Sugar Substitutes Are Everywhere - Consumer Reports

You’re probably used to seeing diet sodas made with artificial sweeteners like aspartame and sucralose. But now there are fresh-sounding sodas with zero grams of sugar or no artificial sweeteners that contain allulose, monk fruit, or stevia—and you have to wonder, are these newer sugar substitutes better for you?

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They also seem to be in many more types of food: sucralose in English muffins, allulose in breakfast cereal, stevia in ketchup, monk fruit in marinated meats.

“People are undoubtedly consuming more sweeteners than they realize as those ingredients make their way into foods like microwave popcorn and chicken nuggets,” says Allison Sylvetsky, PhD, an associate professor of exercise and nutrition sciences at the George Washington University Milken Institute School of Public Health in Washington, D.C.

And that has Sylvetsky and other experts concerned. Limiting the consumption of added sugars and all of their nutritionally empty calories clearly has health benefits, but research suggests that some sugar substitutes may pose certain health risks. How concerned should you be?

The Calorie Control Council says that nonsugar sweeteners are safe, pointing out that governments around the world, including the U.S., allow their use. The FDA has approved all the sweeteners added to food in the U.S., based on studies on animals and people. It also set acceptable daily limits for many of them.

Still, questions remain about their effects on our health. While our bodies know how to process sugar, Nestle says that we didn’t evolve to metabolize nonsugar sweeteners and that “we don’t know nearly enough about how they behave in the body.” She adds that there are just enough suggestions of potential harm to make health professionals uneasy.

Some of the most worrisome data suggests a connection between sweeteners and an increased risk of certain cancers, heart disease, diabetes, depression, and poorer gut health.

Cancer: A French study that followed more than 100,000 adults for nearly eight years found a link between a higher intake of artificial sweeteners—especially acesulfame potassium and aspartame—and cancer. People who consumed an average of about 80 mg per day of them—the amount in one-third to one-half of a 12-ounce can of diet soda—had a 13 percent higher risk of cancer than those who didn’t consume any amount.

Heart disease: Another study by the same French researchers found that people who consumed the most artificial sweeteners had a 9 percent increased risk of heart disease and an 18 percent increased risk of a stroke. Acesulfame potassium, aspartame, and sucralose had the greatest effect.

More recent studies suggest that sugar alcohols such as erythritol and xylitol may also harm the heart. “Immediately after eating them—and for several hours after—people are more susceptible to blood clots,” which are a leading cause of heart attacks and strokes, says the study’s author, Stanley Hazen, MD, a cardiologist at the Cleveland Clinic.

Diabetes: People who regularly eat foods with sugar substitutes may be more likely to develop type 2 diabetes, and a study published in the journal Cell hints at a possible reason. The researchers measured the glucose levels in 120 volunteers over two weeks after they consumed 102 mg of sucralose or 180 mg of saccharin. “We saw a gradual disruption of the body’s ability to handle glucose,” says Suez of Johns Hopkins, who led the study. Over time, this may increase the risk of diabetes.

Depression: A study in the journal JAMA Network Open involving more than 30,000 women found that those with the highest intake of artificial sweeteners had the greatest risk of depression. “We know from animal studies that artificial sweeteners may trigger the transmission of signaling molecules in the brain that are important for mood,” says Andrew T. Chan, MD, a professor of medicine at the Harvard Medical School and one of that study’s authors.

Gut health: An imbalance in the collection of healthy bacteria in the digestive system is thought to contribute to a variety of diseases. The study in Cell that looked at sweeteners and diabetes risk also investigated the effect of aspartame, saccharin, stevia, and sucralose on the composition of bacteria in the gut. “All four sweeteners caused notable alterations to gut bacteria,” Suez says. “They led to changes in the microbiome that were significant enough to disrupt metabolic health.”

Unless you totally steer clear of packaged and processed foods, there’s a good chance you’re getting at least some nonsugar sweeteners in your diet. And given how widely these ingredients are now being used in hundreds—if not thousands—of products, the amount you consume could really add up.

And that’s what worries the experts. “We don’t know scientifically what the threshold is for when you might start to see negative effects” from consuming the sweeteners, Sylvetsky says.

Moderation is key. “I don’t think anyone worries too much about the occasional artificially sweetened beverage,” Nestle says. “It’s regular consumption of these sweeteners in large amounts that seems unwise.”

To help keep your intake of sweeteners in check, follow these suggestions:

Cut down on packaged and processed foods whenever you can. When you eat mostly whole foods (like fresh fruits and vegetables, whole grains, legumes, and nuts) and limit your consumption of packaged and processed ones, you don’t have to worry about consuming an overload of added sugar or sugar substitutes.

Read labels carefully. Don’t just check the nutrition facts label on products; also read the ingredients list on the back of the packaging. Scan it for all the sugar substitutes it may contain. See our complete list of these ingredients (PDF) and refer to it when you head to the grocery store.

Get your sugar fix naturally. Fruit or fruit-sweetened dishes can give you that taste you crave without added sugar or sugar substitutes.

Be aware of how often you eat foods with sugar substitutes. The occasional diet soda or light yogurt is fine, but if you regularly consume several foods that contain these sweeteners, consider cutting back on them. The experts we talked with say that in general, less is better.

If you’re looking to improve nutrition and cut your sugar intake, you may have considered alternative natural sweeteners. But there’s a lot to keep in mind when choosing these sweeteners.

