Could Those ‘Glutening’ Symptoms Actually Be Due to Sugar Alcohols?

GlutenFreeDrugs.com has become one of the top resources for information on gluten in medications. Clinical pharmacist Steven Plogsted is the man behind the site, and he’s been a huge help in spreading the word about NFCA’s Gluten in Medications Survey. Recently, Steve graced our inboxes when he responded to a listserv query about a particular medication. His response explained a mix-up related to sugar alcohols in certain medications, and we thought it was important information to share. So, we asked him to do a quick Q&A.

Steven Plogsted

What are sugar alcohols?

Sugar alcohols are better known as the artificial sweeteners. They are not truly sugars or alcohols (chemicals with a specific type of carbon and oxygen bond), rather they are carbohydrates with a structure similar to sugars and alcohols and impart a sweet taste to the foods or drinks that to which they are added.  Examples include sorbitol, mannitol, xylitol, maltitol and others.

Why are they used in medications?

They are used in medications as sweetening agents, general fillers, tablet coatings and as an emollient. Applied topically, they can act as a cooling agent on the skin like menthol.

Why should celiac and gluten sensitive individuals be aware of sugar alcohols in medication?

When taken in large amounts, sugar alcohols can cause significant abdominal discomfort, but it is not due to gluten. Celiac and gluten sensitive individuals who are on a gluten-free diet don’t need to be concerned about sugar alcohols affecting their disease. However, they should know that sugar alcohols could be the cause of some discomfort.

How are sugar alcohols causing confusion among manufacturers and gluten-free consumers?

One method of manufacturing these products is by purification of any starch, including wheat. Since they are highly purified, there are no gluten remnants remaining and therefore they are gluten-free. My feeling is that these manufacturers are taking labeling practices to the extreme and informing people that it contains gluten because it was derived from wheat. Since the manufacturers are telling consumers that their product contains wheat, individuals with celiac disease are avoiding those products.

If sugar alcohols can cause GI issues, are they actually safe to consume?

Taken in moderation, these are generally safe to consume. Anyone who consumes large amounts of the sugar alcohols will most likely experience GI symptoms since they act as an osmotic cathartic (laxative).

You encourage consumers to push manufacturers to explain why their product ‘may’ contain gluten. Why?

I encourage consumers to push manufactures to disclose the source of the gluten contamination in case they are claiming gluten contamination due to one of these sugar alcohols or other reasons. As an example, one company I called told me their product contained gluten. When I pressed them to disclose where the gluten was from, they told me it was from the corn starch. I explained to them that corn starch and corn gluten were OK, but they told me that to them, gluten is gluten, so they don’t differentiate what kind of gluten it is. They just tell the caller that it contains gluten.

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To summarize, if you experience GI issues as a result of taking a medication, gluten contamination may or may not be the culprit. Sugar alcohols can cause similar symptoms, so contact the drug manufacturer to learn more about the medication ingredients.

– Cheryl

*Don’t forget to take the Gluten in Medications Survey. The survey closes next Tuesday, Feb. 28!

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