Sugar in Food: Sugar Substitutes that are Safe in Moderation

Sugar Alcohols

Sugar alcohols aren’t sugar and they’re not alcohol. Most are made by adding hydrogen molecules to sugars. The added hydrogen makes it harder for them to be absorbed in the digestive tract, which means they deliver fewer calories. But reduced absorption has a downside: sugar alcohols can cause GI distress if you eat too much.


On the plus side, sugar alcohols (along with non-caloric sweeteners) don’t promote tooth decay. And they’re absorbed slowly and don’t cause blood sugar to increase rapidly, which makes them better than sugar for people with diabetes.

Erythritol: It’s 60 to 70 percent as sweet as sugar. Erythritol is unique among sugar alcohols. It has far fewer calories than the others (so little that a teaspoon has less than 1 calorie), and most of it is excreted unchanged in the urine. The other sugar alcohols end up in the large intestine, which can cause diarrhea and gas. However, eating more than about 50 grams of erythritol may cause nausea.

Xylitol, maltitol, sorbitol, mannitol, isomalt, lactitol: They vary from roughly as sweet as sugar (xylitol) to about a third as sweet (lactitol). (We’ve listed them in descending order of sweetness.)

Consuming even as little as 20 grams a day of some of these sugar alcohols may lead to bloating, gas, and diarrhea. (Sensitivities vary widely, though, and some people develop a tolerance to GI distress.)

The FDA requires foods “whose reasonably foreseeable consumption may result in a daily ingestion of 20 grams of mannitol” to carry this warning: “Excess consumption may have a laxative effect.” The same goes for foods that could lead someone to consume 50 grams of sorbitol in a day. Warnings aren’t required on foods that contain other sugar alcohols, but they should be.

Nutrition Facts labels don’t have to list the amount of sugar alcohols per serving unless the package makes a sugar or sugar alcohols claim (“Sugar Free,” for example).

3 Replies to “Sugar in Food: Sugar Substitutes that are Safe in Moderation”

  1. 1. I read your comments about “effects of low-carbohydrate and low-fat diets by Bazzano, et al.

    The study compared the differences in high fat and low fat diets one year from baseline, in terms of “predicted” values in CVS risk.

    This study contains major flaws. For example, appendix table 1 shows 2.6 kg more weight loss in high fat than in high CHO diet. In pounds, the difference is -5.72 lbs (high fat over high CHO) over a year. If my math is correct, this is statistically significant, but clinically meaningless.

    The high fat diet contains high protein. The loss in muscle body mass is less in the high fat diet. But the authors, to my reading, do not examine protein intake as a factor in preserving muscle mass. They insinuate by omission, that the dietary difference in body mass muscle dynamics is due to the high fat or low CHO in the diet.

    The authors discuss some of their limitations, but where other studies are reviewed,those that differ are discounted.

    The most important criticism is that this study includes only obese people. It cannot be generalized to others. Yet a detailed NY Times article does not mention this. It indicates that all of us should change to a high fat diet.

    It is difficult to make strong statements that refute 50 years of research with one or even a few studies. This study has 400 subjects. The NY Times article calls this study a large one. As an epidemiologic study it is small.

    Conclusions are based indirectly on a computed parameter, (CVS risk). There are large studies that data directly. I think this is important if sweeping conclusions are to be made.

    I would appreciate if you would help me understand your take of this report.

    2. You’ve written about sweeteners. As I can see, in two articles, saccharin has been omitted.
    I’d like your evaluation as to its safety.

    Thank you very much.

    EZ Hirsch, MD FAHA

    1. From Nutrition Action Healthletter: We recommend avoiding saccharin. In studies on rodents, saccharin has caused bladder cancer, especially in males, as well as other types of cancers in males and females. Additional studies have shown that saccharin increases the potency of other cancer-causing chemicals. The best human study also found a link with bladder cancer. And a very recent study suggested that saccharin might trigger metabolic problems in some people by changing microbiota in the gut.

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