How healthy is sugar alcohol?

If you’re trying to cut down on added sugar—and you should, because excess sugar increases your risks of obesity, diabetes, and heart disease—you may be tempted by products advertised as low-sugar, sugar-free, or sugar-free.

Many contain familiar low-calorie sugar substitutes such as aspartame or sucralose instead of sugar. And while you’re reading labels, you might also come across another ingredient: sugar alcohol, which is used in products like sugar-free cookies, candy, ice cream, drinks and gum. Are any of these sweeteners a better choice from a nutritional perspective? Dr Frank Hu, Professor of Nutrition and Epidemiology at the Harvard TH Chan School of Public Health, weighs in below.

Are low-calorie or no-calorie sweeteners healthier than natural sugar?

Also known as artificial sweeteners or sugar substitutes, the list of low-calorie and no-calorie sweeteners you may see on product nutrition labels includes acesulfame-K, saccharin, sucralose, neotame, and advantame. They have a higher intensity of sweetness per gram than natural sugar.

So far, research on them has been mixed, although some observational studies have found that drinks containing low-calorie sweeteners are associated with a higher risk of diabetes and weight gain.

What exactly are sugar alcohols and how can you recognize them?

Sugar alcohols may have the most misleading name because they are neither sugar nor alcohol, according to Dr. Hu. “They are a type of carbohydrate derived from fruits and vegetables, although most commercial sugar alcohols are synthetically produced.”

You can usually spot many sugar alcohols on ingredient lists by the “-ol” at the end of their names. Examples include sorbitol, xylitol, lactitol, mannitol, erythritol, and maltitol.

Are sugar alcohols healthier than other sugar substitutes or natural sugar?

Here’s a look at the pros and cons.

The benefits of sugar alcohols

Sugar alcohols sit in the sweet spot between natural sugar and low-calorie sweeteners. They are not overly sweet like sweeteners and do not add too many extra calories like sugar.

“Sugar alcohols are about 40% to 80% sweeter than natural sugar, while artificial sweeteners like aspartame are about 200 times sweeter,” says Dr Hu. “And they have about 25% to 75% fewer calories per gram than sugar.”

Another plus of sugar alcohols is that they break down slowly in the gut. Therefore, your body absorbs only a fraction of their total carbohydrates. “This keeps your blood sugar and insulin levels from spiking like sugar does,” says Dr. Hu. “This makes them a useful sugar substitute for people with diabetes.”

The disadvantage of sugar alcohols

The main disadvantage of sugar alcohols is this: when taken in large quantities, they can cause gastrointestinal problems, such as abdominal pain, diarrhea or infrequent stools.

Because sugar alcohols are digested slowly, they have more time to feed the bacteria in the gut, which can lead to fermentation and excess gas. Their slow digestion can also draw extra water into the colon and cause a laxative effect.

People’s tolerance to sugar alcohols depends on many factors, including body weight, health status, and the amount and types of sugar alcohols. “Individual differences in digestion and metabolism, gut microbiome composition, and dietary habits may also play a role,” says Dr. Hu. “For these reasons, we recommend introducing sugar alcohols into your diet gradually and watching how your body responds.”

For people who experience gastrointestinal symptoms caused by sugar alcohols, Dr. Hu says that reducing the amount of foods and drinks made with them often can correct the problem. “Sugar alcohols are usually found in sugar-free or low-carb products, so pay attention to food labels,” he says. “Because different sugar alcohols can have different effects, it may be useful to identify specific types of sugar alcohols that cause GI side effects.”

Do sugar alcohols pose health risks?

The possible long-term health risks of sugar alcohol are still being researched. A 2023 observational study found a link between the use of erythritol as an added sweetener and cardiovascular disease, such as stroke and heart attack, in people with heart disease or who have risk factors such as diabetes and high blood pressure. However, these findings have not been confirmed in subsequent studies.

“Sugar alcohols offer a healthier alternative to sugar because of their lower calorie content and reduced glycemic response, which is the effect food has on blood sugar levels,” says Dr Hu. “But they also have potential drawbacks, especially for those with sensitive digestive systems, so it’s best to consume them in moderation as part of an overall healthy eating pattern.”

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