Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
15 Feb

Sugar Alcohols: Everything You Need to Know

I’ve been on a bit of an alternative sweetener kick these past few weeks, for good reason: people want and need to know about this stuff. While a purist shudders at the prospect of any non- or hypo-caloric sugar substitute gracing his or her tongue, I’m a realist. People are going to partake and it’s important to understand what’s entering your body and what, if any, effects it will have. Whether it’s diet soda, artificial sweeteners, stevia, or the mysterious sugar alcohols, people want the sweet without worrying about a big physiological effect – an insulin surge, a blood glucose dip, even a migraine. So I’ve been covering the various types and have tried to be comprehensive about it. As a whole, it all seems fairly safe. Alternative sweeteners might mess with some folks’ adherence to a low-sugar diet, and they might induce or fortify cravings, but the research doesn’t suggest that they’re going to give you cancer or diabetes. The potentially negative effects are all fairly subjective, so it’s safe to play around with them and determine their role in your life based on how they affect your appetite, state-of-mind, and any other subjective health markers.

One remains, however. I have yet to cover sugar alcohols. I was surprised, actually, having gone through my archives and finding nothing. Sugar alcohols are pretty prominent in the low-carb world – all those sugar-free desserts and chocolates and protein bars geared toward Atkins types tend to use sugar alcohols – so I had better get to it, huh?

What Are Sugar Alcohols?

A sugar alcohol, also known as a polyol, is an interesting type of carbohydrate. Its structure is kind of a hybrid between a sugar molecule and an alcohol molecule (hence the name “sugar alcohol”) and, for the most part, our bodies do a poor job of digesting and breaking down sugar alcohol in the small bowel. It’s also sweet to the tongue and resistant to fermentation by oral bacteria, meaning sugar-free gum manufacturers employ it judiciously to sweeten their products without causing cavities. Our colonic bacteria, however, can and do ferment the stuff. For that reason, it’s a kind of prebiotic that, as Kurt Harris points out, can stimulate diarrhea and exacerbate existing irritable bowel syndrome-related symptoms. Common side effects of sugar alcohol consumption (or over-consumption) include bloating, gas, and abdominal pain. Sugar alcohols are not quite non-caloric, but all contribute fewer calories than sucrose, and their effects on insulin and blood sugar (if any) are pretty minimal.

Sugar alcohols pop up in nature, in fruits like apples and pears, but any commercial product that contains them must list the specific alcohols in the ingredients. If they aren’t counted toward the official carb count, they must be listed separately in the nutritional information. Let’s look at some of the popular ones you’ll be encountering:

Xylitol – Glycemic Index of 13

Xylitol is one of the more popular sugar alcohols. It tastes remarkably like sucrose, has about half the calories, and is 1.6 times as sweet, with little effect on blood glucose and none on insulin levels. You can find xylitol in certain berries, corn husks, mushroom fibers, and oats; most commercial xylitol comes from hardwood and corn. Xylitol has a cooling effect on the mouth and is actively protective against dental caries (as opposed to merely being neutral or non-contributive, like the other sugar alcohols), making it the favorite choice of sugar-free chewing gum makers.

There appear to be some interesting health benefits to xylitol, too, beyond the well-established preventive actions against dental plaque and cavities. Xylitol shows promise as a bone remineralization agent, positively affecting both tooth enamel and bone mineral density (albeit, thus far, in rats). I count at least ten studies showing xylitol’s promise in the treatment or prevention of osteoporosis.

Just don’t feed it to your dog. Also, it may exacerbate intestinal distress or cause diarrhea, so exercise caution (and linger near a toilet if you’re unsure of its effect on you).

Sorbitol – Glycemic Index of 9

Sorbitol is found primarily in stone fruits, and manufacturers use it in diet sodas, sugar-free ice creams and desserts, as well as mints, cough syrups, and gum. It’s about half as sweet as sucrose, with 2.6 calories per gram (compared to sucrose’s 4 calories per gram, of course). Being a polyol, it has the potential to cause great gastrointestinal distress, especially in patients with IBS. This is compounded by its relative lack of sweetness when compared to other polyols, like xylitol; people are more likely to consume greater amounts of sorbitol to attain the desired level of sweetness and companies are more likely to use more of it.

