Xylitol is a common zero-calorie sweetener aka sugar substitute found in sugar-free confectionery and toothpaste.
Artificial sweeteners, sugar substitutes or non-nutritive sweeteners are chemicals that provide an intense level of sweetness and no calories.
They offer the sweet taste of sugar but have no carbohydrates or calories. Artificial sweeteners do not raise blood sugar levels. So when used instead of sugar, sugar substitutes can help you keep within your carbohydrate goals when planning meals. And because they have no calories, choosing foods made with them may lower your calorie intake.
Sugar substitutes stimulate the tongue’s sweet taste buds adding flavor without extra sugar or calories. Food companies use them to market their foods as ‘low-carb,’ ‘sugar-free’ or ‘diabetes-friendly’ without sacrificing taste.
Because of this, you will find them in products usually labeled “diabetes-friendly” or “keto-friendly.” Some of the most common artificial sweeteners you will come across are:
- Xylitol.
- Erythritol.
- Sorbitol.
- Maltitol.
- Mannitol.
- Isomalt.
- Lactitol.
Sugar substitutes are generally considered a safe addition to your diet —but in moderation. Up to 10 to 15 grams a day are safe. Also, there’s the advantage of fewer calories: easier blood sugar management, less dental risk, and fewer carbs. But many processed foods have levels far greater than that threshold. New research is showing that high levels of sugar alcohols, artificial sweeteners or sugar substitutes can be dangerous to your health.
Our bodies can digest sugar easily and use it for energy. But it cannot absorb or fully digest sugar alcohols and as a result, can cause problems.
Over the past decade, the use of sugar substitutes, including sugar alcohols and artificial sweeteners, has increased significantly in processed foods that are promoted as healthy alternatives.
Here are at least 4 major health risks linked to sugar substitutes.
1. Heart attack and stroke
Circulating levels of both xylitol and erythritol are associated with an increased risk for “major adverse cardiovascular events.” That includes a heightened risk for heart attack, stroke and even death.
While association doesn’t equal causation, studies with blood, platelets and non-human models all point to erythritol and xylitol enhancing blood clotting risks (what happens in a heart attack or stroke). Eating foods with these sugar alcohols may put you at a higher risk for heart attack and stroke.
High levels of xylitol and erythritol can send your platelets into overdrive. Platelets are the components in your blood that allow it to clot. Clotting keeps you from bleeding out. But when your blood clots inside your body, it results in a medical emergency — like a heart attack or stroke.
For example, just one scoop of keto-friendly ice cream contains up to 30 grams of xylitol. Research suggests that’s enough to agitate your platelets and make them more likely to form clots. The increased risk lasts about four to six hours (or until you eat more xylitol-containing foods.)
When you eat foods containing erythritol, the risk can remain for several days.
More research is required to understand the effects of other sugar alcohols. But based on xylitol and erythritol, sugar alcohols must be consumed with caution especially since they are found in foods typically marketed to people with diabetes, who already have an increased risk for major heart events. And the sugar alcohols in their diets may inadvertently be adding to that risk.
2. Gastrointestinal (GI) issues
Your body can’t fully digest sugar alcohols, leading to some unpleasant GI symptoms when eaten in larger quantities — and they usually happen pretty soon after you eat them.
In a 2006 British study, researchers gave participants doses of sugar or one of two types of sugar alcohols (xylitol and erythritol). Those who took xylitol reported bloating, gas, upset stomach and diarrhea. Erythritol had milder effects on the stomach, only increasing nausea and gas when consumed in large doses.
Eating foods with sugar substitutes several times a day can result in tummy troubles on top of raising your risk for heart conditions in the long term. If you notice this happening, be careful or find another sweetener option.
3. A laxative effect
Sugar alcohols may make you poop because your stomach can’t absorb them. This makes them linger in your intestines and ferment.
This usually happens with children and in adults who:
- Have irritable bowel syndrome(IBS).
- Are having a GI flare-up from Crohn’s disease.
- Have a sensitivity to FODMAPs.
4. Weight gain
Though low in calories and carbs, depending on the type, sugar alcohols aren’t free of them. So, it’s still possible to gain weight when you’re eating foods that contain sugar substitutes, especially if you eat them in excess.
