Sugar intake is a real concern for people who’ve had gastric bypass, in fact most patients fear sugar. The foremost fear isn’t weight gain, it’s dumping. Foods containing sugar pass too quickly through the small pouch, they are rapidly absorbed and cause insulin levels to drop resulting in dumping.

Very unpleasant. Instead of taking chances with sugar many of us reach for “sugar free” sweets or diabetic candy to satisfy our sweet tooth. Many of these products contain sugar alcohol, a natural sweetener derived from fruits and berries. Unlike artificial sweeteners that contain no calories, sugar alcohol has about half the calories of sugar. Diabetics are able to have food with sugar alcohol because it’s converted more slowly to glucose and require very little insulin to be metabolized.

While sugar alcohols are low in calories and slow to convert to glucose, the down side is they can cause gas, bloating and diarrhea. I learned this the hard way. One day that devil we call temptation seduced me into buying a bag of sugar-free jelly beans. Jelly beans are dangerous because they are little bites of soft food which means a gastric bypass patient can eat too much volume. I ate the entire bag in about an hour (true confessions of the closet snacker). I soon became uncomfortable with a small tummy ache. The tummy ache turned to bloating, cramping and gas. Extreme cases of all three symptoms. Painful “take me to the hospital I think I’m gonna explode” symptoms. It took a couple of days for my body to return to normal, a couple of stressful and uncomfortable days.

The jelly beans I ate contained Mannitol, a common sugar alcohol extracted from seaweed. I know they contained Mannitol because I read the package mid-way through the crisis. The package contained this warning, “Warning: excessive consumption can cause a laxative effect” Fine time to be reading labels I told myself! Mannitol is found naturally in pineapples, olives, asparagus, sweet potatoes and carrots. It’s about 60% as sweet as sugar, so more product is needed to replicate the sweetness of sugar. “Mannitol lingers in the intestines for a long time and therefore causes bloating and diarrhea.” Yup! That’s exactly what happens all right.

What other names are sugar alcohols called?

Sorbitol is found naturally in fruits and vegetables. It is manufactured from corn syrup. Sorbitol has only 50 percent of the relative sweetness of sugar which means twice as much must be used to deliver a similar amount of sweetness to a product. It has less of a tendency to cause diarrhea compared to mannitol. It is often an ingredient in sugar-free gums and candies.

Xylitol is also called “wood sugar” and occurs naturally in straw, corncobs, fruit, vegetables, cereals, mushrooms and some cereals. Xylitol has the same relative sweetness as sugar. It is found in chewing gums.

Lactitol has about 30-40 percent of sugar's sweetening power, but its taste and solubility profile resembles sugar so it is often found in sugar-free ice cream, chocolate, hard and soft candies, baked goods, sugar-reduced preserves and chewing gums.

Isomalt is 45 - 65 percent as sweet as sugar and does not tend to lose its sweetness or break down during the heating process. Isomalt absorbs little water, so it is often used in hard candies, toffee, cough drops and lollipops.

Maltitol is 75 percent as sweet as sugar. It is used in sugar-free hard candies, chewing gum, chocolate-flavored desserts, baked goods and ice cream because it gives a creamy texture to foods.

Hydrogenated starch hydrolysates (HSH) are produced by the partial hydrolysis of corn. HSH are nutritive sweeteners that provide 40 - 90 percent of the sweetness of sugar. HSH do not crystallize and are used extensively in confections, baked goods and mouthwashes.

Should Gastric Bypass Patients indulge their sweet tooth with sugar alcohol?

The American Diabetes Association claims that sugar alcohols are acceptable in a moderate amount but should not be eaten in excess. In addition, weight gain has been seen when these products are overeaten. Personally, I’m not dipping my sticky fingers into sugar-free candy again. For gastric bypass patients generally the key, as in all eating, must be moderation, not a full bag of jelly beans. And of course, we can always rely on the old advice of conventional dieters, “Hungry for something sweet? Reach for a piece of fruit.”