9 Natural Sugar Alternatives: Dietitian’s Guide

We know that excessive sugar can be harmful to our health in the long run. If you have a sweet tooth and just can't drink that coffee black, you may be wondering: are sugar alternatives any better for us than the "real thing"? Let's explore the options, and the research.

As is the case whenever you are weighing the pros and cons of a particular food, the health risks—and, in some cases, benefits—of sugar alternatives depend very much on the type of sweetener, how much you're using, plus your health goals and any conditions you may be living with.

Sugar vs. sugar alternatives

Not sure whether to stick with good old-fashioned sugar or go for those colorful paper packets? Fortunately, you can compare sugar and other sweetener options using a wide array of criteria:

• Real or "fake":

  Occurring naturally (such as coming from a plant) vs. made in a lab. Artificial ingredients come with potential drawbacks that you won't encounter with plant-based foods. (By the way—actual sugar is very much "real." Granulated sugar aka table sugar comes from sugarcane—a grass that grows in stalks and looks similar to bamboo—and is commonly known as cane sugar. Sugar may also be derived from sugar beets.)

• Calorie count:

  Artificial sweeteners are calorie-free. Sugar, honey and coconut sugar contain calories, while some plant-based sweeteners like xylitol and stevia contain few or no calories.

• Glycemic index (GI):

  This scale ranks foods from 0 to 100 according to how high blood sugar peaks within two hours of consuming a specific carbohydrate-containing food, with pure glucose having a GI of 100 as a reference point.  Foods that have a GI of 70 or more have a high glycemic index, while 55 or less is a low glycemic index. Most sugar alternatives will fall into the low glycemic category.

• Nutritive vs. non-nutritive:

  Nutritive sweeteners impact our blood sugar and insulin response differently depending on their composition. Non-nutritive sweeteners (all of those lab-created sugar alternatives) do not have this effect—but, there may be other concerns.

• Composition:

  Table sugar (sucrose) is comprised of equal parts glucose and fructose. The types of sugars in other options will vary.

All of these factors should be taken into account when you're deciding how to sweeten your beverage, breakfast or baked goods!

Sweeteners to avoid: Artificial sugar substitutes

As a general rule, don't trade sugar for artificial sweeteners, which should be considered as food additives to avoid. The most popular manmade sweeteners include:

• Aspartame (NutraSweet® and Equal®) - GI of 0, 0 calories per tablespoon, 200x sweeter than sugar
• Saccharin (Sweet'N Low®) - GI of 0, 0 calories per tablespoon, 200-700x sweeter than sugar
• Sucralose (Splenda®) - GI of 0, 0 calories per tablespoon, 600x sweeter than sugar

Acesulfame potassium (acesulfame-K), neotame and advantame are additional sugar alternatives that you might want to stay away from.

You'll note above that the lab-created sweeteners have a GI index of 0. They also have no calories. A zero-calorie sweetener? If this sounds too good to be true, it is! And this brings us to why I believe you should avoid these sweeteners. While the United States Food and Drug Administration considers them to be "safe," a number of studies should give us all pause:

• The big "C":

  In a large-scale prospective cohort study, artificial sweeteners were associated with increased cancer risk.

• Fertility woes:

  In a retrospective cohort study of 840 pregnant women, aspartame consumption was associated with increased infertility risk.

• Gut health:

  Artificial sweeteners may also contribute to imbalanced gut health (dysbiosis).

• They may make you crave more sweets:

  A few theories suggest that sugar substitutes create (more) sugar cravings. Why? One line of thinking is that artificial sweeteners tend to be much sweeter than sugar, and the intensity can modify our palate perception by creating a higher tolerance for sweetness. Another theory is that they trick the body, only to leave us wanting the real thing. Notably, some of the natural alternatives also have a sweetness intensity greater than sugar.

• Heart disease risk:

  In a meta-analysis of prospective cohort studies, sugar-sweetened beverages and artificially sweetened beverages were both associated with cardiovascular disease (CVD) incidence. Each serving of an artificially sweetened beverage was associated with a 7% higher incidence of CVD incidence. Each serving of a sugar sweetened beverage daily was associated with an 8% higher risk of cardiovascular disease incidence and mortality.

• Weight Loss:

  Non-sugar sweeteners won't help with long term weight management, according to a 2023 guideline from the World Health Organization.

Again, despite these studies, the FDA considers manmade sweeteners "safe." However, the FDA has put a limit on how much is generally recognized as safe to consume. Ultimately, though, we don't know enough about the long-term effects of these chemicals.

Better options: sugar alternatives derived from plants

Of course, the best sugar alternative is fruit, because fruit is naturally sweet and provides vitamins, antioxidants, and fiber. When you're craving something sweet, a piece of fresh fruit is always the right choice! That being said, sometimes we need a little something more for our coffee/tea or to cook with. Here are some options that are safer than the artificial stuff.

To give a point of reference for the information below, table sugar has a glycemic index (GI) of about 65 and provides 4 calories per gram (1 gram is 4.2 teaspoons) and 48 calories per tablespoon. There are 3 teaspoons in a tablespoon.

