How Healthy Are Sugar Substitutes?

The World Health Organization (WHO) recently recommended that NSS not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases.^1,2,4 Except for individuals with diabetes, this recommendation applies to everyone, including children, all adults, and women who are pregnant or lactating. A systematic review of evidence by the WHO showed that replacing added sugars with NSS does not promote long term weight loss in adults and children. The review also suggest that long term use of NSS could potentially increase the risk of cardiovascular disease, type 2 diabetes, and mortality in adults.¹ The WHO noted that “reverse causation” may have contributed to this positive association, meaning that participants with the highest intake of NSS tended to have a higher body mass index, obesity, and/or metabolic risk factors, which may have already predisposed them to chronic diseases.⁵

Should you give up sugar substitutes?

The WHO recommendation is to reduce overall sweetness in the diet starting early in life and to choose naturally sweet whole foods rather than NSS, which have no nutritional value.^1,5

Consider these tips:

• If you’re switching from regular sweetened beverages in an effort to cut calories, switching to NSS will be a lower calorie option. Still, just because it’s calorie-free, doesn’t mean it’s a good thing. It’s still a processed food. So, occasionally having a diet beverage may be ok, but having six is not.⁶ Choose water rather than sugar-sweetened or NSS beverages as often as you can.
• Turn to fruit for flavoring and sweetness. When you have a sweet craving, choose fresh, canned, frozen, or dried fruits. Just ensure they are in their natural form without added sugars used as preservatives. Try using citrus fruits and their juices, like lemons, limes, or oranges for sweetness and enhanced flavor.⁶ Berries can also be a sweet addition. Try using mashed bananas, unsweetened applesauce, or blended dates in oatmeal, smoothies, or baked goods for sweetness.⁷
• Reduce the sweetness of your overall diet.¹ Try to move away from adding so much sweetness, in general. Gradually cut down on sweeteners little by little or take a “sweetener sabbatical” for a few weeks to help retrain your tastebuds to savor the natural sweetness of foods.
• Try to move away from added sugar and artificial sweeteners and focus on eating more whole foods. Reducing processed food consumption may help you reduce overall sweetener consumption.

What about other natural sugars?

You may have heard that honey, maple syrup, and/or agave nectar could be better, natural sweetener alternatives. Bees produce honey from flower nectar; maple syrup is made by boiling tree sap to reduce its water content until it becomes a solid sugar; and agave nectar comes from the fluid of the blue agave plant. Thus honey, maple syrup, and agave nectar are all considered natural sugars because they occur naturally and are made without added sugars. However, they are often high in calories without providing significant nutritive value and should therefore be consumed in moderation.

In terms of benefit, honey, maple syrup, and agave nectar contain trace amounts of minerals and vitamins, which are not present in table sugar or NSS. Raw honey and pure maple syrup both contain antioxidants and have prebiotic oligosaccharides that help feed gut flora (which can help keep your digestion on track).⁸

“The thing to remember about natural sources of added sugar: In terms of your weight and blood sugar, they behave just like sugar.”⁸

So, if you’re substituting one of these options for table sugar, you might gain a small amount of benefit, but the bottom line is this: While some natural sweeteners provide a few more nutrients than table sugar, they’re all still forms of sugar and are high in calories, should be counted toward your daily sugar intake, and just like refined sugar should be limited.⁸