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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
Just one correction, erythritol is rapidly absorbed in the upper intestine by a concentration-dependent diffusion process and is excreted in the urine. It does not ferment in the intestines.
That’s what happens in theory, not in reality.
Sarah, I enjoy your posts and share them often. I hate to see all these strongly differing opinions from people who are generally on the same page because it is not only confusing, but even dangerous in and of itself for people who are not inclined to do their own research and just give up trying to be healthy in the midst of all the controversy. I switched from coconut sugar and other whole food sweeteners two years ago and it has been the difference of night and day in my health and all for the good. Years of over consuming bad sugars had damaged my endocrine system to the point that even these healthy sweeteners were triggering problems for me. Getting off all sweeteners that raise blood sugar levels has helped me lose 50 pounds and being able to enjoy high quality erythritol, xylitol and stevia has made all the difference in helping me maintain a much healthier body weight. I have had no problems with them at all other than a little bloating when I first began to consume the xylitol, but that quickly dissipated and my gut health is so much better now than it has ever been! I know I’m just one person and I do blog about my recipes (though I make no money to do so) but please consider that some of this negative information might possibly be a response to the damage that these sweeteners are doing to the pocketbook of the large chemical companies that have so lucratively pushed these artificial sweeteners as the only alternative to obesity. I’m not a scientist, of course, just one happy person who has found hope for staying on a healthy satisfying diet if big food doesn’t succeed, with the help of all these well meaning articles, in their quest to pull these products off the shelf and “help” us out once again. Just a few thoughts and again, I love your information in general and enjoy your blog.
I whole-heartedly agree. I too struggle with endocrine issues. Using organic cane and coconut sugars were not enough of a change. It is not until I cut sugar out completely did I see a difference in my health. I enjoy your blog and your recipes as well.
Another area of concern I have is sugar addiction in general, studies have shown sugar to be more addictive in properties than Cocaine. So there is danger of addiction even with well sourced organic cane.
Recent studies have also shown Alzheimer’s to be called Type 3 Diabetes recently. So using Organic Cane sugar is not enough for some people. Healthy fats also a critical piece of the puzzle for optimal brain health.
Hi, thanks for the caring information! I read a lot on this stuff, as I’m fighting candida and have an incurable sweet tooth!
So I see a lot of conflicting info.
Just one question for you, to better understand… On the GI list, why would the GI of organic sugar be so much lower than that of unrefined/raw sugar, please? As much as I think we should all have access to organic, a lot of us don’t, so I don’t like to see it attributed with magic powers, lol!
Hi
Just wanted to add my two cents worth on this.
I am currently working with Kaayla Daniel in terms of nutritional supplements. I take the supplements and do hair analysis as well as follow a WAPF diet. What I find interesting is that the guidelines set out by the lab who issues the supplements (EndoMet) in terms of “nutrition” to follow while taking the supplements suggest limiting all sugars from fruits and complex carbohydrates like starches as well as added sugars (which include the WAPF -approved ones such as maple syrup, honey and the like). Nowhere do they suggest using these sugar alcohols at all.
There are many nutritional practitioners who do recommend these sugar alcohols to avoid sugar. So I have tried the xylitol-mannitol gums that are on the market, but I experienced severe gas and stomach cramps. I have not tried using them in cooking but I think if this is my reaction with a little gum, I would need to stay away from them, period.
I still think the WAPF way is the wisest way – using traditional sweeteners sparingly in dishes. Even on the program, I do still make ice cream – just use a little less maple syrup and more cream and eggs.
I would agree that increasing the good fats needs to be the way to go in order to address serious sugar cravings. This is what I find to be true with my kids as well.
Sarah’s strong negative bias notwithstanding, xylitol is a remarkably health and versatile sweetener, and I take serious issue with this article. So much that I’ve decided to add my USD 0.02.
I have used stevia and a few of the other natural sweeteners, besides xylitol, and will attest that nothing else comes close to xylitol’s TOTAL package.
First, it’s incorrect to lump all the sugar alcohols in the same category to make it appear as if they’re all the same.
To do so is akin to lumping soybean oil with butter, coconut oil, and red palm oil, etc., as “cooking oils” as if they’re all the same thing.
1. Xylitol is NOT the same thing as mannitol, sorbitol, erythritol, etc. Xylitol is a NATURAL sugar alcohol that is even found in things like raspberries and the human body in small concentrations.
2. For those who didn’t get the message, this bears repeating: Xylitol is NOT a manufactured chemical.
3. People might not know that xylitol is anti-Candida, anti-Streptococcus mutans, anti-osteoporosis.
4. Some studies show that xylitol may even help to rebuild collagen.
5. Importantly, xylitol does not require the secretion of insulin to be metabolized. It is completely safe, even for Type I diabetics!