There don’t appear to be any proactive beneficial effects with sorbitol. It doesn’t affect insulin or blood glucose, which could be good for diabetics, but there’s nothing like xylitol’s promise.

Erythritol – Glycemic Index of 0

Erythritol is almost non-caloric (0.2 calories per gram) and about 60-70% as sweet as sugar. It’s the only sugar alcohol that doesn’t appear to cause gastrointestinal distress (because the body absorbs it rather than let it pass to the colon for fermentation), it doesn’t affect blood sugar or insulin, and it cannot be fermented by dental bacteria (and it exhibits some of xylitol’s inhibitory effect on carie-causing oral bacteria, though not all of it).

For the most part, erythritol seems pretty safe, and it’s rumored to taste very similar to sugar. Overconsumption – taking in more than your body can absorb – can result in bloating and gastrointestinal distress, but it takes a lot.

Maltitol – Glycemic Index of 36

Maltitol is very similar to actual sugar in terms of mouth feel, taste, and even cooking performance (except for browning, which it cannot do). It’s 90% as sweet with half the calories, so manufacturers love using copious amounts of maltitol in sugar-free desserts and other products. That’s all well and good while you’re eating the stuff, but what about half an hour later once all that sugar alcohol has finally reached your colon and the bacteria has started feasting and fermenting? Bloating, diarrhea, abdominal pain.

It’s right there in the name, isn’t it? Mal.

There are others, but those are the big ones. Overall, the literature shows that sugar alcohols are fairly neutral as far as blood glucose and insulin effects go. Some people may see spikes, as I’ve seen reports on blogs and in comment boards to that effect, but most people won’t. They can hit your gut pretty hard and cause problems there, especially if you’ve got a preexisting condition, but healthy people with healthy digestion (which isn’t as widespread as most people think, of course) should be okay with some here and there. Xylitol in particular seems promising, and I’ll keep my eye out for more information on that as it emerges.

If you’re doing fine without sweeteners (non-caloric, hypo-caloric, artificial, natural, whatever), keep it up. Don’t go looking for an excuse to introduce sugar substitutes. But if your desire for something, anything sweet is derailing your attempts at a healthy diet, sugar alcohols may be worth experimenting with. Give it a shot if you’re gonna and let me know how it goes.

What have your experiences been with sugar alcohols? They get a bad rap from being used in so many processed “low-carb” treats, but have they helped or hindered your path to health? Let me know in the comment section!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Sugar Free since 1996 here and dealing with IBS, candida, maybe SIBO…anyway here’s my experience
    1. dig stevia completely

    2. reserve birch tree xylitol for special occastions when I make flourless choclate cake. Will not freeze a lemon sorbet however!

    3. Have had bowel issues with both erythritol and maltitol and avoid them and sorbitol at every turn since I don’t trust it for good reason.

    Paula Springer wrote on February 16th, 2011
  2. Oh yea.. Lets get LOHAN into this discussion. Its a sweet Chinese herb that’s got my attention for the dark brown sugar taste but since its an HERB there’s no nutrition data on it.

    Mark how can I find out the effect of LOHAN?? I bought a bottle of finely powdered stuff and it tastes great in combo with Xylitol and Stevia because it broadens the flavor notes. However hus far I’ve only toe- dipped since I only find broad claims that it is safe but I want more info.

    Paula Springer wrote on February 16th, 2011
  3. I guess I’m really lucky: never had a problem with Xylitol or Maltitol. Love both of them!

