Your Guide to Sugar Substitutes: Safe Natural Sweeteners vs Unsafe Artificial Sweeteners

As so many people try to break free from their sugar addiction, they are turning to sugar substitutes. Initially it might seem like a win-win—little to no calories, fewer blood sugar rollercoasters AND still satisfies sweet cravings. When you dig a little deeper it becomes clear that the hype is too good to be true. You can’t really have your cake and eat it too!But food manufacturers are milking this trend for every cent by sweetening their products with sugar substitutes and labeling them as sugar-free and guilt-free. A report from 2012 found that 15% of the volume of foods purchased in 2009 in the United States contained non-caloric sweeteners. And you better believe that number has only gone up since. A 2018 study found that the following categories of food products purchased in the US contain non-nutritive sweeteners:

21.67% of beverages

51.73% of beverage powder mixes

64.91% of energy drinks

14.42% of fruit and vegetable juices

29.23% of soda

37.94% of sports drinks

30.20% of water

21.7% of yogurt

That gives you an idea that they are very prevalent in the food supply. But here’s the important point to note: sugar substitutes are not created equal. The safety of each sweetener depends on the category, with artificial sweeteners being the most concerning. Let’s review all of the popular sugar substitutes on the market, including sweeteners that are possibly worse than sugar and those that are very safe in small quantities.

Background on Sugar Substitutes

Let’s start with the basics. Sugar substitutes are sweeteners that provide little to no caloric value and little immediate effect on blood sugar levels. They are advertised as guilt-free, weight loss promoting, low glycemic, and everything you can imagine! The most common sugar substitutes can be broken down to three categories:

1. Non-Nutritive Natural Sweeteners

Ex: stevia & monk fruit (luo han guo extract)

2. Non-Nutritive Artificial Sweeteners

Ex: aspartame, sucralose, acesulfame-potassium (ace-k), saccharin, neotame & advantame

3. Sugar Alcohols

Ex: xylitol, erythritol, mannitol, and anything that ends in ‘ol’

The FDA has approved eight non-nutritive sweeteners for use in the food supply stevia, monk fruit, aspartame, sucralose, acesulfame-potassium, saccharin, neotame, and advantame. These sweeteners are typically 200-20,000 times sweetener than actual sugar, depending on the sweetener. Each non-caloric sweeter has an Acceptable Daily Intake (ADI) level, which has been established by the FDA. These levels indicate what the FDA thinks is the maximum quantity that can be safely consumed on a daily basis, without adverse effects, over a person’s lifetime. Outside of the non-caloric sweeteners group are sugar alcohols which do contain calories and are 25-100% less sweet or as sweet as sugar.

Universal Truths About All Sugar Substitutes

The first truth that they all sugar substitutes have in common: they are all sweet and carry little to no calories which may create a neurological imbalance. The brain knows that in nature, anything that is sweet contains calories. And since sugar substitutes have a sweet intensity that is much higher than sugar, the brain expects energy/calories but the energy never comes. This is thought to create an imbalance which stimulates your appetite at the next meal or the next day, in order to obtain the energy balance that did not accompany the sweetness.

While it seems like you are “saving” calories by consuming non-nutritive sweeteners, it may not actually lower your total calorie intake over time. One study had males consume beverages that were either sweetened with sugar (sucrose) or non-nutritive sweeteners and had roughly the same number of calories. Those that consumed the non-nutritive sweetened beverages consumed more at their subsequent meal.

The other concern is that the sweet taste of all of these products do not curb your sweet tooth, and may actually increase cravings for sweets by desensitizing the taste buds. When you regularly consume a lot of foods that contain stevia and monk fruit, you taste buds will still crave sugar. Whereas if you reduced sugar and sugar substitutes at once, you may increase your sensitivity to sweets, even including natural sweets like an apple.

Given that food manufacturers are adding non-nutritive sweeteners and sugar alcohols to many foods, it is possible that people eat more than the level of safety. And let’s be honest, the long-term safety of most of these products is unknown.

Non-Nutritive Natural Sweeteners

Stevia: 200-300 times Sweeter Than Sugar

Stevia is made from the leaves of the stevia rebaudiana plant. The substances within the leaves are the sweetest part. It’s very sweet but also has a strong aftertaste. Stevia appears to be safe, if used in small quantities and may have some health benefits. One study compared the use of sucrose, stevia and aspartame intake before lunch. Those that were given stevia had a lower response in blood sugar after the completion of the meal, compared to the others.

One possible concern with stevia is that in large doses, it may affect male and female fertility. Stevia was used by indigenous groups in South America as a contraceptive. There have been a few small studies that found male rats fed high doses of stevia experienced reduced sperm production and pregnant female hamsters gave birth to smaller and fewer offspring. These results do not indicate that there is a true concern and more research is needed in this area.

Takeaway: Of all non-nutritive sweeteners, stevia appears to be one of the safest. It’s best to buy 100% pure organic stevia. For anyone that has pre-diabetes, type 2, type 1 diabetes, high triglycerides and even cancer, sweeten with stevia.

Monk Fruit: 100-250 Times Sweeter than Sugar

Monk Fruit is also known as Luo Han Guo Fruit Extracts. Monk fruit gets its sweetness from antioxidants called mogrosides. Monk fruit recently gained popularity as a sweetener with zero calories that does not have the strange aftertaste of stevia and is great in baked goods. Since it is a fairly new sugar-substitute, there have not been many studies conducted.

Takeaway: Like stevia, monk fruit is likely to be a safe sugar substitute but needs more research. Overall, the effects of these natural non-nutritive sweeteners are dose dependent, meaning that you shouldn’t include them at every meal. Read your labels for these ingredients because they can add up.

