Are sweeteners better than sugar?

Sugar contributes to tooth decay, obesity and diabetes, but we still spoon it onto our cereals and into our coffee and tea, and the food industry puts heaps – known as added sugar – into their food products. 

So are artificial sweeteners better and healthier than table sugar and other sugars? To help you decide, Defeat Diabetes dietitian Nicole Moore shares her take on the common sugars we consume and the different types of sweeteners.

Should we eat sugar or sweeteners? 

There are five main types of sugar: glucose, lactose, maltose, sucrose and fructose.

1. Glucose is what we call a monomer or single sugar. Bread, cereals, pasta, rice and potato, commonly known as starchy carbohydrates, break down in our body into glucose. Glucose directly impacts our blood sugar. High intakes of glucose over time can lead to insulin resistance. Insulin resistance leads to a cluster of metabolic abnormalities, including obesity, dyslipidemia, hypertension, and hyperglycemia (pre-diabetes), collectively increasing the risk of cardiovascular disease and type 2 diabetes. Therefore, too much glucose/sugar can worsen insulin resistance and chronic disease, glycating and damaging our nerves, cells and even cholesterol.  Highly-refined processed carbohydrates and sugar in our diets have been linked to diabetes, chronic disease, and obesity.

2. Lactose comprises two sugars, glucose and galactose, which impact blood sugar levels.  Even if a product is lactose-free, it contains the same carbohydrate sugar. The lactose has simply been split into two sugars, glucose and galactose, to make it digestible for people with intolerances. So lactose will still have an impact on the sugar in our blood.

3. Maltose is made up of two glucose molecules stuck together. It’s the malt component found in grains, corn syrup and maltodextrin.  Maltodextrin is a starchy powder that manufacturers add to many foods to improve their flavour, thickness or shelf life.  Maltose and maltodextrin split when digested and turn into glucose, and – surprise, surprise! –  this contributes to the impactable sugar in our blood and, therefore, the insulin resistance chronic disease cycle.

4. Sucrose comprises 50% fructose and 50% glucose and is a disaccharide (two sugars).  The most straightforward example of sucrose is refined sugar or “table sugar,” made from sugar cane and beets.  It’s added to many processed foods such as sugar-sweetened beverages, breakfast cereals, cakes, biscuits, cereals and bread, and people spoon it every day on foods like their bowl of oats or add it to their tea and coffees! Sucrose and fructose also contribute to metabolic disease.

5. Fructose is a monomer or single sugar but is often eaten in combination with glucose in natural foods such as fruits and honey (honey is made up of  40% fructose and 30% glucose).  Most of our fructose consumption is, however, from added table sugar.  Studies indicate that overeating fructose may increase the risk of non-alcoholic fatty liver disease (NAFLD) when too much fat is stored in liver cells. Fatty liver disease can lead to liver inflammation and damage, resulting in a more aggressive disease called non-alcoholic steatohepatitis (NASH). Overeating fructose from high-calorie foods has been associated with NAFLD development, increased fatty acid production, oxidative stress, and worsening insulin resistance.

Many metabolic diseases are associated with insulin resistance, including:

1. Obesity
2. Metabolic Syndrome 
3. Diabetes 
4. Non Alcoholic Fatty Liver 
5. Cancer 
6. Pre diabetes
7. Hyperlipidaemia
8. Hypertension

There is also a growing body of research on the relationship between high carbohydrate diets and insulin resistance, the root cause of diabetes, obesity and chronic disease. Some studies suggest that high carb diets, particularly those with a high glycemic load, can lead to insulin resistance and metabolic syndrome. In contrast, others emphasise the importance of carbohydrate quality and overall caloric intake.

Low sugar, low carbohydrate diets are more effective than low fat diets for improving insulin sensitivity and other metabolic risk factors. 

Based on this evidence, we should avoid all sugars and limit carbohydrates in our diet, prioritising protein and healthy fats. Many studies show a low carbohydrate diet assists with managing insulin resistance and chronic disease.

What about replacing sugar with sweeteners?

There have been many studies on the health effects of sweeteners, and the results are mixed. Some studies have suggested that consuming sweeteners can have adverse health effects, while others have found no significant harm.

To help you decide, here is the deal on some common sweeteners to determine if they are right for you.

