You walk into a grocery store and can’t avoid it, there are sweeteners everywhere! Ranging from white sugar to brown sugar to honey to sucralose to Stevia to erythritol. How can you know which to choose? Is sugar “as bad as they say”? Are sugar substitutes better or worse? Let me break it down for you. I will compare and contrast sugar vs artificial sweeteners, discuss potential risks and benefits based on literature, and assist you in making the best decision on safe consumption.

Sugar

Sugar is getting a false bad rep. Regular consumption is necessary for a healthy functioning body. Carbohydrates are sugar and we need these for energy. Carbohydrates include not only breads, grains, pasta, etc but also fruit. These are healthy sugars. (Check out the glycemic index chart on this post https://lrxwellness.com/everything-you-need-to-know-about-prediabetes/ to get a better idea of the sugar content in healthy carbohydrates.) But there are a lot of different types of sugars and sweeteners out there.

Pure sugar may be harvested from the plant sugarcane. To obtain the product it does undergo some form of refinement. Other refined sugars may include: brown sugar, coconut sugar, and high fructose corn syrup. Natural sugars that may be obtained without or lesser refinement include molasses, maple syrup, and honey.

How Much Sugar?

Is added sugar really that bad? To keep it simple: in moderation no. But it can be a slippery slope. Too much added sugar can lead to weight management and other health issues.

Recommended daily limits of <50 g or <36 g in men and <25 g in women are suggested by the US Dietary Guidelines and American Heart Association respectively.

12 oz Coca Cola = 39 g	1 scoop of vanilla ice cream (Ben and Jerry’s) = 21 g
Hershey’s chocolate bar = 21 g	Starbuck’s grande caffe latte = 18 g

Potential Risks of Sugar

• Obesity
• Diabetes
• Heart disease– inconsistent risk amongst multiple studies
• Neurological– some studies demonstrate adverse neurological effects including: depression, anxiety, hyperactivity, and poor cognition.
• Gastrointestinal effects- gut microbiome disruption may lead to irritable bowel, digestive issues, and more.

These risks may be relevant and increased when sugar is consumed in excess.

Potential Benefits of Sugar

• Energy– a quick energy source, although not nutrient dense like carbohydrates.
• Taste– enhanced flavor making food or beverage more desirable.
• Antioxidants– depending on the formulation it may have antioxidants, protecting the body from cellular damage. However, the quantity is tiny; there are other nutrient dense foods high in antioxidants.
• Improved mood– a boost of happy may be short lived.

Artificial Sweeteners

Then along came artificial sweeteners. These “additives” may be just as sweet (or sweeter!) as sugar without causing a spike in blood sugar and with zero to very little calories. They are made through various chemical reactions.

• aspartame (Equal)
• sucralose (Splenda)
• acesulfame-K (Sweet One, Sunett)
• neotame (Newtame)
• saccharin (Sweet’N Low)

Other sugar substitutes include stevia leaf and monk fruit extracts and sugar alcohols. These are naturally occurring alternatives.

Possible Risks of Artificial Sweeteners

• Heart disease– studies have found increased risk. This may be in part due to increased “bad” cholesterol and risk of high blood pressure.
• Cancer– few older studies found increased cancer risk, particularly with aspartame. However, since then multiple studies have been performed and there is no confirmed association or causation at this time.
• Gastrointestinal (GI) effects– gut microbiome disruption may lead to irritable bowel, digestive issues, and more.
• Neurological– headaches, anxiety. This may be in part due to increased cortisol (a stress hormone)
• Diabetes– interestingly, studies have found increased risk type 2 diabetes.
• Male infertility– there have been few studies in rats which identified significant reduction in sperm count. However, there are other studies which do not identify this same risk. Studies in humans are lacking.

It appears that these risks may increase with long-term daily use. Confounding factors must be considered in several retrospective studies.

Possible Benefits of Artificial Sweeteners

• Little to no effect on blood sugar
• Appetite control/suppression
• Fewer to no calories
• Oral health– lesser cavities/tooth decay

In Conclusion

Sugar is essential for a healthy functional body. However, there are naturally occurring sugars (carbohydrates) and then there are added sugars. To mitigate adverse health effects of too much added sugar, sugar substitutes were discovered and developed. There are risks and benefits to each. You may have noticed that several of the risks were similar amongst added sugar and artificial sweeteners. Additionally, prospective human studies assessing these risks are limited. Based on available literature, knowledge, and experience: a little bit of added sugar is ok. If added sugar consumption is leading to so many empty calories that you turn to artificial sweeteners, then re-evaluate and reduce sugar intake. If you prefer sugar alternatives, stevia leaf and monk fruit extracts may be safer options. But less is better. Moderation is key.

Please reach out with questions, comments, or for further discussion.

Lindsey, PharmD, BCPS

References

Ghusn, W., Naik, R., & Yibrin, M. (2023). The impact of artificial sweeteners on human health and cancer association: A comprehensive clinical review. Cureus, 15(12). https://doi.org/10.7759/cureus.51299

Gillespie, K. M., Kemps, E., White, M. J., & Bartlett, S. E. (2023). The impact of free sugar on human health—a narrative review. Nutrients, 15(4), 889. https://doi.org/10.3390/nu15040889

Kearns, M. L., MacAindriu, F., & Reynolds, C. M. (2022). The impact of non-caloric sweeteners on male fertility: A systematic review and narrative synthesis in rodent models. Frontiers in Nutrition, 9. https://doi.org/10.3389/fnut.2022.854074

Mayo Foundation for Medical Education and Research. (2023, January 10). Pros and cons of artificial sweeteners. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936