Can sugar alcohols cause inflammation? Understanding the evidence

January 13, 2026 •

5 min read

According to a 2023 study published in Bioscience, Biotechnology, and Biochemistry, erythritol can aggravate gut inflammation in mice, suggesting that the popular sweetener may not be completely benign. This raises a critical question for many consumers: Can sugar alcohols cause inflammation?

Quick Summary

This article explores the connection between sugar alcohols and inflammation, detailing how poor absorption leads to fermentation and can disrupt the gut microbiome. It examines specific sugar alcohols like erythritol, xylitol, and sorbitol, discussing their different impacts on digestive and systemic health.

Key Points

Poor Absorption Causes Fermentation: Many sugar alcohols are poorly absorbed in the small intestine and are fermented by gut bacteria in the colon, leading to gas, bloating, and diarrhea.
Erythritol’s Cardiovascular Link: Recent studies suggest that high blood levels of erythritol may be associated with an increased risk of cardiovascular events, possibly due to oxidative stress and blood vessel effects.
Individual Sensitivity and Dosage: The inflammatory and digestive effects of sugar alcohols are highly dependent on the individual and the amount consumed. Some people with sensitive guts or IBS are more susceptible.
Impact on Gut Microbiome: The fermentation process can disrupt the balance of the gut microbiome, which is a known factor in inflammation. For people with IBD, this can aggravate symptoms.
FODMAP Triggers: Poorly absorbed sugar alcohols like sorbitol and maltitol are considered high-FODMAPs and are particularly known for triggering symptoms in individuals with IBS.
Consider Alternatives: For those with sensitivities, natural sweeteners like stevia or monk fruit, or simply opting for whole foods without sweeteners, can be a safer alternative.

The Link Between Sugar Alcohols and Gut Inflammation

Sugar alcohols, also known as polyols, are a class of carbohydrates used as sugar substitutes in many 'sugar-free' products. Unlike regular sugar, which is absorbed in the small intestine, most sugar alcohols are poorly absorbed and travel largely intact to the large intestine. Once in the colon, gut bacteria ferment these compounds, a process that can lead to several gastrointestinal issues. This fermentation is the primary mechanism linking sugar alcohols to digestive distress, and for sensitive individuals, it can contribute to a state of low-grade gut inflammation.

The Role of the Gut Microbiome

The human gut is home to trillions of bacteria, collectively known as the gut microbiome, which plays a crucial role in overall health. When sugar alcohols are fermented, they can alter the balance of this microbial ecosystem, a condition called dysbiosis. For individuals with inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS), this microbial disruption and fermentation can exacerbate existing symptoms. While some sugar alcohols like xylitol may promote beneficial bacteria growth in some contexts, overconsumption can still lead to a negative inflammatory response. The resulting imbalance can lead to increased gut permeability, allowing bacterial toxins to cross into the bloodstream and potentially trigger a systemic inflammatory response.

Sugar Alcohols and Systemic Inflammation: The Case of Erythritol

While digestive discomfort is a well-known side effect of many sugar alcohols, recent research has raised more serious concerns about systemic inflammation, particularly regarding erythritol. A landmark 2023 study from the Cleveland Clinic linked high blood levels of erythritol to an increased risk of cardiovascular events like heart attack and stroke. Researchers found that erythritol can affect blood vessel function and increase oxidative stress, which contributes to inflammation in the cardiovascular system. This was observed even with typical consumption levels. However, the effects appear to be highly dose-dependent and may vary significantly between individuals based on their overall health and pre-existing risk factors.

How Different Sugar Alcohols Compare

Not all sugar alcohols are created equal when it comes to their impact on inflammation and digestion. Their effects depend on their absorption rate, fermentability, and how the body processes them. This can lead to vastly different experiences for consumers.


Sugar Alcohol	Absorption in Small Intestine	Fermentability in Colon	Primary Side Effects	Impact on Sensitive Gut	Potential Systemic Issues
Erythritol	High (90%)	Low	Minimal digestive upset at low doses; some bloating at higher doses.	Best tolerated; can still aggravate IBD in animal studies.	Increased cardiovascular risk at high blood levels.
Xylitol	Poorly absorbed	Moderate; prebiotic effect.	Gas, bloating, and diarrhea, especially with large amounts.	Can trigger IBS symptoms; high doses are problematic.	Potential link to cardiovascular events; more research needed.
Sorbitol	Very poorly absorbed	High; high FODMAP.	Significant laxative effect; gas, bloating, diarrhea.	Major trigger for IBS and IBD flare-ups.	Found at increased levels in active IBD patients.
Maltitol	Poorly absorbed	High.	Digestive issues similar to sorbitol; gas, bloating, diarrhea.	High FODMAP content makes it a trigger for IBS symptoms.	No specific link to systemic issues mentioned in sources.

