Sugar vs. Artificial Sweetener: Which Is Healthier?
'Tis the season for holiday treats galore, but not all sweets are created equal.
The average American eats around 77 grams of sugar per day, or 60 whopping pounds per year. Let that sink in—it’s a lot of sugar! If you’re trying to cut back on the sweet stuff, it only gets tougher during the holiday season. Grocery shelves are stocked with sugar cookies, coffee shops dole out sweet seasonal drinks, and pumpkin pie is top of mind on most Thanksgiving menus.
But not every dessert contains natural sugar. You can order a skinny peppermint mocha at Starbucks with sugar-free syrup or bake gingerbread men with Stevia. Are these sweetener alternatives healthier than plain-old fashioned Domino? According to a new study in Journal of the American College of Cardiology, artificially sweetened beverages are no better than sugary drinks as far as long-term implications for cardiovascular disease.
But what about people with blood sugar issues, or folks who just want to keep their caloric intake down? We wanted to know more about which sweetener is better, so we dove into the research. And, well… it’s complicated, and pretty much depends on your specific health goals.
Your Body on Sugar
When you eat a donut (or any sugary food item), your body immediately gets to work breaking it down. “Sugars have calories, so they are metabolized and provide energy,” says Chris D’Adamo, Ph.D., director of the Center for Integrative Medicine at the University of Maryland School of Medicine in Baltimore. “But depending on the type of sugar, they are metabolized differently.” Natural sugar occurs as one of two types of monosaccharides, a.k.a. simple compounds: glucose and fructose. Both are found in a variety of foods like fruits, vegetables, and starches. Sucrose, or table sugar, is made up of both glucose and fructose. Let's take a closer look at these two forms of sweetness.
Glucose: This is the body’s main source of energy, and it’s also what you think of when you hear about a spike in blood sugar. “When one consumes glucose, it gets metabolized by cells throughout the body, which tends to raise blood sugar, leading to an insulin response,” D’Adamo says. In people with insulin resistance (those with diabetes or prediabetes), cells stop taking in the energy correctly, causing blood sugar levels to rapidly rise and fall.
Fructose: Commonly called “fruit sugar,” fructose is frequently found in large quantities in sugary, prepackaged drinks like lemonade and soda. (Hello, high fructose corn syrup!) This puts a strain on your liver, the organ responsible for breaking down the compound. “When we have unlimited uptake of fructose by the liver, all that essentially gets turned into hepatic fat [a.k.a. liver fat],” says Karen Aspry, M.D., chair of the American College of Cardiology Nutrition Workgroup and associate professor at Brown University Alpert Medical School in Providence, RI. “That puts a person at risk for fatty liver and high blood triglycerides because the hepatic fat drives secretion of VLDL cholesterol [a type of bad cholesterol]. It also puts them at risk for developing diabetes because of the excess calories and less satiety from liquid fructose.” Some studies have found fructose to be even more damaging that glucose in its long-term effects on insulin sensitivity, obesity, and diabetes risk.
Now let’s dive into sugar’s number one rival: Artificial sweeteners. Many are non-nutritive, or zero-calorie, making them an appealing alternative for someone trying to cut back on calories. “They tend not to increase blood sugars the way sugars do,” D’Adamo explains.
These calorie-free or low-calorie compounds are as much as 700 times sweeter than regular table sugar, so a little goes a long way. You’ll see them in stores under names like Sweet & Low, Nutrasweet, or Splenda, or in ingredient lists under names like saccharin, aspartame, or sucralose. “They’re non-nutritive, no-calorie sweeteners, so they’re really not causing the same metabolic derangements in the liver” that fructose does, Dr. Aspry says.
That said, there has been controversy over whether these sweeteners are really the healthy option they’re advertised to be. D’Adamo explains that artificial sweeteners can “trick” the body into thinking it is eating calories, which may ultimately lead to an increased hunger response that leads to weight gain. “This real sweet taste with no calories can derange the appetite system,” he says. A study in Cell Metabolism found that frequent consumption of sucralose can increase the motivation to eat. “They may make people want to eat more sweets because the brain is sort of tricked into liking sweets,” Dr. Aspry notes. (Research also shows that the more often you eat sweet foods, the more you crave them.)
