Intended for healthcare professionals

Practice Lesson of the Week

Severe weight loss caused by chewing gum

BMJ 2008; 336 doi: (Published 10 January 2008) Cite this as: BMJ 2008;336:96
  1. Juergen Bauditz, consultant1,
  2. Kristina Norman, nutrition scientist1,
  3. Henrik Biering, junior doctor1,
  4. Herbert Lochs, head of department1,
  5. Matthias Pirlich, consultant1
  1. 1Department of Gastroenterology, Hepatology, and Endocrinology, Charité Universitätsmedizin, 10117 Berlin, Germany
  1. Correspondence to: J Bauditz juergen.bauditz{at}
  • Accepted 10 July 2007

Sorbitol intake should be considered in patients with bowel problems, chronic diarrhoea, and weight loss

About 10-20% of adults and adolescents are estimated to have symptoms related to functional bowel disorders, resulting in high healthcare costs.1 We report two cases of chronic diarrhoea and substantial weight loss in which extensive investigations had been performed previously. However, final diagnosis was only established after precise evaluation of eating habits, which showed habitual ingestion of sorbitol, a widely used sweetener in food products which has laxative properties.

Case reports

Case 1

A 21 year old woman had experienced diarrhoea and diffuse abdominal pain for eight months. She had four to 12 bowel movements with watery stools daily. She was initially suspected to have infectious colitis. However, as clinical investigation suggested no clear diagnosis and diarrhoea persisted, she was transferred to our department for further evaluation. At that time she had lost 11 kg and weighed 40.8 kg (body mass index 16.6). Laboratory analysis showed hypoalbuminaemia (albumin 30.7, normal range 33-50 g/l; total protein 64.3, 66-87 g/l). Further laboratory investigations (including antigastrin antibodies, antigliadin antibodies, endomysial antibodies, stool pancreatic elastase, and stool cultures) were normal. The colon had a normal macroscopic appearance on colonoscopy; histology showed no specific changes (single lymphocytes and plasma cells, no granulocytes, normal mucosal architecture) and no evidence of microscopic colitis. Findings of gastroscopy with deep duodenal biopsy, abdominal ultrasound, and computed tomography …

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