Natural and artificial sweeteners

The Complete Guide To Sugar Substitutes

Artificial, or alternative sweeteners, are becoming increasingly popular. Especially among people experimenting with low carbohydrate or ketogenic diets. These sweeteners come in a variety of types. And you can find them in nearly every food – from coffee creamers to pizza to flavored water. But some may have worse health effects than the sugars they replace.

This article serves as a comprehensive guide to artificial and alternative sweeteners. We will describe the different types of sweeteners and how they work. We’ll explore the pros and cons of each type and what the research says about their safety. We’ll wrap up with some FAQs and discussion points. The goal is to share the most accurate information on sweeteners so you can make informed, healthy decisions.

Sugar and Sweeteners

First, let’s talk about sugar and sweetness. Sweetness comes from sugar. Plants make sugars and carbohydrates, all types, for a variety of reasons. Cows make sugar too – lactose – but that won’t really play in here. Sucrose and fructose are probably the most well-known natural sugars. Sucrose, AKA table sugar, comes from refined sugar cane or beats. Sucrose is also the reference sugar for sweetness – more on that later.

What is sweetness?

Sweetness depends on the types of sugar, and how much of them, a portion of food has. Fruits have lots of sucrose and fructose, so they tend to be sweet. Vegetables have fewer of these sugars and more complex carbohydrates, so they are less sweet. But these are natural sugars found within the foods themselves. We can also increase a food’s sweetness by adding sugar (think cupcakes or candy bars.) This is the line between natural sugars and sweeteners or added sugars.

Remember, sugar (i.e. glucose) is a macronutrient that provides energy. Sweeteners are not considered nutrients, even if they have a small number of calories. This will come in handy later.

What are sweeteners?

Table sugar is the most common sweetener. Table sugar has been around for millennia. It sweetens foods including cakes, coffee, and soda. In the last 50 years, we’ve seen the rise of many other sweeteners. These synthetic sweeteners replicate or even increase the sweetness of foods, but with fewer (or no) calories. They are also referred to as non-nutritive, or low-calorie sweeteners (LCS). These sweeteners are also used in both individual servings and commercial food production.

There are many types of sweeteners. They fall into three categories – artificial, natural, and sugar alcohol. Not all sweeteners are actually approved for use in foods. Here we describe those approved or generally recognized as safe for consumption:

1. Artificial Sweeteners

Artificial sweeteners are man-made. They are several hundred to thousands of times sweeter than sucrose. You can find them in single-use packets at grocery stores or restaurants. Commercial food manufacturers also rely on them heavily.


AKA Sweet’N Low, has been around since the late 1800s. It is the oldest and, until recently, the most common sweetener. It is non-caloric and 200-700 times sweeter than sucrose. Saccharin was very commonly found in sodas and other beverages. The term is so synonymous with sweetness that it’s even found its way into some popular songs.


Aspartame is the sweetener in Equal and NutraSweet. It is a byproduct of the amino acid phenylalanine made in the 1960s. It is 200 times sweeter than sucrose.


AKA Ace-K, was also discovered in the 1960s and is about 200 times sweeter than sucrose. It is commonly found mixed with other sweeteners in baked goods, gums, and beverages. There are two new variations of aspartame – Neotame and Advantame. These are very similar but have differing levels of sweetness.


AKA Splenda, sucralose is one of the more well-known sweeteners. It is a derivative of sucrose but is 600 times sweeter. Additionally, Sucralose is in many foods but usually in low amounts due to its high relative sweetness.

2. Natural Sweeteners

In addition to the above artificial sweeteners, the FDA also recognizes a few naturally derived, non-calorie sweeteners. Both of them are fairly new and gaining in popularity. You can find these sweeteners sold for individual use. They are not currently used in large-scale food production.


This sweetener comes from the leaves of the stevia plant. It is 200-400 times sweeter than sucrose. It is gaining in popularity, especially among low-carb and keto diet advocates. This is likely the one you’ve heard about most. Note: the stevia leaf itself is not approved as a sweetener.

Monk Fruit

AKA luo han guo, this sweetener comes from the Chinese monk fruit. It is also gaining in popularity and tastes very much like table sugar. You’ll likely find this at specialty grocery stores.

3. Sugar Alcohols

Sugar alcohols are an older, but very reliable, class of sugar substitute. Sugar alcohols come from actual sugars, and are 25-100 times sweeter. You will see these commonly used in baked goods, beverages, and gum (which may help to reduce cavities.) You will only see these as additives during large-scale food production. The most common sugar alcohols are erythritol, sorbitol, xylitol, and mannitol.

You may have heard that sugar alcohols cause stomach issues. This is true. Sugar alcohols and water get along nicely in the gut. When you consume too much you might experience bloating, cramps, or even diarrhea.

Other Sweeteners

Besides the sweeteners listed above, there are a few honorable mentions. Keep in mind these are not low calorie. However, they are often used as substitutes for table sugar or syrups. These include coconut sugar and agave syrup. Most of them take the form of refined sugars or syrups. You will find these in retail settings for individual use, rather than as additives.

These ‘alternative sweeteners’ consist of sugar, usually with less sucrose or fructose. They often have other features that make them less sweet. Hence they might make good substitutes. They are also useful in baking and home cooking.

Who Should Use Sweeteners?

People who are trying to reduce their sugar intake might benefit from using sweeteners. But this is a personal choice and depends on your goals and dietary preferences. Here are some reasons why you might want to consider using sweeteners:

Weight Management

The most common reason for using sweeteners is dieting. Remember – table sugar is a macronutrient and contributes calories. Sugar often makes up a large part of our daily calories – up to 77g per day! Sweeteners replace sugar while maintaining sweetness. People use sweeteners to replace sugar in low or no-carb diets, particularly keto diets.

