What’s the Healthiest Sweetener?

The United States is ranked as having the highest sugar consumption per day, with the average American adult consuming about 77 grams (almost 20 teaspoons) of added sugar daily and American children consuming roughly 65 grams (16 teaspoons) a day. These numbers are 2–3 times the daily recommended allowance, as the American Heart Association (AHA) recommends limiting daily added sugar intake to 9 teaspoons (36 grams) for men; 6 teaspoons (25 grams) for women; less than 6 teaspoons (24 grams) for toddlers and teens between the ages of 2 and 18; and zero added sugars for children under the age of 2.

Correlation studies continue to link excessive sugar intake with negative health effects and chronic diseases, and it is well established that an increase in dietary sugar has led to a higher prevalence of most modern chronic health problems. These include type 2 diabetes, insulin resistance, dementia, obesity, cardiovascular disease, high blood pressure, liver disease, cancer, kidney disease, tooth decay, skin disease, joint disease, and insomnia. Though many of us are aware of these health effects and make great efforts to reduce our sugar consumption or use a sugar substitute, it’s still confusing as to what’s the best sugar alternative. This makes it all the more important to find a healthy substitute for refined table sugar.

Sugar Substitutes

Here’s a breakdown of the most commonly available sugar substitutes:

Artificial Sweeteners: At first glance, artificial sweeteners —Splenda (sucralose),  NutraSweet and Equal (aspartame), Sweet’N Low (saccharin) — look tempting because they offer essentially zero calories and are much sweeter than regular sugar, only requiring a small amount to sweeten your food or drink. However, artificial is the key word. Artificial sugars are synthetic sugar substitutes that are linked to negative health effects. Numerous studies that span decades have been conducted on the safety of artificial sugars. Some raise concerns that frequent consumption of artificial sweeteners can actually cause weight gain while other studies link artificial sweeteners with diabetes, obesity, metabolic syndrome, cancer, and cardiovascular problems. These studies are ongoing to determine the long-term health effects of artificial sweeteners.

Sugar Alcohols: Common sugar alcohols include xylitol, erythritol, sorbitol, and maltitol. This kind of sugar substitute is a carbohydrate naturally derived from fruits and vegetables, although many sugar alcohols are manufactured from other sugars. Compared to table sugar they are lower in calories and not as sweet. Xylitol is one of the most popular sugar alcohols and considered safe in small amounts. However, sugar alcohols do come with some health warnings. Large consumption of certain sugar alcohols can cause gastrointestinal issues. Consumption of maltitol can also cause a rise in blood sugar levels.

Novel Sweeteners: Stevia, for example, is a non-caloric, plant-based sweetener and is 200 times sweeter than table sugar, which means you don’t need to use a lot. Stevia from the whole plant is the least processed and the best source to consume. Monk fruit sweetener, also known as Lo Han Guo, is also plant-based, contains zero calories or carbohydrates, does not raise blood pressure, and is significantly sweeter than table sugar. Monk fruit may also provide antioxidant properties. Like stevia, monk fruit is very sweet. A little goes a long way.

Natural Sugar Sweeteners: Honey, molasses, maple syrup, fruit juices, and nectar (like agave nectar) all fall under the natural sugar sweetener category, but even these require a word of caution. Though promoted as a healthier option than table sugar because they are naturally derived, these kinds of sweeteners contain a lot of sugar (e.g. fructose) and are often highly processed. When consuming a natural sugar sweetener, use it in small amounts.

Wiseman Health Take-Home Advice

• Most important: Avoid eating any processed food with added sugar or consuming any added sugar at all, as we really should get our sugar solely from natural whole foods like fruits and vegetables. However, we do recognize that avoiding all added sugar is difficult in our modern food culture, so we encourage you to be aware that the less added sugars you consume, the better chance you’ll have for good health. Be mindful of the AHA’s daily recommendations for added sugar: 9 teaspoons (36 grams) for men; 6 teaspoons (25 grams) for women; less than 6 teaspoons (24 grams) for toddlers and teens between the ages of 2 and 18; and zero added sugars for children under the age of 2. As well, to learn some practical strategies to help decrease your daily sugar intake read The Importance of Decreasing Daily Sugar Consumption.
• Avoid all artificial sweeteners—Splenda, NutraSweet, Equal, and Sweet’N Low. It’s tempting to choose this kind of substitute over table sugar because of its “zero calorie” allure, but artificial sweeteners are not the healthier option.
• Be mindful of replacing table sugar with brown sugar, turbinado sugar, or coconut sugar, as they are not necessarily the healthier option. Brown sugar is basically refined white sugar with added molasses. Turbinado sugar, often marketed as a “raw” sugar, is partially processed sugar that retains some of the original molasses from the sugarcane but also contains the same calories and carbs as table sugar. Coconut sugar, which does not come from the coconut fruit itself but rather the sap of the coconut palm, is still similar to table sugar with its sucrose and fructose content. Be careful of agave sweeteners or syrups, as they are often highly processed and contain high amounts of fructose.
• If you’re trying to avoid sugar sweeteners and would like to use a non-caloric sweetener, then stevia is the best option.The best source of stevia is the whole leaf concentrate or the actual stevia leaf. If you have to use stevia extracts, which are more widely available but less raw, use the ones that are less processed such as SweetLeaf Stevia®.
• If you would like to use a natural sugar sweetener, we prefer honey. Honey, which is a “whole food” source, is best when it’s raw—meaning that it is both non-heated and unfiltered. It is also best to buy and consume local raw honey, when possible. Using honey in unsweetened food or in your morning coffee is a great strategy. You can also use grass-fed butter to make butter coffee; the butter is a healthy substitute for sugar and can be used in place of honey. Remember, if you’re using honey on a daily basis, try to keep your total honey consumption to no more than a tablespoon a day.

Editor’s Note: This article was originally published on April 4, 2014 and has since been updated.