Sugar Alcohols (Sorbitol, Maltitol and More)
Last reviewed October 18, 2026 · Evidence strength: Moderate · How we grade evidence
In plain words: Sugar alcohols (names ending in "-itol") are low-calorie sweeteners in sugar-free candy and gum. Many people, especially kids, get gas, bloating or diarrhea from them, and maltitol raises blood sugar more than people expect. A 2024 study also linked high xylitol levels to heart risk, so "sugar-free" doesn't automatically mean "better."
Also listed on labels as: Sorbitol, Maltitol, Xylitol, Isomalt, Mannitol, Lactitol, Polyols, E420, E965
What is it, and why is it in food?
Sugar alcohols (polyols) are carbohydrates that taste sweet but are only partly absorbed. That's why they have fewer calories, and also why the rest ferments in the gut. They're used in sugar-free candy, gum, chocolate, "no sugar added" ice cream and protein bars.
What does the science say?
| The popular claim | "Maltitol and sorbitol raise blood sugar and cause digestive upset; xylitol and erythritol are good low-glycemic choices." (Dr. Eric Berg; Dr. Steven Gundry lists xylitol as a "Yes.") |
| Our verdict on that claim | Partly supported |
| Evidence strength | Moderate: well-documented gut effects from human studies; newer heart findings are early. |
| Kinds of studies | Human challenge studies, population study, small human experiments, regulations |
- Digestive effects: In healthy volunteers, 10 grams of sorbitol caused symptoms in 45% of people, and 20 grams in everyone. Even four sorbitol candies (6.8 grams) caused symptoms in half.1
- Blood sugar: Maltitol is absorbed more than most sugar alcohols and raises blood sugar more. This is broadly accepted, though we didn't review a specific study on it.
- Xylitol and the heart: A 2024 study found people with the highest blood xylitol had a 57% higher risk of heart attack, stroke or death over 3 years. In volunteers, a xylitol drink made platelets stickier.2 This is the same pattern seen with Erythritol.
What do regulators say?
- FDA requires the warning "Excess consumption may have a laxative effect" on foods that could give 50 grams of sorbitol a day.3
- EU: foods with more than 10% added polyols must carry a similar warning.
Who should be careful?
- Kids get stomach upset at lower doses. Watch sugar-free candy at parties and holidays.
- People with IBS often react strongly to polyols.
- People with diabetes: count maltitol carbs; "sugar-free" doesn't mean "carb-free."
- People with heart or clotting risk: go easy on xylitol and erythritol.
How common is it in US foods?
In our check of USDA's Branded Foods database, 8,646 of 438,129 US packaged foods with an ingredient list name sorbitol, maltitol, xylitol, isomalt, mannitol or lactitol (about 2.0%, or roughly 1 in 51).4 It shows up most often in: candy (2,147); snack, energy & granola bars (1,160); chewing gum & mints (1,026); chocolate (801); cookies & biscuits (388). These are label records companies sent to USDA, mostly in 2021 to 2023, so some products have changed since. Counts come from a text match of ingredient lists and are approximate.
Swaps and tips for families
- Offer small portions of regular candy instead of large amounts of sugar-free candy.
- For gum, sugar-free gum is fine for teeth in normal amounts; just don't let kids chew pack after pack.
- Check "total carbohydrate," not just "sugar," if you're managing blood sugar.
Beyond the plate: related non-food exposures
Xylitol is extremely poisonous to dogs, even in small amounts. It causes a fast drop in blood sugar and liver failure. Keep sugar-free gum, candy, some peanut butters and xylitol toothpaste away from pets. For people, xylitol is commonly used in gum and toothpaste for teeth.
Frequently asked questions
Why do sugar alcohols cause diarrhea?
They're only partly absorbed. The rest pulls water into the gut and gets fermented by bacteria, causing gas, bloating and loose stools.
Does maltitol raise blood sugar?
Yes, more than most sugar alcohols. People with diabetes should count it.
Are sugar alcohols safe for kids?
In small amounts, yes. Kids get stomach upset at lower doses, so limit sugar-free candy.
Is xylitol dangerous for dogs?
Yes, very. Even small amounts can be deadly. Call a vet right away if your dog eats xylitol gum or candy.
Related guides
Sources
Every source below was checked against PubMed, the publisher or the official page by our research team in October 2026.
- Sorbitol malabsorption in normal volunteers and in patients with coeliac disease. Gut, 1988. PubMed 3343011 · doi:10.1136/gut.29.1.44
- Xylitol is prothrombotic and associated with cardiovascular risk. European heart journal, 2024. PubMed 38842092 · doi:10.1093/eurheartj/ehae244
- 21 CFR 184.1835 Sorbitol. Link
- FoodData Central, Branded Foods dataset (release 2026-04-30). U.S. Department of Agriculture, Agricultural Research Service, 2026. Link
This guide is for general education. It is not medical advice and does not replace advice from your doctor, pediatrician, allergist or registered dietitian. If you think you or your child reacted to a food, talk to a health professional. Research changes; we review these pages when new evidence or rules come out. Last reviewed October 18, 2026. Spotted an error? Email [email protected].