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Sugar alcohols like xylitol, erythritol, and sorbitol are heavily marketed to the overweight and diabetic and now those on the keto diet, but over time, their use can lead to worse problems and compromised immunity from gut balance disruption.
The growing diabetes epidemic has spawned a whole new industry of alternative sweeteners known as sugar alcohols. Consumers typically view them favorably because they are not artificial like aspartame. These products with low glycemic indexes are aggressively marketed to the overweight and those with insulin problems as ideal sugar substitutes.
Why? Because they are derived from natural plant-based sources. These chemicals, also known as polyols, are interestingly comprised of neither sugar nor alcohol. The most familiar of these are xylitol, erythritol, mannitol, and sorbitol.
The glycemic index (GI) is the value assigned to a specific food that indicates its effect on blood sugar. The number ranges between 0 and 100, with 100 representing the effect of pure glucose. While the glycemic index of any food can be easily reduced by consuming traditional fats at the same time, for those with blood sugar issues, this is not always enough to prevent problems with insulin.
Below is a table with the glycemic index (GI) of many common sugar alcohols and sweeteners on the market. Note that a higher GI value correlates with a higher blood sugar spike when that particular sweetener is consumed. The sweeteners in bold are sugar alcohols.
Stevia 0
Erythritol 0
Yacon 1
Mannitol 2
Lactitol 6
Xylitol 13
Sorbitol 9
Isomalt 9
Agave 15-30
Date Syrup and Sugar 20
Brown Rice Syrup 25
Coconut Sugar/Coconut Nectar 30
Maltitol 36-53
Raw Honey 35-58
Sucanat 43
Organic Sugar 47
Maple Syrup (Grade A or B) 54
Blackstrap Molasses 54
Evaporated Cane Juice 55
Raw Sugar (Turbinado) 65
Corn Syrup 75
White Sugar 80
High Fructose Corn Syrup 87
Glucose 100
Sugar alcohols contain fewer calories than real sugar and natural sweeteners like honey and maple syrup. They also have lower glycemic indexes. The sweetness of these chemicals ranges from half as sweet as sugar to equally as sweet.
The low-calorie count and glycemic index combined with the fact that they do not spike blood sugar in the same way as natural sweeteners make the sugar alcohols a marketing bonanza for food manufacturers. It is also highly attractive if not enticing to consumers!
How Common Sugar Alcohols are Made
Let’s examine how each of the most popular sugar alcohols are manufactured:
- Erythritol is derived from corn sugar which is most often from genetically modified (GMO) corn.
- Sorbitol, a slow metabolizing sugar alcohol, can be made from fruits, (GMO) corn, and seaweed, but commercially, the source is dextrose (glucose) produced from gluten-free cornstarch, likely of GMO origin.
- Xylitol is a carbohydrate found naturally in the birch tree. Safer alternatives are manufactured and concentrated from birth wood waste. However, most xylitol on the market is derived from GMO corn.
- Mannitol is manufactured via sugar hydrogenation. This process rearranges the fructose molecule, usually from (GMO) corn, to the sugar mannose.
It is important to understand that all sugar alcohols are highly refined in order to get them into the state in which they are able to be consumed or added to foods. This is true even if the source is natural and a non-GMO source like the birch tree.
Sugar Alcohols are Highly Indigestible
The big problem with sugar alcohols and gut health is that they are, for the most part, indigestible. This is the reason why they are so low calorie in the first place! Indigestibility is not necessarily a problem when the source is a whole food like plantains or potatoes which contain resistant starch, for example.
When the indigestible source is a manufactured, highly refined and processed food like erythritol, sorbitol, mannitol or xylitol that the body would not naturally encounter in that state or quantity simply consuming whole foods, however, it opens the door to creating or contributing to gut imbalance.
Manufactured foods such as sugar alcohols can cause problems even for healthy people of normal weight. They do this by triggering gastric distress, bloating and diarrhea. For those who suffer from any sort of gut disorder or autoimmune disease, sugar alcohols and processed foods containing them should most especially be avoided.
Disruption of the Gut Lining
Sugar alcohols have the potential to disrupt the functioning of the lining of the gut. Ironically, this is the very tissue that is already compromised for those suffering from diabetes and other autoimmune disorders.
The body’s inability to effectively break down sugar alcohols causes them to arrive for the most part intact when they reach the intestines. At that point, a process called “passive diffusion” takes place whereby the sugar alcohol that was consumed draws water into the bowels. This results in only partial breakdown. The unmetabolized portion begins to rot, creating the perfect environment for undesirable bacteria and pathogens to feed, thrive, and grow.
