Sweet or sinister? A guide to sugar substitutes.

Since their massive popularity climb in the 1980s, sugar substitutes have experienced a fraught history. While consumers enthusiastically embrace options for no- and low-calorie sweeteners, reports continually emerge with new health concerns – everything from evidence of cancer growth in lab rats to proof they actually make you gain weight.

With so much information circulating about sugar substitutes, and a huge variety of products on the market, navigating them can be a challenge. Here to help explain sugar substitutes and how to use them responsibly is the team of registered dietitians from Novant Health Bariatric Solutions.

What are sugar substitutes?

Most sugar substitutes (also known as non-sugar sweeteners) are created in laboratories, though a handful are derived from plants. These sweeteners contain fewer calories than sugar and, in some cases, no calories at all. Yet they can taste as much as 700 times sweeter than sugar.

A variety of non-sugar sweeteners are available, including:

• Artificial sweeteners — aspartame, sucralose, saccharin, acesulfame K
• Sugar alcohols — sorbitol, xylitol, mannitol, isomalt, maltitol, lactitol, erythritol
• Novel sweeteners — allulose, tagatose, monk fruit, stevia

Sugar substitutes can be found in a variety of products, including:

• Granulated or powdered versions for baking, sweetening coffee or tea and other kitchen uses.
• Foods and beverages labeled “sugar free,” “diet” or “low-calorie.”
• Specialty items for those following ketogenic or low-carb diets, like ice cream, protein bars and chocolate.

What risks are associated with sugar substitutes?

Traditionally, artificial sweeteners have been the only option for people who need to monitor their blood glucose levels or weight. Some experts believe that artificial sweeteners pose health hazards, from weight gain to cancer. New research in 2024 linked higher blood levels of xylitol with increased risk of heart attack and stroke.

But research on these links is ongoing, and past studies showing health risks were conducted on animals, not humans. Studies on people have shown these products to be generally safe if no more than the acceptable daily intake for each is consumed.

Are there any benefits to consuming sugar substitutes?

There may be benefits on a person-to-person basis.

If you have uncontrolled diabetes, then using sugar alcohol or plant-derived, nonnutritive sweetener to replace sugar would help decrease your hemoglobin A1c — the number that indicates how well your diabetes is controlled — and decrease other risks that come along with that.

There's a lot of conflicting evidence about whether artificial sweeteners help with weight loss or cause an increase in hunger. If you're relying on eating foods that are lower in calories, in which the flavor is coming from those artificially sweetened sources, they're likely processed. We know that processed foods are easier to digest, and that decreases satiety, meaning you don’t stay full for as long. They're also going to be lacking protein, healthy fats and fiber. So you might consume a sugar-free drink or sugar-free peanut butter cup to prevent eating a more substantial midday snack, but in the long run, you're just setting yourself up to be extra hungry for the next eating encounter, and that can set off that chain of events of overeating. You end up being hungrier because of the food you choose.

Are some sugar substitutes healthier to consume than others?

Aspartame is labeled as possibly carcinogenic to humans by the International Agency for Research on Cancer. But that doesn't necessarily mean that aspartame is linked to cancer. There is no hard evidence that says you should stay away from it if you don’t want to get cancer. A lot of studies completed on non-sugar sweeteners were done on rodents, and so they might not necessarily apply to humans.

It's also worth noting that there's research linking added sugar intake to cancer. So both sugar and sugar substitutes could cause risk.

Stevia and monk fruit are plant-based sweeteners that do not have evidence connecting them to adverse health effects, but that does not mean you should be consuming large amount of them every day. The bulk of your calories should come from whole foods like vegetables, fruits, lean proteins and grains. Don’t use low-calorie sweeteners as a replacement for whole, nutritive foods.

How can people choose between sugar, “natural” sweeteners and “artificial” sweeteners?

There are positives and negatives to all. Ultimately, moderation is key.

A lot of people struggle with an all-or-nothing mentality. For example, you might cut out all sugar and artificial sweeteners. This level of restriction may backfire because it can cause binge-eating, overindulging in the food you plan to restrict.

If you are consuming a balanced diet, it is OK to eat a little bit of sugary food, such as for a celebration. You don’t have to choose only one type of sweetener, or no sweeteners, to achieve balance in your diet.

Want to cut down on sweets? Here are some healthy pointers.

• Eat consistent meals and snacks. Skipping meals and snacks leaves you feeling ravenous and robs your body of energy. Eating regular, balanced meals and snacks helps reduce cravings for junk food because you’re balancing your blood sugar, preventing hunger pangs, and helping prevent those moments that you’re so hungry you will reach for anything.
• Learn to recognize emotional eating. It’s fine to eat a sweet dessert and really savor it. If you recognize that you are eating a sweet because you are sad or angry, try to redirect that energy into a different activity or outlet, like taking a walk or listening to a podcast.
• Get enough sleep. When you're tired, your body wants easy, quick energy that doesn't have to do much to break down: sugar and simple carbohydrates. A full night’s sleep (7-9 hours a night for adults) can help fuel healthy eating choices.
• Give your taste buds time to adapt. If you consume a lot of sugar or artificial sweeteners, be patient with allowing your taste buds to adapt to the natural sweetness of foods like fruit. For example, if you are used to drinking soda, it will take a while to adjust to unsweetened sparkling water.
• Try to avoid all-or-nothing thinking. Don’t cut sugar and sweeteners out cold turkey. This is typically not sustainable. Sticking to a healthy diet with occasional treats is a more realistic and attainable long-term goal.