Sugars and Sugar Substitutes

Sucrose is basic table sugar. All patients with CSID have a significantly decreased ability to digest sucrose because they lack the enzyme sucrase. Sucrose is known by several different names such as table sugar, white sugar, cane sugar, beet sugar, evaporated cane juice, raw sugar, brown sugar, turbinado sugar, and others as shown in the table below. Patients with CSID should be vigilant about reading food labels to discover hidden sugars. Names of the types of sugar content are listed in the “ingredients” section of a food label, while the total sugar content is listed by weight in the “nutrition facts” section of a food label.


Fructose is also commonly used as a sweetener in many foods. Fructose is usually tolerated fairly well by most CSID patients, although it is important to introduce it slowly to be sure.


A sugar substitute is a food additive that mimics the taste and sweetening attributes of sugar. Some sugar substitutes are natural and some are synthetic, with the latter being known as artificial sweeteners. In the United States, there are several sugar substitutes approved for use including aspartame, sucralose, neotame, acesulfame potassium, and saccharin. Although there is some ongoing controversy on whether artificial sweeteners are safe for consumption, the US Food and Drug Administration (FDA) considers all 5 of these (aspartame, sucralose, neotame, acesulfame potassium, and saccharin) to be Generally Recognized as Safe (GRAS). Unfortunately, there are no studies on the effects of these sweeteners and possible long-term consequences of children consuming them. For this reason, artificial sweeteners should be used in moderation. Consult a medical professional when weighing the health benefits for your unique situation.


Some non-sugar sweeteners are known as sugar alcohols. Sugar alcohols are generally less sweet than sucrose. Sugar alcohols generally are not used when preparing food at home, but are widely used in processed foods. Sugar alcohols are considered nutritive sweeteners because they provide calories, but fewer calories than sugar. Sugar alcohols are not completely absorbed by the body, which is why they sweeten with fewer calories than sugar. Therefore, a high intake of foods containing some sugar alcohols can lead to gas and diarrhea for all people, not just CSID patients. Contrary to their name, sugar alcohols are neither sugars nor alcohols. Instead, they are carbohydrates with chemical structures that only resemble sugar and alcohol. As with artificial sweeteners, the FDA regulates the use of sugar alcohols.


FDA-approved sugar alcohols and novel sweeteners include erythritol, hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol, and stevia preparations that are highly refined (e.g., Pure Via®, Truvia®). Currently, the FDA has not approved the use of whole-leaf stevia or crude stevia extracts for use as a sweetener. FDA approval does not mean these sweeteners are all appropriate for use by a CSID patient—see table below.


Sweeteners to Avoid and Acceptable Sweeteners

Sweeteners Tolerated by Most
Patients with CSID
Sweeteners Tolerated by Some
Patients with CSID
Sweeteners to AVOID by All
Patients with CSID
Aspartame (Nutrasweet®)
• 200x sweeter than sucrose
• has no calories
Acesulfame-K (acesulfame potassium, Ace-K, Sunett®, Sweet One®)
• 200x sweeter than sucrose
• often mixed with other sweeteners
• has no calories
Beet sugar
Dextrose (another name for glucose)
• a monosaccharide
• 75% as sweet as sucrose
Agave nectar
• consists primarily of glucose and fructose
• 1.5x sweeter than sucrose
Brown sugar
• a combination of sucrose & molasses
Fructose (crystalline fructose or crystalline fructose syrup)
• a monosaccharide
• 110% as sweet as sucrose
Corn syrup
• primarily glucose syrup
Cane juice
• a monosaccharide
• 75% as sweet as sucrose
Equal® Original in blue packaging (dextrose, maltodextrin, aspartame, Acesulfame K blend) Cane sugar
Lactose (milk sugar)
• a disaccharide that breaks down into glucose and galactose
High fructose corn syrup (HFCS)
• corn syrup where some of the glucose has been replaced with fructose
• sweetens similar to sucrose
• HFCS comes in 2 main types: 1. HFCS 55 (55% fructose and 45% glucose); commonly used in soft drinks, very similar in sweetness to table sugar 2. HFCS 42 (42% fructose and 58% glucose); commonly used in ice cream, canned fruits, ice cream, and other sweetened processed foods
• consists primarily of glucose (≈38-39%), fructose (≈30-31%), and sucrose (≈1-2%)
• 1-1.5x sweeter than sucrose
Coconut sugar
Hydrogenated starch
hydrosylates (HSH)
• a mixture of several sugar alcohols
• 40-90% as sweet as sucrose
Inverted sugar syrup
Invert sugar
• a mixture of glucose and fructose obtained by splitting sucrose into these two components
Date sugar
Maltose (malt sugar)
• a disaccharide formed from two units of glucose
Maple syrup
Saccharin (Sweet’N Low®)
• 200-700x sweeter than sucrose
• has no calories
Stevia (Truvia®, PureVia®)
• South American herb used as a sweetener for centuries
• 200-400x sweeter than sucrose
• has no calories
Raw sugar
Sucralose (Splenda®)
• 600x sweeter than sucrose
• sometimes maltodextrin (a starch) is used as an additive in sucralose
• has no calories
Sugar alcohols (sorbitol, mannitol, maltitol, xylitol, erythritol, lactitol)
• neither a sugar nor an alcohol
• excessive consumption can cause abdominal discomfort and/or a laxative effect
• has fewer calories than sucrose
Turbinado sugar