A Buyer's Guide to Sugar Substitutes

By: Joyce Hendley, M.S.

Maybe you think you don't use sugar substitutes. Maybe you steer clear of diet sodas and "lite" foods to avoid chemicals like aspartame. But if you've eaten certain high-fiber cereals, salad dressings, frozen entrees—or even sipped some nondiet iced teas—then you've probably consumed a lot more of them than you realize. And your odds are only growing: sugar substitute use in packaged foods has been rising steadily for the past -decade—the amount in our food supply now tops 26 pounds per person annually. And the global market for sugar substitutes (including both artificial and natural no-calorie sweeteners) is expected to grow—topping $18 billion by 2019.

Not only are these sweet nothings cropping up in more and more foods—there are also more sugar substitute options, -period. With today's consumers clamoring for "clean" ingredients lists, food-and-drink makers are increasingly turning to "natural" plant-based sweeteners. Trending now are products using stevia leaf extract and monk fruit extract (from an Asian melon), as well as erythritol, a sugar alcohol found in certain fruits. Other next-generation sweeteners that are artificial, like advantame and neotame, have also recently come on board. 

Many of these sugar substitutes—both new and old—have spurred a lot of concerns and confusion: Are alternative sweeteners needed weapons against the ills caused by our overly sweetened lifestyles? Or are they the toxic, junk-food additives their detractors believe them to be? Here's our take on your biggest sugar substitute questions, based on the latest research.

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Can Sugar Substitutes Help You Lose Weight?

Yes—but only a little.

A small but strong handful of clinical trials suggest that using sugar substitutes—usually in the form of diet beverages—can help people lose weight, especially those "who are getting a fairly prudent diet already," according to obesity expert Barry Popkin, Ph.D., a professor of nutrition at the University of North Carolina at Chapel Hill. One major review involving more than 1,900 participants concluded that when sugar substitutes and low-calorie foods were swapped in for their full-calorie counterparts, people lost an average of 1 to 2 pounds.

Another study found that when 31 men and women snacked on crackers with sweetened cream cheese before lunch and dinner, they felt just as satisfied when the cream cheese was sweetened with stevia or aspartame as they did with sugar, despite taking in around 300 fewer calories.

That said, large, long-term studies show that people who regularly consume sugar substitutes aren't leaner—and are sometimes heavier—than those who don't. Why the discrepancy? One factor is what Popkin calls, "the Big Mac with a Diet Coke" effect—the all-too-human self-foolery that happens when we eat something labeled "diet," then feel entitled to pig out because we were "good." Overweight people also tend to choose more diet foods in general to prevent further gain.

Bottom line? If you use sugar substitutes wisely—swapping them for their full-on-sugar counterparts, and keeping the rest of your diet sensible—they may make your weight-loss journey a little sweeter. "But they're never going to be a magic bullet," says Popkin.

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Do Alternative Sweeteners Amp Up Your Taste for Sweet?

Not any more than sugar does.

We already have a hard-wired love of sweetness, and health advocates say that with so much added sugar in our food supply—even in things like crackers and ketchup—many of us have become used to a higher level of it. With sugar substitutes, which are often hundreds—sometimes thousands—of times sweeter than sugar, some experts worry they'll flood our sweet taste receptors, causing us to crave ever-stronger amounts of sugariness, and make naturally sweet, nutritious foods, like fresh fruit, seem dull by comparison.

Of course, foods sweetened by sugar substitutes aren't hundreds or thousands of times sweeter than the regular stuff. And concerns about them creating a super-sweet tooth don't hold up to scientific scrutiny. One study Popkin co-authored found that when overweight people swapped their usual two daily servings of sugar-sweetened beverages with diet drinks or water for six months, the diet group took in, on average, about 40 fewer calories from desserts and added sweeteners than the water group. "The study pokes a hole in the idea that people who drink diet beverages have an increased preference for sweet tastes," says Popkin.

Do They Screw Up Your Microbiome?

Possibly, yes.

Last year, a study at Israel's Weizmann Institute found that mice fed a fairly high daily dose of saccharin, sucralose or aspartame for 11 weeks began to develop symptoms of glucose intolerance, a precursor to diabetes. Suspecting gut bacteria (the "microbiome") might be involved, the researchers did further testing using saccharin, the sweetener that had the biggest effect—and discovered changes in the mice's gut bacteria that are associated with a high risk of obesity and diabetes.

To see if something similar might happen in humans, the team then recruited seven healthy, lean volunteers—none of whom normally consumed artificial sweeteners—and fed them a daily dose of saccharin that was high, but within the FDA's acceptable limit. (Equivalent to 10 packets of Sweet'N Low.) After a week, four volunteers developed glucose intolerance, and their gut bacteria shifted toward those linked to obesity and diabetes.

The study generated major buzz, "but as impressive as it is, it's only one study," notes Justin Sonnenburg, Ph.D., an assistant professor of microbiology and immunology at Stanford University School of Medicine, and co-author of The Good Gut. "It does reinforce that what we eat directly impacts our health and our gut microbiota—that's incredibly clear."

Ultimately, though, experts say there's a bigger-picture issue here—beyond whether sugar substitutes are good or bad for us. The real problem is the sheer amount of sweet stuff of any kind in our food supply—a whopping 140 pounds' worth annually for every adult in the U.S. So making an effort to cut down on sugar (real and fake) is a smart idea. We're not saying life can't be sweet—on occasion, sugar substitutes are fine—but they aren't necessarily the better choice, for your health or your waistline.

