Losing weight is something most of us are interested in doing. We are bombarded by advertisements for sugar-free and calorie-free products on a daily basis.
Are sugar-free products better?
Are they healthy?
What are the best options to replace sucrose?
This post will explore some alternatives to table sugar.
What we are looking for is a substance that:
- Contains very few if any calories or carbohydrates.
- Is safe for human consumption.
- Has either no effect, or a positive effect on blood sugar levels.
- Does not cause unwanted side effects when consumed at reasonable doses.
- Has research to support its safety.
- Contains no hidden sources of carbohydrates.
- Can be used in cooking. Does not decompose into simple sugars or become bitter or toxic when exposed to heat.
Sucrose
Sucrose is what we refer to as table sugar. This is the substance that all other sweeteners are compared to.
Sucrose is known as a disaccharide because it is composed of two monosaccharides, glucose, and fructose.
This substance is a natural compound found in plants.
Sucrose is obtained mostly from sugarcane in hot climates and sugar beets in colder regions. Hot water is used to extract the sucrose, and this mixture is then concentrated into a syrup. The syrup is then crystallized to make table sugar.
One teaspoon of table sugar contains about 16 calories and 4 grams of carbohydrates. These are known as “empty calories” because they are very limited in their nutritional value and contain no vitamins or minerals.
The glycemic index (GI) is a measure of how quickly a food increases blood sugar levels.
Foods with a low GI typically release glucose slowly and steadily, whereas those foods with a high GI release glucose into the bloodstream rapidly, causing a “spike” in blood glucose levels.
Spikes in blood glucose cause the body to release more insulin, which can lead to health problems over time. Some of these include metabolic syndrome, diabetes, and insulin resistance.
Those foods that contain fiber, fat, and or protein have a lower glycemic index because the body cannot digest the food as quickly.
The glycemic load (GL) is a measure of the effect a serving of food will have on the blood sugar level.
The GL is obtained using the following equation:
Glycemic Load (GL) = Glycemic Index (GI) x Carbohydrate (g) per portion /100
A low GL = 1-10
Moderate GL = 11-19
High GL = greater than 19.
The glycemic load is significant because it takes into account the amount of food being consumed, which leads to a more accurate estimate of the effect of the food on blood sugar.
The table below lists GI and GL values for some common foods.
There are three main types of sweeteners.
- Natural Sweeteners
- Sugar Alcohols
- Artificial Sweeteners
Natural Sweeteners
Stevia, also known as the sugar leaf, is 100 to 300 times sweeter than table sugar. This natural sweetener has been used in South America for its sweetening properties for hundreds of years.1
Stevia is calorie-free. This is the sweetener I choose to use.
Stevia has some studies to suggest it may lower blood pressure.2
Another study has shown no significant change was seen in patients with mild hypertension.5
Stevia is sweet but doesn’t taste much like sugar. It also has a bitter aftertaste, which some dislike.
Some individuals may suffer from digestive problems when using stevia.
Stevia: GI = 0, Net Carbs (per 100g) = 5, Calories (per 100g) = 20
Allulose is a sugar that resembles fruit sugar or fructose. This sugar is only about 70% as sweet as table sugar. Although not calorie-free, allulose provides about 0.4 calories per gram (g), which is much lower than sucrose. The body does absorb this sugar but does not metabolize it into glucose.
A 2018 study of 144 individuals with a BMI greater than or equal to 23 kg/m2 found allulose was able to reduce body weight in overweight or obese subjects. This study also stated that the effects are likely dose-dependent.6
Another study from 2015 suggested allulose may also have benefits for type 2 diabetes.7
Some studies suggest It may even have antioxidant and lipid-lowering effects, although more studies are needed to confirm this.
Allulose has no glycemic index or net carb count because it is excreted by the body unchanged.
This substance is more expensive than some other sweeteners and not as sweet as table sugar.
Allulose GI = 0, Net Carbs (Per 100g) = 0-5, Calories (Per 100g) = 20-40
Monk Fruit is a medicinal fruit from China.
It has been used as a digestive aid and in the treatment of the common cold.
Monk fruit sweetener is 100-250 times sweeter than sugar and contains no calories, carbohydrates, or sugars.
Like stevia, this product may leave a bitter aftertaste. The sweetness comes from mogrosides that are antioxidants separated from fresh-pressed juice during processing.
Monk fruit is more expensive than some other sweeteners but is a viable healthy option.
