A key part of following a ketogenic, or keto, diet is reducing your sugar intake. This is necessary for your body to enter ketosis, a state in which your body burns fat rather than sugar for energy. However, that doesn’t mean you can’t enjoy sweet-tasting foods. Sugar alcohols are sweeteners that have tastes and textures similar to those of sugar, but fewer calories and a less significant effect on blood sugar levels. As a result, they can be a satisfying option for individuals looking to reduce their sugar intake, such as those following a keto diet.
This article explains whether sugar alcohols are keto-friendly, as well as which ones may be better options for you.
What are Sugar Alcohols?
The term itself is actually misleading: There is no ethanol in sugar alcohols, and there’s no table sugar either. “Sugar alcohols are a type of carbohydrate and have a chemical structure that’s similar to sugar,” Bissell clarifies. Though they occur naturally in some foods and are made by your body, the levels present are vanishingly small. Most sugar alcohols found in packaged foods are manmade and manufactured. Sugar alcohols occur naturally in some fruits and vegetables. However, most are commercially manufactured in a lab.
Due to their low calorie contents, sugar alcohols are frequently used to sweeten sugar-free or diet products like gum, yogurts, ice cream, coffee creamers, salad dressings, and protein bars and shakes. Food manufacturers use these sugar alcohols to sweeten their products while reducing calories. “Sugar alcohols stimulate the tongue’s sweet taste buds, which adds flavor without extra sugar or calories,” Bissell explains. “Food companies use them so they can market their foods as ‘low-carb,’ ‘sugar-free’ or ‘diabetes-friendly’ without sacrificing taste.” Because of this, they’re often found in products, again, that are labeled “diabetes-friendly” or “keto-friendly.”
Common Types of Sugar Alcohols
While there are many types of sugar alcohols, common ones you may see on food labels include:
Read also: Comprehensive Guide to Sugar on Keto
- Erythritol: Often made by fermenting the glucose found in cornstarch, erythritol has 70% of the sweetness of sugar but 5% of the calories. Erythritol is a popular sugar substitute found in many low-calorie, keto, and high-protein products. From sugar-free protein bars to low-carb desserts and energy drinks, erythritol is marketed as a natural, zero-calorie sweetener that doesn’t spike blood sugar. Erythritol is 60% to 80% as sweet as sugar. While it can be found in small quantities in things like pears, soy sauce and watermelon, on an industrial scale, it’s made by yeast fermentation of corn or wheat starch. 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 back to baseline levels.
- Isomalt: Isomalt is a mixture of two sugar alcohols - mannitol and sorbitol. Providing 50% fewer calories than sugar, it’s most commonly used to make sugar-free hard candies and 50% as sweet. Isomalt is about 45% to 65% as sweet as sugar. It comes from beet sugar.
- Maltitol: Maltitol is processed from the sugar maltose. It’s 90% as sweet as sugar with almost half the calories. Maltitol is about 75% as sweet as sugar and is made from corn, wheat and potatoes, and catalytic hydrogenation.
- Sorbitol: Commercially produced from glucose, sorbitol is 60% as sweet as sugar with about 60% of the calories. Sorbitol is about half as sweet as sugar. Naturally, it’s found in apples and pears, but industrially, it’s made from potato starch.
- Xylitol: One of the most common sugar alcohols, xylitol is as sweet as regular sugar but has 40% fewer calories. Xylitol is about 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. It’s often found in sugar-free desserts and candies. Also frequently found in diabetic candies. Notably, you’ll also find it in some oral care products, like toothpaste and mouthwash because it helps prevent dental carries. The dangers associated with xylitol are related to eating it in large quantities. So, it’s not going to cause negative effects in your dental care (swish and spit) routine.
- Lactitol: Lactitol provides about 40% of the sweetness of sugar. Manufacturers make it from milk.
- Mannitol: Mannitol is 50% to 70% as sweet as sugar. Naturally, it occurs in carrots, olives and asparagus. While some manufacturers make it from seaweed, much is made from hydrogenation of fructose at high temperatures and pressure.
How Sugar Alcohols Affect Blood Sugar
When you eat sugar, your body breaks it down into smaller molecules. These molecules are then absorbed into your bloodstream, which causes your blood sugar levels to rise. In contrast, your body cannot fully break down and absorb carbs from sugar alcohols. As a result, they cause a much smaller rise in blood sugar levels. One way to compare the effects of these sweeteners is their glycemic index (GI), which is a measure of how quickly foods can raise your blood sugar.
