What You Should Know About Sugar Substitutes

Americans consume a lot of sugar—to the tune of about 130 pounds per person each year when you add up all the sweet products we consume, including table sugar and high-fructose corn syrup in processed foods. While a bit of this ubiquitous flavor booster isn’t completely off limits if you have diabetes, eating and drinking too much sugar can cause you to pack on unwanted extra pounds and sabotage your efforts to keep your blood glucose under control.

With that in mind, choosing foods and beverages made with no- and low-calorie sugar substitutes may seem like a guilt-free way to satisfy a sweet tooth. But questions have long lingered about these alternative sweeteners. Are they safe? Can they help manage your weight? And how do they affect blood glucose?

They’re everywhere

If you’re a fan of sweet foods and beverages, the appeal of sugar substitutes is understandable. Sugar is a carbohydrate and is high in calories; carefully limiting your intake is essential for managing your blood glucose and your weight.

Sugar substitutes, also called non-nutritive sweeteners, have been available since the late 19th century, and their use has grown exponentially over the years. Today, not only are sugar substitutes used in the home for things like sweetening your coffee and baking, they’re also commonly used in a variety of processed foods that you buy at the grocery, including baked goods, candy, cereal, yogurt, juices, soft drinks— even chewing gum.

The U.S. Food and Drug Administration calls these various products “high-intensity sweeteners,” and they can be up to 20,000 times sweeter than sugar. Because of their intense sweetness, sugar substitutes can be used in small amounts, and as a result, they contribute few calories when added to foods (and some contain no calories at all). Sugar alcohols are a less intensely sweet alternative to sugar.

Safety record

Over the years, concerns about the safety of sugar substitutes have surfaced periodically. While some people should avoid or limit consumption of certain alternative sweeteners, products available for sale in the U.S. meet the FDA’s safety standards. These products include:

• Saccharin (brand names include Sweet ’N Low, Necta Sweet and others). Studies in the early 1970s found that lab rats fed saccharin developed bladder cancer, and packages warned about cancer concerns. But 30 subsequent studies in humans failed to show that saccharin raises the risk for any cancer, and the warning labels have been removed.

• Aspartame (NutraSweet, Equal). This popular tabletop sweetener can also be found in processed foods, such as some cereals and beverages. Aspartame has been extensively studied and deemed safe, though it should be avoided by people with phenylketonuria, a rare condition that causes people to be unable to properly metabolize the sweetener.

• Sucralose (Splenda). Another common tabletop sweetener, sucralose is also widely used in food processing and can be found in products such as some desserts and beverages. According to the FDA, more than one hundred studies have demonstrated the sweetener’s safety.

• Stevia. Derived from a plant that grows in South America, stevia (Truvia) has become very popular in recent years. The FDA allows products containing a highly purified derivative of stevia to be sold as sweeteners in the United States. However, products containing whole leaf or extract of stevia are not permitted to be marketed as sugar substitutes because of concerns about how these products affect control of blood sugar, as well as their effects on the heart, kidneys, and the reproductive system.

While manufacturers promote stevia as a “natural” sweetener, solid evidence to support claims that it’s healthier than other sugar substitutes is lacking.

• Other sugar substitutes. These include products such as acesulfame potassium (Sweet One), neotame (Newtame) and a new sweetener, advantame; all have been reviewed and approved by the FDA.

Effect on blood glucose

Sugar substitutes (other than sugar alcohols) won’t raise blood glucose levels, but they don’t improve them, either; in studies lasting up to four months, people who consumed food and drinks containing substitute sweeteners showed little change in HbA1c levels and other measures of blood glucose.

Keep in mind that just because a product contains a sugar substitute, doesn’t mean it doesn’t also contain a significant amount of carbohydrates. To avoid wreaking havoc on your blood glucose level, it’s important to check
the package’s “Nutrition Facts” panel—even when the product is labeled “sugar free” or “no sugar added”—to see how many carbohydrates it contains.

Effect on weight

Studies evaluating the role of no- and low-calorie foods and drinks as aids to weight loss have had mixed results. Some trials have suggested that consuming foods and drinks that contain a sugar substitute instead of high-sugar products may lower overall calorie intake. However, a few studies have shown that people who drank soda containing a sugar substitute as part of their daily diets ended up consuming a similar number of total calories as individuals who drank regular high-sugar soft drinks.

How could that happen? Research suggests that dieters who switch from sugary drinks to sugar-free versions sometimes compensate for the missing calories by consuming more food and beverages overall. In fact, some scientists believe that eating and drinking foods and beverages containing sugar substitutes can promote weight gain.

According to one hypothesis, sugar alternatives block chemical signals in the body that regulate satiety, or our sense of fullness after a meal, which could leave you feeling hungry and promote overeating. Another hypothesis is that sugar substitutes rev up the desire for sweets, making high-calorie sugary treats harder to resist.

None of these ideas has been proved, however, and well- designed clinical trials are lacking. The American Diabetes Association (in a joint statement with the American Heart Association) concluded that it’s plausible that products containing no-calorie sweeteners could help induce modest weight loss when consumed instead of full-calorie products—as long as a person can resist the urge to compensate for the missing calories.

A matter of taste

If you want to include foods sweetened with sugar substitutes in your diet, moderation is a good idea, since there’s no truly long-term research on safety in humans.

Each sugar substitute tries to mimic the real thing. Choosing the one you think succeeds is strictly a matter of taste. Also, consider the alternative: Limit sweetened foods and beverages, however they’re sweetened. Opt for water or seltzer or unsweetened coffee or tea, and most of the time, choose naturally sweet fruits (but be sure to count the carbohydrates). In time, you’re likely to lose your sweet tooth—or at least become better at controlling your cravings.

Meet Our Writer

HealthAfter50 was published by the University of California, Berkeley, School of Public Health, providing up-to-date, evidence-based research and expert advice on the prevention, diagnosis, and treatment of a wide range of health conditions affecting adults in middle age and beyond. It was previously part of Remedy Health Media's network of digital and print publications, which also include HealthCentral; HIV/AIDS resources The Body and The Body Pro; the UC Berkeley Wellness Letter; and the Berkeley Wellness website. All content from HA50 merged into Healthcentral.com in 2018.