A study of college students found that consuming high levels of dietary erythritol were associated with weight gain — specifically, increased belly fat — throughout their freshman year.
How can you tell if a food contains sugar substitutes?
Just as sugar lurks behind different terms on food labels, sugar alcohols go by different names. When you see one of these on a label, here’s what it means.
Xylitol
Xylitol is a common sugar substitute used in sugar-free confectionery, gums, baked goods, and oral products like toothpaste and mouthwash because it helps prevent dental carries.
As sweet as sugar it comes from wheat straw and some cereals. On an industrial scale, it’s produced from wood materials or by microbial fermentation. Xylitol is dangerous when eaten in large quantities. No need to worry about your toothpaste and mouthwash that you just swish and spit.
Higher amounts of the sugar alcohol xylitol are associated with an increased risk of cardiovascular events like heart attack and stroke.
Erythritol
This is 60% to 80% as sweet as sugar. It is found in small quantities in things like pears, soy sauce, and watermelon. It’s made by yeast fermentation of corn or wheat starch. As one of the fastest-growing sugar substitutes in the food industry, ingesting it as a sugar substitute can raise blood levels more a 1,000 fold, and take days before returning to baseline levels.
Isomalt
This is about 45% to 65% as sweet as sugar. It comes from beet sugar.
Lactitol
This has 40% of the sweetness of sugar and is made from milk.
Maltitol
This is about 75% as sweet as sugar and is made from corn, wheat, and potatoes, and catalytic hydrogenation.
Mannitol
This is 50% to 70% as sweet as sugar, occurring naturally in carrots, olives and asparagus. It is made from seaweed or hydrogenation of fructose at high temperatures and pressure.
Sorbitol
This is about half as sweet as sugar and naturally found in apples and pears, but industrially, it’s made from potato starch.
But here is the thing. You could be eating foods made with sugar alcohols without even knowing it — even if you’re reading those labels closely. The U.S. Food and Drug Administration (FDA) doesn’t require food companies to list sugar alcohols on their ingredient lists. Besides food labels, you can identify products that contain sugar alcohols by looking for processed foods that claim to be:
- Keto-safe.
- Diabetes-safe.
- Sugar-free, no sugar or low sugar.
- Artificially sweetened.
- Naturally sweetened or sweetened with natural compounds.
- Low-calorie or calorie-free.
Another way to find out if a product includes sugar alcohols is a label that says, Excessive consumption can cause a laxative effect. The FDA requires this language on any product that contains added sorbitol or mannitol.
Findings published in the European Heart Journal confirmed the association in a large-scale patient analysis, preclinical research models and a clinical intervention study. Xylitol is not as prevalent as erythritol in keto or sugar-free food products in the U.S. but is common in other countries.
The research study that linked xylitol to cardiovascular events like heart attack and stroke also found a link between erythritol and cardiovascular risk.
However, more research is required to investigate sugar alcohols and artificial sweeteners, especially as they continue to be recommended in combatting conditions like obesity or diabetes. So you may not need to throw out your toothpaste if it has xylitol, but it is good to know that high levels of the product could increase the risk of blood clot-related events.
Also, the study found that high levels of circulating xylitol were associated with an elevated three-year risk of cardiovascular events in an analysis of more than 3,000 patients in the U.S. and Europe. A third of patients with the highest amount of xylitol in their plasma were more likely to experience a cardiovascular event. To confirm the findings, pre-clinical testing was conducted, and found that xylitol caused platelets to clot and heightened the risk of thrombosis.
Researchers also tracked platelet activity from people who ingested a xylitol-sweetened drink versus a glucose-sweetened drink and found that every measure of clotting ability significantly increased when xylitol was ingested but not glucose.
Talk to your doctor or a certified dietician to know more about healthy food choices and for personalized recommendations.
Some foods, especially desserts and baked goods made with artificial sweeteners may have more calories or fat than the original sugar-sweetened product.
Read food labels to compare products for serving sizes, calories and fat. Choose a smaller portion of a sugar-sweetened product as this may be lower in calories than the artificially sweetened version!
While artificial sweeteners can help reduce your carbohydrate intake, the risks suggest cutting their intake or even avoiding them completely. Researchers don’t yet know their full impact on your health. As with most foods, consume products with sugar and sugar alcohols only in moderation and to focus on whole foods instead.
