Understanding the Distinction: Does Sugar Alcohol Still Count as Sugar?

October 9, 2025 •

5 min read

A 2023 study associated high erythritol levels with increased cardiovascular risk, highlighting the complex nature of sugar substitutes beyond just calories. When it comes to managing diet and health, a common question arises: Does sugar alcohol still count as sugar? The answer, as with many nutritional topics, is nuanced and depends on how your body processes these unique carbohydrates.

Quick Summary

Sugar alcohols, or polyols, are carbohydrates with fewer calories and a lesser effect on blood sugar than regular sugar. Digested differently by the body, they offer sweetness with benefits like dental health but can cause gastrointestinal issues in high amounts. Understanding these differences is crucial for mindful consumption, especially for diabetics or those on low-carb diets.

Key Points

Not Sugar: Sugar alcohols are carbohydrates, but their chemical structure and metabolic pathway are different from traditional sugars like sucrose.
Lower Caloric Impact: Most sugar alcohols contain fewer calories per gram than regular sugar because they are not fully absorbed by the body.
Minimal Blood Sugar Spike: They cause a minimal and more gradual rise in blood glucose and insulin compared to regular sugar, making them useful for diabetics.
Potential for Digestive Issues: Overconsumption can lead to gas, bloating, and diarrhea due to fermentation in the large intestine.
Count Carbs Carefully: For carbohydrate counting, only half the grams of sugar alcohol are typically factored in, with erythritol often being the exception.
Emerging Health Concerns: Recent studies suggest a potential link between high intake of erythritol and xylitol and increased cardiovascular event risk, particularly for those with pre-existing heart conditions.
Benefits for Oral Health: Unlike sugar, sugar alcohols do not promote tooth decay and can even help prevent cavities, especially xylitol.

What Exactly Are Sugar Alcohols?

Sugar alcohols are a class of polyols, which are carbohydrates derived from sugars or starch. Despite their name, they are neither sugar nor the type of alcohol found in beverages (ethanol). While they occur naturally in small amounts in some fruits and vegetables, most of the sugar alcohols used in commercial food production are manufactured through a hydrogenation process.

These compounds are widely used as low-calorie sweeteners and bulking agents in products labeled “sugar-free” or “no added sugar.” Because they are not fully absorbed during digestion, they provide sweetness with a significantly lower caloric load than traditional sugar. Common types you'll see on ingredient lists include:

Erythritol: Found in fruits and fermented foods. It is nearly calorie-free and well-tolerated digestively.
Xylitol: Found in various fruits and vegetables. It is as sweet as sucrose and known for its dental health benefits.
Maltitol: Extracted from maltose. It has a similar texture and taste to sugar and is often used in chocolate and candies.
Sorbitol: Found naturally in fruits like apples and berries. It is a common ingredient in sugar-free gums and lozenges.

Sugar vs. Sugar Alcohol: A Comparative Breakdown

To truly answer the question of whether sugar alcohols count as sugar, it's essential to compare their fundamental differences in the body. While both are carbohydrates and can taste sweet, their metabolic paths diverge significantly. The following table summarizes their key distinctions:


Feature	Sugar (e.g., Sucrose)	Sugar Alcohols (e.g., Maltitol, Sorbitol)
Chemical Structure	Simple or double sugar molecules (monosaccharides, disaccharides).	Hybrid molecules with both sugar and alcohol-like components (polyols).
Caloric Content	Approximately 4 calories per gram.	Varies by type, but averages around 2 calories per gram. Erythritol has almost zero calories.
Absorption Rate	Rapidly absorbed in the small intestine, leading to a quick rise in blood sugar.	Poorly and slowly absorbed, with the unabsorbed portion traveling to the large intestine.
Impact on Blood Sugar	Causes a significant spike in blood glucose and subsequent insulin release.	Causes a minimal and gradual rise in blood sugar, with a lower glycemic index.
Dental Impact	Fermented by oral bacteria, leading to acid production and tooth decay.	Not fermented by oral bacteria, making them non-cariogenic (doesn't cause cavities).
Digestive Impact	Easily digested with few issues unless lactose intolerant.	Can cause gas, bloating, and diarrhea in excess due to fermentation in the large intestine.

How Sugar Alcohols Impact Your Body

Because of their poor absorption, most sugar alcohols act as a hybrid between regular sugar and fiber. They provide some energy, but the effect is less pronounced and more drawn-out than with sucrose or glucose.

The Glycemic Index Difference

The Glycemic Index (GI) measures how quickly a food raises blood glucose levels. Regular table sugar (sucrose) has a GI of 60, while pure glucose is 100. Most sugar alcohols have much lower GI values, ranging from 0 to 36, meaning they have a significantly smaller impact on blood sugar. This makes them a popular alternative for people managing diabetes, though careful counting is still necessary. Erythritol is a notable exception, as its GI is effectively zero due to its minimal absorption.