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A recent study links some sweeteners containing erythritol to a higher risk of heart attack, stroke and blood clotting. More research is needed, but the findings are cause for caution.

“Natural sweeteners have become more appealing than sugar because they are less processed and may contain more nutrients and provide healthy benefits,” says University Hospitals registered dietitian Elizabeth Traxler, RD, LD. “Based on the latest study results, it may be best to consume sweeteners that contain erythritol in moderation until we know more.”

The Basics of Sugar

Many healthy foods – fruits, vegetables, whole grains and milk – contain natural sugars. Excess or added sugars are the real problem.

Sugarcane and beet sugar are the two main crops used for table sugar and most natural sweeteners. They contain two types of sugar: fructose and sucrose. The body processes those sugars into glucose for energy. But because sugarcane and beet sugar are highly processed, these sweeteners don’t contain many nutrients, vitamins, minerals or bioactive components such as antioxidants. Stripped of their nutrients, cane and beet sugar provide only extra calories.

The health benefit from different types of sweeteners depends on how you are eating it. No matter the source, keep in mind that an excess of calories, especially from “added” sugars (those that do not occur naturally in food), is associated with obesity, diabetes, heart disease, high blood pressure and other chronic health problems.

Natural Alternatives to Refined Sugar

With those basics in mind, here are some natural sweeteners you can consider as substitutes for conventional sugar.

Sugar Alcohols: Erythritol and Xylitol

Erythritol and xylitol are low calorie sweeteners. Sugar alcohols are considered natural because they are derived from plants, but they are chemically reformulated for use. They taste much like conventional sugar, but can leave a mild aftertaste. They don’t spike blood sugar or insulin levels and don’t cause tooth decay like other types of sugar. However, they are poorly digested and may cause digestive distress if consumed in excessive amounts.

Erythritol may be linked to an increased risk of heart attack, stroke, and blood clotting, according to a new study published in Nature Medicine. More research is needed to understand the risks. In the meantime, it’s best to use caution when choosing how much or how often to use erythritol.

Stevia

Stevia is a plant leaf extract. Because it is hundreds of times sweeter than conventional sugar, very small amounts are needed for intense sweetness. This zero-calorie sweetener has a low glycemic index, so it doesn’t impact insulin or blood sugar levels. While that makes it a good sweetener for weight management and diabetes, it may trick the body into wanting more.

While high-purity stevia is considered safe when consumed in moderate doses, many product manufacturers mix stevia with erythritol. Use caution when choosing how much or how often to use it.

Agave

Agave is a plant nectar. Like stevia, agave is extremely sweet and is only needed in small amounts. It has a lower glycemic index because of its high fructose content, which means it won't spike blood sugar. Agave nectar may also benefit gut health, thanks to its prebiotic activity. However, studies have shown that the high fructose content can increase triglycerides and the risk of fatty liver disease. It may also leave you craving more if you aren’t careful to limit your intake.

Coconut Sugar

Coconut sugar comes from the sap of coconut trees. It is evaporated into a crystalline product and is similar to brown sugar in texture and flavor. It has a lower sucrose content and is considered a lower glycemic sweetener. It has good nutritional profile with vitamin C, B vitamins and antioxidants.

Date Sugar

Date sugar and syrup are high in sugar, but are less processed and therefore retain some of the fiber, minerals and antioxidants of dates.

Monk Fruit

Monk fruit extract is a zero-calorie, low glycemic index sweetener. It is high in antioxidants, offers possible anti-cancer effects, and has a favorable effect on blood glucose regulation.

Many product manufacturers mix monk fruit with erythritol, so use caution when choosing how much or how often to use it.

Fruit Puree

Fruit puree is a great sweetener alternative as a topper for dishes or for baking. Blending ripe fruits such as apples, pears or bananas provides a nutritious sweetener with fiber, nutrients and water.

Honey

Honey has a high moisture content and, especially when unprocessed, a varied nutritional profile containing minerals, vitamins, proteins and other valuable nutrients. It is an antimicrobial and its antioxidants fight inflammation.

Maple Syrup

Pure maple syrup has many nutritional benefits due to its antioxidant and cancer-fighting properties. Maple syrup contains a compound that slows down its blood sugar absorption, which may be good for people with diabetes. Darker syrup may have more nutritional benefits than lighter products.

Brown Rice Syrup

Brown rice syrup is produced from breaking down rice into a syrup. It is considered a healthier alternative to HFCS because it has no fructose and most of the sugar is glucose, readily available to the body for energy. Brown rice syrup has a high glycemic index. A few studies have shown it contains trace amounts of arsenic, though it’s still considered safe for consumption in moderation.

Blackstrap Molasses

Blackstrap molasses comes from sugarcane or sugar beet juice, but is boiled down further than standard molasses. Rich in iron, B vitamins, potassium, magnesium, calcium, and antioxidants, it may support immunity and fight inflammation. Blackstrap has a lower glycemic index and more bitter taste than regular molasses.

The Bottom Line

Natural sweeteners are considered healthier than conventional sugar because these sweeteners usually contain more vitamins, minerals, antioxidants and other bioactive molecules that may be healthful. However, just because they have more nutrients than conventional sugar does not mean that frequent consumption of these sweeteners is encouraged. It’s important to practice moderation as most of these sweeteners contain other ingredients.

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