Too much at once loosens the bowels
The small intestine absorbs maltitol poorly. What reaches the large bowel is fermented by bacteria, making gas and drawing water in, which causes bloating, wind and loose stools. It varies from person to person, but studies report noticeable effects in many adults above 20 to 30g at once. UK law requires a laxative warning where added polyols make up more than 10% of the food.
Maltitol above roughly 20 to 30g at once caused laxative symptoms, including loose stools and wind, in volunteer studies.
2003Review of human studiesLivesey G, Health Potentials of Polyols as Sugar Replacers, Nutrition Research Reviews
Foods with more than 10% added polyols must say "excessive consumption may have laxative effects".
LawEU Regulation 1333/2008, Annex III, Part C (kept in UK law after Brexit)
It still raises blood sugar
Maltitol raises blood sugar and insulin less than sugar does, but not by a trivial amount. Its glycaemic index is about 35, against about 65 for table sugar. People with type 1 or type 2 diabetes who count carbohydrates still need to count it.
Maltitol has a glycaemic index of about 35 and an insulin index of about 27, clearly lower than sugar but not negligible for people managing blood sugar.
2003Review of human studiesLivesey G, Nutrition Research Reviews
A missing test of whether it damages DNA
As part of their review of all approved sweeteners, European reviewers asked makers for a specific lab test of whether maltitol damages DNA, because the standard test now required was missing. That does not mean maltitol is known to damage DNA. It means the set of tests regulators expect today is not complete, and the review has not yet been published.
Reviewers found a required lab test for DNA damage (the in vitro micronucleus test) was missing for maltitol, and formally asked for the data.
Regulator reviewEFSA Call for Data: Genotoxicity data on maltitol (E 965 i)
Kinder to teeth than sugar
Mouth bacteria do not easily turn maltitol into the acid that rots teeth, so it causes far less decay than sugar. It is not completely inactive in the mouth, though.
Maltitol and maltitol syrup caused no decay, or clearly less than sugar, in animal studies and tests of acid in human dental plaque.
1983Lab and animal studyImfeld T, Caries Research