Here are the GI values of common sugar alcohols:
- Erythritol: 0
- Isomalt: 2
- Maltitol: 35-52
- Sorbitol: 9
- Xylitol: 7-13
Overall, most sugar alcohols have negligible effects on your blood sugar levels. To compare, white table sugar (sucrose) has a glycemic index of 65. Given that your body can’t fully break down sugar alcohols, they cause a much less significant rise in your blood sugar levels than sugar does.
Sugar Alcohols and the Keto Diet
Sugar intake is limited on a keto diet, as eating it causes your blood sugar levels to rise. This is an issue, as raised blood sugar levels can make it difficult for your body to remain in ketosis, which is key for reaping the benefits of the keto diet. Given that sugar alcohols have a much less significant effect on blood sugar levels, they’re commonly found in keto-friendly products. Furthermore, since they aren’t fully digestible, keto dieters often subtract the sugar alcohols and fiber from the total number of carbs in a food item. The resulting number is referred to as net carbs.
Still, due to the variation in GIs of different types of sugar alcohols, some are better for the keto diet than others. Erythritol is a good keto-friendly option, as it has a glycemic index of 0 and works well in both cooking and baking. Plus, due to its small particle size, erythritol tends to be better tolerated than other sugar alcohols. Still, xylitol, sorbitol, and isomalt are all suitable on a keto diet. You may simply want to scale back your intake if you notice any gastrointestinal side effects. One sugar alcohol that appears to be less keto-friendly is maltitol. Maltitol has a lower GI than sugar. However, with a GI of up to 52, it’s likely to have a more significant effect on your blood sugar levels than other sugar alcohols. As such, if you’re on a keto diet, you may want to limit your intake of maltitol and choose a sugar alternative with a lower GI.
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Technically, most sugar alcohols should be counted as regular carbohydrates and kept to a minimum on the ketogenic and modified Atkins diets (MAD). Although they may affect blood glucose differently in different people, most sugar alcohols have the potential of raising blood sugar. The exception to this rule is erythritol since it is metabolized differently and does not affect blood glucose. I also tell my patients that sugar alcohol can only be deducted from the total carbohydrate amount if erythritol is the only sugar alcohol used in a product. Each dietitian has his/her own protocols, so while I allow my keto patients to deduct erythritol but no other sugar alcohols from total carbohydrate content, your provider may have different recommendations. The ketogenic diet for epilepsy should be used under medical supervision.
Potential Risks and Side Effects
When consumed in normal amounts through food, sugar alcohols are considered safe for most individuals. However, they do have the potential to cause digestive issues, especially in larger amounts. Side effects like bloating, nausea, and diarrhea have been observed when intake of sugar alcohols exceeds 35-40 grams per day. Additionally, individuals with irritable bowel syndrome (IBS) may experience negative side effects with any amount of sugar alcohols. As a result, if you have IBS, you may want to avoid sugar alcohol completely.
Sugar alcohols have long been considered a safe addition to your diet - in moderation. Studies have shown 10 to 15 grams a day of sugar alcohols are safe. But many processed foods containing sugar alcohols have levels far greater than that threshold. And new research is showing that elevated levels of sugar alcohols can be dangerous to your health.
Heart Attack and Stroke Concerns
Dr. Hazen and his team have conducted studies on the effects of both xylitol and erythritol. And the findings are highly concerning. Circulating levels of both xylitol and erythritol have been shown to be associated with an increased risk for “major adverse cardiovascular events.” That includes a heightened risk for heart attack, stroke and even death. Now, association doesn’t equal causation. But 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). The concern is that 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 is a good thing if you have an open wound. It keeps you from bleeding out. But when your blood clots inside your body, it’s a recipe for a medical emergency - like a heart attack or stroke. It doesn’t take much either. For example, just one scoop of keto-friendly ice cream contains up to 30 grams of xylitol. Dr. Hazen’s research suggests that’s enough to agitate your platelets and make them more likely to form clots. And 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 needs to be done to understand what the effects are of other sugar alcohols. But based on what we see from xylitol and erythritol, it’s fair to say that sugar alcohols should warrant caution,” Dr. Hazen states. “These compounds are in foods that are 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.”
Two major studies have recently raised concerns about erythritol's impact on cardiovascular and metabolic health:
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- Erythritol and Brain Vascular Cell Damage (Berry et al., 2025): Published in the Journal of Applied Physiology, this study examined how erythritol affects human brain microvascular endothelial cells (the cells that line small blood vessels in the brain). Researchers found that erythritol: Increased oxidative stress, Reduced nitric oxide (NO), which helps blood vessels relax, Increased endothelin-1, a vasoconstrictor, Suppressed tPA, a key enzyme that breaks down blood clots. These findings suggest that erythritol may contribute to vascular dysfunction and increase the risk of blood clots and stroke-especially concerning for people with existing cardiovascular risk factors.
