Dietary changes are often recommended for people with ulcerative colitis (UC) to control inflammation and improve gastrointestinal function, and limiting refined sugars is usually part of this change, says Pratima Dibba, MD, a gastroenterologist at Manhattan Medical Practice in New York.
Sugar consumption has been associated with worsened disease activity in animal models of UC, due to the way sugar changes gut bacteria and affects the lining of the digestive tract, she says.
Preliminary animal research also suggests that sugar may hinder the body’s ability to repair the lining of the colon.
Eating sugary foods often and in large quantities can also lead to an overgrowth of pro-inflammatory yeast and bacteria in the gut, says Adiana Castro, RDN, a gut health dietitian and owner of Compass Nutrition in New York City. “This can cause an imbalance that reduces beneficial bacteria,” she says.
“In turn, this can weaken the immune system and create blood sugar problems that impact both energy and mood, as well as increase the risk of developing more UC symptoms.”
This doesn’t mean you should eliminate all sweeteners from your diet, however. Here are some better alternatives for maintaining gut health.
1. Honey
“Honey is a good alternative to sugar when you have UC because it provides vitamins and minerals and has other beneficial properties,” she says. “That means you get some sweetness, as well as nutritional benefits.”
In addition to being tastier than refined sugars, honey contains traces of fiber and protein, is rich in antioxidants and has anti-inflammatory properties.
2. Maple syrup
Another sweetener that contains small amounts of vitamins and minerals is pure maple syrup, says Stoffels. This only applies to syrup classified as 100% pure, meaning it’s made simply by removing excess water from the sap of maple trees – and contains no corn syrup, artificial flavors, preservatives or other additives.
Pure maple syrup contains potassium, calcium, magnesium, manganese, phosphorus and iron, as well as traces of several vitamins.
This means you can get some nutritional benefits by adding a one-tablespoon serving to whatever you’re looking to sweeten, says Stoffels.
3. Coconut sugar
Like honey and maple syrup, coconut sugar without any additives can be a good choice in place of table sugar, Castro says.
This type of sugar is made from the sap of coconut palms, and research indicates that it contains antioxidant compounds, vitamins C and E, minerals like potassium and magnesium, and a soluble fiber called inulin, which may reduce the risk of blood sugar spikes after eating.
4. Fruit preserves, jams and jellies
Fruit preserves, jams and jellies that contain only fruit and their juices can be another good choice for adding a little sweetness to snacks like yogurt or toast, says Castro. However, always read the label, as these products often contain refined sugars.
“These will retain the vitamins and minerals found in whole fruits, so you can have some nutrients in your sweetener,” she says.
The nutritional profile will depend on the fruits used. Although the processing method may reduce the nutrient content and function of bioactive compounds compared to fresh fruit, you still get health-beneficial vitamins, minerals and plant chemicals that are not present in refined sugars.
5. Monk fruit
Available in both liquid and granulated sweetener form, monk fruit is derived from the fruit of the plant of the same name.
“Although it has not been studied extensively for UC or other forms of inflammatory bowel disease, it is considered a natural sugar substitute and is likely well tolerated in small amounts,” says Stoffels.
The research does, however, highlight some possible benefits. A study of the main components of monk fruit found that the sweetener has antioxidant properties and contains a potential prebiotic – a component that provides nutrients to gut bacteria – which could benefit health.
What about artificial sweeteners?
The sugar substitutes listed above are considered natural because they are derived from plants, Stoffels explains, but there are many options classified as artificial or non-nutritive sweeteners, derived from chemical processes. They include:
There are also sugar alcohols, which are sometimes derived from plants and have a chemical structure similar to sugar, although most are made synthetically. These include:
Although artificial sweeteners and sugar alcohols have benefits (they taste sweet while being calorie-free and less likely to raise blood sugar levels), they can often be problematic for people with UC, says Stoffels.
“Artificial sweeteners as well as sugar alcohols can cause gastrointestinal discomfort, especially in people with inflammatory bowel disease,” she says.
“These substitutes may also contribute to the imbalance of gut bacteria, making people with IBD more susceptible to inflammation. For these reasons, I generally suggest limiting them in the diet as much as possible.”
How much is too much?
In general, natural sweeteners are better than table sugar, artificial sweeteners, or sugar alcohols, but that doesn’t mean you can have as much natural sweetener as you want without potential repercussions, says Stoffels.
“As with anything, the word ‘excess’ is important,” she says. “Small amounts of these sugars can be part of an overall healthy diet, but there is such a thing as too much.”
Adding small amounts of natural sweeteners can enhance flavor and sweetness, but even these should be used in moderation, says Castro. The American Heart Association’s recommendation is to limit added sugars, which include natural sugars, to no more than 6% of your daily calories. For most women, this represents a limit of around 100 calories per day; for most men, that’s no more than about 150 calories per day.
Takeaways
- Because refined sugars such as table sugar (sucrose) have been linked in preliminary research on ulcerative colitis to worsening the disease and a bacterial imbalance in the gut, experts recommend limiting them and considering alternatives.
- The best sweetener options include natural options like honey, maple syrup, coconut sugar, fruit preserves, jams, jellies, and monk fruit, all of which have nutritional benefits as well as a sweet taste.
- It is important to consume any type of added sweetener, even natural ones, in moderation.
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