The best and safest sugar substitutes are erythritol, xylitol, stevia leaf extracts, and neotame—with some caveats:
- Erythritol: Large amounts (more than about 40 or 50 grams or 10 or 12 teaspoons) of this sugar alcohol sometimes cause nausea, but smaller amounts are fine. (Sensitivities vary among individuals.) Erythritol, small amounts of which occur naturally in some fruits, is about 60 to 70 percent as sweet as table sugar and has at most one-twentieth as many calories. Unlike the high-potency sweeteners, erythritol provides the bulk and “mouthfeel” of sugar.
- Xylitol: This sugar alcohol, which occurs naturally in birch and some other plants, is about as sweet as table sugar and has about three-quarters of the calories. Too much xylitol (about 30–40 grams or 7–10 teaspoons, although sensitivities vary) could produce a laxative effect and/or gastrointestinal distress.
- Stevia leaf extracts: Stevia leaves have long been consumed in Japan, and we rate the extracts made from those leaves as safe, although additional safety tests (particularly long-term tests for cancer) should be conducted. That’s because some short-term tests found that some stevia-related substances caused mutations and other changes in DNA, yet stevia has been tested for cancer in only one species (rat) instead of two species, as usually recommended.
- Neotame: We also rate this among the safest sugar substitutes, but taste problems limit its use.
If you find that certain sugar substitutes taste best in different foods, you could keep several in your cupboard. Note, though, that while any sweetener can be used in a cold beverage, for baking you’ll need a sweetener that holds up to the heat (not aspartame). Also, for baking you may need to use either xylitol or a sugar-substitute product that includes maltodextrin (manufactured from cornstarch) or another bulking agent to make up for the volume of missing sugar. (Maltodextrin is safe.)
What about sucralose?
We rate sucralose as caution. The same lab that found that aspartame caused cancer also announced—but has not yet published—its findings that sucralose caused leukemia in mice that were exposed to it from before birth.
Which sugar substitutes should you avoid?
Aspartame tops our list of sugar substitutes to avoid, because it caused cancer in three independent studies using laboratory rats and mice. According to the International Agency for Research on Cancer and government agencies around the world, a chemical that has been shown to cause cancer in animals should be assumed to pose a cancer risk to humans.
Based on those studies, the Food and Drug Adminstration (FDA) should ban aspartame. We also recommend avoiding saccharin because of evidence from human and animal studies, albeit inconsistent, that it may increase the risk of cancer. Acesulfame-potassium (acesulfame-K) also gets our “avoid” rating since two 1970s-era, industry-sponsored studies in rats suggested that it may cause cancer, and it lacks high-quality, modern-day safety studies.
Which are the safest sugar substitutes for children?
It is especially important for children to avoid consuming any substances that may pose a risk of cancer or other chronic effect, since their bodies are still developing and since they have longer to manifest a disease like cancer that has a long latency period. For that reason, we recommend that children avoid aspartame, acesulfame-K, cyclamate (available in Canada), saccharin, and sucralose.
Among the safest sugar substitutes for children is erythritol, although too much could produce nausea. Limited amounts of the other sugar alcohols are safe for children, though too much can cause diarrhea. Neotame, though rarely used, also appears to be safe.
Is it OK for pregnant women to use sugar substitutes?
We recommend that pregnant women make a special effort to avoid consuming artificial sweeteners, since two Scandinavian studies linked artificially sweetened beverages to pre-term delivery of babies. The studies could not distinguish between the various artificial sweeteners, although aspartame and acesulfame-K are the most widely used in those countries.
Are all sugar substitutes suitable for individuals with diabetes?
Sugar substitutes do not contain carbohydrates and most studies indicate that they do not increase blood sugar levels (saccharin may be an exception for some people). However, foods containing them are not necessarily carbohydrate-free, or low in carbohydrates, even if they claim to be “sugar-free,” “reduced sugar,” or “no sugar added.”
Always check the Nutrition Facts panel and ingredient list on food packages. For example, even when you buy sugar substitutes as table-top sweeteners, bulking agents, such as dextrose and maltodextrin, may be present. Those ingredients add a small amount of carbohydrate (and calories).
Sugar alcohols do provide calories, although less than sugar, and have less of an effect on blood sugar than other carbohydrates. Drinks, desserts, and other foods with sugar substitutes may still be high in calories, so, again, check the label. If you use a large amount of these products, the calories could start to add up.
Are there some people who should not use sugar substitutes?
People who have phenylketonuria (PKU), a rare genetic disorder, have difficulty metabolizing phenylalanine, a component of both aspartame and advantame, and should avoid aspartame. All newborn babies are tested for PKU. FDA requires that all packaged foods containing aspartame be labeled “PHENYLKETONURICS: CONTAINS PHENYLALANINE” so that people with PKU can avoid it. Since advantame is so much sweeter than aspartame, a much smaller amount is used, and thus FDA does not require foods containing advantame to bear that statement.
If I have an adverse reaction to a sugar substitute, what should I do?
FDA has a program called MedWatch where consumers can report non-emergency adverse reactions to FDA-regulated products, including food and food additives such as sugar substitutes. FDA recommends consumers contact the FDA Consumer Complaint Coordinator for their state. You can obtain the phone number from FDA’s website.
If you think you may be having a reaction to a sugar substitute or another ingredient in food, you may find it useful to keep a record of what foods you eat, when you eat them, what symptoms you have, and when you have them. That, combined with closely reading food labels, may help you pinpoint what is causing the reaction, and help you avoid the offending ingredient.
Do you have a favorite sugar substitute? Let us know in the comments.
Sources: Halldorsson TI, Strom M, Petersen SB, et al. Intake of artificially sweetened soft drinks and risk of preterm delivery: a prospective cohort study in 59,334 Danish pregnant women. Am J Clin Nutr 2010;92(3):626-33. doi: 10.3945/ajcn.2009.28968.
Englund-Ogge L, Brantsaeter AL, Haugen M, et al. Association between intake of artificially sweetened and sugar-sweetened beverages and preterm delivery: a large prospective cohort study. Am J Clin Nutr 2012;96(3):552-9. doi: 10.3945/ajcn.111.031567
This post was originally published in 2014 and is updated regularly.