Written by Dr. Nicole Avena
Dr. Avena is a professor, research neuroscientist, and author on food & addiction. She has done extensive research on sugar and the effects it can have on health. She is the author of Sugarless: A 7 Step Plan to Uncover Hidden Sugars, Curb Your Cravings and Conquer Your Addiction.
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As more and more research surfaces highlighting the negative health consequences of excess sugar intake, a growing number of consumers are looking for low sugar foods. To meet this demand, many food companies have started using sugar alcohols as alternative sweeteners in their products. These products are often then advertised as “zero sugar” or “low sugar”, which can sound appealing, but we have to ask: are sugar alcohols actually a healthier alternative? This question has become more and more important, especially in light of the recent research studies that have come out linking erythritol and xylitol to negative heart health.
To dig into this, let’s first break down what sugar alcohols are:
Sugar Alcohols 101
Sugar alcohols are low calorie sweeteners that are 25-100% as sweet as sugar, and are synthetically produced or come from fruits and vegetables. There are various types of sugar alcohols, but the most common types you see in the US food supply include erythritol, xylitol, maltitol, lactitol, sorbitol, mannitol, and isomalt. In general, it is easy to identify sugar alcohols on the food label as they typically end in “ol.” You also see sugar alcohols listed in the nutrition facts panel as shown below.
Benefits of Sugar Alcohols
Foods sweetened with sugar alcohols can be useful for some individuals when they are seeking to lower their added sugar intake. One advantage to choosing products sweetened with sugar alcohols over added sugar is that they provide on average, 50% less calories. For individuals eating in a caloric deficit, sugar alcohols can help them enjoy some of their favorite snacks without greatly impacting their caloric intake.
Another benefit of sugar alcohols is that they break down slowly in the gut, which helps prevent blood sugar spikes. Since sugar alcohols elevate blood sugar at a much slower rate compared to added sugar, products containing sugar alcohols are often marketed towards diabetics. Also, sugar alcohols do not cause dental cavities the same way that added sugar does.
Are Sugar Alcohols Safe to Eat?
Despite these benefits, two recent studies have identified some health issues resulting from the consumption of erythritol and xylitol; so you may be wondering, are sugar alcohols safe to eat? Sugar alcohols are considered safe when consumed in moderation, which means in amounts of 10-15g per day. It is important to note though that sugar alcohols are now present in a multitude of processed foods, and the amount within products often exceeds the threshold considered safe. Additionally, you may be consuming more sugar alcohols than you realize if you are eating multiple low/zero sugar products a day.
Despite the proposed benefits of swapping out added sugar for sugar alcohols, it is generally best to not solely rely on them when transitioning to a diet free from added sugar because there are potential harmful effects that can come from sugar alcohol consumption. Let’s discuss what some of the research suggests about their impact.
Sugar Alcohols and Cardiovascular Health
Recent studies have raised concerns about the cardiovascular health impacts of erythritol and xylitol. A study published in 2023 found that erythritol was linked to an increased risk of heart attack and stroke. This research observed that elevated levels of erythritol in the blood could promote clot formation, which raises the risk of cardiovascular events, particularly in individuals already at higher risk due to conditions like obesity or diabetes [1]. Similarly, recent findings indicate that xylitol may also be associated with heightened cardiovascular risks. A 2024 study suggested that higher circulating levels of xylitol could lead to increased incidents of major cardiovascular events, such as heart attacks and strokes [2]. The study found that xylitol might enhance the early stages of blood clotting, adding to the potential risk. While there is a need for more in-depth research to confirm these associations and to better understand the long-term effects of these sugar substitutes on heart health, it does shed light on the potential downsides of these common sweeteners.
Sugar Alcohols and Your Gut
As previously mentioned, sugar alcohols are broken down more slowly in the gut because the body cannot fully digest or absorb them. This means they have more time to feed bacteria in the gut, which can often lead to unpleasant gastrointestinal symptoms in some individuals. After consuming sugar alcohols, side effects such as nausea, gas, bloating, and diarrhea are often reported. Experiencing these side effects can be extremely frustrating for many individuals, especially those who have worked to reduce their intake of added sugar to address other health concerns, whether gastrointestinal or others. Who wants to replace one discomforting symptom or problem with another? Not me!
How to Reduce Sugar Intake without Sugar Alcohols
The good news is that you do not need to rely on sugar alcohols to enjoy a sugar-free lifestyle! There are other great alternative sweeteners that can still satisfy your sweet tooth. Three sugar substitutes that may be more beneficial to incorporate include allulose, stevia, and monk fruit.
Allulose occurs naturally in a variety of foods, such as maple syrup, corn, figs, and raisins. Allulose is lower in calories than sugar at 0.4kcal/g, and has virtually no impact on blood sugar and insulin. Many people prefer allulose to sugar alcohols because it has no aftertaste, and is often reported to be gentler on the digestive system.
Monk fruit sweetener is naturally extracted from the monk fruit, which is a fruit that is native to China. Monk fruit contains zero calories; however, it has an intense sweet taste that exceeds the sweetness of sugar. Stevia is a sugar substitute that is derived from the leaves of the stevia plant. Similar to monk fruit, stevia contains zero calories and only a small amount is needed to sweeten foods.
Satisfying Sugar Cravings without Compromise
When in doubt, it is best to focus on whole, plant-based foods to fuel your body, mind, and overall health long term. Fruit is a natural source of sugar, which can help to satisfy your sweet tooth when cutting back on your intake of added sugars. Eating fruit by itself is a great option, but you can also add fruit to your oatmeal or low-sugar yogurt with some nuts and seeds to create a more balanced snack option or addition to a meal. Apples and natural peanut butter are another great option to satisfy sugar cravings.
And when fruit just isn’t cutting it, don’t worry, but do skip the sugar alcohols. Instead, remember to reach for products sweetened with allulose, monk fruit, or stevia, and you can continue to enjoy the sweet treats you love, without the potential negative health impact.
References
1. Common sweetener linked to potential cardiovascular risks. Available at https://www.nhlbi.nih.gov/news/2024/common-sweetener-linked-potential-cardiovascular-risks. Accessed July 17, 2024.
2. Cleveland Clinic-Led Study Links Sugar Substitute to Increased Risk of Heart Attack and Stroke. Available at https://newsroom.clevelandclinic.org/2024/06/06/cleveland-clinic-led-study-links-sugar-substitute-to-increased-risk-of-heart-attack-and-stroke. Accessed July 17, 2024.