I can go on and on about xylitol, but for those who need more education, this link does more justice than anything I could have said http://authoritynutrition.com/xylitol-101/.
Those who claim that it’s difficult to digest are technically correct, but altogether wrong.
Although xylitol can lead to bloating and other gastro-intestinal “issues,” this only happens in the early stages of being a xylitol consumer.
In other words, say you buy 100% xylitol gum. You might have a few “issues” but with frequent use of this gum things will stabilize.
Ditto with xylitol consumption. You need to ease the body slowly into learning how to metabolize xylitol. I used to have issues with bloating, but after taking it slow and letting my body figure it out, I no longer have them.
Lastly, I only use natural xylitol made from birch trees.
I’ll not post the link to the brand I use, because I might be accused by some of being a paid shill for that company.
I empathize with those who are looking for solutions to quit the sugar habit, or those who have issues with diabetes, etc.
But I could not disagree more with Sarah on this one.
Natural xylitol from birth is still a very highly processed food in amounts you would never encounter via whole foods. Kind of like insisting that white sugar is fine because it comes from a natural source … the cane plant.
i just made some diy toothpaste with xylitol. Is that okay as long as I don’t swallow?
I think that is fine unless you are ultra sensitive.
So glad to read this. xylitol made me incredibly sick in the midst of an auto immune flare, but also when I was “well”. I avoid it now, of course and use only organic raw honey
Great article! I would also like to throw in a link to a related article on the WAPF website at http://www.westonaprice.org/health-topics/sugar-free-blues-everything-you-wanted-to-know-about-artificial-sweeteners/.
Yes, this is a great article!
The BED diet (body ecology diet) allows the use of LAKANATO…..From the BED website…..”What is Lakanto Made From?
The two natural ingredients in Lakanto are Non-GMO erythritol and the supersweet extract of the luo han guo fruit. Erythritol is a sugar alcohol naturally found in grapes, pears, mushrooms, soy sauce, cheese, wine and beer, so it and has been part of the human diet for thousands of years.
You may be familiar with other sugar alcohols like xylitol, sorbitol, and malitol used in sugar-free candies and chewing gum. But erythritol is different and much better than these other sugar alcohols because it is fermented. Yes, it is made by fermenting the sugar in corn. Many people have trouble with foods sweetened with sugar alcohols. Diarrhea and gas and bloating are frequent complaints. But Lakanto does not cause diarrhea, gas and bloating. We believe it may be because Lakanto is made by fermentation while the other sugar alcohols are made from hydrogenation.
The Erythritol in our Lakanto is:
Specially fermented from non-GMO corn so that you know it’s safe.
Naturally low calorie because your body excretes about 90% of it.
The 10% that remains in your system turns into harmless gases and short chain fatty acids in your large intestine. (NO, Lakanto will NOT cause embarrassing flatulence.)
Sounds like it isn’t a bad sugar free option if Donna Gates recommends it …..
That’s what I thought about erythritol. I began having headaches, bad stomach cramps and, sometimes, vomiting. I finally connected my problems to veruse of Quest bars, but it never occurred to me that erythritol was the culprot, because of comments by a lot of health experts that this is the best//safest sugar substitute for a variety of reasons. Then a few days ago I made a single serving of a chocolate treat using Swerve and spent the next morning in the bathroom with horrible intestinal cramps. I finally realized that the primary sweetener in Quest bars is erythritol.
I don’t have a history of any gut problems, but people need to be aware that they may have problems with these products, even the so-called good ones. .Sadly, I’ve had one too many problem with erythritol, so I’m probably done with it.
I love xylitol, it’s many positives far outweigh the alleged negatives, which I don’t believe. I highly recommend xylitol to friends, after explaining all the pros and cons, and to go organic. Statements like “long term unknown” is true of thousands of things, things that will likely never have human trials, things that are NOT healthy like xylitol. Bringing up high-dose long-term rodent studies is as patently dishonest as bringing up the saccharin studies, which were thoroughly discredited (crappy studies used to make way for aspartame, a true killer). Almost anything, unnaturally high-dose & long-term, will have a negative effect (duh). Our own bodies manufacture xylitol daily. I am usually a huge fan of and impressed with this blog, but not today. On this topic I’m a very educated consumer, and therefore I am very disappointed. Also, this blog dumps all the bad ones – yes many of the other sugar alcohols are bad – in with the good ones. Strongly disagree about (organic) xylitol being bad, when used properly by educated consumers.
hmmm. my naturopath just put me on xylitol twice a day because of a stool analysis that showed three different kinds of step bacteria in high numbers. there have been some studies that show xylitol effective at killing strep, which is why I guess you see it in throat sprays now. i would be curious to see where the information that xylitol damages the gut comes from as I obviously do not want to do any further harm.