Sugar Substitutes

"Are you sure those things are good for me?"

"I heard they cause cancer."

"Just don't eat sugar... at all."

"It's all chemicals."

Ever heard any of these statements? Do you feel run down by the heaps of evidence (or lack there of) regarding artificial sweeteners? Yes, I'm talking about: Splenda, Equal, Sweet & Low, Stevia, just to name a few. Are you overwhelmed by the vast amount of "chemical"sweeteners that you can't even fathom figuring out what's good or not-- so you avoid them all together? Well, I get it, even as a Registered Dietitian, I'm plagued with these questions daily.

Let's start from the beginning. What is sugar?

Sugar at the molecular level is a string of glucose molecules that together form carbohydrates. There are typically two kinds of carbohydrates out there: simple (also known as "sugar") and complex. Simple, as the name suggests, contain a small number of glucose, fructose, or galactose molecules. Complex carbohydrates, however, contain more molecules in different sequences and arrangements, are water insoluble and are higher in molecular weight.

Glucose is essential to the body's survival.

The brain cannot survive without glucose. But our body is so well adapted that it can essentially "create" glucose within the body, even if you don't eat it in order to provide energy for life-sustaining organs. At a minimum, the body requires 50 gm carbohydrates per day in order to prevent what's called ketosis (a topic for a later day). However, the required carbohydrate intakes are estimated to be ~ 200 gm per day. The Western diet, however, is likely to contain way more carbohydrates than what is recommended.

If glucose cannot readily enter our blood cells to be used for energy, it stands outside of the cell and accumulates in our blood--hence, the term "high blood sugar". These sugar molecules require the use of a hormone created in your pancreas, insulin. However, when the insulin produced by your pancreas cannot keep up with the demand of glucose coming from your diet or your body's reserves, it begins to overproduce and eventually tire out, leading to Diabetes Mellitus.

However, non-sugar, artificial sweeteners are processed differently. Because these chemically-created sweeteners do not have any nutritive values, they also do not contain glucose. Therefore, they do not require the use of insulin to be shuttled into the cells. There is still some controversy as to whether artificial sweeteners may still spike blood sugars, but at the molecular level, they are not glucose which is why they are commonly suggested for those with diabetes compared to table sugar.

Artificial sweeteners as approved by the FDA are: saccharin, acesulfame, aspartame, neotame, and sucralose. Stevia is not on this list, because it is considered a "natural low-calorie sweetener", not a "no-calorie sweetener"-- semantics ladies and gentlemen. Generally, these sweeteners provide all the sweetness of sugar (and then some) without the added calories. In addition to their lack of calories, artificial sweeteners also have no nutritional value. The do not provide you any vitamins, minerals, etc., but neither did plain table sugar!

According to Dr. Christopher Gardner, an associate professor of medicine at Stanford University in California, “While they are not magic bullets, smart use of non-nutritive sweeteners could help you reduce added sugars in your diet, therefore lowering the number of calories you eat. Reducing calories could help you attain and maintain a healthy body weight, and thereby lower your risk of heart disease and diabetes." Similarly, the opinion of the American Heart Association and American Diabetes Association, is that "substituting non-nutritive sweeteners for sugars added to foods and beverages may help people reach and maintain a healthy body weight – as long as the substitution doesn’t lead to eating additional calories later as compensation."

As Dietitians, we know full well that going "cold turkey" on a diet plan, is never going to work-- it just isn't sustainable. If you cut out desserts all together, swear off sugar forever, the cravings will become so intense, you will feel as though something has overtaken your body and forced you to catapult yourself into the nearest Dunkin Donuts stuffing your face with munchkins. But for people with Diabetes (specifically, type 2) and for those at risk for diabetes, having high blood concentrations of glucose for a sustained period of time is dangerous, fatal even. Therefore, the continued curbing of sugar-sweetened items is key. So it's safe to say if blood sugar control is your priority, swapping a few sugar packets for artificial sweeteners won't cause any harm and may help you reduce a few calories!

So just stop eating sweets. It's not that hard.

Yes it is-- and i'm a Registered Dietitian, i'm suppose to be good at this! We all love sugar, we crave it! It's actually wired as a craving and addictive substance in our brains. A little bit of sugar (especially mixed with fats like butter and lard) throws off synapses in our brain causing us to want more and more. So curbing your sugar intake can be very difficult! The FDA has determined that non-nutritive, artificial sweeteners are safe for consumption. They are helpful, low-calorie/no-calorie way to satisfy your sweet tooth, without adding more calories to your diet, reduce your risk of hyperglycemia, and may help you lose a little weight. However, you cannot replace the calories removed from a packet of regular sugar with say, a donut.

