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  • Meera Shah, MS, RD

Sugar Substitutes...which color packet should you be putting in your coffee?

What are some common sugar substitutes in the market? Are they safe? Lets take a glance at a few common ones:

1. Sugar Alcohols: Most are naturally found in small amounts in fruits & vegetables. They are also commercially made from sugars & starches. Most function as low-calorie sweeteners and they are added to foods like gum (to provide cooling effect, in addition to sweetness), dairy desserts, frostings, grain-based desserts & sweets. Sugar alcohols do not spike blood sugar or insulin.

  • Sorbitol: 65% of calories & 60% as sweet as sugar. Potentially support digestive and oral health.

  • Erythritol: Only 6% of calories & 70% as sweet as sugar.

  • Xylitol: 60% of calories & just as sweet as table sugar. It helps prevent dental cavities & inflammatory gum diseases. It feeds friendly microbes in your digestive system. Also, Xylitol-sweetened gum can reduce ear infections in children and combat candida yeast infections.

  • Mannitol: 40% of calories and 50% as sweet as sugar.

  • Maltitol: 53% of calories and 90% as sweet as sugar.

Sugar alcohols are generally safe. We cannot digest most sugar alcohols due to their unique chemical structure (which is why they are "low calorie"). In the colon, they are fermented by the resident bacteria, which produce gas as a side product. Consequently, eating high amounts of sugar alcohols may cause bloating & digestive upset. Also, there may be unintended long-term metabolic effects that we don't know about yet. Use sugar alcohols in moderation. [Sugar alcohols are generally limited for people following a low FODMAP diet or people with IBS.]

2. Artificial sweeteners:

Aspartame is one of the most popular artificial sweeteners available on the market. It is 200x sweeter than sugar, meaning you can use less to achieve the same level of sweetness. It's sold under the brand names NutraSweet & Equal. It’s also used widely in packaged “diet” foods. It is generally safe & does not cause a blood sugar/insulin spike. The FDA & EFSA have set a recommended daily upper limit. So, for example, a can of diet soda contains about 185 mg of aspartame. A 150 pound person would have to drink more than 18 cans of soda a day to exceed the FDA daily intake & 15 cans to exceed the EFSA recommendation. There may be unintended long-term metabolic effects that we don't know about yet. [People who have PKU or are taking meds for schizophrenia should avoid aspartame]

Sucralose is sold under the brand name Splenda. It is 400-700x sweeter than table sugar and contains 84% of the calories. Sucralose may raise blood sugar and insulin levels in people who don’t consume artificial sweeteners regularly. However, it probably has no effect on people who regularly use artificial sweeteners. One study found that sucralose, under high heat, forms unwanted compounds that have been found to be detrimental to health; Thus, the use of sucralose (Splenda) for baking may not be a good choice. Lastly, there may be unintended long-term metabolic effects that we don't know about yet.

3. Novel sweeteners:

Stevia products (Truvia & Stevia in the Raw) contains no calories & are 200-300x sweeter than table sugar. Stevia products use a highly refined stevia leaf extract called Reb-A. Not everyone likes the way it tastes. Some people find it bitter, but others think stevia tastes like menthol. In other parts of the world, people have been using stevia leaves to sweeten drinks like tea for many years and it is considered generally safe. Stevia products do not cause a blood sugar/insulin spike. There may be unintended long-term metabolic effects that we don't know about yet.

Monk Fruit Extract contains no calories and is 250x sweeter than sugar. Monk fruit gets its sweetness from antioxidants called mogrosides which are separated from the juice. Monk fruit sweetener has been around for decades but has recently grown in popularity since it’s become more readily available. Studies have used high doses of monk fruit extract that are much more concentrated than what you’re likely to encounter with a sweetener. It’s not clear what dosage you would need to experience health benefits or detriments & so it is generally safe. There may be unintended long-term metabolic effects that we don't know about yet.

4. Natural sweeteners:

Honey, Maple, Agave, Molasses act the same way as regular table sugar in our bodies, resulting in a blood sugar and insulin spike. They also contain the same calories as sugar. These sweeteners, as opposed to table sugar, contain micronutrients which have antioxidants and anti-inflammatory properties (which is a nice bonus). They may be labeled "healthy" or "natural", but that does not mean they won't contribute toward your sugar/caloric intake.


Eating too much sugar has been linked to several deadly diseases, including obesity, diabetes, heart disease, and cancer. Sugar alternatives may be healthier in theory, but they’re not a magical answer to your health problems. Sugar alcohols, artificial & novel sweeteners are a great option for people with diabetes as research has found these result in little to no sugar/insulin spike. Sugar substitutes may cause you to crave more sweet and sugary foods (source) & there may be a link between sugar substitutes to a higher risk of glucose intolerance or weight gain (source). The sweeteners in this article are good alternatives, though the key word here is alternatives, meaning they should be used instead of refined sugar & in moderation. Natural sugars like maple syrup, molasses, and honey are less harmful than regular sugar and even have health benefits. Yet, they should still be used sparingly as they still behave the same way as table sugar, metabolically, in our bodies. As with most things in nutrition, moderation is key.

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