Wednesday, December 7, 2011

Sugar Alternatives

In our last post, we talked about the dangers of eating too much sugar. Diabetes, heart disease, and a host of other problems, pretty clearly, are associated with eating too much, or the wrong types of sugars. But if you want to avoid sugar, but don’t want to give up sweet tasting foods, the different alternatives to sugar can be confusing.

Equal, Sweet’n’Low, Splenda, Stevia, and dozens of others are all “sweet” alternatives to sugar. At a restaurant or coffee shop, you might get a choice between 3 or 4 of them, in different brightly colored packages, and you probably have one you instinctively reach for. But do you really know what’s inside that package and what it does when it goes into your body.


Sucrose, or common table sugar, is a 50/50 mix of glucose and fructose bound together. This is one of the most common forms of sugar that people use. When you eat sucrose, your body splits the glucose and fructose and sends each on its way to get processed. The fructose portion of sucrose is what gives it the “sweet” flavor we all associate with “sugar”.

Sucrose is generally refined from sugar cane or beets. The refined white sugar we all know has been refined removing all of the nutrients and fiber that originally existed in the sugar cane or beets. Sugar cane and sugar beets are the source of most of the world’s sugar.

“Evaporated cane juice” is another way of saying “sugar with some trace amounts of minerals and vitamins”. Though it may sound nicer, the actual sugar makeup is virtually identical to that of sucrose (table sugar).

Fructose is sometimes sold by itself as a sweetener and the primary sugar found in fruit. While this might suggest that it is good for you, in fact, fructose is the most unhealthy sugar for our bodies. See our earlier article on sugars for a more thorough discussion.

High Fructose Corn Syrup (HFCS) was created in a lab and was subsequently marketed as a much cheaper alternative to sugar in food products. HFCS comes in a few varieties, but the most commonly used version (HFCS-55) contains about 55% fructose and 45% glucose (about the same as honey). Other, less used versions contain 60% or even 65% fructose. This increased amount of fructose makes HFCS slightly sweeter than ordinary table sugar (sucrose) which is probably why it is so widely used in sodas and candy. While HFCS actually contains fewer calories than sucrose this means nothing positive for your health because the dangerous sugar (fructose) is even higher than regular sugar (sucrose).

Heated Honey and Agave syrup are essentially the same sugar makeup as high fructose corn syrup. They both contain about 50-55% fructose and the rest is glucose with some water and a small amount of vitamins, minerals, and other beneficial compounds. They pretty much have the same effect on blood sugar as HFCS and sugar do. Though these have been marketed as a “safer” alternative to sugar, they are pretty clearly not.

Raw, unfitered honey is honey that has never been heated or filtered. It is basically what you get in a honey comb and put in a jar without the wax of the honeycomb. This type of honey has some very valuable properties and so this must be considered in making any decision about your health. For example, raw, unfiltered honey has significant anti-microbial properties and is used successfully to assist in fighting infections. Please don’t be confused though, honey whether raw or heated is still made up of essentially the same sugar profile as High Fructose Corn Syrup. Therefore, eating too much honey can still be very problematic.


There are a lot of chemical and natural alternatives to sugar that aim to replace the sweet flavor with something that doesn’t contain calories or impact blood sugar (and therefore overall health) in the negative way that happens with sugar. The diet food and diet drink markets are full of products with this goal in mind. Many of these sweeteners are much sweeter than sucrose (100-500x), so very little of them is needed to sweeten products when compared with sugar. These are some of the most common sugar substitutes:

Aspartame (found in Equal and Nutrasweet brand sweeteners) is about 200 times as sweet as sugar. It is made up of two amino acids (the building blocks of proteins), aspartic acid and phenylalanine. Both of these amino acids are not produced by our bodies and are only acquired through our diet.

