I get a lot of questions about sugar alcohols. People want to know if these sugar substitutes are a healthy way to satisfy your sweet tooth.
They’re curious about sugar alcohols, but the words “sugar” and “alcohol” aren’t helping. It’s like a restaurant called “Flavorless Gruel.” Unless you want to live like an 18th-century footsoldier, it doesn’t sound appealing.
But the truth is, sugar alcohols are neither sugar nor alcohol. They’re a class of sweet carbohydrates with fewer calories—and fewer health risks—than sugar.
Sugar alcohols taste sweet, but they’re not digested and metabolized like fructose, sucrose, and other compounds we call “sugar.” Because of this, they don’t affect your body like sugar does.
If you’ve been following my work for any amount of time, you know my stance on added sugar. The runaway consumption of this crap—mostly in liquid form as high-fructose corn syrup—is making millions (and probably billions) of humans fat, sick, and inflamed.
We need to find other ways to satisfy our sweet urges. Sugar alcohols are one of those ways.
They’re definitely not the best option—(I prefer keto-friendly sweeteners like the stevia we use in LMNT)—but they’re uncontroversially better than sugar. I’ll review some pros and cons of sugar alcohols later in the article.
But first I want to talk about sugar. This will help set the stage for later when we review the differences between sugar and sugar alcohols.
What Is Sugar?
According to the dictionary, sugar is defined as “any of the class of soluble, crystalline, typically sweet-tasting carbohydrates found in living tissues and exemplified by glucose and sucrose.”
The term “sugar” can refer to many molecules. When someone talks about blood sugar, for instance, they’re talking about glucose. This molecule is also how plants store energy as carbohydrates.
But when people say “pass the sugar”, they’re usually talking about sucrose. This combination of the simple sugars glucose and fructose is the white stuff in the glass jar at the diner.
The other main form of added sugar (also called refined sugar) is high-fructose corn syrup (HFCS). Also a blend of glucose and fructose, HFCS sweetens sports drinks, fruit juices, sodas, and other saccharine beverages.
High fructose corn syrup is the primary source of added sugar in the American diet. Our continued consumption of this high-calorie goo is linked to obesity, diabetes, and a range of other health problems.
There are a few reasons why high sugar intakes are problematic. The first is that refined sugar provides a hit of empty, non-satiating calories. You can eat (or drink) sugar almost all day and not get full. Not ideal for weight loss or weight maintenance.
Another is that a high-sugar diet puts you on the blood sugar rollercoaster. The highs are high and the lows are low. This also isn’t ideal because:
- High blood sugar is a proinflammatory state
- Chronically high blood sugar leads to the blood sugar regulation problems (called insulin resistance) that underlie type 2 diabetes
- When blood sugar dips, cravings go up and energy goes down
Finally, fructose is of special concern. When you consume fructose—in fruit or refined sugar—it zooms straight to your liver for conversion to fat. This fructose-to-fat mutation served us well in Paleolithic times—it fattened us up to prepare for winter months with little available food—but with the greater volume of food available today, it’s just fattening us perpetually.
What are Sugar Alcohols?
Sugar alcohols (also called polyols) are usually derived from sugar, but they aren’t the same as sugar. They’re sweet carbohydrates with a different chemical structure, mouthfeel, caloric load, and metabolic impact.
The most common sugar alcohols are xylitol, erythritol, mannitol, sorbitol, maltitol, and lactitol. Of these options, I prefer erythritol. I’ll explain why later.
And no, sugar alcohols DO NOT contain ethanol, though I see why this is a common point of confusion.
Sugar alcohols naturally occur in grapes, mushrooms, soy sauce, and a range of other fruits, vegetables, and fermented foods. They’re also used to sweeten processed foods (ice cream, candy, cookies), chewing gum, medicines, and toothpaste.
Sugar alcohols contain fewer calories than sugar because they’re metabolized differently than sugar. Instead of coming through the small intestine, they travel to the large intestine to become dinner for gut bacteria.
The exception is erythritol. Erythritol is absorbed through the small intestine and into the bloodstream, but it’s not broken down. Rather, about 90% is excreted intact through urine.
Differences Between Sugar and Sugar Alcohols
Sugar alcohols differ from sugar in several important ways. Let’s cover those now.
Sugar is obesogenic largely because it adds unnecessary calories that are easy to consume in excess. Think of a big bag of Twizzlers and a 32-ounce coke at the movies. That’s about 3,500 calories of sugar in one sitting.
