The best and worst sweeteners for your gut

THE SWEETENER WAR HAS been raging for decades, though the battlefront shifts often – from debates over sugar versus fructose, refined versus unrefined, natural sweeteners versus artificial, caloric versus non-caloric and more.

I've more or less remained neutral in such scuffles. The way I see it, different people have different health needs, and different sweeteners will make sense for different people. What matters more is making sure sweeteners of any kind aren't such a big part of your diet that your overall health suffers.

[See: These Healthy Seasonings Are Tasty Substitutes for Sugar and Salt.]

Healthfulness considerations aside, though, different sweeteners affect the gastrointestinal tract differently – a point that should also be taken into account when figuring out which type is right for you. Here's how the most common types stack up, gut-wise:

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Best sweeteners
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Best sweeteners

The Most GI-Friendly

Glucose

The Most GI-Friendly

Sucrose (white sugar, table sugar, cane syrup, maple syrup)

The Most GI-Friendly

Maltose (brown rice syrup)

The Most GI-Friendly

Stevia

The Most GI-Friendly

Monkfruit extract (luo han go)

The Most GI-Friendly

Aspartame (Equal)

The Most GI-Friendly

Saccharin (Sweet'n Low, Sugar Twin)

The Most GI-Friendly

Acesulfame potassium

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I call these sweeteners "GI neutral" because the vast majority of people can consume them in pretty high doses without experiencing digestive distress. That's because these sweeteners are very easily absorbed in our digestive tracts. To be clear, I'm not suggesting that doing so is necessarily healthy.

My patients are often surprised when I tell them that white ("refined" or "table") sugar makes this list. But if you divorce philosophical or moral opinions from consideration and focus purely on physiology, you'll see that the human body was designed to absorb sugar quickly, easily and completely. Simple sugars like glucose, maltose and sucrose are therefore unlikely to provoke digestive distress in the vast majority of people. Because maple syrup is primarily composed of sucrose, it has a pretty neutral effect on the digestive tract, too. (There are exceptions for people who have undergone certain intestinal surgeries that alter the digestive tract anatomy. For them, simple sugars can pose a significant problem called "dumping syndrome" that results in diarrhea, dizziness and weakness.)

[See: 10 Weird Things That Can Make You Poop.]

Among the non-caloric sweeteners, there are examples of both natural and artificial sweeteners that pass through the digestive process without stirring up any drama. Aspartame, saccharin andacesulfame potassium are the artificial sweeteners that are best tolerated digestively, though the Center for Science in the Public Interest has raised safety concerns about chronic use of all three of them. Among the natural sweeteners, stevia and monkfruit extract shouldn't aggravate sensitive bowels, either, though beware for branded products like Truvia that blend these ingredients with other less digestively-friendly ones like erythritol.

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Risky Sweeteners
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Risky Sweeteners
The More Risky for Some People's Guts

Fructose (including high-fructose corn syrup, agave nectar and honey)

The More Risky for Some People's Guts

Erythritol (including Truvia)

Erythritol is a so-called "sugar alcohol" that's somewhat better absorbed than its cousins whose names also end with "ol," though it can still provoke gas and diarrhea in people who are fructose intolerant. You'll find it in many sugar-free or low-carb sweets and in most so-called "healthy ice creams."

The More Risky for Some People's Guts

Sucralose (Splenda)

Sucralose is an artificial compound made from sugar, of which only 15 percent is absorbable in our guts; the 85 percent that isn't absorbed is not fermentable by our resident bacteria. Therefore, it has a negligible number of calories when consumed and should not produce gas, either. Unlike other poorly-absorbed sweeteners, though, it does not draw water into the bowel through osmosis and shouldn't cause diarrhea. In short-term studies of healthy volunteers consuming very high doses of sucralose (the equivalent of 28 Splenda packets per day for a 150-pound person), no adverse digestive symptoms were reported. However, digestive tolerance has not been studied in people with irritable bowel syndrome, and given a number of studies in both animals and humans that found sucralose to have adverse effects on the gut microbiota, I wouldn't be so quick to give it the green light as "GI neutral."

The More Risky for Some People's Guts

Lactose

Lactose is a natural sugar found in dairy products, and most lactose intolerant people know to be careful when consuming certain types of dairy. But isolated lactose is used as an added sweetener to items ranging from birth control pills to milk chocolate-based candy bars. Since large swaths of the U.S. population are lactose intolerant, it pays to know where else lactose lurks so as to avoid any unpleasant surprises of the gas and diarrhea variety.

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The Least GI-Friendly

  • sorbitol
  • maltitol
  • mannitol
  • xylitol
  • lactitol

The "ols" are a family of very low-calorie sweeteners that can be both naturally derived (xylitol comes from wood pulp; sorbitol occurs naturally in many fruits) or synthesized in a lab. Sometimes, they're referred to as "polyols" or "sugar alcohols." They're low in calories because they're so difficult for our guts to absorb; if we can't absorb them, then we can't access their calories, after all. The side effects of malabsorbing such small sugar-like molecules are – surprise, surprise – gas and (sometimes explosive) diarrhea. In fact, several of these ingredients are added to constipating medications precisely because of their laxative properties!

[See: What to Eat, Drink and Do to Relieve Constipation.]

You're likely to encounter sugar alcohols in medications; sugar-free gum and candies; low-carb and low-sugar energy bars; "no sugar added" or "sugar-free" frozen yogurt, cookies and cakes; and chewable vitamins or supplements. The more of these sweeteners you consume, the greater the chance that you'll fall victim to their laxative effects.

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