Health
Woman adding sugar to her coffee.
Woman adding sugar to her coffee.
Woman adding sugar to her coffee.

Facts About Sugar and Sugar Substitutes

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Everywhere you look, people seem to be touting the benefits of a sugar-free diet. But not all sugar is created equal, and no one approach is the best for every person’s goals and preferences. Jessica Ziesel, M.S.P.H., R.D.N., L.D.N., a registered dietitian at Johns Hopkins Medicine, weighs in on sugar, sugar substitutes and sugar-free diets.

What is sugar?

Sugar is one type of carbohydrate, as are fiber and starch. Although carbohydrates are essential macronutrients (nutrients the body uses in large amounts), sugar is not. Sugar is an umbrella term for many types of simple carbohydrates, including white table sugar. Also called sucrose, this is the most common sweetener used in sweet desserts and baked goods.

Sucrose is only one of several types of sugar naturally found in foods including fruits, vegetables, grains and dairy products. Other natural sugars include:

  • Fructose
  • Galactose
  • Glucose
  • Lactose
  • Maltose

Is sugar bad for you?

Sugar isn’t inherently bad. Actually, it’s necessary. “Our bodies run on sugar,” Ziesel explains. “We process the carbohydrates from the food we eat and turn much of it into glucose (sugar). Our cells pull the glucose from the bloodstream and use it for fuel and energy. Removing natural sources of sugar and other carbohydrates from your diet — fruits, dairy products and grains — is not a healthy choice. But we can make choices about where sweetness in our foods is coming from.”

Consider your sources of sugar

There’s a big difference between added sugar and naturally occurring sugar. Much sugar is added to processed foods such as donuts, bread, candy, soda, fruit punch, sweet tea, and even condiments like ketchup and barbeque sauce. The result is that many people consume a large amount of added sugar that has no nutritional benefits. And too much added sugar can lead to health problems including high blood sugar, insulin resistance, metabolic syndrome, dental issues such as cavities, increased triglycerides, obesity and type 2 diabetes.

Sweeteners like fruit juice, honey, molasses and maple syrup contain natural sugar and have some nutritional benefits. “Fruit has fiber, vitamins and antioxidants,” says Ziesel. “Even raw honey and maple syrup can contain antioxidants and minerals like iron, zinc, calcium and potassium.”

What are sugar substitutes?

Sugar substitutes taste sweet but don’t contain sugar. They have fewer calories than sugar, and some have no calories at all. Foods labeled “sugar-free,” “keto,” “low carb” or “diet” often contain sugar substitutes, which fall into three categories: artificial sweeteners, sugar alcohols and novel sweeteners.

Artificial Sweeteners

Most artificial sweeteners (also called nonnutritive sweeteners) are created from chemicals in a lab. A few are made from natural substances like herbs. They can be 200 to 700 times sweeter than table sugar.

These sweeteners don’t contain calories or sugar, but they also don’t have beneficial nutrients like vitamins, fiber, minerals or antioxidants. They are regulated by the U.S. Food and Drug Administration (FDA) as food additives.

Traditionally, artificial sweeteners have been the only option for people who need to monitor their blood glucose levels or weight. Some experts believe that artificial sweeteners pose health hazards, from weight gain to cancer. But research on this is ongoing, and past studies showing health risks were conducted on animals, not humans. Studies on people have shown these products to be generally safe if more than the acceptable daily intake for each is not consumed.

The FDA has approved several artificial sweeteners:

  • Acesulfame potassium (Ace-K)
  • Advantame
  • Aspartame
  • Neotame
  • Saccharin
  • Sucralose

Sugar Alcohols

Similar to artificial sweeteners, sugar alcohols are created synthetically (typically from sugars themselves). Sugar alcohols are used in many processed foods. They’re not as sweet as artificial sweeteners, and they add texture and taste to foods like chewing gum and hard candies. They can cause gastrointestinal irritation like bloating, gas or diarrhea in some people.

Unlike other sugar substitutes, sugar alcohols must be listed on nutrition facts labels. Examples include:

  • Erythritol
  • Isomalt
  • Lactitol
  • Maltitol
  • Sorbitol
  • Xylitol

Novel Sweeteners

Novel sweeteners are derived from natural sources. This relatively new group, sometimes called “plant-derived noncaloric sweeteners,” provides many of the benefits of both artificial and natural sweeteners like fruit or honey. Novel sweeteners are not a significant source of calories or sugar, so they don’t lead to weight gain or blood sugar spikes. They are also typically less processed and more similar to their natural sources compared to artificial sweeteners.

Examples include:

  • Allulose
  • Monk fruit
  • Stevia
  • Tagatose

“Stevia and monk fruit are both naturally derived from plants,” explains Ziesel. “Many people feel they have a flavor very similar to regular sugar. These are very popular sweetener options for people who need to watch their blood sugar or calorie intake.”

The FDA says these sweeteners are “generally regarded as safe,” which means they are safe to use for their intended purpose.

Should I cut sugar from my diet?

Removing all sugar from your diet means you might miss important nutrients found in fruits, whole grains and dairy. Diets that cut out all carbohydrates and sugars, such as the ketogenic diet, can be harmful to your health.

Without sugar, our bodies have to find alternative sources of energy. So, they use ketone bodies (substances produced by the liver) for fuel. “This is basically our body going into starvation mode,” explains Ziesel. A diet without any carbohydrates or sugars often causes a group of symptoms known as “keto flu,” which can include headache, fatigue and brain fog.

Ziesel recommends cutting way back on highly refined foods and beverages with added sugars and artificial sweeteners, but not removing all carbohydrates from your diet.

So what are some sweet ways to stay healthy?

Ziesel has a few tips for people who want to reduce the refined sugars in their diets:

  • If you absolutely must use a sweetener, consider a sugar substitute like stevia or try using a mixture of sugar and stevia.
  • Load up on whole foods such as fruits, vegetables, whole grains, dairy products, lean proteins, seafood, nuts and seeds.
  • Skip the soda, energy drinks, sweet teas and fruit juices.
  • Use whole fruit as a sweetener. Add a mashed banana to oatmeal, or blend dates into a smoothie.

Read the nutrition facts label on food packages and avoid “healthy” foods that have added sugar, like granola or energy bars.

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