    Anne H. wrote on February 16th, 2011
  4. I don’t consider myself a “purist” by any means.. and although I don’t always succeed in staying away from sugar, I never knowingly ingest any of these alternative sweeteners.. there’s more to health than just blood sugar, insulin, etc..

    as mentioned in the post, xylitol for example, is manufactured mostly from either hardwood or corn (from wikipedia: Xylitol is produced by hydrogenation of xylose, which converts the sugar (an aldehyde) into a primary alcohol.).. doesn’t sound very natural to me..

    if I choose to make a treat, I use a little bit of honey or maple syrup.. I’m in no way saying those are healthy or beneficial, and I try to minimize their use.. but at least they’re recognizable whole / real foods..

    The Primalist wrote on February 16th, 2011
  5. I wonder if adding xylitol in a smoothie containing fruit could mitigate the effects fructose may have on your dental health. I read that it helps regulate pH in the mouth, which could be beneficial since fructose is acidic? Or is it alkaline, cause I thought that only occurred in the body.

    That’s if fructose does have any effect on teeth within the mouth, or just all damage is resulted in the blood sugar spike it creates.

    Steve wrote on February 17th, 2011
  6. I can only tolerate sugar alcohols in small amounts, as in a couple of pieces of gum. More than that creates intestinal issues.

    But has anyone had a problem with mouth sores from sugarless gum? If I chew sugarless gum daily, which I would when I exercise because it keeps my mouth from getting dry, then I will develop canker sores in my mouth. Regular gum doesn’t do that, so I switched to that.

    cathyx wrote on February 17th, 2011
  7. I only chew Xylitol sweetened gum. As far as cooking.. depending on sweetness required I use a combinattion of stevia and Xylitol or just Xylitol with very good results. If the item I am making only needs to be mildly sweet I can use more stevia since when I use it in high doses it has an aftertaste. With Xylitol you can’t tell the difference from table sugar.

    Lee wrote on February 17th, 2011
  8. I was always suspect of the “sugar free” sweetened things, they made me feel like crap (literally) every time I ate them. Chewing gum makes me feel bloated and gassy…. I know some of that is the air I am swallowing, but I suspect it is also the sweeteners.

    I am really physically sensitive to artificial flavorings (savory or sugary) so I usually avoid them and go natural (honey, sugar, spice, salt) in small amounts.

    Mary wrote on February 18th, 2011
  9. I used to Protein bars with sugar alcohols but had to stop because they gave “intestinal issues” and did not help me lose weight at all.

    Nathan wrote on February 20th, 2011
  10. I had my first experience with xylitol when I was offered some sugar-free chocolate made with xylitol at work one day. Oh my God, what a horror. I spent the entire afternoon in the bathroom, and was not sure I’d be able to get out and get home at quitting time! And since I don’t want to kill my dogs I won’t have xylitol in the house either. And malitol is even worse. I don’t eat any commercial sugar-free chocolates as I have not found any yet that don’t contain malitol.

    But I do sometimes make my own at home, melting unsweetened chocolate and coconut oil, and adding chopped nuts, etc., and I use erythritol these days. I love the taste, it has no intestinal effects, and doesn’t affect my blood sugar either.

    I’m afraid I still need “sweet” every now and then. I’ve tried to give it up but the longer I do without the more likely I am to fall face-down into a sugar binge. Having my own sweets every so often definitely keeps the sugar demon at bay. I love erythritol!

    Debbie wrote on February 20th, 2011
  11. I really didn’t think that any of these products were to be used in amounts large enough for baking. But I’m surprised that even small amounts such as gum will produce such bowel distress for some people.

    Carey wrote on February 21st, 2011
  12. I slowly switch my family over to Xylosweet when I went Primal. It was a gradual thing, so as not to cause any abdominal distress for anyone. I now use it 100% for my almond flour baking and drinks, with no problems. My diabetic hubby,who hatea all things artifical, loves it. But we are super careful not to give it to our dog, as it is even more deadly for them than chocolate!

    Marlowe wrote on February 22nd, 2011
  13. Xylitol is a great gum! Make sure the gum uses xylitol as its only sweetener though, like Spry products!

    Beth wrote on February 23rd, 2011
  14. If you cut out all sweets for a week or 10 days, you lose the taste for it. Try just not doing any of it!