There are three groups of sweeteners:

1. Non-nutritive sweeteners

Non-nutritive sweeteners have zero or lower calories than sucrose (commonly called table sugar) and are used as a sugar substitute.  They’re much sweeter than sucrose, so they’re used in smaller amounts and won’t add calories or energy to food.

a) Ace K 

Ace K or Acesulfame potassium, or E950, is the first on my list. Ace K is a non-nutritive sweetener in soft drinks, chewing gum, gelatins and frozen desserts.  There have been no reports of significant concerns, and large consumption of Ace K has shown not to affect blood glucose levels or insulin. 

b) Aspartame

Sweetener E951, or NutraSweet or Equal, was first approved in the 1960s, making it one of the earliest approved sweeteners.  Aspartame has just as many calories as sugar.  However, it contributes zero calories or energy when added to food because such minute amounts are added due to it being 180 times sweeter than sugar. No toxicity or health issues or studies have reported a rise in blood glucose and insulin. However, it does not taste very natural compared to sugar. Aspartame is recognised as safe for human consumption by more than ninety countries worldwide.

c) Saccharin

Commonly known as Sweet and Low, in the pink packet, or E954, it’s found in drinks, lollies and canned goods.  Although it contains 4 calories per gram, being 300 times sweeter than table sugar means the tiniest amount is consumed, so you consume no calories from it.  There is no evidence for toxicity and no shown effects on glucose or insulin. Some misleading studies in rats indicated it caused cancer, but the rats were fed an eighth of their body weight in saccharin, and it was concluded that dose is what matters – and that people would never come close to eating the dose that the rats were fed.

d) Sucralose 

Commonly called Splenda in the yellow pack or E955, it is found in fruit drinks, canned fruits and syrups. 600 times sweeter than table sugar, it has the same calories as sugar per gram, but again no calories at the level we consume. It is not sensitive to heat and can be used in baking.  TGA reports mixed evidence regarding its impact on metabolic health, with some studies indicating that it may be detrimental for people with poor metabolic health. Some research has also suggested that high doses of sucralose may disrupt gut bacteria and negatively impact overall gut health. However, these studies have been limited.  In determining the safety of sucralose, the FSANZ reviewed data and found it to be safe with an acceptable daily intake of 0 to 15 mg/kg bw/day.

e) Cyclamate

Cyclamate has been used as a sugar substitute since the 50s and is an odourless white crystalline powder and is 30 times sweeter than table sugar. It’s used to sweeten baked goods, confectionery, desserts, soft drinks, preserves and salad dressings and is often combined with saccharin. In the past, there have been concerns about the safety of cyclamate due to studies in rats that suggested it might cause bladder cancer. However, subsequent research has not found a clear link between cyclamate consumption and cancer in humans.

Overall, the TGA has concluded that using cyclamates as a food additive is safe when consumed within the limits established by the regulatory agency. However, individuals should still exercise caution and avoid excessive consumption of cyclamates, as the FSANZ advises.

f) Stevia

Stevia is pleasant tasting compared to other non-nutritive sweeteners.  It is 200-300 times sweeter than table sugar, is used in tiny amounts, and offers zero calories.  There are limited studies on this sweetener, but there is no reported impact on blood glucose or insulin levels.  And another bonus, minimal gut issues have been reported compared to other sweeteners.  Studies have indicated that stevia may lower elevated blood pressure. Studies have found that consuming stevia as a sugar substitute improved glucose control and lipids in people with type 2 diabetes, suggesting that it may help improve the nutritional health of people with type 2 diabetes. More research is required.

g) Monk Fruit

Monk fruit is a non-nutritive sweetener that I give 10/10 for taste compared to all the non-nutritive sweeteners we have discussed.  It’s made from the natural luohan guo plant and does not trigger gastrointestinal (GI) effects.  When it reaches the colon, the gut microbiome absorbs the glucose for energy, but the rest is not absorbed and is excreted, so there are no GI effects, and it does not add calories. 

According to a review published in the Journal of Food Science and Technology in 2021, monk fruit extract is generally recognised as safe and has been approved as a food additive by the FSANZ. 

Summary of non-nutritive sweeteners 

• They provide minimal gastrointestinal problems such as diarrhea and gut pain. 
• They consistently do not appear to increase blood glucose or insulin levels.
• They do not alter glucose metabolism. However, we flag sucralose as one study has suggested it may increase fasting glucose.
• They offer zero calories which is great if weight loss is a goal.

2. Alcohol Sugars

The structure of alcohol sugars resembles alcohol, but some of these sugars have more calories than others, and they have some advantages to them, but there are also some gastrointestinal disadvantages. 

The common alcohol sugars are xylitol, sorbitol, erythritol and maltitol. 

a) Xylitol has a similar sweetness to sucrose, BUT xylitol can have a laxative effect. Xylitol has a negligible impact on blood glucose and insulin levels, significantly less than glucose directly. Xylitol can prevent tooth decay and has been deemed safe by the TGA and FSANZ).

b) Sorbitol is half as sweet as table sugar, and so is a high calorie sweetener, as you need to eat more sorbitol to achieve the same sweetness. In saying that, it’s poorly absorbed, so you don’t get many calories, but it does cause loads of gastrointestinal issues like diarrhoea, bloating, and pain. Sorbitol doesn’t increase insulin or blood glucose. When eaten on its own, it has a lesser impact on blood glucose and insulin than glucose and table sugar.

