Are Sugar Alcohols Safe for People with Diabetes?

Lindsay Cohen, RDN

Credit: Mama-Betes

If you live with diabetes, you’ve likely seen “sugar-free” or “low-carb” products that contain sweeteners like xylitol, erythritol or sorbitol. These belong to a category called sugar alcohols, and despite the name, they’re not actually made from sugar or alcohol.

But are they actually safe for people with diabetes? Let’s walk through what sugar alcohols are, how they affect blood sugar levels and what you should know about them.

What Are Sugar Alcohols?

Sugar alcohols are a type of carbohydrate often used as reduced-calorie sweeteners. You’ll find them naturally in some fruits and vegetables in small amounts, but most of the sugar alcohols in packaged foods are manufactured from sugars and starches. Sugar alcohols are considered a low-calorie sweetener, but they are not a zero-calorie sweetener.

Some of the most common sugar alcohols you might see include the following:

• Xylitol: found in sugar-free gum, mints and dental products.
• Erythritol: common in low-carb baking and ketogenic snacks. Erythritol is one of the most commonly used types of sugar alcohols.
• Sorbitol: often used in sugar-free candy and cough syrups.
• Maltitol: found in sugar-free chocolate and protein bars.
• Mannitol: used less often in everyday foods, but you may find it in some processed products.

They’re called “sugar alcohols” because their chemical structure looks a little like both sugar and alcohol molecules, but they don’t contain ethanol, the type of alcohol you find in wine or beer.

How Sugar Alcohols Impact Blood Sugar Levels

One of the reasons sugar alcohols are so popular in “diabetes-friendly” products is that they typically cause less of a blood sugar spike than table sugar because our bodies only absorb sugar alcohols partially in the small intestine. This means fewer carbohydrates enter the bloodstream as glucose, and they will generally cause a smaller and slower blood sugar rise.

Most sugar alcohols have a glycemic index (GI) much lower than sugar’s GI of 65. For example, erythritol has a GI of 0, while xylitol’s is around 13.

Because they aren’t fully absorbed, sugar alcohols usually provide fewer calories, about 0.2 to 3 calories per gram, compared with sugar, which contains 4 calories per gram.

The Benefits for People With Diabetes

If used thoughtfully, sugar alcohols can offer some benefits for those with diabetes. Compared with eating the same food made with sugar, sugar alcohol-containing products usually contain less sugar and carbohydrates and cause smaller rises in blood sugar.

Many people with diabetes subtract half the grams of sugar alcohols from the total carbohydrate count when calculating insulin needs; however, make sure to always check with your diabetes care team for what’s right for you.

For those also managing weight, sugar alcohols can also reduce calorie intake without giving up sweetness.

Lastly, sugar alcohols can promote dental health. Some sugar alcohols, like xylitol, may inhibit the growth of bacteria in our mouths that cause cavities. This is why many brands of sugar-free mints, gum and toothpaste use xylitol.

Possible Downsides and Side Effects of Sugar Alcohols

While sugar alcohols can be helpful tools, they also have some possible negative effects, especially if you overdo them.

Because they aren’t fully absorbed, sugar alcohols pass into the large intestine, where bacteria ferment them. This can cause gas, bloating and diarrhea in some people. Sorbitol and mannitol are especially known for this.

Additionally, blood sugar responses can vary from person to person. Some people see almost no rise after eating foods containing sugar alcohols, while others may see changes, especially with larger servings. Remember, “sugar-free” doesn’t always mean “carb-free.” A product may still have enough carbohydrates to raise the blood sugar even if it is advertised as being “sugar-free.”

What About Long-Term Safety?

Research suggests that sugar alcohols are generally recognized as safe (GRAS) by the U.S. Food and Drug Administration when consumed in moderate amounts. There’s no strong evidence linking them to serious long-term health issues in people with or without diabetes.

However, because many of these studies have been relatively short-term, we don’t know everything about the effects of consuming large amounts over time, so moderation is still recommended.

In Summary

Sugar alcohols can be a useful tool for people with diabetes who want to enjoy sweet flavors with less impact on blood sugars. They’re not a freebie for unlimited “sugar-free” treats, and their effects vary depending on the type, the amount and your individual response.

When consumed in moderation, they can be part of a balanced eating plan. As always, work with your health care team to decide how sugar alcohols fit into your diabetes management plan.