Aspartame is generally found in diet sodas, frozen desserts, gelatin (Jell-O) snacks, chewing gum, and little blue packets in restaurants for sweetening drinks like coffee, tea, or lemonade. It doesn’t taste exactly like sugar, but it is sweet. Aspartame cannot be used in baking, as high temperatures break it apart into the amino acids and it loses its flavor.

There has been some controversy about the safety of Aspartame. In general, it is considered safe for consumption in normal amounts except in patients who have a condition called phenylketonuria, because they have a decreased ability to metabolize the amino acid phenylalanine. However, many clinicians and patients find that Aspartame may not always be well tolerated in "normal individuals". There has been controversy about whether Aspartame has the potential to act as a neurotoxin because aspartic acid has an excitatory effect in the central nervous system. Research on this subject is unclear and clinical reports are at odds with the clinical reports. In general, I recommend caution, especially if you have noticed that you ever feel unwell after ingesting Aspartame.

Cyclamate was banned in the United States in 1970 after a study showed an increase in bladder cancer rates in rats. But, it was later found out that rats produce a specific protein (which humans do not) that caused them to be susceptible. Cyclamate is still used in many countries, including the European Union, and is generally considered to be safe (after many more studies, of course).

Saccharin (Sweet-n-Low) - is about 300 to 500 times as sweet as sugar (sucrose) and is one of the oldest sugar substitutes, having been used for over a hundred years. It is most often used to improve the taste of toothpastes, dietary foods, and dietary beverages. The somewhat bitter aftertaste of saccharin is often masked by being mixed with other sweeteners in many products. In diet soft drinks, especially, Saccharin is mixed with Aspartame to closer match the sweetness profile of normal sugar or HFCS soda products.

Saccharin was banned in Canada and almost banned in the United States for a similar reason to Cyclamate; it causes bladder cancer in rats. However, since humans lack the specific rat protein that causes this problem, it is not carcinogenic to us.

In fact, saccharine passes right through the body without being digested. This means that it is, effectively, zero calories and doesn’t directly impact blood sugar levels. Unfortunately, Saccharin is also not able to be used in cooking, as it breaks down under high heat. Despite this limitation, Saccharin is a very stable and safe product with a long track record of safety.

Stevia comes in many forms, including tablets,
powder, and liquid for cooking.
Stevia is about 200 times sweeter than sugar (sucrose) and has been used for centuries in South America as a sweetener (traditionally for yerba mate drinks). It is becoming extremely popular in the United States and other countries because it has zero calories and does not impact blood sugar levels, all while being marketed as “natural”.

Though Stevia has been used as a sweetener for a long time by natives of South America, few studies exist on its safety until recently. The studies that exist seem to support that Stevia is safe. Stevia appears to have possible benefits for diabetics (demonstrated in rats so far), which is especially good considering that they are a prime market for artificial sweeteners. The studies showed that the chemicals found in Stevia helped to grow back pancreatic cells that produce insulin, reduce insulin resistance, and overall help insulin generation and efficacy, at least in rats.

Even though it is considered to be “natural”, it is important to remember that the chemical that makes products like Truvia and PureVia (Coca-cola and Pepsi products, respectively) sweet do originate in the Stevia plant, but they are still heavily processed and refined using ethanol, methanol, and crystallization and separation technologies. Even though the packaging and commercials say it’s “natural”, it is still refined in a laboratory. If this refining process worries you then you may want to obtain and grow the plant yourself and simply use the leaves to sweeten foods and drinks, much the way it is traditionally used.

When cooking with Stevia or adding it to food, there are some helpful hints you can follow. Stevia has a slightly bitter aftertaste, so it may not be the best choice for subtle foods like tea and certain fruits. I find that the aftertaste is barely noticeable in strongly flavored foods like coffee or chocolate. Also, I find the aftertaste is not a problem if you make sure to not use too much. Because Stevia is so sweet, even a tiny bit too much can make the difference. Stevia comes in many forms, including powder, bare leaves, and a liquid. The liquid form is easiest to use when cooking, because the liquid is easier to measure and the powder is very fine,tends to fly all over the place and may not mix as well.

