that, yeah, if we wipe out all of our species of bacteria and then we’re feeding high amounts of things, that can be really irritating on the gut lining or in, or this, the species that are left over in this forest, as a patient described it this week, which I really [00:13:00] loved.

Um, they’re just gonna metabolize things differently and you’re gonna have maybe more visceral hypersensitivity. So maybe we’ll see these, um, studies in humans, but I think that’s something to keep in mind too. If your microbiome has been impacted by medications, if you’ve had a colonoscopy, if you’ve had like a stomach flu or something that has altered this ecosystem or this forest of species, you might be noticing symptoms where you hadn’t before to the foods you eat.

And same thing goes with, with these polyols because they are reaching the gut and they are getting fermented. Have you guys

Dr. Christina Carew, ND: read anything- Actually, made me think of, uh, something ’cause xylitol, we’ll use it often in biofilm reduction. Mm. So it actually opens some of the goopy stuff that holds all these bacteria in, and I wonder if some of the bloating or some of the sensation is because we’ve, like, kinda opened Pandora’s box a little bit.

And so in taking xylitol maybe as a [00:14:00] food additive, we’re actually also doing some, uh, biofilm opening.

Dr. Dominique Vanier, ND: That’s a good thought actually. Um, al- also the reason why xylitol is added to some toothpaste for that exact reason, of it being a- Mm-hmm … a biofilm opener. Um, I think maybe, like, listeners at this point will have a question.

Okay, so if we have some sugar alcohols that we know feed good bacteria and then increase, uh, their populations, why are we sensitive to it? ‘Cause we wanna have good bacteria, and isn’t that protective? And the reason why is I think it has to do with the fermentability of the sugar alcohols to begin with.

So, like, the issue is starting up a little bit higher, is, like, you wanna think about how things travel from the mouth to the esophagus to the stomach to the small intestine, and it’s the fermentability kind of upper in the GI tract. So that’s kinda the issue. Even though it’s feeding some good species lower down, we’re, we’re, like, we’re looking up, a little bit higher up in the GI tract.

Dr. Christina Carew, ND: Yeah. And it’s probably a sy- a symptom of quantity too. So, like, if [00:15:00] you’re someone that eats, like, a whole pack of gum a day, you’re gonna have a different experience than someone that might have a pack a week. Uh, and so it’s like quantity is a big com- comparison point too, or how many of the foods that you’re eating have these additives, um, structured into them versus, you know, once in a while.

Dr. Whitney Baxter, ND: Yeah. Yeah, totally. And all these things are built with other items. Like, even with gum, yeah, it could be the sugar alcohol, or if you’re chewing, you’re swallowing more air more likely. So that can also be a cause of gas and bloating. Or these baked goods, they might have other things that you’re sensitive to or-

Dr. Christina Carew, ND: Yeah.

Dr. Whitney Baxter, ND: Yeah. Small things to keep in mind.

Practical Takeaways

Dr. Whitney Baxter, ND: So this was a short and sweet episode, so we’ll just kind of give you some practical takeaways, um, about these sugar alcohols and polyols, and if they could be causing your bloating or other indigestion symptoms. So just remember, [00:16:00] um, they occur both naturally and commercially produced in candies, gums, baking, frozen desserts, and fermented products.

So just look out for that O-L word, the xylitols, the sorbitols, um, and start to recognize them in your packaged foods. They can cause a laxative effect, so especially in higher amounts. They can impact some people more than others, depending on your tolerance or if you have something called visceral hypersensitivity.

So if you’ve been told you have irritable bowel syndrome, um, this, you can just feel more sensations in your gut, and sometimes your brain thinks that that’s pain. Um, so that can a- absolutely trigger discomfort. They are not harmful as far as we know. Studies are always ongoing. Whenever I search something, I can find something from, like, a few months ago.

So studies on the microbiome in our gut is always evolving. Um, and they don’t have negative impacts on our microbiome. They have positive effects overall. Most studies are still in mice, but it’s [00:17:00] not something to be concerned about. So let’s talk about some ways of how to talk to your practitioner if you need some more support.

Talking to Your Practitioner

Dr. Whitney Baxter, ND: You guys can jump in on this one.

Dr. Dominique Vanier, ND: You wanna explicitly say, “I’m noticing whatever symptoms, X, Y, Z. So I’m noticing more gas, bloating, diarrhea, pain. Wondering if this is the food that I ate.” Or something like, “I’ve noticed when I eat more of the following. Can we do a lactose intolerance test?

Is there a better- is there a tool that I can use to track this? Is there an app that I can use to track this? Could this be gluten intolerance?” Again, you wanna, I think, tracking- tracking somebody’s diet and for enough time to give them a representative picture of what their average diet looks like, and that could sometimes be five days, sometimes that’s two weeks, whatever it is, like, personalized to them.

But really noticing if this happens after very spif- specific foods like baked goods, chewing gum, ice cream, stone fruits, things like that. [00:18:00]

Dr. Whitney Baxter, ND: And yeah, if you’re noticing symptoms after rounds of antibiotics or after you’ve been sick, that can be totally normal. Still good to check in with your doctor, naturopathic doctor, whoever you’re working with.

Sometimes it is just a short-term intolerance, and as you slowly build back up this ecosystem of your microbiome, your tolerance, you can repair it over time, so that sensitivity might decrease. So we hope to empower you to better understand what could be contributing to the bloating and gas, and at the end of the day, help you read food packaging, which is always really handy.

So we’ve included a reference with this episode of how to find these in packages, so you can check that out. ‘Cause knowing why you’re bloating can just put you at ease and help you eat the foods you love. So even those treats, we’re not saying avoid treats. If you can have the muffin, and if you know you’re gonna bloat, sometimes it’s worth it.

But if you’re chewing gum all day, like Christina said, if you’re chewing a higher quantity or having a lot more of those [00:19:00] candies, they can just stack, and higher consumption can lead to more, more symptoms. But they’re not harmful. Understanding how to consume less may really help you. But again, thank you so much for joining us today for another episode in our bloating series.

We hoped you learned a few things about sugar alcohols, and we sure love learning how and why certain things can impact our gut and teaching you how to feel better. Because after all, better gut health changes everything.