Sugar alcohols explained by hobbit ;). Sugar alcohols are right up there with fiber and protein in the “conventional wisdom might not be so wise” column. Drop into in any low carb group or blog, 90% of the time you will see “you don’t need to count sugar alcohol carbs.” Correct. False. Both? Neither? Depends on the person. Heyyyyyyy, where have we heard that before? :D. Let’s see if we can hammer this thing out, sound good?
First things first: Sugar alcohol is not a form of booze, you aren’t going to get drunk off them or fail a roadside test. Phew!! Sugar alcohols do not contain ethanol – the stuff in booze – they are derived from carbohydrates (sugars) that exist in plant products (such as fruits and berries) through a chemical process that ends up with a molecule that looks part sugar, part alcohol but in reality, is neither.
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Most sugar alcohols contain between 1.5 and 3 calories per gram compared table sugar’s 4 calories per gram. If you see a product that would typically contain sugar being marketed as “sugar-free,” odds are it contains one or more types of sugar alcohol, modified sugars, or artificial sweeteners (the government considers those three things separate ingredient types of “not sugars”). Since sugar alcohols go by some pretty bizarre names, many people don’t even notice them on an ingredients list. If you see erythritol, xylitol, lactitol, isomalt, maltitol, mannitol, hydrogenated starch hydrolysates (HSH), or sorbitol on a label, those are sugar alcohols and fall under this discussion. Things that are NOT sugar alcohols: polydextrose, inulin, soluble corn fiber, maltodextrin, dextrin, dextrose, sucrose, sucrolose, aspertame, acesulfame potassium, aspertame, cyclamete, saccharin, steviocides, Reb A, Reb B, agave, rapadura, barley malt extract, sucanat, allulose, yacon, ogliosaccharides, fructose, and glucose. Confused yet? Don’t blame you. It will get ugly, especially I suspect in the comments, but since we are all about the truth, science, individuals, and of course peace\love\compassion, we can handle this :).
First thing we need to understand is not all sugar alcohols are created equal. We cannot treat them as the same because they don’t treat US the same. This is where part of the confusion and bad advice comes from, if you see “you don’t count sugar alcohols” in a comment, scroll right past because that could be true, could be false, it depends on the type and the person. Let’s break them down:
Eyrthritol: typically derived from corn or beets, is about 70% as sweet as sugar, with a commonly accepted glycemic index of zero, and 10% of the carbs and calories of sugar. In most people, erythritol is the “safest” sugar alcohol because of its “zero” glycemic index. Most. Not all. If you are blood type “O” you may see as much as a 45% increase in serum blood glucose levels in the 2 hour period after ingestion. If you have ribose-5-phosphate isomerase deficiency, also known as KEGG disease, erythritol has been linked to complications with this metabolic dysfunction. Additionally, there have been studies that show it passes easier through the placenta and may affect fetal development. There’s significant research currently active on its contribution to IBS and SIBO, still in the works. So, you can count none, 10%, 45% of the carbs, depending on what your body says.
Hydrogenated Starch Hydrolysates (HSH) are a mixture of sorbitol, maltitol and hydrogenated oligosaccharides. depending on the type of HSH desired (the maltitol and sorbitol content can be varied), the sweetness of HSH varies from twenty-five percent to fifty percent that of sucrose. HSH sweeteners are used in a wide variety of candies, gums and mints. Also known as maltitol syrup and hydrogenated glucose syrup. It has about 35% the impact on blood sugar and calories as sugar. Count 35% of these carbs.
Isolmalt, lactitol, and maltitiol are the most commonly used sugar alcohols in mainstream “low carb” or “sugar free” foods. They have between 2-15% effect on blood sugar in most people, though diabetics – especially Type 1 and Type 2 who supplement with insulin, should be careful as they can trigger release of glucose and glycogen from the liver without being metabolized directly themselves.
Mannitol is about 70% the calories and sweetness as sugar. It has also been recently removed from the Generally Recognized as Safe list and now listed as a “food additive” instead of a non-sugar food. There are some questions about its effect on metabolism as recent studies show that both mannitol and sorbitol (below) can easily be converted to fructose and glucose in the body. It also is linked to drastic gastro disruption. If you see this on a label, you might want to reach for something else.
Sorbitol, like mannitol, is in the 70% range and can be converted to glucose and fructose. It is a sugar alcohol that falls under “nutritive sweetener” classification. It not only is an added ingredient in foods, it also can exist naturally in the body, and excess sorbitol in the cells has been linked to diabetic retinopathy and neuropathy. You should count this 100% as sugar.
Xylitol is a naturally-occurring sweetener, derived from birch tree pulp. It is the one sugar alcohol that is beneficial for oral health as it is anti-bacterial. It can be used intravenously for patients with impaired glucose tolerance in the case of severe trauma as it doesn’t need insulin to metabolize. It also passes through the blood brain barrier easily and can affect individuals with certain neurological disorders. You must count 40% of the carbs and calories from Xylitol.
Even though these sugar alcohols can have very low glycemic impact and low carbohydrate energy density for many, if consumed in large enough quantities they can cause fluctuations in blood sugar levels for anyone. This needs to be monitored if these products are to be consumed. As with anything side effects will vary from person to person, some will have an instant reaction while others may never notice anything at all. People with diabetes MISTAKENLY think that foods labeled as “sugar free” or “no sugar added” will have no effect on their blood glucose. Foods containing these sugar alcohols need to have their calorie and carbohydrate contents accounted for in your overall meal plan, as they can raises blood glucose levels. Since many people typically overeat “sugar free” or “no sugar added” foods, their blood glucose may be significantly elevated.
The problem with these types of sweeteners is that they have been shown in studies to be “antiketogenic”, meaning that they interfere with the process of ketosis, just as eating “regular” carbohydrates does. Using these sweeteners in excess may reverse what you are trying to accomplish. In addition, most of these sweeteners are excreted in the urine, which increases the amount and frequency of urination. This increased urination will result in a higher loss of body minerals such as calcium, magnesium and potassium and possibly cause muscle cramping. Some people may be more sensitive to them than others, so you’ll have to check your own results, as your mileage may vary. This is why induction, followed by a slow, systematic introduction of other foods in conjunction of self-testing is critical to understand your INDIVIDUAL needs and reactions so you can have the best chance of success.