Guide to Sugar Substitutes

Here’s a rundown of some FDA-cleared sweeteners—which have also earned the go-ahead from major health organizations, like the American Heart Association. To get FDA approval, manufacturers must submit dozens of tests to prove safety, and establish maximum intake levels (called Acceptable Daily Intake, or ADI). However, some groups, like the Center for Science in the Public Interest (CSPI), quibble with the quality of these studies, which are usually conducted by the manufacturers themselves, or companies they hire. (See “The Scoop,” below.) A handful of sweeteners, such as stevia leaf extract, are classified by the FDA as GRAS—Generally Recognized as Safe. Even though “natural” sugar substitutes like these are often perceived as healthier options, GRAS sugar substitutes usually don’t have as much safety data as approved additives. And with the science changing all the time, it’s worth using any of them sparingly.

Artificial Sweeteners

Aspartame

Names: NutraSweet, Equal, SugarTwin

Where You'll Find It: America’s most common artificial sweetener, found in drinks, tabletop sweeteners, yogurt, candy, desserts, gum and medicines.

The Scoop: Some 200 times sweeter than sugar, a little aspartame goes a long way. It’s one of the most widely studied sweeteners, but CSPI advises steering clear—citing data that hint at a slightly increased cancer risk in men, and rat studies linking it to leukemia and lymphoma. (The FDA disagrees.)

Acesulfame Potassium

Names: Sweet One, Sunett

Where You'll Find It: Drinks, desserts, yogurt, candy, chewing gum, tabletop sweeteners. Often blended with other sugar substitutes to overcome its sometimes bitter aftertaste.

The Scoop: Detractors of “Ace-K” say a few of the original animal studies submitted for FDA approval that ruled out cancer risk should be redone because of flaws. Proponents cite 30-plus years of use in the U.S. and Europe, with no reports of serious health effects.

Saccharin

Names: Sweet’N Low, Sugar Twin, Necta Sweet, Equal Saccharin

Where You'll Find It: Tabletop sweeteners, “diet” or “light” foods like jams or candies, and medicines. Also used in fountain versions of diet sodas (to improve stability of sweet taste).

The Scoop: Saccharin has a pronounced bitter aftertaste some hate and others crave. It was threatened with a ban in the 1970s when a few studies linked it to bladder cancer in rats. The National Institutes of Health later deemed the studies irrelevant because rats’ cancer-development mechanism is different from humans.’ Still, CSPI urges avoidance, claiming cancer risk can’t be fully ruled out.

Sucralose

Names: Splenda, Equal Sucralose

Where You'll Find It: Tabletop sweeteners and many foods and beverages— including salad dressings, microwave kettle corn, pickles, and English muffins.

The Scoop: Derived from sugar, sucralose has a “cleaner” sugar taste, according to fans. And it’s calorie-free because our bodies don’t break it down. While 100-plus studies confirm sucralose’s safety, some question whether its increasing use might expose children to amounts higher than the ADI, due to their smaller size. A 45-pound kid could hit their ADI with just two 12-ounce sodas.

Neotame

Names: Newtame

Where You'll Find It: Not yet in wide commercial use. (Its extreme sweetness tends to linger, making it a challenge for food manufacturers.)

The Scoop: Neotame is a derivative of two amino acids that has 7,000 to 13,000 times the sweetening power of sugar. CSPI considers it a safe choice, since the amounts used will likely be microscopic.

"Natural" Sweeteners

Stevia Leaf Extract (Rebiana)

Names: Truvia, PureVia, SweetLeaf, OnlySweet, Stevia in the Raw

Where You'll Find It: Tabletop sweeteners (also sold in blends with sugar, such as PureVia or Born Sweet Zing, at 8 to 10 calories per teaspoon).

The Scoop: Coveted as a natural alternative sweetener, this no-cal extract from the leafy, green stevia plant has a licorice-y, slightly bitter aftertaste, so it often appears in blends. The FDA has only approved highly purified stevia extracts (Rebaudioside A, or Reb A) for use as sweeteners, because safety data is lacking on whole- leaf stevia’s effects on the cardiovascular, urinary and reproductive systems. Whole stevia leaves, or products containing “crude stevia extracts” or “whole leaf stevia”—which are sold at some health-food stores—are not approved by the FDA.

Monk Fruit Extract (Luo Han Guo)

Names: Monk Fruit in the Raw, Purefruit

Where You'll Find It: Monk Fruit in the Raw is available as a packaged sweetener; monk fruit extract can be found in a few foods and beverages, like no-sugar-added fruit cups, sparkling fruit beverages and some cereals.

The Scoop: Extracted from the juice of an Asian subtropical melon, it has a slightly fruity taste, so it’s often blended with other sweeteners to mute the flavor. Though the extract has not been extensively tested, the fruit has a long history of consumption in China, where it’s used medicinally to help soothe colds and sore throats.

Sugar Alcohols

Erythritol

Names: ZSweet

Where You'll Find It: Sugar-free candies, cookies and chewing gums, packaged sweeteners. Often blended with other sugar substitutes.

Xylitol

Names: XyloSweet

Where You'll Find It: Sugar-free candies, cookies and chewing gums, tabletop sweetener.

The Scoop: Sugar alcohols are calorie-free carbohydrates that are chemically identical to those found naturally in some fruits. Erythritol measures similarly to sugar and has a real-sugar texture. And it’s the least likely of all the sugar alcohols to cause stomach upset. Xylitol can have—ahem—laxative effects at higher doses, like most sugar alcohols.