Monk fruit GI = 0, Net Carbs (Per 100g = 0-25, Calories (Per 100g) = 0-100
Tagatose is a monosaccharide that occurs in some fruits such as apples, oranges, and pineapple. It can also be found in sterilized milk.
This substance is about 92% as sweet as table sugar but only contains about 38% of the calories. This sugar has a minimal effect on insulin and blood glucose levels.
Tagatose contains more calories than some other sweeteners and is also more expensive than some.
Tagatose has also been shown to have some probiotic properties.
Tagatose GI = 3, Net Carbs (Per 100g) = 35, Calories (Per 100g) = 150
Inulin is a soluble fiber found in some plants. It is also a prebiotic, meaning it feeds beneficial bacteria in the gut.
Inulin has also been shown to improve the body’s ability to absorb calcium, which may lead to stronger bones and teeth.8
This sweetener is only 35% as sweet as sugar. The good news is, inulin caramelizes like sugar and doesn’t have a bitter aftertaste. The bad news is, it may cause gastrointestinal symptoms to become worse.
Another problem with inulin is that if heated above 275 degrees Fahrenheit, a portion of the molecule will break down into fructose.
Fructose will not spike blood sugar levels, but it does contain calories.
Inulin GI = 0, Net Carbs (Per 100g) = 1, Calories (Per 100g = 150
Sugar Alcohols
Sugar alcohols, or polyols, are substances that are hard for the body to metabolize and thus have less effect on blood sugar than table sugar. Since these are hard to digest, they are mostly broken down by bacteria in the large intestine. This can lead to gas and bloating, especially at higher doses.
These molecules are not sugars or alcohols. They are carbohydrates that have a structure that resembles sugars and alcohol. Besides providing a sweet taste to foods, sugar alcohols add bulk and texture and inhibit browning.
An advantage of sugar alcohols is that they are not acted on by bacteria in the mouth, and because of this, do not promote tooth decay.9
One of these substances, xylitol, has been found to inhibit bacteria.
There are many sugar alcohols. This post will focus on just three.
Xylitol (pictured above) is as sweet as table sugar and is found in fruits and vegetables.
This substance has 40% fewer calories than sugar.
Xylitol is great for your teeth because it starves harmful bacteria in the mouth and increases calcium absorption into the teeth. This leads to its widespread use as a sweetener in gums and toothpaste.
Please be aware that this sweetener is toxic to many animals, including dogs and cats, even in small doses.
Keep this substance and anything containing it away from your pets.
Xylitol may cause excessive gas and bloating especially at higher doses.
Xylitol GI = 13, Net Carbs (Per 100g) = 60, Calories (Per 100g) = 240
Erythritol is present in some fruits and vegetables. It is the sugar alcohol with the lowest calories and net carbs.
This sweetener also causes fewer GI complaints compared to the other sugar alcohols because it gets metabolized before reaching the colon.
Erythritol has been available as a sweetening agent since 1990.
It does produce a cooling sensation on the tongue, especially when used in large quantities.
Erythritol GI = 0, Net Carbs (Per 100g) = 5, Calories (Per 100g) = 20
Maltitol is commonly used as a sugar substitute because it tastes and bakes similarly to sugar with fewer calories.
It does have a higher glycemic index than the other sugar alcohols and can spike insulin levels.
I would advise against consuming products containing maltitol if you are trying to lose weight. The other problem is this sweetener tends to cause more bloating, abdominal pain and diarrhea when compared to erythritol and xylitol.
Maltitol GI = 36, Net Carbs (Per 100g) = 67, Calories (Per 100g) = 270
Artificial Sweeteners
Artificial sweeteners are the compounds synthetically produced to replace sugar. These are sucralose, aspartame, and saccharin.
Aspartame is contained in one of my favorite soft drinks, Diet Coke. Drinking this beverage is one of the few bad habits I have that affect my health. Let us take a look at these sweeteners.
Aspartame is probably the most studied artificial sweetener. This substance is 200 times sweeter than sucrose. If you consume sugar-free products, chances are you are being exposed to aspartame. There have been reports of aspartame causing everything from headaches to cancer.
Aspartame is composed of aspartic acid and phenylalanine. These are both amino acids. When aspartame is metabolized in the body, a portion of it is converted to methanol. Methanol is toxic in large doses.
Those who have phenylketonuria (PKU) and those taking medications for schizophrenia or Parkinson’s disease should avoid aspartame. Those with PKU already have too much phenylalanine in their blood. Aspartame is toxic to these individuals.