An imbalanced intestinal environment where pathogens and other undesirable microbes have a favorable place to exist is exactly the set of conditions that eventually compromise the gut lining, damage the critical enterocytes that line the gut wall, and promote the development of autoimmune disease symptoms.
And, while it is true that sugar alcohols do not feed pathogenic yeasts like Candida albicans like sugar does, the undesirable fermentation of undigested sugar alcohols has the potential to exacerbate yeast problems.
Sugar Alcohols Contraindicated for Gut Healing Diets
As discussed above, sugar alcohols like xylitol, erythritol, mannitol and sorbitol are incredibly detrimental to gut health. This is particularly true when used over extended periods of time. In recognition of this, healing protocols such as SCD, Autoimmune Paleo, and the bone broth diet do not allow them.
Another effective protocol known as GAPS was developed by Natasha Campbell-McBride MD. It works to reverse a variety of autoimmune conditions including eczema, psoriasis, ADD/ADHD, autism, celiac disease, allergies, asthma, Crohn’s disease, ulcerative colitis, IBS, obsessive-compulsive disorder, depression, anxiety, rheumatoid arthritis, lupus, fibromyalgia, diabetes, cancer, and the list goes on.
Kim Schuette, CN, Certified GAPS™ Practitioner and owner of the clinic Biodynamic Wellness in Solana Beach, CA points out that WebMD warns the following about xylitol in particular:
There is not enough information to confirm xylitol’s safety in pregnant and breastfeeding women, so they should not use it for medicinal purposes. Although some animal studies have shown tumor growth resulting from high doses of xylitol over long periods, more research is needed.
She also emphasizes the following for her clients regarding the dangers of sugar alcohols:
It is also important to note that while these refined, highly processed sweeteners have received GRAS (generally recognized as safe) status from the Food & Drug Administration (FDA), no rigorous, long-term studies have been performed. Our recommendation is that all refined food products are best avoided. While on the GAPS Diet, limit your sweeteners to fresh fruit, raw honey, and whole leaf stevia in very small amounts.
Flatulence a Common Side Effect
If you doubt that the sugar alcohols you are consuming are harmful to intestinal flora, observe how you feel a few hours or the next day after eating them.
While you might be one of the lucky ones who don’t get bloated or get diarrhea, consider that these alternative sweeteners typically cause flatulence problems at the very least. This is a sign of a negative unbalancing agent present in the gut.
Zero Scientific Data on the Safety of Sugar Alcohols
Rami Nagel, author of Cure Tooth Decay, doesn’t even recommend xylitol gum or supplements despite its reputed ability to fight cavities and quickly resolve ear infections by encouraging proper bacterial balance in the ear canal.
His research combing through the scientific literature for any long term safety data on xylitol turned up the following:
- Epidemiology: No information found
- Teratogenicity: No information found
- Reproductive Effects: No information found
- Mutagenicity: No information found
- Neurotoxicity: No information found
In essence, the xylitol found in a variety of children’s products such as chewing gum and candies is a complete wild card with regard to long term safety.
Warning: Sugar Alcohol Frequently Hides Artificial Sweeteners
While sugar alcohols can be a health danger in and of themselves, the threat grows when they are combined with artificial sweeteners like aspartame (Nutrasweet).
This is exactly what food manufacturers frequently do!
According to Dr. Mercola, sugar alcohols like erythritol are “frequently combined with other low-calorie or artificial sweeteners such as aspartame, acesulfame-K, neotame, saccharin, or as in the case of VitaminWater, crystalline fructose“.
Crystalline fructose is just another name for corn syrup, which is nearly always of genetically modified origin and the same cheap sweetener used in soda.
Don’t fall for the lure of sugar alcohols. While it may seem like a good idea in the short term to wean yourself off sugar, the long term risks to gut health and the potential for autoimmune disease by unbalancing the gut environment and damage to the gut wall aren’t worth it.
Better to address that sweet tooth head-on and fix the source of the problem in a manner that will truly enhance health and not ultimately harms it with a band-aid approach.
