Artificial sweeteners, sugar alcohols, and natural sweeteners:
Are they ok and how much can you use?
In this article, I will address non-nutritive sweeteners (aka, artificial sweeteners), sugar alcohols, and natural sweeteners.
Artificial sweeteners, sugar substitutes, non-nutritive sweeteners, natural sweeteners… regardless of what you call them, there always seems to be a debate happening about which ones are ok to use and how much you should consume them. I’ll give a brief overview of what they are, the different types, and how they’re used. Then we’ll take a look at what the research says about them, my opinion based on that research, and which ones I prefer to use.
But before we get started, I want to address something that seems to be missing from a lot of articles on this topic, or any hotly debated topic in food and nutrition for that matter…
When you read an article about something like artificial sweeteners, sugar alcohols, and natural sweeteners, or any other nutrition topic, you need to be able to determine if it is someone’s opinion or if it is science-based information. Now, those two don’t have to be mutually exclusive by any means, but it can be hard to decipher sometimes. We can form educated opinions based on the information we are given from research studies, but it’s important to clarify if the article you’re reading on any topic is reporting:
what research has actually shown
a theory the author has formed based on research
a theory the author has formed based on personal opinion or bias
educated professional/personal opinion
un-educated professional/personal opinion
I’ll do my best as we go through this to make sure I’m clear on what we know from research and what is my opinion… and whether or not my opinion is based on said research or is just a personal preference.
And as always, remember that this article is not intended to provide medical advice, diagnosis, opinion, treatment or services. This article and the links contained in it provide general information for educational purposes only. The information provided in this article is not a substitute for medical care, and should not be used in place of the advice of your physician or registered dietitian.
We typically refer to these sweeteners as sugar substitutes or artificial sweeteners, but the official term is “non-nutritive sweeteners”. Here’s some general facts about all non-nutritive sweeteners:
They contain no (or very little) calories or nutrients (this is why they’re called “non-nutritive”)
They can be derived from plants, and sometimes even sugar itself
They are sweeter than sugar, so you don’t need to use as much
Some artificial sweeteners are not digested, and pass through the GI tract almost unchanged
There are currently eight (8) non-nutritive sweeteners approved for use in food, beverages, and medications in the US. All non-nutritive sweeteners must be approved by the US Food and Drug Administration (FDA) before they can be used in products. The eight approved non-nutritive sweeteners are:
Aspartame (sold in the US as Equal® or NutraSweet®) It is 200 times sweeter than sugar. It is also used in many different food products: cereals, yogurt, frozen desserts, candy, sugar-free gum, juices, and diet sodas. This sweetener CANNOT be consumed by people who have phenylketonuria (PKU).
Acesulfame potassium (also known as Acesulfame K) is typically found in diet sodas.
Neotame is not as common but is also used in diet foods and drinks. It is 7,000 to 13,000 times sweeter than sugar.
Saccharin (sold in the US as Sweet 'N Low®) is the oldest artificial sweetener still sold today. It is 200 to 700 times sweeter than table sugar.
Sucralose (aka, Splenda®) is 600 times sweeter than sugar. Sucralose has many uses and is used in everything from low calorie foods, to beverages, to baked goods, or as is to be added into beverages or foods by the consumer.
Stevia (sold in the US as Truvia®, Stevia in the Raw®, SweetLeaf® Sweet Drops™, Sun Crystals® and PureVia®) comes from the leaves of the stevia plant. Stevia is 200-300 times sweeter than sugar. Stevia is used in many foods and beverages, or on it’s own. Many people report a bitter flavor when stevia is used, so it is usually mixed with another non-nutritive sweetener.
Luo han guo (Monk fruit extract) (Monk Fruit in the Raw®) is made from crushed monk fruit. Up until January 2019, It was the newest non-nutritive sweetener available in the US (it was approved for use here in 2010), but it has been used in China for centuries. It is about 10-250 times sweeter than sugar. It is often used in combination with other non-nutritive sweeteners or sugar.
Advantame is the newest non-nutritive sweetener approved by the FDA in January 2019, and available for use in the US. It is 20,000 times sweeter than sugar, but it is not widely used at this time.
Health Warrior Superfood Protein and Health Warrior Protein Mug Muffins are lightly sweetened with monk fruit extract.
Sugar Alcohols are also considered sugar substitutes but they do provide some calories so they are classified as “nutritive sweeteners”. On average, they provide about 2 calories/g (compared to sugar which is 4 calories/g). Their chemical structure does resemble alcohol and sugar, but they do not affect the body like alcohol does. Sugar alcohols can be derived from fruits and vegetables, but the sugar alcohols found in foods and drinks are often manufactured. You’ll usually see sugar alcohols in foods and drinks labeled as “sugar free” or “reduced sugar” or “no sugar added”. Additionally, with the popularity surge of the keto diet here in the US, we are starting to see more and more processed foods looking to be “keno-friendly” that use sugar alcohols in place of sugar.
There are several types of sugar alcohols but the most common ones include:
hydrogenated starch hydrolysates (HSH)
Some sugar alcohols (mannitol and sorbitol especially) can cause excessive bloating, loose stools, and gas. This is why you’ll see a GI distress warning on many “sugar free” or keto products. This pdf from the FDA is a great resource for learning more about sugar alcohols.
These sweeteners are generally considered to be more “natural” forms of sugar/sweeteners and have the same nutritive/calorie value as table sugar. My use of the term “natural” here is my own opinion and does not have any sort of official definition for the purposes of this article. The sweeteners listed here are not heavily processed and more closely resemble how they exist in nature… but that is not a reason/excuse to consume large amounts of them. They are still sugar and should be consumed in moderation based on your own personal health status and goals.