Now, I'm not saying every single person should switch to artificial sweeteners such as Splenda, Equal, and Sweet-n-Low, or that switching to chemical sweeteners will magically cure the obesity epidemic. There is more to weight loss than merely calorie deficits. But, let's do the math together. Making one simple swaps from, lets say 3 regular soda's per day to having 3 diet (artificially-sweetened) sodas, can cut down on 75 grams of sugar per day! That's a lot of sugar!

I've read countless articles and newsletters comparing soda, pastries, and the use of non-nutritive sweeteners to the act of eating an apple. Such that, authors sign off their articles by stating how instead of the sweeteners they will "stick to eating an apple instead". Well, I hate to burst your bubble, but this is not a fair comparison. Of course eating an apple is better than a sticky bun, no one is refuting that. However, an apple, or any fruit for that matter, has a mixture of carbohydrate molecules not just table sugar, in fact it doesn't even have any table sugar! Majority of the carbohydrates in fruit is Fructose, but some contain pectins and cellulose which are fibers, that cannot be digested for energy in human bodies. Therefore, we are comparing an item that contains fiber, vitamins, minerals, phytochemicals, natural occurring sugar--- to sugar cubes and plain cane sugar-filled-black-tar-colored beverages? Nope not the same thing. So your heroic, uber healthy sign offs don't make sense to this Dietitian, sorry.

We cannot dispute the high-volume consumption of non-nutrient dense, sugar-laden foods in our society. My motto has and always will be that health and weight are not the same thing, but they are correlated at times. The decision between artificial sweeteners and natural-occurring, sweet foods such as fruits and dairy products, is a matter of health goals.

What are your health goals?

At this moment, what is your health goal? Right now. Is your goal to:

Lose weight?

Become more 'healthy'?

Eat more fruits and vegetables?

Remove processed foods/junk food from your diet?

Or do you have a chronic disease, such as Diabetes, that needs managing?

For me, it is always important to consider one's health goals when faced with this argument of artificial sweeteners. Many patients have asked me, "well are artificial sweeteners safe?" To which, I answer: "When used in the appropriate amounts, the FDA has approved the five alternative sweeteners (listed above) as being safe for consumption." The next question is always, "Do you use artificial sweeteners?" I always stay true and honest, as I will with you today. Yes, I do use artificial sweeteners in things I absolutely HAVE to make sweet. I've slowly weaned myself off of the need to use sugar in coffee and tea and I do not bake with any artificial sweeteners. My thoughts with baking are, you don't have to have a cookie. You are making a conscientious choice to eat a cookie which is fine, because life is about balance-- but eat the real, damn cookie. Junk food and desserts are still the same thing, even if they are made with Splenda or Equal. I also have learned to have limits and make trade offs. I will forgo the real sugar packet or the new hype "agave-syrup" in my morning coffee but, when I really want a whole bagel and jam-- I'll do it. Trade offs are my friend. They are also the way I have maintained long-term health goals.

But, in the case of Diabetes, or glucose mismanagement, simple swaps to artificial sweeteners as you begin to wean yourself off the dependence from sugar-laden items, may be crucial to your health. Nutrition, health, and food is an individual journey! What works for one person is not going to work for another. So don't let the fear of "chemically-processed" artificial sweeteners give you the fear of not using them appropriately, if they help you reach your current health goal. As always, follow up with your health care provider/primary care physician for any health care advice and management of your chronic disease symptoms. Ask them what they think of artificial sweeteners!

And as always, food should be fun-- so take everything in moderation as you reach your health goals to promote sustainability!


Strawbridge, H. (2012). Artificial sweeteners: sugar-free, but at what cost?. Harvard Health Blog [Blog]. Recuperado de: http://www. health. harvard. edu/blog/artificial-sweeteners-sugarfree-but-at-what-cost-01207165030.

Gardner, C., Wylie-Rosett, J., Gidding, S. S., Steffen, L. M., Johnson, R. K., Reader, D., & Lichtenstein, A. H. (2012). Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation, 126(4), 509-519.

Non-Nutritive Sweeteners (Artificial Sweeteners). American Heart Association.

Mueller, C., Kovacevich, D., McClave, S., Miller, S., & Schwartz-Baird, D. (2012). The ASPEN nutrition support core curriculum: a case-based approach-the adult patient (Vol. 1). Silver Spring, MD: American Society for Parenteral and Enteral Nutrition.