    Apollonius wrote on February 23rd, 2011
  15. I found that xylitol (I use Ideali brand) is excellent for making any baked goodies, tastes good in drinks, etc. I’m pretty moderate with it, and tend to use slightly less than the sugar called for in recipes, as it seems slightly sweeter to me. I’ve noticed no gastro effects specifically from it that I’m aware of, but it’s frankly hard to tell since I must take Metformin for my diabetic management, and it wreaks havoc on me. I have no dogs, only cats, but I am very careful when I use it not to spill any of it, or the treats that I make with it. My hubby reports that since he’s been enjoying the treats I make with it, he has less plaque on his teeth.

    I also buy a box of Rocky Mountain Chocolate Factory sugar-free chocolates now and then for a special treat. They use maltitol. I only eat 2 or 3 pieces per day, and have had no ill effects from it. It’s the best chocolate I’ve ever had. Apparently maltitol actually makes better chocolate than sugar.

    I tried stevia in a flavored water drink once. I believe it was Truvia or PureVia. It gave me a migraine almost instantly. I’m reluctant to try it again, but I wonder if one of the pure forms would be okay. Sadly, I’m prone to migraines, so I have to be careful.

    I’m not completely Primal yet (baby steps) but so far, I find that I mostly don’t use sweetener that much. My sense of taste is greatly improved with no sugar in my diet. These sweeteners don’t seem to have any effect on that. Unfortunately, being a cook and serious baked goods junkie, I’m having a hard time giving up the sweet in my life.

    Queenbee wrote on February 25th, 2011
  16. My dentist has been recommending Xylitol for a couple years now. He swears by it and has seen results in various patients. He says the important thing is to have the equivalent DOSE OF SIX pieces of Xylitol gum a day to get the proper effect/benefits.

    I currently (tho sparingly because I don’t do much sweet stuff) use Xylitol from Birch Tree and mints that I got from Swanson’s. I also eat and give my 2 year old daughter Sparx Candy(tiny hard almost pure xylitol candies) as a much better alternative to other treats out there.

    Thanks Mark for all the great info! and again!

    Nathan wrote on February 25th, 2011
  17. I can’t believe people are buying into this artificial sweetener stuff.

    Read ‘Cure Tooth Decay’ and you” understand.

    Tooth decay is not caused by bacteria but by an imbalance of ca/phos ratio which all these artificial sweeteners cause.
    Your ph in blood and saliva changes and needs to be corrected with —> minerals.
    Everytime your ratio is out of wack you have tooth and bone decay.

    If you want to flame me go right ahead…but read Ramiel Nagel’s Book first.

    Trying to halt tooth decay with lab produced sugars…what else are these pharmaceutical companies gonna come up with. /sigh

    Suvetar wrote on March 27th, 2011
    • Sugar alcohols and stevia aren’t artificial sweeteners. Saccharin, aspartame, acesulfame potassium, and sucralose (Splenda) are.

      Podsixia wrote on November 7th, 2011
  18. Xylitol doesn’t cause the irritability that sugar does. One regular cookie and I feel like everything is being done to purposely bother me. A cup of xylitol/almond flour based cake, however, has no effect. Of course, I also don’t get mood swings from sugar-heavy fruits either.

    And I know it’s not coming from expecting the result because I’ve suddenly realized I’m being irrationally cross and only remembered I had grain/sugars later.

    Liz wrote on July 5th, 2011
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    sacred heart diet wrote on July 14th, 2011
  20. I read recently that sugar alcohols including erythritol trick your mind/body – that it doesn’t know the diff and your “sweet” cravings escalate. Thoughts?

    Lauri wrote on September 24th, 2011
  21. I’ve been using xylitol for baking, and luckily for me, I never experience any side effects. I must say, when I first switched to a primal diet I was craving sugar like crazy and I would actually consume more and more food just because there was always SOMETHING missing. Thankfully xylitol curbs all my sugar cravings and I don’t feel guilty about eating it.

    Brad wrote on October 19th, 2011
    • Me too, I plan to use xylitol to sweeten my sweeten potato souffle and to sweeten my cranberries this holiday season. It is great and I use xylitol moderately usely once every 2 weeks.