Many of these “natural” sweeteners have other nutrients or properties (think antioxidants, vitamins, etc.) that make them a slightly better choice than table sugar. For someone with diabetes, like myself, it is important to understand that every person is unique and your body may tolerate each of these differently than other people and even other diabetics, but they are still sugar.
Now that we’re all on the same page about what non-nutritive sweeteners, sugar alcohols, and natural sweeteners are and the different kinds, let’s dive into what the research says, and some common questions I get…
Which sweeteners are bad for you? What does the research say about their effects on health? Do they cause cancer?
My opinion (a mix of professional and personal): For the general person without diabetes or insulin resistance, I recommend avoiding artificial sweeteners (numbers 1-5, and 8 above) and sugar alcohols. Without even addressing the research data on health effects, you can tell that many of the artificial sweeteners are infinitely sweeter than actual sugar. Consistent exposure to these intensely sweet tastes acclimates your taste buds to prefer sweet flavors. Sugar alcohols do cause stomach upset for many people, and I do not typically recommend products that contain them. With that being said, occasional consumption of any of these is fine and will not cause harm. If people wish to use an alternative sweetener, I recommend stevia or monk fruit (numbers 6 and 7 above). Monk fruit is my personal choice if/when I consume products that use artificial sweeteners because I prefer the flavor over stevia.
Now, here is what the research says and some background info that I believe is helpful to know…
When the FDA approves a non-nutritive sweetener for use in the US, they designate an Acceptable Daily Intake (ADI) level. The ADI is the amount that a person (including pregnant and nursing women) can safely consume each day for a lifetime. It would be incredibly difficult for a person to reach the ADI level for any non-nutritive sweetener. However, there are animal studies that do link higher consumption of artificial sweeteners (this does not include stevia or monk fruit) with negative health outcomes like cancer, changes to gut bacteria, and decreased glucose tolerance. (This article from Harvard lists the ADI for each of the non-nutritive sweeteners and is also a good resource if you’re looking to learn more.)
We cannot say any of these non-nutritive sweeteners directly causes any negative outcomes, but it is important to remember their impact on your taste preferences and the associations in animal studies (and some human studies) with negative outcomes.
If I eat/drink something that has a non-nutritive sweetener in it, my personal preference is to consume products that utilize the plant-based non-nutritive sweeteners: stevia and monk fruit.
I’ll talk about this more below, but my preference for the average person is to use traditional sugar or natural sweeteners (as defined in this article) in smaller amounts, however for the person with diabetes this may not be possible since these natural sweeteners still raise blood sugar levels. For diabetics, including myself I recommend using stevia and/or monk fruit when needed.
How do different sweeteners effect your blood sugar and should you take insulin for them?
You do not need to take insulin for non-nutritive sweeteners.
On average, sugar alcohols contribute about half of the carbohydrate value that sugar does. On a nutrition label, sugar alcohols are listed as a type of carbohydrate and are included in the Total Carbohydrate count. It is recommended to subtract half of the Sugar Alcohol grams from the Total Carbohydrate grams when calculating insulin dosages. This will vary form person to person though and should be monitored closely with help from your doctor.
Natural sweeteners (as defined in this article) are absorbed just like table sugar, and if you need to inject insulin to manage your diabetes, you should take insulin for them as you do other carbohydrates.
Do artificial sweeteners cause insulin resistance? Do they make us crave sweet things more?
Some research does support the idea that artificial sweeteners make people crave sweet things more and increase insulin resistance. It’s easy to see how consistent exposure to intensely sweet things can create a preference for (aka, craving) sweet foods, but this is not decisively documented in the research. Again, I recommend avoiding sugar alcohols and non-nutritive sweeteners 1-5 above. This article also has some great information.
How much is too much for artificial sweeteners?
See the discussion above on ADI and the safety levels set by the FDA. My recommendation to people though is always “as little as possible.”
Why does stevia have a weird taste?
The bitter taste associated with stevia comes from the plant it is derived from. Because of this, it is often used in combination with sugar or another non-nutritive sweetener.
What’s better: smaller quantities of the real stuff or bigger amounts of the fake stuff?
For the average person, without diabetes: smaller quantities of the “real stuff”, natural sweeteners, or stevia or monk fruit. For someone with diabetes, this should be discussed with your physician or dietitian.
What’s the best natural sweetener?
As defined in this article, I prefer maple syrup, dates, or coconut sugar. This is purely personal preference based on how they affect my blood sugars and how each of these performs in recipes.
What is your go-to artificial sweetener?
I try not to use them often. I do not use them as table top sweeteners (adding to coffee, tea, drinks, etc.), but if I eat or drink a product that has one in it, I prefer it to have monk fruit for both taste and health/nutrition.
What are your thoughts on monk fruit? Is it actually natural? Does it raise blood sugar?
Monk fruit extract alone will not raise your blood sugar. it has zero calories and has been used for centuries in China without any reports of side effects. It was just approved for use in the US by the FDA in 2010. It is also said to have antioxidant properties as demonstrated in animal and lab studies, though no human studies have been conducted to test these properties. It is likely these properties exist but more research is needed to confirm this. This article explains how monk fruit extract is produced and more information on potential health benefits.
Health Warrior Superfood Protein and Health Warrior Protein Mug Muffins are lightly sweetened with monk fruit extract.
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