Are Sugar Alcohols a Healthy Sugar Alternative? Here’s What the Research Says

Sweet But Not Simple

Often marketed as an all-natural and healthy replacement for refined sugar, sugar alcohols come in many forms: xylitol, erythritol, sorbitol, maltitol, and mannitol are some of the most well-known examples. Popular in the keto-world and with those who want to avoid the calories and other drawbacks of table sugar, sugar alcohols can be found in a variety of processed foods as well as granular form for baking and sweetening beverages. They differ from artificial sweeteners as they are not chemicals that provide intense sweetness with zero calories. Instead, sugar alcohols are a type of carbohydrate that isn’t as sweet as sugar, with fewer calories. They are often used in low-carb diets due to their lower glycemic index, as well as those who want to manage their blood sugar and reduce the risk of cavities. So far, so good — right? Not so fast. Recent research may give you pause for thought as sugar alcohols aren’t quite as benign as they might seem.

Health Risks of Sugar Alcohols

While some sugar alcohols are produced from natural sources, such as certain types of xylitol that are extracted from birch trees, most fall squarely under the artificially processed banner. Another distinction is that your body can easily digest any type of regular sugar, whereas you cannot fully digest sugar alcohols. This is what causes the digestive distress that many experience when they’ve overdone foods that contain it. What’s more, one study found that erythritol aggravates gut inflammation, which in turn led to leaky gut and an uptick of neuroinflammation and subsequent anxiety.¹

But that’s not all. As I wrote in “Common “All-Natural” Sugar Substitute Linked with Increased Risk of Blood Clots, Heart Attack“:

“A National Institutes of Health (NIH) funded study in 2022 involving more than 1,000 people established that “elevated levels of erythritol and several related artificial sweeteners were associated with the risk for cardiovascular events.” The team examined blood samples of the participants to document compounds that indicate future cardiac risk. For three years they also tracked adverse cardiovascular events, which included death and nonfatal heart attack or stroke. The findings were published in Nature Medicine, February 2023.”^2,3

It isn’t just erythritol that is a cause for concern. A study published in July of 2024 found that elevated blood levels of xylitol also increased platelet reactivity that heightened the risk of cardiovascular events, such as heart attack and stroke.⁴ The study participants were given a drink sweetened with 30 grams of xylitol — about the amount you would find in a single scoop of keto ice cream or serving of diabetic-friendly cookies.

Lead author, Stanley Hazen, MD, PhD, notes “In the presence of xylitol, platelets become much more angry and ready to clot,” Dr. Hazen reports. “It’s as if our platelets have a kind of taste bud receptor for xylitol that makes them go into overdrive. And that’s very significant because enhanced clotting can stop blood flow.”5

In light of these findings, swapping out sugar alcohols for organic stevia or pure monk fruit extract without erythritol may be a wise choice.

Where are sugar alcohols found?

Just like sugar, sugar alcohols are found in a surprising number of processed foods and aren’t just limited to low-carb or diabetic-friendly products. Look for labels that state:

• Artificially sweetened
• Naturally sweetened or sweetened with natural compounds
• Low-calorie or calorie-free
• Sugar-free, no or low sugar
• Keto-safe
• Diabetes-safe

You will also see this FDA-required statement on the packaging: “Excessive consumption can cause a laxative effect”.

Heart-Healthy Herbal Remedies

If you are concerned about maintaining cardiovascular health, avoiding sugar alcohols is a good first step. For an extra level of support, herbal remedies are an outstanding option. My favorite botanicals for heart health and blood sugar regulation include Hawthorn, Tulsi (Holy Basil), Fenugreek, and Bilberry. Each is found in our Heart Health Blend. Here are the unique benefits of each:

HAWTHORN

• Lowers blood pressure
• Decreases triglycerides and cholesterol in animal models
• Promotes circulatory health
• Excellent source of heart-healthy antioxidants, including polyphenols
• Reduces inflammation

FENUGREEK

• Helpful for diabetics
• Regulates blood sugar levels
• Slows absorption of carbohydrates
• Increases insulin release
• Controls appetite and fat consumption
• Tames inflammation
• Improves the efficiency of how the body uses sugar

TULSI (HOLY BASIL)

• Adaptogen and Detoxifier
• Reduces blood glucose levels and insulin resistance
• Enhances the production of insulin
• Lowers cholesterol and improves lipid profiles
• Helps to prevent weight gain
• Supports heart health by soothing anxiety and stress
• High in antioxidants
• Calms inflammation

BILBERRY

• Reduces blood pressure
• Combats obesity by decreasing fat absorption
• Regulates cholesterol levels
• Strengthens blood vessel walls
• Lowers blood sugar levels and insulin resistance
• Improves vision and heart health
• Outstanding antioxidant profile, including anthocyanins
• Powerful anti-inflammatory

OUTSTANDING!

“Love this stuff! Does what she says it will do. Purchased several times and will do it again!” -Terri

Your heart does a lot for you — give it a little help in return.

Our Heart Health Blend is made with herbs traditionally used to support circulation, blood pressure, and overall cardiovascular wellness — including managing glucose levels. It’s an easy way to show your heart some daily care. Stop by my apothecary today and give it a try. Your heart will thank you!

Nicole Apelian

Nicole’s Apothecary Products in this Post

References

1. Jiang, Y., Yin, H., Wang, H., Tao, T., & Zhang, Y. (2023). Erythritol aggravates gut inflammation and anxiety-like behavioral disorders induced by acute dextran sulfate sodium administration in mice. Bioscience, biotechnology, and biochemistry, 87(11), 1354–1363. https://doi.org/10.1093/bbb/zbad119
2. “Erythritol and cardiovascular events” by Brian Doctrow, PhD, National Institutes of Health, March 14, 2023. https://www.nih.gov/news-events/nih-research-matters/erythritol-cardiovascular-events
3. The artificial sweetener erythritol and cardiovascular event risk. Witkowski M, Nemet I, Alamri H, Wilcox J, Gupta N, Nimer N, Haghikia A, Li XS, Wu Y, Saha PP, Demuth I, König M, Steinhagen-Thiessen E, Cajka T, Fiehn O, Landmesser U, Tang WHW, Hazen SL. Nat Med. 2023 Feb 27. doi: 10.1038/s41591-023-02223-9. Online ahead of print. PMID: 36849732.
4. Marco Witkowski, Ina Nemet, Xinmin S Li, Jennifer Wilcox, Marc Ferrell, Hassan Alamri, Nilaksh Gupta, Zeneng Wang, Wai Hong Wilson Tang, Stanley L Hazen, Xylitol is prothrombotic and associated with cardiovascular risk, European Heart Journal, Volume 45, Issue 27, 14 July 2024, Pages 2439–2452, https://doi.org/10.1093/eurheartj/ehae244
5. “Eating Foods With Xylitol Can Be a Risk to Your Heart” Cleveland Clinic | Health Essentials, June 7, 2024. https://health.clevelandclinic.org/dangers-of-xylitol