References
(1) University of Sydney Glycemic Index Database
(2) The Sour Truth About Sugar Alcohols
(3) Alternative Sweetener Risks
This just hit my inbox from Pam F., a registered nurse:
I just experienced a horrific reaction to sugar alcohols. I picked up an Organic Reduced Sugar Acai berry juice from Costco. I mix only a small amount with San Pelligrino water as a nice refreshment during the day. I thought I would try the “reduced sugar” because we keep being told how sugar is bad for us. It said 100% Organic Juice so I thought it would be OK. For 2 days I had GI upset and raging headaches. It felt like the meninges of my brain were hurting so badly. I thought I had eaten something like fresh strawberries that may have gone bad or some food with something that did not agree with me. Then it dawned on me to read the ingredients in the Acai Berry juice. It had a “sugar blend” in it of Erythritol, Xylitol, and stevia. Something in that juice was making me deathly ill and I cannot thing of anything else it would be because I do not take any of those types of sweeteners. I took it back to Costco and got my money back!! I will avoid those like the plague. Normally I am an avid “ingredient reader”, however I can drink the regular Acia Berry Juice by Sambazon with no problem. How can they call it 100% organic juice if it is not?
Your article came out at a perfect time for me. Thank you! I shared it on FB.
There is a vast difference between xylitol taken from 100% hardwood and one taken from GMO corn. I’m sure the label didn’t say which was in the product. With that said if this product was the first time or first time in a long time your body has been exposed to xylitol that could have cause the GI upset.
And what might those differences be? People experience digestive problems from xylitol no matter what it is derived from.
A GAPS and WAPF teacher suggested using the sweetener Rapadura in an apple crisp recipe.
I looked on the list in this great blog to see how Rapadura compares to the other sweeteners.
Any chance you can give the GI for Rapadura? Thanks so much!
Rapadura is wonderful, but it contains sucrose, a disaccharide which is unfortunately not permitted on GAPS .. however, once GAPS is complete, it would be wonderful to use in moderation!
I thought this article was interesting, until I checked out the additional information and “sources” section… I am still interested in where your information on the effects on the gut came from as research on this was not readily available under “sources”. Also, how long does one need to be using these sugar alcohols and to what level before serious gut problems occur?
What really bothered me was :
The GAPS Diet developed by Natasha Campbell-McBride MD is one of the most effective ways to heal and seal the gut wall in order to reverse a variety of autoimmune conditions including eczema, psoriasis, ADD/ADHD, autism, celiac disease, allergies, asthma, Crohn’s disease, ulcerative colitis, IBS, obsessive-compulsive disorder, depression, anxiety, rheumatoid arthritis, lupus, fibromyalgia, diabetes, cancer, and the list goes on.
That part really just turned what seemed like an informational blog into an advertisement, ie, GAPS diet will solve all your problems, regardless of what they are!!! And since GAPS doesn’t recommend sugar alcohols (which may be great for diabetics trying to level insulin levels), so sugar alcohols are therefore bad.
Only an extremely uneducated person would believe such a thing, because different physical/genetic/environmental influences can be related to each of the conditions listed, and there is not magic pill to “reverse” some of these conditions. It is very unethical and unprofessional to put out a statement like that, and unfortunately for me, negated everything else this article had to say.
I hope readers don’t just take everything for face value, and actually look into this.. or just see it as what it was, an advertisement.
How can it be an advertisement when I am basing it on my own experience on GAPS several years ago (blogs about this on this site) and the experience of many other I know who have used it successfully. The CN I quote in this article has a practice where she has helped hundreds of people with GAPS. Just because someone states an opinion, doesn’t mean its an advertisement or that it’s bought. Your comment is overly cynical.
[apologies in advance for TMI; I’ll keep it clean] Several years back I bought a small bag of chocolates sweetened with one of these sugar alcohols. I knew of their reputation, so it was mainly an experiment. Holy cow! Within about 20 minutes my intestines started making a weird sort of howling noise, like wind whistling through an abandoned building. There was absolutely no pain, just a very slight sensation of … distention. But the audio! You’d have thought there was a tiny little elephant in my bowels, trumpeting for all he was worth. Then, a short time later, there was a remarkable volume of air or gas, completely odorless. (Where did it all come from?!) And that was it. No lasting effects whatsoever, but I can certainly see how it could cause serious problems for folks with digestive complaints.
Some of the funniest stuff I have ever read were the reviews on Amazon for the Haribo sugar free gummy bears. I had tears running down my face I was laughing so hard! They used a sugar alcohol for the sweetener. I wasn’t able to find that product any more on Amazon but there were other brands with some pretty funny reviews. If you need a good laugh or just want verification of the intestinal distress caused by these sweeteners read some of those reviews!
Is there a chewing gum you would recommend?
We have been chewing Zellies gum. I actually met her demoing her gum at Whole Foods. Of course she is a huge proponent of xylitol. I wish I had asked her about gut health :/
I am not crazy about any of the gums on the market to be honest. These gumballs are the very best I’ve found (http://amzn.to/19U5UMS) but they have natural sugar in them, so use sparingly and certainly don’t allow your kids to chew them often only as an occasional treat.
