Sugar Alcohols & WLS … the Good, the Bad and the UglyMarch 14, 2018
Sugar alcohols are a mix of sugar and alcohol (hence the name), but they do not act as either sugar or alcohol inside of your body. They are found naturally in fruits and vegetables like apples, apricots, peaches, plums, watermelon, and green bell peppers.
Sugar alcohols used in foods and other ingested products are made from cornstarch, but can also be made from corn cobs, sugar cane stalk, table sugar, birchwood waste, and whey (dairy). The sugar alcohols are made when Hydrogen ions are attached to the sugars molecules, which can change the way your body breaks it down or digests it.
Sugar alcohols are sweet like sugar, but your body is not able to break them down the same way as it does with sugar. Some sugar alcohols are just not absorbed in the gut, are only absorbed partially, or are absorbed but not metabolized (broken down inside the body). Because of this, sugar alcohols have fewer calories than regular sugar does and do not affect blood sugars the same way. This makes them a great option for those who need to watch their sugar intake to help control blood sugars, or who are trying to reduce their calories but still want to enjoy something sweet.
Unlike calorie-free sweeteners, which tend to be much sweeter than regular sugar, sugar alcohols are usually substituted 1:1 in recipes. Sugar alcohols more closely resemble sugar and can provide more bulk to recipes, making them an easier replacement for sugar when baking or cooking.
Products you are likely to find sugar alcohols include, but are not limited to sugar free gum, candy, cough drops, mints, maple syrup, ice cream, protein bars.
What Are The Names of Sugar Alcohols?
Sugar alcohols include Sorbitol, Mannitol, Xylitol, Erythritol, D-tagatose, Disaccharide Polyols Isomalt, Lactitol, Maltitol, Isomaltulose, Trehalose, and Polysaccharide Polyols Hydrogenated Starch Hydrolysates.
The most common sugar alcohols you are likely to come across are:
Sorbitol is about half as sweet as sugar and has about 1/3 fewer calories. Consuming large amounts in a single sitting can cause bloating, gas, cramping, and diarrhea, so it is recommended you introduce sorbitol-containing foods gradually. All products that contain sorbitol are required to have a warning on the label, indicating that consumption can cause a laxative effect.
Mannitol is another sugar alcohol found often in commercial sugar-free products. Like sorbitol, large amounts (>20g/day) may cause a laxative effect, so foods containing mannitol should be introduced gradually. Also, like sorbitol, products containing mannitol are required to be labeled with a warning regarding the potential laxative effect.
Xylitol is often used in foods as a sugar alternative because it is just as sweet! As a bonus, it will not cause cavities and may help prevent them, making it a common additive in sugar-free gum, toothpaste, and mouthwash. Xylitol can be purchased in granular form like table sugar to make use easier, especially as it too has fewer calories than regular sugar.
This sugar alcohol is turning up more often in low sugar products such as sugar-free ice cream or protein bars used often after weight loss surgery or when trying to lose weight. Erythritol is also used to help bulk calorie-free sweeteners like Stevia such as Truvia®, or as a standalone sweetener and Swerve®. Erythritol is an especially helpful sugar substitute for patients suffering from diabetes, as it is not metabolized by the body and has little to no effect on blood sugar levels.
Do Post-Ops Adjust Carbohydrate Counts?
Sugar alcohols are listed under "carbohydrates" on the food and nutrition label. If you are tracking carbohydrates for blood sugar monitoring, or keeping macronutrients within a specific ratio, you want to adjust the carbohydrate total for sugar alcohols. To do so, divide the sugar alcohols (grams) in half, and subtract that from total carbohydrates. This will give you a better estimate of how much your body is absorbing or how much your blood sugars may be affected.
Of note, this is only an estimate, so you want to pay attention to your blood sugars after consuming products with sugar alcohols (if you have diabetes) and pay attention to how your weight is affected to make sure you are working towards weight loss or maintenance, and not accidentally sabotaging your progress.
What Are the Negative Side Effects of Sugar Alcohols?
Some sugar alcohols can cause gastrointestinal distress in significant quantities, so intake may need to be limited, especially for products containing mannitol or sorbitol.
For those who already suffer from irritable bowel syndrome or other bowel issues, you may need to avoid sugar alcohols completely as they may exacerbate symptoms. The key is to be aware of whether or not sugar alcohols are present in your food and to pay attention to how your body responds. I strongly recommend all patients keep food records tracking what they are eating and drinking, which is also a good way of tracking your individualize response to specific foods.
Are Sugar Alcohols Safe to Eat?
The US Food and Drug Association is responsible for determining the safety of additives in our food supply. Many sugar alcohols are designated as generally recognized as safe (GRAS). This designation is given when foods have been around for many years without demonstrating negative effects. Others have been approved as a food additive requiring the manufacturers to submit proof of safety to the government for review.
Can Patients Use Sugar Alcohols & WLS?
The short answer is maybe. Some people tolerate sugar alcohols as part of their diet without any problems, and others are very sensitive to the potential gastrointestinal effects. Overall, sugar alcohols can help you include sweets in your diet with fewer calories or consume sugar, which for some, is a helpful way of indulging while still meeting weight loss goals.
- https://www.accessdata.fda.gov/scripts/interactivenutritionfactslabel/sugar-alcohol.html accessed 10/25/17
- http://www.eatrightpro.org/~/media/eatrightpro%20files/practice/position%20and%20practice%20papers... accessed 10/25/17
- https://www.sugar.org/other-sweeteners/sugar-alcohols accessed 10/25/17
- http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/sugar-alcohols.html accessed 10/25/17
- http://www.joslin.org/info/what_are_sugar_alcohols.html accessed 10/25/17
- https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm094211.htm#how accessed 12/6/17
ABOUT THE AUTHORJessica Peters, MS, RD, joined the UCHealth Surgical Weight Loss Center in June 2017. She completed her initial training in the field of bariatric nutrition at Massachusetts General Hospital and completed her MS in Nutrition and Dietetics from Boston University in 2012. Jessica has spent her entire career counseling patients undergoing weight loss surgery at a Level 1A Accredited Bariatric Center of excellence in the suburbs of Boston prior to joining the team here at UCHealth.