Sucralose (Splenda) - is about 600 times as sweet as sugar (sucrose) and is a very popular alternative to sugar because it can be used as a direct weight for weight replacement in most cooking applications like baking. Sucralose is a “chlorinated sugar” which means that chlorine atoms replace three sections of a normal sucrose (sugar) molecule, thus making it incompatible with our digestive system. Because of this incompatibility, it provides us with zero calories and doesn’t directly impact blood sugar levels.

Some people are concerned about the safety of Sucralose because chlorine can be toxic or carcinogenic, but Sucralose is a very stable molecule that doesn’t release its chlorine atoms under any conditions that exist in our bodies (only under extremely high heat applied to the powder form of the molecule). In fact, sucralose is so stable that it can be used to track areas that have been exposed to human waste-water (i.e. after it has passed right through us).

Glycine is an amino acid that is found naturally in our body that happens to taste sweet. Glycine is not typically used outside of protein shakes and some supplements, but can be found in health food stores as small packets called “Glycine Sticks”. Glycine is very safe, as it is easily removed from the body if you happen to have too much and also happens to be one of the amino acids essential in our liver detoxification pathways. Furthermore. there is some evidence that eating 3,000mg of glycine before bed can help you fall asleep faster and improve the quality of your sleep.

Inulin can come from many sources.
Inulin is an interesting substance that behaves like fiber in your body and can be used to replace sugar, fat, or flour in foods. It has a sweet taste because it contains fructose, but unlike other sources, this fructose is chemically different enough that your body can’t process it and it passes right through our digestive system.

Inulin also has other health benefits. Because Inulin acts like fiber in the human body, it appears that Inulin can increase calcium absorption and possibly magnesium absorption, while also promoting the growth of helpful intestinal bacteria.

Inulin is found in many plants, but the most commercially available source is from the roots of a plant called Yacón. Yacón roots are made up of essentially all water and Inulin, making it a good, healthy source of the sweetener. The products that contain Inulin can come in many forms, from a dried powder to a thick syrup, and are very useful for cooking, since they can replace so many different types of ingredients.

Sugar Alcohols like sorbitol, mannitol, xylitol, and many more -ols behave differently in your body than traditional sugars do. For instance, they do not cause tooth decay like sugar does because they cannot be metabolized by bacteria in your mouth. They also do not cause blood sugar levels to spike suddenly, as with sucrose, which makes them particularly useful as sweeteners in food for diabetics.

However, like many other incompletely digestible substances, eating too much food containing sugar alcohols can lead to bloating, diarrhea, and flatulence because they are not absorbed in the small intestine. Also, there is some evidence that they may worsen conditions like Irritable Bowel Syndrome and Dysbiosis as these alcohols may feed abnormal gut microbes. Many people who eat foods containing sugar alcohols report that these symptoms go away after an initial adjustment period.

Sugar alcohols taste less sweet than sucrose, so they are often combined with other sweeteners.

Xylitol is a specific sugar alcohol which stands out from the rest for its beneficial side effects. Xylitol is roughly the same sweetness as sucrose, but with about 1/3 the calories. In addition, it produces a nice cooling effect when you taste it, due to the way it absorbs heat when it changes states (solid to liquid). For this reason, it is often used in sugar free gums, toothpastes, and breath mints, where it produces a slightly sweet, mint-like flavor. But, xylitol also helps to protect teeth and bones, because of the way it interacts with calcium and phosphates in your body. Xylitol also both attracts and starves the bacteria in your mouth that lead to tooth decay and other dental problems.

Since there are no known side effects (other than those common to all sugar alcohols) and no upper limit for toxicity, xylitol is extremely safe.

Glycemic Index - What is it and what does it mean?