- Erythritol Linked to Increased Risk of Heart Attack and Stroke (Witkowski et al. 2023): Published in Nature Medicine, this large-scale study investigated erythritol levels in the blood and their association with major adverse cardiovascular events (MACE) such as heart attack and stroke. and Europe and found that individuals with higher erythritol levels had a significantly increased risk of experiencing these cardiovascular events. Beyond observational data, the study also explored mechanisms. Laboratory experiments showed that erythritol enhanced platelet reactivity and clot formation, providing a plausible biological explanation for the clinical findings. Importantly, the researchers noted that erythritol remained elevated in the blood for many hours after ingestion-particularly concerning for people who frequently consume erythritol-rich products. These results underscore the need for further clinical studies, but they also suggest that regular use of erythritol may not be advisable for those with existing cardiovascular risk factors.
These studies don't mean you should immediately stop consuming anything with erythritol. However, they do raise red flags, especially for people with heart disease, diabetes, or those who frequently consume large amounts of sugar alcohols.
Gastrointestinal Issues and Laxative Effects
Your body can’t fully digest sugar alcohols, which can lead 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 appeared to have milder effects on the stomach, only increasing nausea and gas when consumed in large doses. “If you eat foods with sugar alcohols several times a day, you could wind up with some tummy troubles on top of raising your risk for heart conditions in the long term,” warns Bissell. “If you notice this happening, use caution or find another sweetener option.”
In everyday terms, this means that sugar alcohols may make you poop. Again, this is because your stomach can’t absorb sugar alcohols, which can cause them to linger in your intestines and ferment. This effect is most common in children and in adults who:
Potential for Weight Gain
Sugar alcohols are low in calories and carbs, but, depending on the type, aren’t free of them. So, it’s still possible to gain weight when you’re eating foods that contain sugar alcohols, 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.
Identifying Sugar Alcohols on Food Labels
“Just as sugar lurks behind different terms on food labels, sugar alcohols also have many names,” Bissell clarifies. When you see one of these products on a label, here’s what you’re getting: But frustratingly, you could be eating foods made with sugar alcohols without even knowing it - even if you’re reading those labels closely. Food and Drug Administration (FDA) doesn’t require food companies to list sugar alcohols on their ingredient lists.
Aside from reading the ingredients on food labels, Bissell says you can identify products that may contain sugar alcohols by looking for processed foods that say they’re:
- 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 dead giveaway that 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.
Sugar Alcohols vs. Artificial Sweeteners vs. Sugar
Sugar alcohols are sometimes referred to as artificial sweeteners, a category that includes aspartame and saccharin, but they’re actually not the same thing. Though they’re both manufactured, they differ in a couple of key ways. “Sugar alcohols have very few calories, and they’re not as sweet as sugar,” Bissell notes. “Artificial sweeteners, on the other hand, are chemicals that provide an intense level of sweetness and no calories.” You can also buy artificial sweeteners as a sugar substitute for baking and cooking and find them in packets at restaurants and coffee shops. Sugar alcohols are commonly used in processed foods.
Sugar is 100% natural, exclusively coming from fruits, plants, vegetables and milk. Though some sugar alcohols come from fruits and vegetables, the ones used in processed foods are artificially produced. Sugar alcohols have some advantages over regular sugar, including:
- Fewer calories: Unlike sugar, which has about 4 calories per gram, sugar alcohols have between 0 and 2 calories per gram. “They taste almost as sweet as sugar with about half the calories - or less,” says Bissell.
- Easier blood sugar management: Unlike regular sugar, sugar alcohols don’t cause sudden blood sugar spikes. “They’re considered a low glycemic index food and may cause only a slight rise in blood sugar levels,” she adds. “That’s why they’re used in commercially produced packaged snacks and sweets and are commonly marketed as “good for diabetes.”
- Less dental risk: Sugar alcohols don’t react to dental plaque the way sugar does, which means they don’t contribute to tooth decay. “You may see the sugar alcohol xylitol as an ingredient in your toothpaste, which helps make it taste better while it’s helping to prevent cavities,” Bissell points out.
- Fewer carbs: Sugar alcohols can fit into a low-carb diet because they’re much lower in carbs and have a lower glycemic index than regular forms of sugar.
There’s another key difference between sugar and sugar alcohols. “Your body can easily digest sugar and use it for energy,” Bissell explains. “But it can’t absorb or fully digest sugar alcohols.” As it turns out, that can cause some problems.
