Just how healthy–and safe–are sugar substitutes when it comes to managing diabetes?

Carolyn Williams, Ph.D., R.D.
February 05, 2020
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The family of low-calorie sugar substitutes has almost quadrupled since the 1990s. Those familiar pink and blue packets are now joined by dozens of other granular, powdered, liquid, and brown-sugar-like products, not to mention a host of packaged foods that incorporate sugar substitutes. All of these products can be helpful if you're trying to limit calories or carbs, but how do you know which options to choose?

All About Sugar Subs

What Kinds Are There?

Nonnutritive sweeteners include saccharin, aspartame, acesulfame potassium, sucralose, neotame, advantame, stevia, and monk fruit. The first six are developed in a lab, which is why they're often called "artificial sweeteners." Stevia and monk fruit are the newest additions to the market and are both plant-based, meaning their sweetness is derived from plants. They're marketed as "natural" sugar substitutes, although "natural" is a term very loosely defined and regulated by the FDA. Research has not suggested that "natural" necessarily offers an advantage over artificial.

Sugar alcohols include erythritol, xylitol, mannitol, and sorbitol. They are often used in sugar-free candy and in sugar-replacement baking blends. Sugar alcohols are bulkier than nonnutritive sweeteners, which can make them a better replacement for sugar in baked goods. Created by changing the configuration of a sugar molecule, sugar alcohols are only partially digestible. Only the digestible components provide calories and carbohydrates to the body and impact blood sugar. They can have a small impact on glucose levels, particularly if consumed in larger amounts, but have a smaller impact than sugar. However, they are not as sweet as sugar, so more is often needed to reach the same level of sweetness. Also, for some people, the undigestible components can trigger digestive issues when eaten in excess. (Erythritol tends to cause fewer GI issues than other sugar alcohols.)

How Safe Are They?

Current evidence says that all of these options are safe. Before each product was approved for use in food products or could be sold to consumers, the FDA required a significant amount of research and data showing there is no harm in consuming them.

Even though these products are FDA-approved, some people are still wary of the unknown long-term effects, particularly when it comes to cancer risk. This largely stems from saccharin being associated with an increased cancer risk in rats in the 1970s. However, there have been over 30 human studies since then that have not supported a saccharin-cancer connection, and there is no conclusive research to suggest an association exists between cancer and any low-calorie sweeteners on the market. With that being said, we can only study sugar substitutes for as long as they have been in use, which means we don't yet know the effects of consuming many of them for more than 20 years or over a lifespan.

Can They Help Me Manage My Blood Sugar?

In 2012, the American Diabetes Association and the American Heart Association issued a joint statement saying that using low-calorie sugar substitutes in moderation, and in place of sugar, is one tool available to help with blood glucose management and weight loss. Research to date shows that nonnutritive sweeteners alone do not increase blood sugar. And while sugar alcohols can affect blood sugar, they typically have less of an impact than other carbohydrates like sugar.

If you currently consume a lot of processed products with added sugars, switching to sugar substitutes may be a useful strategy to help you cut down on calories and carbs. But remember that sugar substitutes are just one part of an overall diet. Everything else you eat plays a role too. Other ingredients and calories in a sugar-free product can impact your blood sugar, weight, and appetite, as will all the other foods you eat.

So How Do I Choose a Sweetener?

When it comes to managing diabetes, research doesn't show that any one low-calorie substitute is a better choice over another. Which means the choice comes down to taste and personal preference. Since genetics influence taste bud receptors, everyone perceives tastes slightly differently. The bottom line: If you find a sugar-free product that satisfies your sweet tooth and fits in your budget, it's likely a good option for you. Just don't go overboard—enjoy it in moderation.

Another factor to consider is how the sweetener will be used. Some products are better suited to heat than others. For example, sucralose, stevia, monk fruit, and xylitol are all heat stable, while saccharin and aspartame are not. When baking, it's especially important to choose a sweetener that's heat stable. Sweeteners that can replace sugar in a 1-to-1 ratio in recipes, and sugar substitute blends specifically designed for baking (such as Truvia Baking Blend and Splenda Brown Sugar Blend) typically yield the best results (see What We Found, page 33). Make sure to check the Nutrition Facts panel on baking blends: many contain some sugar, which will affect blood glucose.