Getting more granular, one gram of sucrose contains 3.9 calories. Most sugar alcohols (such as xylitol and sorbitol) contain about half that amount—2 calories per gram or so.
This is because sugar alcohols are different molecules than sugar. Your body processes them differently.
Most sugar alcohols aren’t absorbed in the small intestine, but rather serve as food for gut bacteria. In this way, they’re similar to dietary fiber, which is also low (or absent) in calories.
The lowest calorie sugar alcohol is erythritol, which contains only 0.2 calories per gram. Why so low? Because you pee out most of the erythritol you consume.
#2: Taste and sweetness
You already know what sucrose tastes like. Sugar alcohols taste a bit different.
They’re often described as having a “cooling sensation.” It’s why they make good sweeteners for gum, toothpaste, and ice cream.
Sugar alcohols have varying levels of sweetness:
- Lactitol is 30-40% as sweet as sugar
- Erythritol is 60-80% as sweet as sugar
- Xylitol is 100% as sweet as sugar
Whether you like the taste of sugar alcohols is a matter of personal preference. I prefer the taste of stevia and monk fruit, but I don’t mind erythritol, which is a bit less cooling than the other polyols.
#3: Blood sugar effects
The glycemic index (GI) is a measure of how quickly one’s blood sugar rises in response to a given food. It goes from 0 to 100, with 100 representing the fastest blood sugar spike.
Pure glucose scores 100. Sucrose scores 65. And all the sugar alcohols score 35 and below. For reference, xylitol scores 13 and erythritol scores 0.
To be clear, the glycemic index is an imperfect measure. It doesn’t account for individual variability in our responses to food.
I hammer this point home in my book Wired to Eat. For some people, a banana causes a MUCH bigger blood sugar spike than a cookie. For others, it’s the opposite. Genes matter, people.
But a food’s GI is still directionally accurate. And looking at the vast difference in GIs, sugar alcohols will almost always have a smaller blood sugar impact than sugar.
That’s why you subtract out sugar alcohols (along with fiber) when calculating net carbs on a keto diet. They don’t spike your blood sugar and insulin levels like other carbs do, so they won’t meaningfully interfere with ketosis.
Minimizing blood sugar spikes is also a good practice for general health. It’s a good way to stay metabolically flexible, keep cravings down, and reduce your risk of diabetes.
When you digest sugar, it’s broken down into glucose and fructose and absorbed through the small intestine. The fructose travels to the liver through the portal vein for conversion to fat, and the glucose ends up in your blood to be used for energy or stored as fat or glycogen for later.
Conversely, most sugar alcohols pass through the small intestine and into the large bowel to be fermented by gut bacteria. That’s why sugar alcohols have fewer calories, but it’s also why they tend to cause digestive distress.
For many folks, the fermentation of sugar alcohols causes gas, bloating, and diarrhea. In my view, this is the main drawback of these compounds.
Since it’s absorbed and excreted intact, erythritol largely avoids this pitfall. It’s a big plus for erythritol.
#5: Oral health
Last but not least: cavities. Sugar causes them. Sugar alcohols prevent them.
Sugar feeds a nasty bacteria in your mouth called Streptococcus mutans. Then plaques develop and cavities form.
Sugar alcohols like xylitol and erythritol have the opposite effect. They suppress the growth of S. mutans, making them favorites of dentists and oral hygienists across the globe.
One systematic review found xylitol to be “an effective strategy as a self-applied caries preventive agent.” Dental caries is another term for cavities, by the way.
Erythritol may even be better. In one study, children were given candies sweetened with erythritol, xylitol, or sorbitol over three years. The results? Erythritol had the greatest plaque-reducing power.
Sugar vs. Sugar Alcohols
High sugar diets are bad news. They’re a key driver of obesity, inflammation, and chronic disease in the modern world.
Sugar alcohols are in a separate category. They lend sweetness without the metabolic impacts of sugar.
If I had to pick between them, erythritol is my preferred sugar alcohol. It has the fewest calories, the smallest blood sugar impact, and the lowest potential for digestive distress. I don’t use the others, except xylitol in gum and toothpaste for oral health.
I believe that sugar alcohols (when tolerated) are a healthier sweetener than sugar. But at the end of the day, I also wouldn’t recommend them over other low-carb-friendly sweeteners like stevia or monk fruit.
That’s why I wrote a guide to the pros and cons of 12 popular sugar substitutes—so you can review the evidence for each of these sugar alternatives and pick the option that best benefits your health.