Digestive Side Effects

One of the most well-known drawbacks of sugar alcohols is their potential for causing gastrointestinal issues. Since the small intestine does not fully absorb them, they pass into the large intestine, where gut bacteria ferment them. This fermentation process can lead to gas, bloating, cramping, and even a laxative effect, particularly with excessive consumption. Products containing sorbitol and mannitol are legally required to carry a warning about this laxative effect. For this reason, those with irritable bowel syndrome (IBS) or sensitive digestive systems may need to limit or avoid them.

Potential Cardiovascular Concerns

Recent studies have raised some concerns about the potential link between certain sugar alcohols and cardiovascular health. Research has associated high levels of erythritol and xylitol with an increased risk of heart attacks and strokes, though this area requires further investigation. The findings suggest that these compounds may increase platelet aggregation, promoting blood clots. While the risk for healthy individuals remains unclear, people with pre-existing heart disease or related risk factors, like diabetes, should exercise caution and discuss intake with their healthcare provider.

Counting Carbohydrates with Sugar Alcohols

For those on low-carb diets, such as keto, or for individuals managing diabetes, understanding how to count sugar alcohols is crucial. The concept of “net carbs” often comes into play, where fiber and sugar alcohols are subtracted from the total carbohydrate count. However, this method is not universally endorsed by all nutritional experts.

As a general guideline for products with sugar alcohols:

Calculate half the grams: A common rule of thumb, especially for diabetics, is to count only half of the listed sugar alcohol grams toward your total carbohydrate intake. For example, if a product has 10 grams of total carbs and 6 grams of sugar alcohol, you would count it as 7 grams of carbohydrates (10 - 3 = 7).
Erythritol is often the exception: Because erythritol is almost completely unabsorbed, it is often not counted at all toward net carbs.
Always check the label: Nutritional labels can be deceptive. A "sugar-free" candy may still contain significant total carbohydrates and calories from sugar alcohols. Always read the label carefully and consider the serving size.

Who Benefits from Sugar Alcohols?

Despite the potential downsides, sugar alcohols offer distinct advantages for certain individuals when consumed in moderation.

Individuals with Diabetes: Due to their lower glycemic impact, sugar alcohols can help manage blood sugar levels more effectively than regular sugar. This allows for some sweet foods to be included in a balanced diet, provided portions are controlled and blood sugar is monitored.
Dental Health: Since oral bacteria do not metabolize sugar alcohols, they do not contribute to tooth decay. Xylitol, in particular, has been shown to reduce acid-producing bacteria and inhibit cavity formation, which is why it's a common ingredient in sugar-free gum and toothpaste.
Weight Management: With fewer calories per gram, sugar alcohols can aid in weight management by providing sweetness without the full caloric impact of sugar.

Conclusion: Making an Informed Choice

In short, the answer to the question, "Does sugar alcohol still count as sugar?" is no, not in the same way. While they are a form of carbohydrate that provides some calories and can influence blood sugar, their impact is significantly different due to their unique metabolic pathway. They offer a helpful alternative for managing blood sugar and supporting dental health but must be consumed in moderation, especially considering the potential for digestive distress and emerging cardiovascular concerns. When adding products with sugar alcohols to your diet, always read the nutrition label, understand how to calculate their carbohydrate impact, and listen to your body's response. For individuals with chronic conditions like diabetes or heart issues, a consultation with a healthcare provider is essential to determine the most prudent approach.

Choosing Wisely

To make informed dietary decisions regarding sugar alcohols, consider your individual health profile and potential sensitivities. While they can be a useful tool, particularly for managing sugar intake, they are not a "free" pass to consume unlimited sweets. Prioritizing whole, unprocessed foods and seeking natural sweetness from sources like whole fruits remains the most reliable strategy for overall health.

Frequently Asked Questions

The primary difference lies in their chemical structure and how they are processed by the body. Sugar alcohols are carbohydrates with a different structure that makes them poorly absorbed by the small intestine, leading to fewer calories and a smaller impact on blood sugar compared to traditional sugar.

No, their effect varies. While most have a lower glycemic index than regular sugar, some, like erythritol, have virtually no impact on blood sugar, while others, like maltitol, may have a more noticeable effect.

Since sugar alcohols are not fully absorbed in the small intestine, they travel to the large intestine where they are fermented by gut bacteria. This process can produce gas and cause bloating, cramping, and a laxative effect.

No, most 'sugar-free' products containing sugar alcohols are not calorie-free. Sugar alcohols still contain some calories, although fewer than regular sugar. Erythritol is a notable exception, as it has almost zero calories.

According to some guidelines, people with diabetes should count half of the listed grams of sugar alcohols toward their total carbohydrate intake. It's crucial to check labels and monitor blood sugar levels, as individual responses can vary.

Yes, unlike sugar, sugar alcohols are not fermented by plaque bacteria in the mouth and therefore do not cause tooth decay. Xylitol has been specifically noted for its cavity-preventing properties.

While generally recognized as safe (GRAS) in moderation, excessive intake can cause gastrointestinal distress. Some recent studies have also suggested a possible link between high levels of erythritol and xylitol and an increased risk of cardiovascular events, especially in vulnerable individuals.