      Gayle wrote on November 21st, 2011
  22. I have used Stevia, xylitol, erythritol and oligofructose as natural non GI raising sweeteners for almost 2 years now. I find Stevia to have a weird bitter aftertaste, almost like it’s synthetic, but the good side is that it doesn’t seem to affect my bowels. Xylitol tastes nice, but too much of it causes severe gastro distress! I now use a mixture of xylitol and stevia for certain things and I’m ok. The other two natural derivative sweeteners (erythritol and oligofructose from veg and fruit) are great in crystal or powdered form (like icing sugar). I put the powder in whipping cream for a guilt free dessert topping. What’s more, I have NO gastro effects from either of these and in fact, they are prebiotics and feed the good bacteria in your gut! I have not noticed that this has been a detriment to my weight loss efforts. In fact, I’d say it’s kept me on the straight and narrow during “dark times”. You know what I mean. I will not however touch malitol or any other fake lab chemical mixture because the natural alternative exists, and by my experience, works!

    Stella1964 wrote on March 18th, 2012
  23. I am a grandmother of twin 14 month old boys they are not identical thank god. One of them has a very rare disease called CSID congenital sucrase-iaomaltase deficiency. His body does not make any enzymes to process sucrose, fructose, maltose, and any starches. If he has anything with this he has the most severe diarrhea you could ever imagine, I was changings his diaper once when we still had not found out what wrong with him, it came out like someone turned on the water faucet. They say this is congenital and he will not grow out of it. According to the http://www.csidinfo.com website many people they believe they have been misdiagnosed, with other bowel disorders such as IBS or short bowel. I was diagnosed with IBS when I was young and have always watched what I ate no salads or I would bloat up turn really white and felt like my insides were coming out I had better be close to a restroom or I was going to make a mess. It was just liquid and I felt weak and faint. Come to find out i think I was misdiagnosed, because after finding out this what he has I decided to eat only things he would be able to and with out exercise just watching and making sure nothing I ate had any sugar, fructose, corn syrup, starches, or maltose in it I lost 87#, no longer have diabetes, high blood pressure or stomach issues. He does not know it yet but he probably saved my life. If you have any of these problems I would get on this website and then have my doctor do the upper and lower GI with the biopsy and seen them to be tested for CSID.

    Yvonne wrote on April 4th, 2012
  24. Until today I had no idea I should worry about sugar alcohol. Then about 3 weeks ago I started drinking a zer calorie drink regularly. Suddenly my “IBS” went crazy. I cast about for a reason…stress? Food? Change is cloud cover (haha)? Found sugaralcohol. Specifically erythritol – supposedly the kindest and best. I thought I was being turned inside out by some horrid growling alien beast! No more sugaralcohol for me.

    xerryss wrote on April 19th, 2012
  25. They hurt my stomach so bad!!!!!

    Joy Simmons wrote on June 24th, 2012
  26. One time I ate ONE cookie from the Whole Foods bakery that was sweetened with maltilol. I consider myself to have an iron gut and nothing ever bothers my digestion. Except that cookie. I had 3 days of bloating, gas, and abdominal pain.

    Never, ever, again will I consume maltilol.

    Lisa wrote on July 6th, 2012
  27. I found this post because I was trying to find info about erythritol… I have some sweetener stuff at home that is stevia + erythritol, and I wanted to be sure it is okay to consume. I really wanted to forego any sweet stuff since re-committing myself to primal (let myself go over the past few weeks), but I was having a very bad “sweet craving” so had a cup of tea sweetened with it. I now have a rotten headache, BUT I have no idea if it was the sweetener, or the fact that I’ve ditched sugar today completely and my body is giving me withdrawal symptoms!

    I’m thinking of making some stewed apple sweetened with blueberries tomorrow to get my sweet fix. I eventually want to avoid sweet stuff altogether, but I’m not sure I’m ready yet!

    Fiona wrote on July 18th, 2012

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