When you cut out sugar, you may find your diet is bland. Non-nutritive sweeteners add sweetness back in. This allows dieters more control over their macronutrient intake.


People with diabetes may also benefit from using sweeteners. The hallmark of diabetes is dysregulated blood sugar. Diabetics might use sweeteners to prevent massive fluctuations in blood sugar. This may also help with diabetic neuropathy and even, again, weight management.

Switching Things Up

Some people feel the need to consume less sugar. They may replace sugar-sweetened foods or beverages with sweeteners. This is a great way to experiment with new foods and cooking methods. It may also improve your overall dietary health.

As a personal trainer and nutritionist, I often recommend that clients try sweeteners to curb their sugar intake. I advise against completely cutting out sugars. I find this leads to compulsive behaviors around food. Plus, we aren’t entirely sure of how sweeteners impact our long-term health.

Who Should Not Use Sweeteners?

Artificial sweeteners may not be for everyone. Pregnant women, children, and individuals with stomach or metabolic impairments should consult their physicians before using sweeteners. Some people who are sensitive to taste or sweetness should start with small servings.

Sweeteners and Health

Speaking of health, let’s discuss the health impacts of artificial sweeteners. Remember – sugar isn’t inherently bad. When you over-consume sugar, you can gain unwanted weight. You can also develop insulin resistance and later diabetes. But this is usually a combination of overeating, lack of exercise, and genetic factors.

Both the Food and Drug Administration (FDA) and the American Dietetic Association approve the use of artificial sweeteners. The FDA classifies artificial sweeteners above as “generally recognized as safe” for consumption. This means that sweeteners have little to no known adverse effects on human health. That said, sweeteners aren’t completely understood. Below are the most common health risks associated with artificial sweeteners:


This is the most common concern regarding sweeteners. Early on, several studies showed associations between some sweeteners and several cancers. Lab rats fed large amounts of these sweeteners tend to develop certain cancers. But it seems humans don’t have these same responses to sweeteners.

A recent, massive prospective cohort study – which follows a group of people over time – demonstrated no link between any of these sweeteners and cancer risk. Several subsequent reviews, like this, have also shown that there is no association between sweeteners and cancer.

Weight Gain

People use sweeteners because they can help with weight loss. However, some research suggests it may contribute to weight gain in overweight individuals. A 2017 review suggests that sweeteners may cause metabolic impairments that can lead to weight gain. There is no further evidence to substantiate this observation. Overweight people may be more likely to consume artificial sweeteners to help with weight loss. So the results may actually be misleading.

We still don’t completely understand how sweeteners impact metabolic processes. At this point, we believe that sweeteners do not cause weight gain in healthy individuals.

Heart Disease

A recent study published in the journal Nature shows that erythritol is linked to an increased incidence of heart disease. Erythritol promotes thrombosis, which is directly related to heart disease risk. Of note, this is the only study to investigate an actual mechanism. But it highlights how much we have to learn about sweeteners and other food additives.

Gut Health

The microbiota fundamentally shapes our immune system and influences overall gut health. In fact, alterations to the gut microbiota can contribute to severe health conditions. A 2014 study showed that sucralose and saccharin can impair the composition of the gut microbiota. This can lead to short-term glucose intolerance. Glucose intolerance is the hallmark of diabetes. I should note other sweeteners have not demonstrated this effect.

As you’ve seen, sweeteners may be associated with some adverse health effects. This is not true for all sweeteners, and we need to see more studies on humans. The FDA still considers artificial sweeteners safe. These health impacts likely depend on how much sweetener we consume.

How Much Sweetener Can I Eat?

We measure the intake of sweeteners in the number of tabletop packets. This sounds odd, but it’s the most common method of consumption. The FDA refers to this as the Acceptable Daily Intake (ADI). Here is a list of sweeteners with the ADI:

  • Saccharin: 45
  • Sucralose: 23
  • Aspartame: 75
  • Acesulfame: 23

Note the FDA has not set an ADI for stevia, monk fruit, or sugar alcohols.


Artificial sweeteners come in many varieties. They have been a part of our collective diets for quite some time. Food producers use sweeteners to enhance their products’ taste and appeal. But you can also find sweeteners on retail shelves to use as you like. They might help you curb your sugar cravings or manage weight. Or you may simply like them because they taste better. Overall, sweeteners may be a healthy and easy alternative to added sugars.

Frequently Asked Questions

Do I need sweeteners with keto?

No. You can cut out sugars without adding sweeteners. This is a matter of preference.

Can sweeteners prevent reaching ketosis?

This is unknown. Some anecdotal evidence suggests that some sweeteners can disrupt metabolism. This might give false readings or even prevent ketosis.

Are sweeteners healthier than sugars?

It depends on how you define healthy. Sugar isn’t inherently bad unless you overconsume it. Sweeteners provide a calorie-free alternative to sugars. This may help with weight management. But some sweeteners may contribute to certain health risks.

Which sugars should I avoid?

None, or all of them. This depends on your current health and dietary habits. Most research suggests that we try to reduce or avoid added sugars. I agree that this is a good place to start, rather than immediately cutting out all carb sources.

Which sweetener is best for me?

This really depends on preference. Stevia is one of the more popular brands. And monk fruit is also becoming popular as it is a naturally derived sweetener. But sweeteners have different tastes and sweetness. I suggest trying them all in small amounts to get a feel for what you like.

Which sweeteners are the sweetest, and least sweet?

Aspartame, acesulfame, saccharin, and sucralose are relatively the least sweet. But a small amount still goes a long way. Neotame, a derivative of aspartame, is 7000 times sweeter than table sugar.


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