Drinking carbonated beverages and eating a lot of candy or gum with sugar substitutes are both common causes of gas, and gas can make you feel bloated. The fizz in a diet drink can add to that whatever sweetener the drink holds, and artificially sweetened gum and candy frequently contain indigestible sugars that can lead to production of gas. Change the drinks and the candy one at a time, and you can tell which of the two your afternoons follow.
Do the diet drinks and the sugar-free candy hold the same kind of sweetener?
Not necessarily, because a diet drink and a sugar-free candy can be sweetened from two different classes, the high-intensity sweeteners and the sugar alcohols. A high-intensity sweetener is made to be many times sweeter than sugar, so a product needs only a little of it. Six of them are approved as food additives: aspartame, acesulfame potassium, sucralose, neotame, advantame and saccharin.
Three plant and fruit-based high-intensity sweeteners reached the market by another route. An ingredient generally recognized as safe by qualified experts, known as GRAS, does not require FDA's food additive approval before it is marketed, and FDA reviewed the GRAS notices for certain steviol glycosides from the stevia plant, monk fruit extract and thaumatin and had no questions about their safety conclusions. Sugar alcohols are a class of their own, which FDA permits as sugar substitutes.
| Compared on | High-intensity sweeteners | Sugar alcohols |
|---|---|---|
| Names you may see | aspartame, acesulfame potassium, sucralose, neotame, advantame, saccharin, steviol glycosides from stevia, monk fruit extract and thaumatin | examples include sorbitol, xylitol, lactitol, mannitol, erythritol and maltitol |
| Sweetness | from 100 to 20,000 times sweeter than table sugar, depending on the sweetener | from 25% to 100% as sweet as sugar |
| Where they turn up, among other places | many diet foods and drinks, including carbonated low-calorie beverages | primarily sugar-free candies, cookies and chewing gums |
| What is known about the stomach | some laboratory studies on intestinal cells suggest that neotame and other artificial sweeteners may have adverse effects on intestinal cell function and gut bacteria; these were not studies of people | may cause stomach cramps and diarrhea in some people, and sorbitol, mannitol and xylitol may when eaten in large amounts; erythritol does not cause stomach upset |
Which of the two classes is linked to stomach trouble?
Sugar alcohols are the class linked to stomach cramps and diarrhea: they may cause both in some people, and sorbitol, mannitol and xylitol may cause them when eaten in large amounts, so how much you eat matters as well as who you are. That does not clear the high-intensity sweeteners, which carry an open question of their own about the gut.
Erythritol is the exception: unlike other sugar alcohols, it does not cause stomach upset. A separate question about erythritol and the heart is still open. A recent study linked consuming erythritol to a mildly increased risk of adverse cardiovascular events such as heart attack, stroke and death, and more research is needed. Separately, the observational studies cited in a 2023 paper on erythritol and the heart did not establish a causal link between consuming erythritol and the effects observed.
For the high-intensity sweeteners, the open question comes from the laboratory. Neotame has been studied in laboratory models of intestinal cells, and some of these studies suggest that neotame and other artificial sweeteners may have adverse effects on intestinal cell function and bacteria in the gut. Those were studies of cells, not of people, so they cannot tell you whether your diet drink is behind the gas. Any sweetener can still disagree with one person: sweeteners are considered safe for their intended uses, though some people may have a particular sensitivity or adverse reaction to any food substance.
How to find out which class is in the things you eat
Read the ingredient list on the label of each thing you eat and drink, because you can identify whether a product has a sweetener by looking for the sweetener's name in the ingredient list. The words “sugar-free” or “diet” on the front of a pack do not tell you which class is inside. Sweeteners are widely used in foods and beverages marketed as sugar-free or diet, including soft drinks, powdered drink mixes and candy, and sugar alcohols are used as an ingredient in many food products that are labeled sugar-free, diabetic or low carb. Set the drink's list beside the candy's, so you know which product holds which class before you change either.
Acesulfame potassium is listed as acesulfame K, acesulfame potassium or Ace-K, and it is often combined with other sweeteners, so one product can list more than one. A stevia or monk fruit sweetener product may also contain erythritol, a sugar alcohol, because erythritol is a main ingredient added to stevia and monk-fruit sweetener products, but erythritol is the one sugar alcohol that does not cause stomach upset. A product with aspartame must carry a statement to inform people with phenylketonuria, or PKU, that it contains phenylalanine, which makes that line one more sign of aspartame. People with PKU, a rare genetic disorder, should avoid or restrict aspartame.
What else changed at the same time
Several other common causes of gas may have changed at the same time as the sweeteners, so check which of these started in the same months:
- certain medicines, such as antibiotics, if you began one;
- more fiber, since adding more fiber to your diet can sometimes cause temporary gas, and your body may adjust and stop producing it over time;
- a food or drink your body cannot tolerate, such as dairy for people with lactose intolerance, and fructose and related products, which make many people gassy;
- chewing gum, swallowing air while eating, talking while eating and eating too rapidly.
A weight-loss supplement started in those months is a change as well, and its label may not list everything in it (see Weight-loss supplements reach the shelf without FDA approval).
The tips that may help you prevent gas include not drinking carbonated drinks, not chewing gum, not eating diabetic candy with sugar substitutes often, chewing your food thoroughly, eating more slowly, relaxing while you eat and walking for 10 to 15 minutes after eating. Try them one at a time, so you can tell which change made a difference.
When to contact your doctor about the gas
Contact your doctor's office when the gas comes with other symptoms such as stomach pain, rectal pain, rectal bleeding, heartburn, nausea, vomiting, diarrhea, constipation, fever or weight loss, or if your stools are oily, foul-smelling or bloody. That includes diarrhea you put down to the candy. If your weight loss is planned, say so when you contact the office, since weight loss is one of those symptoms. At that visit, expect a physical exam, questions about your symptoms and your diet, and possibly tests such as blood tests, an abdominal ultrasound or a hydrogen breath test.
If you are concerned about a reaction to a food, talk with your doctor, and you can also report it through MedWatch, FDA's safety information and adverse event reporting program.
For a NicoCares patient, treatment that began in the same months as the new sweeteners is one more change to put a date on. Your physician remains available for side effects, so put those dates, and any symptom above, in a Spruce message for your care team. No reply time is published for Spruce messages, so contact your regular doctor's office about those symptoms as well.