Net Carbs Explained
Net carbs refers to the amount of total carbohydrates in a food, minus the fiber content. Take that medium-sized apple we mentioned earlier. It has about 25 grams of carbs, and about 4.5 grams of fiber. Subtract the fiber, and you’re left with 21.5 net carbs. The other type of carbohydrate that gets a free pass with net carbs is something known as sugar alcohols. Although portions of their structures resemble sugar and alcohol, they are neither. Rather, they are a type of carbohydrate that simulates sweetness. Because they don’t have a significant effect on blood sugar, they get deducted from total carbs. We think it's important to note that the FDA isn’t on board with the concept of net carbs. And while counting net carbs can expand the food choices of someone who is restricting sugars or carbs, they can also be an excuse to add sweets and snacks to the diet. Net carbs isn’t an exact formula.
The Most Popular Sugar Alcohols: What Are They Good For?
Let’s dive into the most common sugar alcohols, how they impact your blood sugar, and what kinds of foods you’ll find them in.
Erythritol
- Sweetness: ~70% as sweet as sugar
- Calories: 0.24 per gram | Carbs: 100g total (0 net carbs) | GI: 0
- Insulin Impact: None; doesn’t raise insulin
- Keto-Friendly: Absolutely, it’s a go-to for keto!
- Where You’ll Find It: Keto-friendly baked goods, beverages, and sugar-free sweets. It’s the favorite because it’s got almost no net carbs and doesn’t mess with your blood sugar.
Xylitol
- Sweetness: Same as sugar
- Calories: 2.4 per gram | Carbs: 100g total (50-60 net carbs) | GI: 7
- Insulin Impact: Mild; might raise insulin a bit
- Keto-Friendly: Good in moderation
- Where You’ll Find It: Sugar-free gum, mints, and even some candies. Bonus: It’s great for your teeth! Just keep it away from dogs - it’s toxic to them.
Sorbitol
- Sweetness: 60% as sweet as sugar
- Calories: 2.6 per gram | Carbs: 100g total (48-60 net carbs) | GI: 9
- Insulin Impact: Moderate; could raise insulin
- Keto-Friendly: Not the best option for strict keto
- Where You’ll Find It: Sugar-free chewing gum, candies, and some diet foods. It’s used pretty often, but it’s not super keto-friendly due to the higher carb count.
Maltitol
- Sweetness: 75%-90% as sweet as sugar
- Calories: 2.1 per gram | Carbs: 100g total (52-60 net carbs) | GI: 35
- Insulin Impact: Significant; can spike insulin
- Keto-Friendly: Best to avoid if you’re sticking to keto
- Where You’ll Find It: Sugar-free chocolates, ice creams, and baked goods. Unfortunately, it’s not great for keto since it can mess with blood sugar and insulin levels.
Isomalt
- Sweetness: 45%-65% as sweet as sugar
- Calories: 2 per gram | Carbs: 100g total (25-30 net carbs) | GI: 2
- Insulin Impact: Minimal; low insulin impact
- Keto-Friendly: Moderate; stick to smaller amounts
- Where You’ll Find It: Hard candies and sugar-free treats. It’s pretty low-impact on blood sugar, but keep portions in check.
Mannitol
- Sweetness: 50%-70% as sweet as sugar
- Calories: 1.6 per gram | Carbs: 100g total (30-50 net carbs) | GI: 0
- Insulin Impact: None; won’t raise insulin
- Keto-Friendly: Yes, this one’s a safe choice!
- Where You’ll Find It: Often in sugar-free products like candies and gums, and even in pharmaceuticals.
What About Acesulfame Potassium (Ace-K)?
Now, Ace-K might show up in some of the same products as sugar alcohols, but it’s not a sugar alcohol. It’s an artificial sweetener that’s super sweet but has zero calories and zero carbs, making it a good fit for keto and low-carb diets.
- Sweetness: 200 times sweeter than sugar
- Calories: 0 | Carbs: 0 | GI: 0
- Insulin Impact: Minimal; usually no insulin spike
- Keto-Friendly: Absolutely
- Where You’ll Find It: You’ve probably seen Ace-K in drinks like Coke Zero, Pepsi Zero, and even Diet Mountain Dew. It’s also in sugar-free gums, candies, and some baked goods, often combined with other sweeteners like aspartame or sucralose to balance out the flavor.
How to Use Sugar Alcohols in Keto Cooking
These sweeteners are super versatile. Erythritol, for instance, works great in baking and drinks. Just a heads up, though - it can sometimes crystallize and get gritty when it cools. Mixing erythritol with other sweeteners like xylitol can help balance that out and improve texture in keto treats.