While I agree with a lot of the info in this article I would hope you are not implying that the GAPS diet will cure type 1 diabetes. I will assume you are talking about type 2 which is completely different than type 1.
replies are moderated, only ones that don’t call out the author are allowed.
I’d reply, as I agree with you.. GAPS is not a magic pill, but this comment will probably get thrown away as well. just supports what I said in my original comment.
my bad… sorry. the computer locked and didn’t show my comment, so i thought it got thrown out. Some of these sites will block comments that are contrary… this is a good discussion so i’m hoping this site is not like that. I use stevia and other sugar alcohols, would be very interested on the research involved with how they affect the gut, what long term effects are, etc.
Every day of my life before discovering the appropriateness of eating animal fats, I only ate meals in order to get to dessert. My low fat, high sugar diet left me with 20 extra pounds and I admit I did Nutrisystem for 5 months last year. Lots of sugar alcohols and other things in their packaged products. As a member of their community for that time, I participated in online chats and many people reported problems with the sugar alcohols.
Last summer, thinner but knowing it was temporary unless I wanted to be hungry all the time, and with my body starting to fall apart in little ways (foot problems, deep muscle pain, thinning hair), I took the plunge of faith and started eating a lot of animal fats, following the full GAPS diet. My sugar cravings subsided so much that now a teaspoon of honey mixed with a quarter cup of creme fraiche (homemade from raw cream) or a piece of raw milk cheese with a bit of honey spread on it is completely satisfying as a dessert. . No sugar substitutes are necessary, but sometimes some organic green stevia in a smoothie. It’s great to be feeling satisfied, healthy and free of the sugar cravings that used to rule my life.
The symptoms of “falling apart” are gone, and weight is not a concern as it it stable while eating delicious meals. It was low fat that made cooking difficult, took away essential nutrients and flavor, made me hungry most of the time, and was the root of my former sugar cravings.
Sugar cravings are a symptom of an unhealthy diet, and substituting sugar alcohols for sugar only pretends to provide a solution.
Wow, awesome testimonial. I agree … the need for sugar substitutes is indicative of a deeper issue that requires addressing or little progress can be expected long term.
I don’t sweeten much with anything, and don’t eat out of a box. So a lot of added sugars are avoided my me and My wife. But, one use for Xylitol is in toothpaste. It created an environment in your mouth to help rid it of bacteria. I am assuming this should be fine, as we are not ingesting it, and actually rinse our mouths after using it.
I would consider xylitol sweetened toothpaste as probably the least risky way to use it.
What about for children’s toothpaste though? My kiddos still swallow their toothpaste as they aren’t old enough to spit. Can anyone please recommend a safe and effective toothpaste for children? Thanks!!
Great article Sarah!
This is what concerns me about the Trim Healthy Mama diet which has a huge following. The diet also has things like processed peanut butter (to separate the fat from the protein.). Maybe you could do a blog post about the dangers of such a diet, and how you lost and maintain your weight with moderation, good fats and real food.
Trim does not equate to healthy especially if the gut is imbalanced! I would be highly suspect of any diet which promotes highly refined pseudo foods as part of its “recommended” list.
Actually, THM does highly recommend making your own nut butters. But if you can’t or don’t want to, they suggest natural organic nut butter. Their first option is always organic, natural, homemade. But they do give the most “healthy” option to use if you are not a “purist”. So that is not completely true…they don’t only promote processed foods.
They do recommend xylitol and stevia, though, ultimately it is your decision to use or not. If there are concerns, it is up to the reader to research on their own. I choose to use stevia because that’s what I like and am comfortable with.
Ultimately, if you want to cut down on sugar, the only real way is to not eat it.
And, in my opinion, unless you eat solely from your own garden and animals, you are still consuming some of these “processed” ingredients, whether you to choose to believe it or not. As inferred above, it doesn’t matter what the FDA says about the food. These days, its all about who has the most money and influence.
THM does encourage you to eat real food, they encourage you to make everything yourself, I wouldn’t slam a lifestyle unless you know more about it. THM is about good fats, real food and moderation.
If you look at the Mannitol candy labels, they will caution if you eat too much of the sweetened candy or whatever it is, it will act like a laxative. “Too much” is what you might normally eat as a snack.
I find it easier to find things I like that aren’t at all sweet (or starchy) but flavorful and eat that instead. Now if there were only nacho pork rinds…