Zero-calorie natural sweeteners

1. Stevia

   – GI 0, 0 calories per tablespoon - Steviol glycosides are natural constituents of the leaves of the Stevia rebaudiana Bertoni plant. This non-nutritive sweetener is 200 to 400 times sweeter than table sugar. Stevia extracts may have positive health effects, such as reducing blood pressure.

2. Monk fruit

   – GI 0, 0 calories per tablespoon – This non-nutritive sweetener goes by a few names including its botanical name, which is Siraitia grosvenorii Swingle fruit, but more commonly known as Luo Han Guo or monk fruit plant. The mogrosides from the plant are 100-250 times sweeter than sugar. More research is needed to confirm health benefits in humans.

3. Erythritol

   – GI 0, 0 calories per tablespoon – Erythritol is considered a sugar alcohol and is found in some fruit and vegetables. It is typically produced for use as a sweetener from the fermentation of corn. It's a popular option in foods marketed as healthier alternatives to ice cream and keto products.

Other plant-based sugar alternatives

1. Xylitol

   – GI 7, 24 calories per tablespoon – This is another sugar alcohol, a non-digestible carbohydrate that occurs in some fruit and vegetables. It offers half the calories per gram by nature compared to sugar. However, it has a much lower GI and xylitol offers dental health benefits and more! As a caution for our furry friends, xylitol is toxic to dogs, so be sure to keep it out of reach.

2. Coconut sugar

   – GI 35, 48 calories per tablespoon – Derived from the sap of the coconut palm tree, this is ultimately another type of sugar. Although it contains the same number of calories per gram as white sugar, it may be better for blood sugar regulation due to its lower glycemic index. Plus, it will offer a small amount of minerals and fiber.

3. Agave

   – GI 10-15, 60 calories per tablespoon – While agave has a lower glycemic index compared to sugar, it is higher in fructose. Sugar is comprised of equal parts glucose and fructose, while agave contains about 85% fructose (amount will vary depending on the variety).

4. Maple syrup

   – GI 55, 52 calories per tablespoon – A quality maple syrup will offer a variety of antioxidants and even some minerals, but since it is still high in sugar content, should still be used in moderation. If you choose maple syrup, make sure it is 100% maple syrup, and not sugar syrup or high fructose corn syrup with maple flavor added, which is commonly found in supermarkets and breakfast restaurants because it's a cheaper pancake topping. I was once in Vermont eating breakfast and was very surprised to find that the restaurant let me know that there would be an additional fee for real maple. I appreciated that I was given the option instead of served fake syrup, but also, it's Vermont…they should only have the real deal as maple syrup is produced there!

5. Honey

   – GI 55, 64 calories per tablespoon – Honey is an amazing food if you think about it, with medical applications beyond ingesting it (such as topical use for burns), but at the end of the day it is still sugary when we do consume it. The taste of honey will vary, with a lot of floral tasting notes.  Some of the most beneficial types of honey include raw, unfiltered local honey and manuka honey. Honey contains enzymes, vitamins, minerals, and antioxidants. It also has antiviral and antibacterial properties.

6. Date sugar

   – GI 44-53, 30 calories per tablespoon – Date sugar is made from dried dates. Dates themselves are high in fiber, which can actually help us avoid sugar spikes. Dates also contain an assortment of minerals and antioxidants.

You may be surprised to find that some honey options have more calories than table sugar. However, the health benefits that these plants offer shouldn't be neglected. Calories are only one piece of information to pay attention to when analyzing a food. Ultimately, it all comes back to moderation. Personally, I don't like the taste or aftertaste of some of the sugar alcohols and non-nutritive options, so I would rather enjoy less processed forms of sugar in moderation in lieu of the alternatives. However, if you are actively trying to keep blood sugar spikes in check, these options are important to have. As always, nutrition should be individualized.

Sweet takeaways:

Now that you know the various benefits and drawbacks of sugar and its copycats, how can you make sure you're making the right choices when you are seeking something sweet? Follow these tips:

• Watch out for added sugar on food and beverage labels, with a common source being high fructose corn syrup (HFCS).
• In fact, try to avoid sugary beverages in general, as they are a major source of added sugar in the American diet.
• Choose less processed, natural alternatives to sugar in moderation for their antioxidant value and mineral content.
• Follow health guidelines for daily sugar intake:
• The Dietary Guidelines for Americans recommends aiming for less than 10% of calories per day from added sugars.
• The American Heart Association recommends limiting added sugars to 36 grams (9 teaspoons) per day for men and 25 grams (6 teaspoons) for women.

References

• Chen, Yang-Ching, et al. "Aspartame Consumption, Mitochondrial Disorder-Induced Impaired Ovarian Function, and Infertility Risk." Int J Mol Sci. October 2022. https://pubmed.ncbi.nlm.nih.gov/36361530/
• Debras, Charlotte, et al. "Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study." PLoS Med. March 2022. https://pubmed.ncbi.nlm.nih.gov/35324894/
• Witkowski, Marco, et al. "The artificial sweetener erythritol and cardiovascular event risk." Nature Medicine. February 2023. https://www.nature.com/articles/s41591-023-02223-9
• Yin, Jiawei, et al. "Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages and Risk of Cardiovascular Disease: A Meta-Analysis and Systematic Review." Adv Nutr. January 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850046/