Understanding the Sweet Debate: Are sugar alcohols worse than sugar?

October 9, 2025 •

5 min read

With the average American consuming far more added sugar than recommended daily, many are turning to alternatives. This shift has prompted a major question for health-conscious consumers: Are sugar alcohols worse than sugar?

Quick Summary

The health impacts of sugar alcohols differ significantly from sugar, with fewer calories and a lower glycemic response. However, they can cause digestive issues, and certain types have been linked to potential cardiovascular risks, emphasizing moderation over direct substitution.

Key Points

Fewer Calories: Sugar alcohols contain fewer calories per gram than regular sugar, with erythritol having almost zero and others ranging from 1.5 to 3 kcal/g.
Lower Glycemic Impact: They are incompletely absorbed, resulting in a much smaller effect on blood sugar and insulin levels compared to sugar, making them suitable for diabetics in moderation.
Improved Dental Health: Unlike sugar, sugar alcohols are not fermented by oral bacteria, which prevents tooth decay. Xylitol and erythritol can actively benefit dental health.
Potential Digestive Issues: High intake can cause gastrointestinal problems such as bloating, gas, and diarrhea due to poor absorption and fermentation in the large intestine.
Possible Cardiovascular Risks: Recent studies suggest a potential link between high levels of erythritol and xylitol and an increased risk of blood clots, especially in individuals with existing heart disease.
Not all Sugar Alcohols are Equal: Different polyols have varying sweetness, calories, and side effects. Some, like erythritol, are better tolerated digestively, while others, like sorbitol and maltitol, are more likely to cause issues.
Moderation is Key: Both sugar and sugar alcohols should be consumed in moderation. Focusing on a diet rich in whole foods and reducing the overall dependency on sweeteners is the healthiest approach.

What are sugar alcohols?

Sugar alcohols, also known as polyols, are a type of carbohydrate with a chemical structure that resembles both sugar and alcohol, though they contain no ethanol. They are found naturally in small quantities in fruits and vegetables but are most commonly manufactured from sugars and starches for use in processed foods labeled as "sugar-free" or "no sugar added". These include diet sodas, sugar-free gums, candies, baked goods, and even some toothpastes.

Unlike artificial sweeteners that are often calorie-free, sugar alcohols are nutritive sweeteners, meaning they do provide some calories and carbohydrates. Their benefits and drawbacks are tied to how the body processes them, which is quite differently than regular sugar.

Common types of sugar alcohols

Some of the most prevalent sugar alcohols you'll encounter on ingredient lists include:

Xylitol: Found in sugar-free gum, candies, and some dental products. Its sweetness is similar to table sugar.
Erythritol: Often used in keto-friendly products and combined with other sweeteners. It has a zero glycemic index and is generally better tolerated digestively.
Sorbitol: Occurs naturally in fruits like apples and pears. Used in chewing gums and cough drops, it can have a significant laxative effect in large doses.
Maltitol: Frequently used in sugar-free chocolate and candy. It has a taste and texture similar to sugar but can cause more significant digestive issues.
Mannitol: Found naturally in many plants. It is less sweet and is often used in diabetic-friendly products.

The benefits of choosing sugar alcohols over sugar

For many, sugar alcohols are seen as a healthy alternative, and they do offer several distinct advantages over traditional sugar:

Fewer calories: Sugar alcohols contain fewer calories per gram than sugar, which has about 4 calories per gram. Erythritol has almost zero calories, while others range from 1.5 to 3 calories per gram. This can be helpful for weight management and calorie reduction.
Lower glycemic impact: Because sugar alcohols are not fully absorbed by the small intestine, they have a minimal impact on blood sugar and insulin levels compared to sugar. This makes them a useful tool for individuals with diabetes or those following a low-carb diet. Erythritol, for instance, has a glycemic index of zero.
Improved dental health: Oral bacteria cannot ferment sugar alcohols to produce the acid that erodes tooth enamel and causes cavities. In fact, specific sugar alcohols like xylitol have been shown to actively reduce plaque formation and harmful bacteria in the mouth, leading to better oral hygiene.

The downsides and risks of sugar alcohols

Despite their benefits, sugar alcohols are not without their drawbacks, and these can differ significantly between individuals based on consumption amount and sensitivity.