However, Dr. Aspry points out that other studies have shown the opposite effect. A study in the American Journal of Clinical Nutrition found that drinking diet beverages, as opposed to sugar-sweetened beverages, did not lead participants to eat a higher-calorie diet.
D’Adamo says that for some people, artificial sweeteners can mess with the delicate balance of their gut bacteria or cause other side effects like migraine or skin issues. There has also been evidence that artificial sweeteners like aspartame could increase cancer risk, but that’s really only when consumed in mass quantities (like drinking six sodas per day). “I don’t think cancer is really the main concern,” D’Adamo says. “I think more it’s that this disrupts our appetite symptoms and may have some of these other issues in susceptible people” who are already prone to digestive issues or headaches.
Which Is Better?
Sorry to say this, but there is no clear-cut answer. “My recommendation for most people who are pretty healthy, is just not to overdo it,” D’Adamo suggests. Aspry echoes this general advice: “If I had to choose between one or if I was counseling folks, I would say choose the non-nutritive one,” she says. “Does that mean that there’s no risk associated with the artificially sweetened beverage? I don’t think we know the answer to that yet, but may over time.”
If you struggle with insulin sensitivity, weight gain, or diabetes, it’s probably better to reach for that diet soda that won’t spike your blood sugar. But if you find that artificial sweeteners make you want to eat more, or if they mess with your gut, stick with table sugar. “Having a little bit in a coffee is going to be okay,” D’Adamo says. “As the saying goes, the poison is in the dose.”
Just don’t go about thinking that artificial sugars are the cure-all for your health goals. “We can’t think that we can replace drinking four cokes a day with four diet cokes and not have an issue,” D’Adamo says. Instead, limit sugary treats and use artificial sweetners in moderation. Think of that sugary peppermint mocha as a special occasion to savor once in a while, not every day. “I really encourage people to drink mostly water, flavored water, tea, or homemade lemonade without a lot of sweetener,” Aspry says. Consider a plain, unsweetened chai tea next time, for balance’s sake.
- Average Sugar Consumption: American Heart Association. (n.d.). “How much sugar is too much?” heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/how-much-sugar-is-too-much
- Artificially Sweetened Drinks & Heart Health: Journal of the American College of Cardiology. (2020). “Sugary Drinks, Artificially-Sweetened Beverages, and Cardiovascular Disease in the NutriNet-Santé Cohort.” sciencedirect.com/science/article/abs/pii/S0735109720365967?via%3Dihub
- Types of Sugar: European Journal of Nutrition. (2016). “A review of recent evidence relating to sugars, insulin resistance and diabetes.” ncbi.nlm.nih.gov/pmc/articles/PMC5174139/
- Glucose vs. Fructose: National Institute of Diabetes and Digestive and Kidney Diseases. (2017). “A tale of two sugars—fructose and glucose cause differing metabolic effects.” niddk.nih.gov/news/archive/2017/tale-two-sugars-fructose-glucose-cause-differing-metabolic-effects
- Insulin Resistance: Centers for Disease Control & Prevention. (n.d.). “Insulin Resistance and Diabetes.” cdc.gov/diabetes/basics/insulin-resistance.html
- Fructose Negative Health Effects: Journal of Clinical Investigation. (2009). “Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans.” pubmed.ncbi.nlm.nih.gov/19381015/
- Artificial Sweeteners: Food and Drug Administration. (n.d.). “Additional Information about High-Intensity Sweeteners Permitted for Use in Food in the United States.” fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states
- Sucralose & Hunger Response: Cell Metabolism. (2016). “Sucralose Promotes Food Intake through NPY and a Neuronal Fasting Response.”
- Diet Drinks & Calorie Consumption: American Journal of Clinical Nutrition. (2013). “Does diet-beverage intake affect dietary consumption patterns? Results from the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial.” pubmed.ncbi.nlm.nih.gov/23364015/
- Sugar Cravings: Cell Metabolism. (2020). “FGF21 Signals to Glutamatergic Neurons in the Ventromedial Hypothalamus to Suppress Carbohydrate Intake.” linkinghub.elsevier.com/retrieve/pii/S1550413120303090