Navigating Your Sweetener Choices

For most people, moderate consumption of sugar alcohols, especially those that are well-absorbed like erythritol, is unlikely to cause noticeable issues. However, the presence of these sweeteners in many processed foods and beverages means it's easy to consume them in larger quantities than intended. For individuals with sensitive digestive systems, like those with IBS, even small amounts of poorly absorbed sugar alcohols can be problematic.

When managing your intake, it's wise to consider the following:

Read Labels Carefully: Always check the ingredient list for sugar alcohols such as erythritol, xylitol, sorbitol, and maltitol. Be aware of proprietary blends that may obscure the amount of each sweetener.
Start Small: If you are new to sugar alcohols, introduce them slowly to assess your individual tolerance. Dosage plays a significant role in determining side effects.
Consider Natural Alternatives: Whole-food alternatives or other sweeteners like stevia and monk fruit may be better tolerated, though research on their long-term effects is ongoing.
Listen to Your Body: Pay attention to symptoms like bloating, gas, cramping, or diarrhea after consuming products with these sweeteners. Everyone's reaction is different based on their unique gut microbiome and physiology.

Conclusion

While offering a low-calorie alternative to sugar, the answer to "can sugar alcohols cause inflammation?" is a complex one, with nuances depending on the specific sweetener and the individual. While many people tolerate them without issue, their poor absorption and subsequent fermentation in the gut can lead to local gastrointestinal inflammation and discomfort, especially for those with conditions like IBS. For specific compounds like erythritol, emerging research points to a potential link with more serious systemic inflammation and cardiovascular concerns at high blood levels. Ultimately, understanding your own body's response and prioritizing a diet of whole foods is the safest path. For those who choose to use them, moderation and careful observation of your body's reaction are key to avoiding adverse effects. For more detailed information on sweeteners and gut health, a comprehensive review of artificial sweeteners and their impact on inflammation and gut bacteria can be found via the National Institutes of Health.

Key Research Points

Gut Fermentation: Most sugar alcohols are poorly absorbed and fermented by gut bacteria, causing gas, bloating, and diarrhea.
Erythritol Risks: High levels of erythritol have been linked to increased cardiovascular risks like heart attack and stroke due to effects on blood vessel function and oxidative stress.
IBD & IBS Triggers: Sugar alcohols, categorized as polyols under FODMAPs, are common triggers that can worsen symptoms for people with IBS and IBD.
Gut Microbiome Disruption: Fermentation of sugar alcohols can disrupt the balance of the gut microbiome, which can be linked to inflammatory processes.
Individual Variation: Tolerance to sugar alcohols is highly individual and dose-dependent, so what affects one person may not affect another.

Comparison of Sugar Alcohols and Health Impact


Feature	Erythritol	Xylitol	Sorbitol	Maltitol
Primary Absorption	High (90%)	Poorly absorbed	Very poorly absorbed	Poorly absorbed
Fermentability	Low	Moderate	High	High
High FODMAP?	No	Yes (in large amounts)	Yes	Yes
Common Digestive Issues	Minimal at low doses; some bloating at higher doses	Bloating, gas, diarrhea in high doses	Strong laxative effect, gas, bloating, diarrhea	Similar to sorbitol; gas, bloating, diarrhea
Link to Systemic Inflammation	Potential link to cardiovascular risk at high blood levels	Potential link to cardiovascular events, requires more research	Can exacerbate inflammation in IBD	Indirect link via gut disruption
Gut Microbiome Impact	Minimal effect shown	Prebiotic effect at lower doses, can disrupt at higher doses	Can be degraded by some gut bacteria; disrupts balance	Fermented by gut bacteria, alters composition

Frequently Asked Questions

Sorbitol and maltitol are known to cause the most digestive issues due to their poor absorption and high fermentability. Xylitol can also be problematic in larger amounts.

Yes, erythritol is generally better tolerated and causes fewer digestive issues than other sugar alcohols because it is mostly absorbed in the small intestine before reaching the colon.

Most sugar alcohols (polyols) are high in FODMAPs and can trigger symptoms in individuals with IBS. It is recommended to follow a low-FODMAP diet, which often means avoiding sugar alcohols, especially during flare-ups.

Not all sugar alcohols are equally implicated in systemic inflammation. Research specifically links high blood levels of erythritol to increased cardiovascular risk and systemic inflammation, while most concerns for other polyols are primarily related to gut inflammation.

The primary mechanism involves poor absorption in the small intestine, which allows the sugar alcohols to reach the large intestine where they are fermented by gut bacteria. This can disrupt the microbiome balance and cause inflammation and digestive distress.

Moderation is key, as side effects are often dose-dependent. Drinking plenty of water can help flush your system. Gentle movement like walking can aid digestion, and consuming ginger or peppermint tea may soothe discomfort.

Emerging research, particularly on erythritol, suggests potential long-term risks such as an increased risk of cardiovascular events at high intake levels. The impact varies by individual and the specific sugar alcohol. Further research is ongoing.