What's in Those Sugar-Free Products?

  1. Del Monte Mixed Fruit Cup (No Sugar Added): Sucralose & acesulfame potassium
  2. Dannon Light & Fit Original Greek Yogurt: Sucralose & acesulfame potassium
  3. Glacéau Vitamin Water Zero: Stevia & erythritol
  4. Coca Cola Diet Coke: Aspartame
  5. Halo Top Mint Chip Light Ice Cream: Stevia & erythritol
  6. Hershey's Genuine Chocolate Flavor Sugar-Free Syrup: Erythritol, acesulfame potassium & sucralose
  7. Sweet 'n Low, Sugar Twin: Saccharin
  8. Equal, NutraSweet: Aspartame
  9. Splenda: Sucralose
  10. Truvia, Pure Via, Sweet Leaf, Pyure: Stevia extract
  11. Sunett, Sweet One: Acesulfame potassium
  12. Newtame: Neotame
  13. Nectresse, Purefruit, Lakanto, Monk Fruit in the Raw: Monk fruit (aka luo han guo)
  14. Swerve, Zsweet: Erythritol (sugar alcohol)
  15. XyloSweet: Xylitol (sugar alcohol)

Don't see your favorite product here? Check the ingredients list to see which sugar subs are used.

What We Tested

With so many sugar subs on the market, how do you choose one to bake with? We ran nine products through a baking test to see how they stacked up. For more baking hacks, check out our Tips for Baking with Sugar Substitutes.

Sugar blends

  • Splenda Sugar Blend Made with: Sucralose and sugar
  • Splenda Naturals Sugar & Stevia Blend Made with: Stevia and sugar
  • Truvia Cane Sugar Blend Made with: Stevia, erythritol, and sugar
  • Whole Earth Sweetener Co. Sugar Blend Made with: Stevia and sugar

Other blends

  • Pyure Organic Stevia Blend Made with: Stevia and erythritol
  • Pyure Bakeable Stevia Blend Made with: Stevia and maltodextrin
  • Lakanto Monkfruit Sweetener Made with: Monk fruit and erythritol

Single-ingredient products

  • Swerve Granular Made with: Erythritol
  • Xylosweet Made with: Xylitol

What We Found

Sugar blends work well

Completely removing sugar from a baking recipe isn't always the goal. Yes, replacing sugar removes carbs from the recipe, but it can also affect the texture. During baking, sugar helps baked goods rise and also, as it caramelizes, helps outer edges brown. So keeping some sugar in a baking recipe can result in a better texture and appearance. For this reason, we found that baking blends that contain both a sugar substitute and sugar performed best in our tests. You can also create your own blend by replacing half the sugar in a recipe with the equivalent amount of a sugar substitute.

You may need to alter the recipe

When using a sugar substitute, our test kitchen recommends also adding ¼ teaspoon of baking soda to help with browning. We also found that most swaps worked better when we adjusted the baking time in the original recipe—many sugar subs we tried needed a little more time in the oven. We recommend checking doneness starting at the time provided in the original recipe, and then checking again every minute or two until the baked good meets the doneness indicator in the recipe. For example, for our cookie recipe, we checked until the edges were set but not browned.

It's a bit of trial and error

All of the baking blends we tested resulted in a product that was noticeably different from the original recipe with sugar. Some rose less than others, some were less sweet, and some had a distinct flavor or aftertaste. Surprisingly, some products, like xylitol, performed great in our cake test but didn't work as well when we baked cookies. If you're baking for a special occasion, we recommend a trial run, to make sure the sugar sub you use works for the exact recipe you are making.

Taste is personal

Ultimately, we found that choosing a sugar sub comes down to taste, and that this is a personal preference. Stevia, saccharin, erythritol, and monk fruit each have a distinct flavor, degree of sweetness, and aftertaste. While our testers always agreed on texture, they were more divided when it came to taste. The only product that had a universally appealing taste to our testers was xylitol, which tastes most like sugar. (However, xylitol products did not always result in the best texture.) Try out different products to decide which flavor you like best.

This story originally appeared in Diabetic Living Spring 2020.