Dietary changes are often recommended for those with ulcerative colitis (UC) as a way to tame inflammation and improve gastrointestinal function, and limiting refined sugars is usually part of that shift, says Pratima Dibba, MD, a gastroenterologist with the Medical Offices of Manhattan in New York City.
Sugar consumption has been linked to worsened disease activity in animal models of UC, because of the way that sugar alters gut bacteria and affects the digestive tract’s mucosal lining, she says.
Preliminary research on animals also suggests that sugar may impede the body’s ability to repair the colon’s lining.
Eating sugar-sweetened foods often and in high amounts can also lead to overgrowth of yeast and pro-inflammatory bacteria in the gut, says Adiana Castro, RDN, a registered dietitian specializing in gut health and the owner of Compass Nutrition in New York City. “This can prompt an imbalance that reduces beneficial bacteria,” she says.
“In turn, that can weaken the immune system and create blood sugar issues that impact both energy and mood, as well as raise your risk of more UC symptoms.”
That doesn’t mean you have to eliminate all sweeteners from your diet, however. Here are some alternatives that are better for maintaining gut health.
1. Honey
“Honey is a good alternative to sugar when you have UC because it provides some vitamins and minerals, and has other beneficial properties,” she says. “That means you get some sweetness, and some nutritional advantages as well.”
In addition to being more flavorful than refined sugars, honey contains trace amounts of fiber and protein, is high 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 applies only to syrup that is categorized as 100 percent pure, meaning that it’s manufactured 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, plus trace amounts of several vitamins.
That means you can derive some nutritional benefits by adding a 1 tablespoon serving to whatever you’re looking to sweeten, Stoffels says.
3. Coconut Sugar
Like honey and maple syrup, coconut sugar without any additives can be a solid choice instead of table sugar, says Castro.
This type of sugar is made from the sap of coconut palm trees, and research indicates it contains antioxidant compounds, the vitamins C and E, minerals including potassium and magnesium, and a soluble fiber called inulin, which can lower the risk of blood sugar spikes after eating.
4. Fruit Preserves, Jams, and Jellies
Fruit preserves, jams, and jellies that contain only fruits and their juices can be another good choice for adding some sweetness to snacks like yogurt or toast, says Castro. Always read the label, however, as these products often contain refined sugars.
“These will retain the vitamins and minerals found in the whole fruits, so you can have some nutrients as part of your sweetener,” she says.
The nutritional profile will depend on which fruits are used. While the processing method may reduce the nutrient content and function of bioactive compounds in comparison with fresh fruit, you’re still getting vitamins, minerals, and health-boosting plant chemicals not present in refined sugars.
5. Monk Fruit
Available both as a liquid and a granulated sweetener, monk fruit is derived from the fruit of the plant of the same name.
“Although it hasn’t been studied extensively for UC or other forms of inflammatory bowel disease, this is considered a natural sugar substitute and is likely well-tolerated in small amounts,” says Stoffels.
Research does highlight some possible benefits, however. A study on monk fruit’s main components found that the sweetener has antioxidant properties and contains a potential prebiotic — a component that provides nutrients for gut bacteria — which could be beneficial for health.
What About Artificial Sweeteners?
The sugar substitutes listed above are considered natural because they’re derived from plants, says Stoffels, but there are numerous options categorized 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 that’s similar to sugar, though most are made synthetically. These include:
Although there are advantages to artificial sweeteners and sugar alcohols — they have a sweet taste while being calorie-free and less likely to raise blood sugar levels — they can often be problematic for those with UC, says Stoffels.
“Artificial sweeteners as well as sugar alcohols can cause gastrointestinal discomfort, especially in those with inflammatory bowel disease,” she says.
“These substitutes may also contribute to the imbalance of gut bacteria that leaves those with IBD more susceptible to inflammation. For these reasons, I usually 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 includes natural sugars — to no more than 6 percent of your daily calories. For most women, that’s a limit of about 100 calories per day; for most men, that’s no more than about 150 calories per day.
The Takeaway
- Because refined sugars such as table sugar (sucrose) have been linked in preliminary research on ulcerative colitis to worsened disease and bacterial imbalance in the gut, experts recommend limiting them and considering alternatives.
- Better sweetener options include natural options such as honey, maple syrup, coconut sugar, fruit preserves, jams, jellies, and monk fruit, which all have nutritional benefits as well as sweetness.
- It’s important to consume any kind of added sweetener — even natural ones — in moderation.