Digestive discomfort: The most common complaint associated with sugar alcohols is gastrointestinal distress. Since they are incompletely absorbed, they travel to the large intestine where gut bacteria ferment them, causing gas, bloating, and diarrhea. The severity of these effects varies by type; maltitol and sorbitol are known to cause more issues than erythritol. Products containing certain polyols must even carry a warning label about their laxative effect.
Potential cardiovascular risks: Recent studies have raised potential long-term health concerns, specifically regarding erythritol and xylitol. Research suggests a possible link between high circulating levels of these polyols and an increased risk of major cardiovascular events like heart attack and stroke, especially in those with pre-existing risk factors. While more research is needed to establish causation, experts advise caution for high-risk individuals.
Xylitol toxicity to pets: It is critical to note that xylitol is extremely toxic and potentially fatal to dogs, even in small amounts. Pet owners should be highly vigilant to ensure dogs do not ingest any products containing it.

Comparison: Sugar vs. Sugar Alcohols


Feature	Sugar (Sucrose)	Sugar Alcohols (e.g., Erythritol, Maltitol)
Calorie Content	Approx. 4 kcal/gram	Varies, 0-3 kcal/gram (Erythritol is ~0.2 kcal/g)
Glycemic Index	High (GI ~60)	Low (GI 0-36). Erythritol is 0.
Dental Health	Promotes tooth decay	Does not promote tooth decay; some, like xylitol, may inhibit it.
Digestive Effects	Easily and fully absorbed	Poorly absorbed, can cause bloating, gas, and diarrhea in excess.
Potential Health Risks	Linked to obesity, diabetes, heart disease	Gastrointestinal distress; recent research links some types to increased cardiovascular risk.
Taste Profile	Sweet, often with a rich mouthfeel	Less sweet than sugar; some have a distinct cooling sensation.

Making an informed choice for your diet

The question of whether sugar alcohols are worse than sugar is nuanced. For those seeking to manage blood sugar or reduce calorie intake, sugar alcohols offer clear benefits over excessive sugar consumption, which is directly linked to major health problems. The potential risks associated with some sugar alcohols are still under investigation, but they primarily involve high consumption and individuals with pre-existing conditions.

The wisest strategy for a healthy diet is to focus on whole, minimally processed foods that are naturally low in added sweeteners. For those times when a sweet treat is desired, it's about moderation and choosing wisely based on your health profile. If you have a sensitive digestive system or risk factors for cardiovascular disease, you may want to limit or avoid certain sugar alcohols like maltitol, sorbitol, erythritol, and xylitol, or choose alternatives like stevia or monk fruit. Always read labels carefully, and consult a healthcare professional for personalized dietary advice. For more information on sugar substitutes, see this guide from Harvard Health Publishing.(https://hsph.harvard.edu/news/sugar-alcohol-health-sweetener/)

Conclusion

While sugar is a known contributor to significant health issues when consumed in excess, sugar alcohols present a mixed bag of pros and cons. They are a valuable tool for reducing calorie and glycemic load, and they offer superior dental health benefits. However, they come with the potential for unpleasant digestive side effects and, more recently, have been associated with heightened cardiovascular risks in certain populations. Ultimately, neither is a perfect solution. The best approach is to minimize reliance on both and prioritize overall healthy eating habits focused on whole, unprocessed foods. When using sweeteners, be mindful of the type and amount, and consider your individual health needs and tolerance levels. Moderation remains the key to navigating the complex world of sweeteners.

Frequently Asked Questions

No, not all sugar alcohols are the same. They vary in sweetness, calorie content, digestive tolerance, and chemical structure. For example, erythritol has a glycemic index of zero and is better tolerated digestively than sorbitol or maltitol.

While sugar alcohols have a much smaller effect on blood sugar compared to sugar, they are carbohydrates and can still cause a slight rise in blood glucose levels, particularly in larger amounts. You should still count the carbohydrates from sugar alcohols if you are managing diabetes.

Sugar alcohols are not fully absorbed in the small intestine. They pass into the large intestine, where gut bacteria ferment them. This process creates gas, leading to bloating, cramping, and, in high doses, a laxative effect or diarrhea.

Sugar alcohols are generally considered safe for people with diabetes when consumed in moderation. They offer a lower glycemic alternative to sugar, but it is important to count the carbs from them and monitor your blood sugar to see how your body responds.

No, sugar alcohols are beneficial for dental health. Unlike sugar, they are not metabolized by the bacteria in your mouth that cause tooth decay. Specific types like xylitol and erythritol can even help prevent cavities and reduce plaque formation.

Recent studies have raised concerns about a potential link between high circulating levels of erythritol and xylitol and an increased risk of cardiovascular events, particularly in individuals with pre-existing risk factors. However, more research is needed to confirm this association.

To use sugar alcohols safely, start with small amounts to assess your tolerance. Pay close attention to how different types affect your digestion. It is best to use them in moderation as part of an overall healthy diet that prioritizes whole foods and limits added sweeteners.