Non-Nutritive Artificial Sweeteners

Artificial sweeteners are made through various chemical processes, altering the elements and structures of molecules to retain the sweet taste without calories. The biggest concern among this group is migraines, risk of cancer and microbiome changes. All artificial sweeteners studied produce changes in the microbiome that can increase risk of type 2 diabetes, and inflammatory bowel disease.

Aspartame: 200 Times Sweetener than Sugar

Aspartame hides under the names Equal or Nutrasweet. It’s also the sweetener in Diet Coke and a combination sweetener with Ace-K in Diet Pepsi. Aspartame is not heat stable so it’s more common to find in beverages. The first studies that assessed the safety of aspartame were conducted in the 1970s. Three studies concluded that consumption was tied to increased development of brain tumors, lymphomas, leukemias, kidney and other cancer in rats. The sweetener was still approved by the FDA in 1983. Since then, the animal studies have been fairly conclusive, linking consumption to an increased risk in developing cancer. It is thought that aspartame may be more toxic to men, since men have enzymes that more readily convert the methanol in aspartame to carcinogenic formaldehyde. Other concerns with aspartame include frequent migraines and other neurological symptoms.

Takeaways: This is one that you absolutely want to avoid due to concerns with cancer risk. If you have frequent headaches or migraines, there’s an even larger incentive to avoid.

Sucralose: 600 Times Sweetener than Sugar

Sucralose is the main ingredient in Splenda. It is used in over 4,500 products and unlike aspartame, is heat stable so it’s used in keto cookies, protein bars, and more. It is made by combining sugar with chlorine to chemically change the structure. A few studies had shown that sucralose was safe and ‘biologically inert’ but in 2016, a large animal study that included over 800 mice showed a dose-related increase in leukemia and other blood cancers in the male mice. Risks appears to be greater when individuals are exposed early in life. Another issue noted with sucralose is its association with the progression of Crohn’s Disease.

Takeaway: Read your labels and avoid foods that contain sucralose, especially if you are pregnant or breastfeeding.

Saccharin: 350 Times Sweeter than Sugar  

Saccharin is found in Sweet’N Low packets and other diet foods. Saccharin was initially discovered in 1878, making it one of the oldest artificial sweeteners out there. It also happens to be one of the most controversial. In 1977, the FDA proposed a ban of saccharin in the food supply due to animal studies that had shown that saccharin causes cancer in the uterus, ovaries, skin, blood vessels and other organs. Congress fought and included it with a warning statement. After observational studies conducted in humans found no increased risk of cancer, the US Department of Health and Human Services removed saccharin as a cancer-causing chemical in May of 2000. It also no longer needs to feature a warning notice.

Takeaway: Most foods do not include saccharin because they have been replaced by aspartame. But it’s still best to avoid it.

Sugar Alcohols

Sugar alcohols differ from the above non-nutritive sweeteners in that they are actually not as sweet as sugar and do contain calories (although fewer calories than sugar). This group includes xylitol, erythritol, mannitol, and anything that ends in ‘ol’. They are low in the glycemic response so they will not spike blood sugar levels like table sugar. While sugar alcohols are technically naturally occurring in some fruits and vegetables, they are not easily digestible in the small intestine. They are found in the polyol category which is a group of FODMAPs. Once they reach the colon, they attract water and are partially digested by the bacteria within the colon, causing gas, stomach upset, and diarrhea. If you feel cramping or get loose stools after scarfing down a pint of low-calorie ice cream, you can thank the sugar alcohols. But GI upset is the only known risk of sugar alcohols.

The benefit of sugar alcohols is that they do not contain a high intensity level of sweetness, like the others on this list. And they do provide some calories so it may not confuse the body as much.

Xylitol: 5% Less Sweet than Sugar

Xylitol is one of the major sugar alcohols, found in gum, mints, and other diet snacks. One of its main benefits is that xylitol and other sugar alcohols has been shown to improve dental health and reduce dental caries. Since xylitol makes it to the large intestine fairly intact, it then serves as food for the bacteria that reside in the colon, namely bifidobacteria. Xylitol may also serve as a prebiotic which may explain its ability to fuel various bacterial strains. This means that there may be some benefits for gut health that are tied to consumption of xylitol but more research is needed.

Erythritol: 30% Less Sweet than Sugar

Erythritol is the more common of these two sugar alcohols, found in protein bars, ice creams, and many other snacks. It is also found naturally in many fruits, though these foods contain only a small quantity. Most erythritol consumed goes into the bloodstream and is excreted through the urine. About 10% seems to make it to the large intestine where it similarly may cause digestive upset. Be sure to monitor your intake for this reason. Keep kid’s intake low as they are more susceptible to the laxative effect.

Takeaways for sugar alcohols: there may be benefits that are related to improving digestive health, lowering blood sugar response, and improving weight loss. However, one of the most common symptoms associated with consumption is diarrhea and GI upset. Avoid large quantities at once. If you try them for the first time, incorporate gradually.

The Bottom Line

If you want to decrease your sugar cravings then it’s best to use little to no sugar substitutes at all, given that most are much sweeter than sugar. My first recommendation is to start decreasing any unnecessary sweeteners in products like yogurt, granola, protein powder, etc. This will help your taste buds crave fewer sweets.

If you are occasionally looking for a sugar substitute then organic stevia, monk fruit, xylitol and erythritol are your best options. If you don’t have diabetes or other conditions that require very low glycemic foods then you may get away with occasional honey or maple syrup.

Lastly, I would highly encourage you to get rid of any products that contain sucralose, aspartame or other artificial sweeteners.

Jamie Foti Contributed to this Article.

Photo by Glen Carrie on Unsplash