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Excess sugar isn’t healthy, but are substitutes any better? Here's alook at the research.

By Rachel Meltzer WarrenApril 26, 2019

Trying to consume less sugar? About 75 percent ofAmerican adults are, according to a survey from theInternational Food Information Council. But thatdoesn’t mean they’re ready to give up sweet flavors.“We are biologically programmed to like sweet things,”says Nicole Avena, Ph.D., an assistant professor ofneuroscience at the Icahn School of Medicine at MountSinai in New York City.

Replacing sugar with low-calorie sweeteners, such asaspartame, stevia, and sucralose, is one way peopleattempt to solve this conundrum, but some studies

The Truth About Sugar vs.Artificial Sweeteners

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suggest that they might not be better for you thansugar. Where does that leave people who don’t want togo cold turkey on sweetness? Here’s a look at how ourbodies respond to sugar and low-cal sweeteners.

Cravings ExplainedOur first food—breast milk or formula—is sweet, andhumans have evolved to equate sweet tastes withsafety, Avena says. For our early ancestors, sweetflavor indicated that a food was okay to eat (bitterfoods were more likely to be harmful) and containedcalories—important for survival at a time when calorieswere hard to come by.

Throughout life,we reinforce thispreference.Whether it’s cakeat a birthday partyor ice cream after abad day, sweetfoods are used tocelebrate andsoothe. Cues in our

environment can cause our brains to release thechemical dopamine. “That can trigger a desire to havethe food so we feel good,” Avena says.

Combine these tendencies with our modern foodenvironment, where sweet foods are everywhere—and


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even savory ones, such as tomato sauce and saladdressing, may contain added sweeteners—and you seewhy kicking sugar is difficult. Humans no longer haveto forage for calories, but “our diet is sooversweetened, and we’re drawn to eat pretty mucheverything,” Avena says.

The Health Toll Sugar Takes“Sugar is a completely nonessential part of our diets,”says Kimber Stanhope, Ph.D., R.D., a researchnutritional biologist in the department of molecularbiosciences at the University of California, Davis. Thehealth risks of getting too much added sugars—thoseadded to foods, not the sugars naturally present infoods—are pretty well-established.

For starters, added sugars equal empty calories,providing few if any nutrients. The weight gain thatresults from consuming excess calories from anysource increases the risk of type 2 diabetes, high bloodpressure, heart disease, stroke, certain cancers, andmore.

And too much added sugar may be harmful even if itdoesn’t cause you to put on pounds. It’s also linked toan increased risk of type 2 diabetes, fatty liver, andother diseases, Stanhope says. People who ate 25percent or more of their daily calories in the form ofadded sugars were more than twice as likely to die ofheart disease over the course of 15 years as those who


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got less than 10 percent of calories from added sugars,regardless of their weight, according to a studypublished in JAMA Internal Medicine.

That’s why several health authorities advise limitingintake. The Dietary Guidelines for Americans saysadded sugars should make up no more than 10 percentof your daily calories. That’s about 10 teaspoons (40grams) for someone eating 1,600 calories. TheAmerican Heart Association’s recommendation is evenlower—about 6 teaspoons (25 grams) for women and 9teaspoons (38 grams) for men.

Currently, counting added sugars in your diet isn’teasy, because the Nutrition Facts labels on foods listonly total sugars, which includes the natural sugars infoods such as fruit. That will change next Januarywhen new regulations for the Nutrition Facts label willgo into effect. Manufacturers will have to list both.

Low-Cal Sweetener EffectsIn advance of those changes and to appeal to health-conscious consumers, many food companies arecutting back on sugars in products, according to themarket research firm Euromonitor. But that doesn’talways mean they’re making them less sweet.

Manufacturers have long used low-calorie sweetenersto deliver the sweet hit consumers crave without thesugars or calories; think diet soda and low-cal yogurts.


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But combining sugar substitutes with sugar in productsis an approach manufacturers are using more andmore to formulate lower-sugar products—and list lowadded-sugar content on labels—without compromisingon the sweetness. This strategy is used even in foodsyou don’t think of as sweet, such as whole-grainEnglish muffins and vegetable juices.

There’s no question that low-calorie sweetenersprovide a sugary flavor without the calories of sugar.But the latest evidence suggests that might not lead toa positive effect on health or weight.

Most recently, a major research review published inBMJ found that the evidence that sweeteners aid oralhealth, blood sugar levels, or other health problems isextremely limited. While the Food and DrugAdministration considers low-calorie sweeteners safefor consumption, some scientists say we don’t have thedata to exclude potential harms. Another recent studypublished in the journal Stroke found that women 50and older who drank 24 or more ounces (two cans) ofdiet soda a day were 23 percent more likely to have astroke than those who drank less than 12 ounces aweek. Previous research has linked low-caloriesweeteners to possible heart problems, type 2diabetes, and potentially harmful changes in the gutmicrobiome.

As for weight loss, results of studies have been mixed;some have linked low-calorie sweeteners with weightgain. “If used appropriately, they can be an effective


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aid for weight management,” says Richard Mattes,Ph.D., R.D., director of the Ingestive Behavior ResearchCenter at Purdue University in West Lafayette, Ind.

But experts say that the types of low-caloriesweeteners may have less in common with each otherthan many studies have accounted for, and that more research is needed. “Everything about them isdifferent, so why do we think we can lump themtogether?” says Mattes, who is studying how a varietyof low-calorie sweeteners behave in the body.

Curbing a Sweet ToothRegardless of how different sweeteners affect ourbodies, consuming them regularly may play a role inhow you eat overall. When people take in less salt andfat, they have what’s called a hedonic shift—in otherwords, they come to prefer foods that have less saltand fat in them. The research on sugar is evolving, butexperts say it’s reasonable to think that sweetness,regardless of the source, would keep us fancying thosesweet flavors. “We get accustomed to a certain level ofsweetness," Mattes says, "and that becomes ourpreferred level.”

What’s more, popular sweet foods—soft drinks, energydrinks, sports drinks, desserts such as cake andcookies, fruit drinks, candy, and dairy desserts—don’tpromote health. Lower-calorie versions of those foodsscore points for having fewer calories but they aren’t


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nutritious.

Cutting back on sweeteners altogether may be yourbest bet to minimize dependence, Avena says. Butthere are exceptions. When a little sweetener makesyou more likely to eat nutrient-dense foods—say,oatmeal instead of a doughnut for breakfast—it may beworth it. “If you weren’t going to eat the oatmealwithout the sugar, you’d be doing yourself a favor,”Mattes says. The key, regardless of the sweetener, is tonot go overboard.

Sugar substitutes may also be helpful as a steppingstone on the way to a more healthful diet, especially inregard to drinks. “The goal isn’t to get people to switchfrom sugar to diet [drinks],” says Vasanti Malik, Sc.D., aresearch scientist in the department of nutrition at theHarvard T.H. Chan School of Public Health. “It’s to getpeople to switch from sugar to water, but diet [drinksor foods] might be an intermediate way to help them.”

Editor’s Note: This article also appeared in the May2019 issue of Consumer Reports On Health.


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