Many people are looking to sugar substitutes as alternatives to sugar, especially if they’re concerned about dental health, weight loss, or have diabetes. Xylitol and erythritol are two you may want to consider. But which of these is the healthier choice? The answer to this question isn’t simple.

Sugar alcohols are reduced-calorie sweeteners. So it’s worth examining the topic in more detail.

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Sugar substitutes are lower- or no-calorie sweetener alternatives to common table sugar. You can find them in many foods and beverages marketed as “sugar-free” or “diet.”

Some of the widely used sugar substitutes are:

  • Artificial sweeteners: Name brand examples include Equal, Sweet’N Low, and Splenda.
  • Novel sweeteners: These are individual or combinations of various types of sweeteners like stevia or monk fruit extract.
  • Sugar alcohols: Xylitol and erythritol are examples.

More about sugar alcohols

Sugar alcohols are reduced-calorie sweeteners.

Despite the name, they contain no alcohol. These sweet alternatives may be helpful for weight loss. They have fewer calories and carbohydrates than sugar. But sugar substitutes aren’t necessarily the secret to weight loss.

Sugar alcohols have other health benefits, discussed below. But in some people, they can cause digestive issues.

Xylitol is a natural substance found in fruits and vegetables, and it also naturally occurs in our bodies. With an equal sweetness, taste, and volume to sugar, it can be used in many of the same ways.

According to the USDA food database, xylitol has 2.5 calories per 1 gram and granulated sugar has 3.87 calories per gram.

High daily intake may result in diarrhea due to its laxative properties. Take note that xylitol is toxic to dogs so be careful not to share any xylitol-containing food with your pets.

Xylitol for diabetes

Xylitol may help people achieve more stable blood sugar levels, according to the Journal of Medicinal Food. It doesn’t cause as high of a spike in blood glucose, therefore less insulin is required to get glucose into cells and overall helps with sugar control.

It may also be beneficial in the prevention and treatment of type 2 diabetes, according to a study by the Journal of Clinical Biochemistry and Nutrition.

Xylitol for oral health

Regular use of xylitol causes cavity-forming bacteria to starve and die off by almost 75 percent, according to a study in the Iranian Journal of Microbiology. It also increases the flow of saliva and creates a more alkaline environment.

According to the Journal of Dental Research, the number of times that you are exposed to xylitol throughout the day matters the most. To prevent cavities, the California Dental Association (CDA) recommends the use of xylitol-containing products three to five times daily, for a total intake of five grams.

Xylitol for ear and upper respiratory infections

Xylitol inhibits the growth of the bacteria Streptococcus pneumoniae. This bacteria is a major cause of middle ear infections and sinusitis.

An analysis by the Cochrane Collaboration shows that children who consumed xylitol in gum, syrup, or lozenges twice a day reduced their risk of ear infections by 25 percent.

No long-term safety data exists for xylitol. But xylitol has been approved for safety by a number of agencies. These include the U.S. Food and Drug Administration, the World Health Organization’s Joint Expert Committee on Food Additives, and the European Union’s Scientific Committee for Food.

This sweetener occurs naturally in many fruits. It’s also found in mushrooms and foods derived from fermentation, like wine, cheese, and soy sauce. It’s commonly used as a bulk sweetener in reduced-calorie foods, and it has no aftertaste.

What sets it apart is that it has no calories and doesn’t seem to cause the same digestive problems as other sugar alcohols. But consuming it may lead to acid reflux and promote dehydration and a loss of electrolytes.

Erythritol for diabetes

A study in Acta Diabetologica suggested that erythritol might be a preferred sugar substitute for people with diabetes.

Erythritol for oral health

Like other sugar alcohols, erythritol doesn’t lead to tooth decay.

Erythritol as an antioxidant

Researchers in a study in Nutrition found erythritol to act as a strong antioxidant with a favorable effect on blood vessels.

A study in Caries Research found that erythritol might be better for tooth health than xylitol. And compared to xylitol, erythritol can be fully absorbed by our bodies, causing less digestive distress. Plus, erythritol doesn’t raise blood sugar at all, while xylitol has a small impact.

The Center for the Science in the Public Interest’s Chemical Cuisine recommends to limit xylitol, while it classifies erythritol as safe.

A recent study in the journal Nature Medicine found an association between erythritol and increased blood clotting activity. Since excess erythritol is absorbed into the bloodstream, this may be a cause for concern. However, this is only one study, and more research is needed.

Both xylitol and erythritol should be used in moderation. Overall, there is not enough research yet on sugar alcohols since they are a relatively new discovery. The best recommendation is to avoid added sugars of any kind and eat whole, unprocessed foods.

If you do choose to use them, it’s best to discuss this decision with your doctor first and to monitor how your body reacts to these substances.