Are Alternative Sugars Healthy and Safe?

by | Dec 1, 2021 | Nutrition, Real Food

Image: Shutterstock

Good question. The majority of clinical studies performed thus far report no significant effects or beneficial effects of artificial sweeteners on body weight and glycemic control.

Since 2016, the FDA has required food companies to state the quantity of added sugars on packaged food labels. This was a step in the right direction, since added sugars have been proven to contribute to type 2 diabetes, obesity, and heart disease. As consumers have become less inclined to buy foods with the high doses of added sugars found in many processed foods, food manufacturers have increasingly turned to sugar alternatives. While it’s true that such alternative sugars carry fewer or no calories in comparison to added sugars, the question remains, is the replacement of added sugars with alternative sugars really a good idea?

While the quantity of added sugars is required on the food nutrition label, alternative sugars, also referred to as “non-nutritive sweeteners,” are not regulated in this way. Consequently, they appear only in the ever-growing list of approved food additives with unfamiliar scientific names which appear as ingredients. Non-nutritive sweeteners include some that are chemically manufactured and some that come from natural sources:

Chemically manufactured non-nutritive sweeteners

  • Acesulfame K Sunett® and Sweet One®
  • Aspartame Nutrasweet®, Equal®, and Sugar Twin®
  • Neotame Newtame®
  • Saccharin Sweet and Low®, Sweet Twin®, Sweet’N Low®, and Necta Sweet®
  • Sucralose Splenda®

Naturally produced non-nutritive sweeteners

  • Steviosides Stevia®, Truvia™, Sun Crystals®, PureVia™, Sweetleaf Sweetener™
  • Luo Han Guo Fruit Extract / Monk Fruit

Sugar alcohols are another category of sugar alternatives, which manufacturers may or may not choose to include on the nutrition facts label.

Sugar alcohols are not calorie free. Gram for gram, they contain about 1/3 – 1/2 the calories of table sugar. They do sweeten food, but they are not completely absorbed by the body, and once they reach the large intestine, they are fermented by bacteria. This can lead to gastrointestinal distress such as abdominal gas, bloating, and diarrhea. In fact, foods with added sorbitol or mannitol must include a warning on the label stating, “excess consumption may have a laxative effect” [1]. To avoid these undesirable effects, be on the lookout for the following names of sugar alcohol:

  • Erythritol
  • Hydrogenated Starch Hydrolysates (HSH)
  • Isomalt
  • Lactitol
  • Maltitol
  • Mannitol
  • Sorbitol
  • Xylitol

Now that you can identify which alternative sugars may be in the food you’re buying, you may still be wondering, are they safe and healthy?

Good question. As to “healthy,” a primary reason to consume alternative sugars is as a weight-control strategy. A 2021 review [2] of studies related to health effects of non-nutritive sweeteners determined that “…long-term studies in humans are scarce. The majority of clinical studies performed thus far report no significant effects or beneficial effects of artificial sweeteners on body weight and glycemic control, but it should be emphasized that the duration of most studies was limited.”

As to “safe”, alternative sugars are categorized by the FDA as GRAS, an acronym for Generally Recognized As Safe. That classification was originally created to allow food substances and additives with a long history of apparently safe usage prior to 1958 to be permitted without extensive further testing. The GRAS category has since been extended to include foods that the FDA deems have been demonstrated to be safe by scientific research, much of which is carried out by the manufacturers of the additive. The same 2021 review has concluded that “further well-controlled, long-term human studies investigating the effects of different artificial sweeteners and their impact on gut microbiota, body weight regulation and glucose homeostasis, as well as the underlying mechanisms, are warranted.” In the meantime, you decide.

In summary:

  • You’ll need to be alert to monitor your alternative sugar intake. It can take some detective work to determine whether and what alternative sugars have been added to your food—and it may be impossible to determine how much.
  • The safety and health effects of alternative sugars have not been proven in long-term human studies.
  • Chemically manufactured alternative sugars and sugar alcohols are found only in processed and highly processed foods, never in real food. For that reason alone, spotting them in an ingredient list might make you think twice about your food purchasing decisions.
Fundamentals of Health Alliance

Fundamentals of Health Alliance


The Fundamentals of Health Alliance works to publish useful and reliable information about nutrition and health. Their mission is to empower readers to be informed with honest, non-biased information about food, nutrition and the vital components of health.

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