c) Erythritol is a truly low calorie sweetener. It’s almost as sweet as table sugar and has only 0.2 calories per gram (table sugar contains 4 calories per gram). 90 per cent is excreted via the kidneys, so it does not trigger gastrointestinal issues like diarrhea and does not increase blood glucose or insulin. Some studies have shown eaten daily reduced HbA1c in people with type 2 diabetes. (MD. Shahidul Islam et al, Vol 60, 2020)

A recent study revealed that erythritol is associated with incident MACE risk and can lead to thrombosis. While this was a very small study, and very high doses of erythritol were used, it warrants further research.

d) Maltitol

Maltitol is found in many sugar-free products. It has 75–90% of the sweetness of table sugar and nearly identical properties, except for browning. It is used to replace table sugar because it is half the calories. Still, it is a carbohydrate with a glycaemic index, so it has an effect, albeit lesser, on blood glucose compared to table sugar and glucose. Maltitol is not entirely digested; some people experience stomach pains and gas. It also can act similarly to a laxative and cause diarrhea. The severity of these side effects depends on how much you eat and how your body reacts to them. Overall, in a review, the authors conclude that maltitol is a safe food ingredient when used with current regulations and guidelines.

Summary of sugar alcohols

•  They are not sweeter than sucrose (table sugar), but when you eat them, you ingest zero calories because much of the sweetener is not absorbed – but you still need to be mindful of the carbohydrates. 
•  They can cause insulin secretion from the pancreas and impact blood glucose levels, so it has an effect. However, it has less effect on blood glucose than sucrose and glucose, and health benefits have also been found.
• Excessive intake can, except for erythritol, cause gastrointestinal distress and can give you diarrhea.
• Erythritol warrants further research.

3. Allulose

This is the new kid on the block and is mainly found online to purchase, but I thought it was worth mentioning.  Allulose is a sweetener that stands in its own place. It is structurally very similar to sucrose (table sugar) but doesn’t behave like toxic sucrose and has health benefits. It was only in 2014 that allulose was regarded as safe by the Food and Drug Administration (FDA).  The kidneys excrete 90% of allulose after we consume it, so it doesn’t cause gastrointestinal issues, which is a plus, and it has 95% fewer calories than table sugar – another plus! Allulose does not cause high blood glucose or insulin spikes like fructose and glucose. It was also found in a recent study that allulose can lower blood glucose after a carbohydrate-containing meal by 10%, which is something to consider! 

One study published in the journal Regulatory Toxicology and Pharmacology found that allulose was safe for human consumption, even at high doses of up to 0.5 g/kg body weight per day. Another study published in the Journal of Nutrition and Metabolism found that allulose had no adverse effects on healthy individuals’ blood glucose levels or insulin response.

Negatives are that it browns when heating, so it presents some cooking challenges, and because it drags sugar out via the kidneys, it may cause some issues with cystitis. 

What about so-called ‘natural sweeteners’? 

There are also many ‘natural sugars’, but are they any better than sugar or sweeteners? Let’s chat about honey, fruit juice concentrate, maple syrup, coconut sugar, raw sugar and brown sugar.

Honey and fruit juice concentrates are natural but are high in fructose sugar, which is not good for your liver if you have metabolic syndrome.  Maple syrup, coconut sugar, raw sugar and brown sugar are mainly sucrose (table sugar), with some trace fructose and glucose (more sugar and sugar), and have high GIs of 56 or more. So, yes, they all impact your blood sugar and health, the same as sugar because they are ALL sugar.

People think natural sugars and sweeteners are better for you, but your body doesn’t distinguish whether sugar is from honey or a lolly. It’s all biologically processed the same way with the same poor health outcomes –  sugar is sugar!

So, are sweeteners better than sugar and ‘natural sugar’?

If you must drink a sweet beverage or eat sweet food, you are probably better off consuming a substitute for sugar than actual sugar if you don’t want to increase your risk of metabolic disease or spike blood glucose. 

However, some of these sweeteners are far from perfect. So, what is my opinion on the best option? Allulose trumps it for me, personally!!

We know how toxic sugar is and that it creates metabolic health issues over time. We know ‘natural sugar’ is still sugar, and so it is no less toxic.  Based on the evidence available, most sweeteners report no major metabolic issues being triggered or impacting blood sugar, insulin, or other toxicity issues, except sucralose, xylitol and sorbitol, which can have a small impact on glucose and insulin.

Are sweeteners “harmless”? Well, not necessarily. Statistically, it appears they are safe until proven not, but there is always a risk with anything that is processed.  And, if you want to stop craving sugar, sweeteners may also trigger more cravings for sweet foods. 

I recommend you:

• JERF (Just Eat Real Food)
• stick to water
• avoid all sugar at all costs
• limit excess consumption of carbohydrate-rich foods, especially refined carbs
• and prioritise protein-rich food sources, healthy fats, and whole foods without additives or sugars.  

Again, we know how toxic table sugar is, so AVOID it!! There is a little room for sweeteners if you need them; just use them sparingly. Some sweeteners, like allulose, may have some health benefits, so this will be on my shopping list to use in moderation.