title: Dose-related gastrointestinal response to the ingestion of either isomalt, lactitol or maltitol in milk chocolate.
abstract: OBJECTIVE
  To determine whether there were differences between different polyols (sugar alcohols) in terms of their ability to stimulate intolerance symptoms when consumed in milk chocolate. Also to discover whether symptomatology can be related to the dose of polyol ingested.
  
  
  METHODS
  The study was of a randomised double-blind cross-over design.
  
  
  METHODS
  59 healthy volunteers aged 18-24 years were recruited from the student population of the University of Salford. All subjects successfully completed the trial.
  
  
  METHODS
  Subjects ingested 100 g milk chocolate containing 40 g bulk sweetner as either sucrose, isomalt, lactitol or maltitol or a mixture (10:30 w/w) of sucrose and isomalt, sucrose and lactitol or sucrose and maltitol. Each bar was taken as breakfast on one day with following products consumed at 1-week intervals. Subjects reported the incidence and severity of the symptoms of flatulence, borborygms, colic, motion frequency and loose stools.
  
  
  RESULTS
  The ingestion of 30 g or 40 g lactitol resulted in a significant increase in the incidence and severity of all symptoms examined compared to reactions after the consumption of standard sucrose-containing chocolate (P <0.01). Similarly, 40 g isomalt led to an increased incidence of all symptoms, including mild laxation (P <0.01), but unlike lactitol none was rated as being severe. A reduction in isomalt to 30 g was marked by increased tolerance with evidence of only mild borborygms (P <0.01), mild flatulence, colic, and laxation (P <0.05), with no increase in motion frequency (P <0.35). Ingestion of 40 g maltitol caused less intolerance than 40 g isomalt, with evidence of only flatulence, borborygms and colic (P <0.01), symptoms being rated as only mild. A reduction to 30 g led to a decrease in all symptoms except mild flatulence. Maltitol did not have any laxative effect when ingested at either 30 g (P = 0.32) or 40 g (P = 0.13) per day.
  
  
  CONCLUSIONS
  This work has shown that there are significant differences in the reporting of gastrointestinal symptomatology following the consumption of isomalt, lactitol and maltitol incorporated into milk chocolate. However, with all three polyols the incidence and severity of symptomatology was dose dependent.
authors.affiliation: Nutritional Biosciences Unit, University of Salford, UK.
authors.forename: G A
authors.initials: GA
authors.lastname: Koutsou
authors.forename: D M
authors.initials: DM
authors.lastname: Storey
authors.forename: A
authors.initials: A
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: Zumbe
authors.forename: B
authors.initials: B
authors.lastname: Flourie
authors.forename: Y
authors.initials: Y
authors.lastname: leBot
authors.forename: P h
authors.initials: Ph
authors.lastname: Olivier
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002099:Cacao; D018592:Cross-Over Studies; D003967:Diarrhea / Q000139:chemically induced*; D004187:Disaccharides / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005414:Flatulence / Q000139:chemically induced*; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D008297:Male; D008320:Maltose / Q000009:adverse effects / Q000031:analogs & derivatives*; D008892:Milk; D012720:Severity of Illness Index; D013402:Sugar Alcohols / Q000009:adverse effects*; D013549:Sweetening Agents / Q000009:adverse effects*
chemical_list: D004187:Disaccharides; D013402:Sugar Alcohols; D013549:Sweetening Agents; C016640:Palatinit; D008320:Maltose; C010745:maltitol; C014635:lactitol