Sorbitol, a common sweetener in many foods, is a sugar alcohol, which means it is neither a sugar nor an alcohol in the sense that most people understand those words, but chemists have their classification systems and sorbitol’s chemical structure is such that, with its hydroxyl groups each attached to one carbon atom, it’s a sugar alcohol.

So, what’s the problem?

We’ll cut right to the chase: it can be indirectly quite harmful to the liver.

To understand why, first understand how fructose is so bad for the liver. It’s so bad, because while glucose and fructose (the monosaccharides found in equal parts in the disaccharide that is sucrose, i.e. table sugar) both ultimately get converted into glycogen (if not used immediately for energy), but for fructose, this happens mostly* in the liver, which a) taxes it b) goes very unregulated by the pancreas, causing potentially dangerous blood sugar spikes.

This has several interesting effects:

• Because fructose doesn’t directly affect insulin levels, it doesn’t cause insulin insensitivity (yay)
• Because fructose doesn’t directly affect insulin levels, this leaves hyperglycemia untreated (oh dear)
• Because fructose is metabolized by the liver and converted to glycogen which is stored there, it’s one of the main contributors to non-alcoholic fatty liver disease (at this point, we’re retracting our “yay”)

Read more: Fructose and sugar: a major mediator of non-alcoholic fatty liver disease

^{*”Mostly” in the liver being about 80% in the liver. The remaining 20%ish is processed by the kidneys, where it contributes to kidney stones instead. So, still not fabulous.}

Now know this: sorbitol can be converted very quickly and easily into fructose (oops!)

Researchers (Dr. Madelyn Jackstadt et al.) found that if you have sufficient quantities of certain Aeromonas bacteria, they degrade sorbitol into harmless byproducts, but without them sorbitol passes to the liver, where it is converted into fructose and fructose derivatives.

However, you cannot rely on “well, I’m pretty sure my gut is in good shape”, because excess sorbitol—whether eaten directly or generated from high glucose intake—can overwhelm even those beneficial bacteria.

You can find the paper itself, here: Intestine-derived sorbitol drives steatotic liver disease in the absence of gut bacteria

What should we use instead?

Honestly, there are no sweeteners that we’re aware of that have no drawbacks.

Simply sweetness itself can cause problems: we can build tolerance to sweetness. Many sugar substitutes are many times (in some cases, hundreds of times) sweeter than sugar. This leads to people craving increasingly sweeter foods for the same experiential sweetness level.

Because of this, the World Health Organization has released a report offering guidance regards the use of sugar-free sweeteners.

In a nutshell, the guidance is: don’t

• Here’s the report itself: Use of non-sugar sweeteners: WHO guideline
• And it was based on this huge systematic review: Health effects of the use of non-sugar sweeteners: a systematic review and meta-analysis
• Here’s the WHO’s own press release about it: WHO advises not to use non-sugar sweeteners for weight control in newly released guideline

Nevertheless, if you really want to, we previously did a rundown on:

• Sucrose (metabolic problems)
• Sucralose (genotoxic)
• Erythritol (ischemiagenic)
• Xylitol (gut disruptor)
• Acesulfame K (gut disruptor)
• Stevia (strong risk of sweetness tolerance problem)
• Glycine (beneficial in moderation, sweetness problem though)

For more details than those one-or-few-word summaries, see: What’s The Healthiest Sweetener?

We’ve also talked about: The Fascinating Truth About Aspartame, Cancer, & Neurotoxicity

…which covers how the most popular beliefs about aspartame are myths, and in large part stemming from a single viral hoax chain letter in the 90s!

Want to do more for your liver?

Consider: N-Acetyl Cysteine For The Liver & More

Or if you prefer a purely dietary approach, then: How To Unfatty A Fatty Liver

Take care!