Aspartame may increase the risk of tardive dyskinesia in those receiving antipsychotic medications.
A study published in 2014, found rats fed a diet containing aspartame experienced hyperglycemia and insulin resistance. This is thought to be due to its effect on the gut microbiota.10
Aspartame GI = 0, Net Carbs (Per 100g) = 85, Calories (Per 100g) = 352
Sucralose is 600 times sweeter than table sugar. This substance is very poorly absorbed by the body. It becomes unstable when heated and can release cancer-causing substances, so do not use it in cooking.
Notice that the GI for sucralose has a range. In its powdered form, sucralose has a higher GI than sucrose, which can lead to large insulin spikes.
Sucralose GI = 0-80, Net Carbs (Per 100g) = 0, Calories (Per 100g) = 0
Saccharin is one of the oldest sweeteners available. It is 400 times sweeter than sugar. This sweetener is not as popular as it used to be due to the bad press it has received. It has been shown to cause cancer in animal models.
Since these studies can not be performed in humans, we are not sure of its cancer-causing potential.
There have also been studies that have shown saccharin, and other artificial sweeteners can cause glucose intolerance by altering the intestinal microbiota.11
Saccharin GI =variable, Net Carbs (Per 100g) =94, Calories (Per 100g) = 364
There were no surprises found while writing this post. Here are my recommendations:
- Avoid artificial sweeteners. Although we don’t have concrete evidence that they are harmful, I believe the risks outweigh the benefits.
- Xylitol is a good option for dental products because it increases calcium absorption into the teeth and decreases harmful bacteria.
- Monk fruit is a reasonable option as its sweetness comes from antioxidant compounds.
- Stevia is also a good choice, although it may produce a bitter aftertaste that some may not prefer. It also has a different taste than sucrose.
- It is crucial to avoid high fructose corn syrup whenever possible. This is a highly processed sweetener that has been linked to heart disease, type 2 diabetes, and obesity.
I plan to write an entire blog post on aspartame in the near future. This sweetener is very popular and I want to give my readers a better understanding of the health effects of using it.
Please read your food labels and remember, it is always best to eat whole foods. Limit artificial and processed foods.
Drink plenty of water, at least eight, 8 oz. glasses per day and exercise for at least 30 minutes five times per week.
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
Samuel P, Ayoob KT, Magnuson BA, et al. Stevia Leaf to Stevia Sweetener: Exploring Its Science, Benefits, and Future Potential. J Nutr. 2018;148(7):1186S‐1205S. doi:10.1093/jn/nxy102
- Hsieh MH, Chan P, Sue YM, et al. Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study. Clin Ther 2003;25:2797-808.
- Chan P, Tomlinson B, Chen YJ, et al. A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Br J Clin Pharmacol 2000;50:215-20.
- Geuns JM. Stevioside. Phytochemistry 2003;64:913-21.
- Ferri LA, Alves-Do-Prado W, Yamada SS, et al. Investigation of the antihypertensive effect of oral crude stevioside in patients with mild essential hypertension. Phytother Res 2006;20:732-6.
- Han Y, Kwon EY, Yu MK, et al. A Preliminary Study for Evaluating the Dose-Dependent Effect of d-Allulose for Fat Mass Reduction in Adult Humans: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2018;10(2):160. Published 2018 Jan 31. doi:10.3390/nu10020160
- Hossain A, Yamaguchi F, Matsuo T, et al. Rare sugar D-allulose: Potential role and therapeutic monitoring in maintaining obesity and type 2 diabetes mellitus. Pharmacol Ther. 2015;155:49‐59. doi:10.1016/j.pharmthera.2015.08.004
- Krupa-Kozak U, Swiątecka D, Bączek N, Brzóska MM. Inulin and fructooligosaccharide affect in vitro calcium uptake and absorption from calcium-enriched gluten-free bread. Food Funct. 2016;7(4):1950‐1958. doi:10.1039/c6fo00140h
- Wolever, T.M.S., et. al. Sugar alcohols and diabetes; a review. Canadian Journal of Diabetes 2002; 26:356.
- Palmnäs MS, Cowan TE, Bomhof MR, et al. Low-dose aspartame consumption differentially affects gut microbiota-host metabolic interactions in the diet-induced obese rat. PLoS One. 2014;9(10):e109841. Published 2014 Oct 14. doi:10.1371/journal.pone.0109841
- Suez, J., Korem, T., Zeevi, D. et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 514, 181–186 (2014). https://doi.org/10.1038/nature13793
