A Systematic Review of the Effects of Polyols on Gastrointestinal Health and Irritable Bowel Syndrome

Abstract

Polyols are sugar alcohols found in certain fruits, vegetables, and sugar-free sweeteners. They make up a component of the diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which is gaining popularity in the treatment of patients with irritable bowel syndrome (IBS). We conducted a systematic review to evaluate the effects of polyols on the gastrointestinal tract in healthy men and women and in patients with IBS. Utilizing PubMed, Ovid, and Embase databases, we conducted a search on individual polyols and each of these terms: fermentation, absorption, motility, permeability, and gastrointestinal symptoms. Standard protocols for a systematic review were followed. We found a total of 1823 eligible articles, 79 of which were included in the review. Overall, available work has shown that polyol malabsorption generally occurs in a dose-dependent fashion in healthy individuals, and malabsorption increases when polyols are ingested in combination. However, studies in patients with IBS have shown conflicting results pertaining to polyol malabsorption. Polyol ingestion can lead to intestinal dysmotility in patients with IBS. Regarding the microbiome, moderate doses of polyols have been shown to shift the microbiome toward an increase in bifidobacteria in healthy individuals and may therefore be beneficial as prebiotics. However, data are limited regarding polyols and the microbiome in patients with IBS. Polyols can induce dose-dependent symptoms of flatulence, abdominal discomfort, and laxative effects when consumed by both healthy volunteers and patients with IBS. Further research is needed to better understand the effects of specific polyols on gastrointestinal function, sensation, and the microbiome in health and gastrointestinal disorders such as IBS.

Keywords: artificial sweeteners; disaccharides; fermentable oligosaccharides; microbiome; monosaccharides; motility; polyols; sugar alcohols.

FIGURE 1

Factors involved in the pathophysiology and symptomatology of irritable bowel syndrome. Pathophysiology: (A) changes in bile acid concentrations, (B) gut microbiome, (C) changes in intestinal permeability, (D) immune activation, (E) dysmotility, and (F) visceral hypersensitivity. Symptomatology: (1) increased gas production secondary to rapid fermentation of carbohydrates by bacteria in the intestine and (2) increased water retention in the gut secondary to the effects of osmosis.

FIGURE 2

Polyol metabolism and fermentation in the colon.

FIGURE 3

Chemical structures of polyols.