Glycemic Index measures how foods
affect blood sugar levels over time.
The Glycemic Index is a way of measuring how foods, and carbohydrates in particular, have an effect on blood sugar levels. Carbohydrates that break down quickly during digestion and release glucose rapidly into the bloodstream have a high glycemic index. High glycemic index foods cause a spike in blood sugar leading to a surge of insulin being released to cope. Carbohydrates that break down more slowly, releasing glucose more gradually into the bloodstream, have a lower score. Low glycemic index foods release their glucose slowly over time avoiding any acute spikes in blood sugar and the negative effects associated with that.

Glucose is the standard by which the scale is set, as that is usually what is tested for in the blood stream on blood sugar tests. Therefore, glucose is 100 on the Glycemic index. Other foods are scored based on that reference point.

Even though some foods are similar, they can have drastically different rankings on the Glycemic index. Eating a raw orange, for example, ranks about 40 on the Glycemic index, whereas drinking an equivalent amount of orange juice scores around 55. This is because of the fiber content of the orange, since fiber slows the absorption of sugars by the body. Fiber is another important component of a healthy diet which we mentioned briefly in earlier posts, and one which we will discuss in more detail in a future post.

Even though the Glycemic index is a useful tool for planning meals and avoiding foods that cause blood sugar problems, it is not an absolute measure of how healthy a food is for you. For instance, chocolate cake has a score of 38 and ice cream is about 37, both chock full of sugar. Worse yet, pure fructose scores 19 on the Glycemic index, but, if you remember from our previous post, fructose is one of the major forces behind developing insulin resistance, diabetes, heart disease, and weight gain.


Simply put, humans did not evolve to eat much sugar. Before agriculture developed, we ate primarily protein and fat, with the occasional small find of nuts, tubers, or berries and other fruits. Our bodies are not designed to drink even a single can of soda (15-30g of sugar) per day. Reducing sugar intake is one of the healthiest changes you can make in your diet and the diet of your family.

Because of the negative effects of sugar, and particularly of fructose in the sugar, alternative sweeteners are very important. With all the different choices available, it is very valuable to know the differences between the alternative sweeteners to help you decide which is right for you.

Finally, it is important to realize that we simply don’t fully understand the effects of sugar and eating sweet tasting foods on our overall health. While research is making great strides in understanding the biochemistry and physiology of the metabolism of these foods, we must remember that it has only been in the last 50-100 years that humans have had access to consume so much sugar and sweetness in our diets.

A theme we want to emphasize again is that our bodies are remarkably complex and we simply don’t understand all the implications of changing our diets from what humans have traditionally eaten for thousands of years. Therefore, you may want to follow the precautionary principle and try to eat closer to the way our bodies have evolved. I personally find that I feel much better and function much better by avoiding sweets and even sweet tasting foods as much as possible.

Researched and written by Dr. Rebecca Malamed, M.D. with assistance from Mr. Malcolm Potter.


  1. One of the things you don't quite say here is that the packets of sugar substitutes contain dextrose as a general rule. Because they are sweeter than sugar they need a bulking agent to replace sugar at the popular 1:1 ratio in cooking. Thus only the liquid forms have no carbohydrates; the packets are close to 1 gram each.

  2. That is a good point and thanks for the feedback. It is important to check what bulking agent is used in any sugar substitute you may consider. Stevia tends to use inulin as a bulking agent. Dextrose (which is glucose) may also be added to others. Others like Xylitol may not require a bulking agent. Since some of these agents have some carbohydrate associated with them, it is important to know what you are getting. Fortunately, inulin is a healthy choice and dextrose (glucose) is the sugar your body needs for everyday function. Unless you eat an excessive amount per day or suffer from severe, unstable diabetes, neither of these bulking agents should pose a significant problem. Nonetheless, I still recommend limiting the amount of sugary tasting foods (or substitutes) you chose to eat as our bodies simply have not evolved to eat this much "sweetness" in our diets. Dr. Rebecca

  3. Dr. Rebecca-Your post has captured the essence of the issue!


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