Since starting my nutrition counseling practice in 2013, I’ve had a lot of clients come to me for help with stomach pain and bloating. For some, solving their problems involves a diet change (for example, the low-FODMAP diet), looking more seriously at stress, or something else outside my scope of practice.
But for a few of these clients, the solution is much simpler.
Recently, for example, I saw a client who had been dealing with stomach pain for nearly a year. It usually got worse throughout the day, she said. Though she had seen GI specialists, no one could figure out what was wrong. She thought perhaps it was related to her diet. But, before taking a look at what she was eating, I asked one question: “Do you chew a lot of sugar-free gum?”
She was surprised, but answered: “Yes, a ton. All day.”
My History with Sugar-Free Gum
In college and in my early 20s, I was constantly chewing gum. I always had a pack of it in my purse or backpack. I chewed gum in class, after meals, before going out, while at my desk job – you name it. I also had stomach problems. Usually sharp pain and bloating that, like my client’s, got worse throughout the day. It didn’t happen every single day and it wasn’t crazy severe, but it started to get more and more frequent, to the point where I wanted to try to do something about it.
One day, I was looking around online when I came across an article that mentioned sugar-free gum can sometimes cause stomach pain and bloating. “No way,” I thought. “Could that be what was making my stomach hurt?” I had always assumed it was what I was eating — too much, or not the right things; too little fiber, or too much fiber; too little water, or too much. It’s easy to drive yourself crazy self-diagnosing on the Internet (this was well before I went back to school to study nutrition).
Figuring I had nothing to lose, I tried going cold turkey. Lo and behold, away went the stomach pain, almost immediately.
Why Sugar-Free Gum Can Cause Stomach Pain
It wasn’t until years later, when I went back to school to become a dietitian, that I discovered why sugar-free gum was making my stomach hurt so much.
There are two main reasons that sugar-free gum can cause stomach pain. The first is that you naturally swallow a lot of air while chewing gum. But the second and, arguably, main reason is the presence of sugar alcohols. If an item is labeled “sugar-free,” that usually means it contains either artificial sweeteners or natural low- or no-calorie sweeteners. In the case of sugar-free gum, it usually contains sugar alcohols.
Sugar alcohols, a form of carbohydrates, are often used in gum for a number of reasons. First, because they are slowly and incompletely absorbed in the body, they contain fewer calories and won’t cause as much of a blood sugar rise and subsequent insulin response as regular sugar. Second, dentists like them better than regular sugar because the bacteria in the mouth don’t act upon them, meaning sugar alcohols don’t contribute to tooth decay and cavities. One sugar alcohol, xylitol, has even been found to inhibit oral bacteria.
The reason sugar alcohols can lead to stomach issues, especially when consumed in high amounts, is due to the fact that they are not well-absorbed or digested by the body. (A “high amount” varies for each person and depends on the type of sugar alcohol used.) Some of the sugar alcohols will pass into the bloodstream, but the majority will travel through the intestines unabsorbed. Once in the intestinal tract, the sugar alcohol will meet bacteria that ferment it and release gas, which leads to bloating, cramps, pain and or diarrhea. This is similar to what happens when someone who is lactose intolerant eats something with lactose.
The easiest way to spot sugar alcohols on an ingredient list is to look for the “-ol” ending — not all sugar alcohols end in “-ol,” but the majority of them do. The names of some of the most common sugar alcohols that you’ll probably recognize from packages include: xylitol, mannitol, sorbitol, maltitol and erythritol.
Besides sugar-free gum, you’ll also often find sugar alcohols in sugar-free versions of candy, frozen desserts, chocolate, and diet and low-calorie packaged products and baked goods. Sugar alcohols also sometimes can be present in mouthwash, toothpaste and multivitamins, but those sorts of products generally don’t contain a high enough concentration to cause any issues.
Obviously, stomach pain, bloating and GI issues can occur for a multitude of reasons besides sugar alcohols. And, if you are struggling with similar issues it may be something else entirely. That said, if you’re having stomach issues and consuming a lot of sugar-free products, give some thought to cutting them out to see if it helps. Nothing to lose, right?