Are There Any Healthy Sugar Substitutes?
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Are There Any Healthy Sugar Substitutes?
If you’ve been diagnosed with breast cancer and have come across some advice that you should avoid sugar because it helps cancer to grow, that’s good advice. So now maybe you’re wondering about whether there are any healthy sugar substitutes – I mean there are loads of these sweeteners out there, but are they safe, viable options for sweetening our food? Do sugar substitutes come with side effects?
I’ve written about this subject before in 2014 (see my article “Are Artificial Sweeteners Safe?”) and I’m writing about it again because it is still a hot topic and there is much to know.
If you are one of those that feel like certain foods or beverages can’t be consumed without some sort of sweetness being added, I get it, I truly do. But there are some important things to know about sugar substitutes, especially if you are healing from breast cancer.
Sugar Substitutes, Artificial Sweeteners
Some sugar substitutes are made up of substances that the body is unable to absorb – our bodies lack the enzymes required to digest them. Many are made from sugar alcohols, which surprisingly enough are neither alcohol nor sugar. Some are made up of acids blended with potassium, some are made from other artificial sweeteners plus other ingredients. All of these substances are many times sweeter than honey or sugar – according to Cancer.gov, sugar substitutes range in sweetness from 200 to 20,000+ times sweeter than regular table sugar. 
I decided to delve deeply into this subject and have a look at the research on sugar substitutes and what I discovered is that all sugar substitutes are not the same. Far from it! I’ve done my best to succinctly explain how each one is made, and which ones are safe and which are not.
I think one of the things that bothers me most about sugar substitutes is that many of them can still raise blood glucose levels – the very thing we are relying on them NOT to do. That’s a good thing to be wary of – just because a food is labeled ”sugar-free”, that doesn’t necessarily mean it is free of carbohydrates or that it won’t raise your blood sugar levels.
There are a huge number of sugar substitutes – some natural and some very decidedly not. Some are better than others. Here is a list of the major ones:
Acesulfame potassium – Brand names Sweet One, Sunett. Made from an acid plus potassium. The US Food and Drug Administration (USFDA) advises over 90 studies have confirmed that acesulfame potassium is safe for consumption. Regardless of that, here’s some disturbing info that I found. A 2014 study  found that acesulfame potassium enhanced glucose absorption in the cells of the small intestine.That means that this sugar substitute HELPS you absorb sugar better. A 2017 animal study  found that acesulfame potassium given to mice for four weeks messed up their gut microbiome, reducing beneficial gut bacteria; and caused weight gain in the male mice, but not the female. While it’s true that the 2017 study used higher amounts than would normally be consumed, this one still gets a thumbs down from me. As old Ben Franklin used to say, “When in doubt, don’t.”
Advantame – Made from aspartame and vanillin (from the vanilla bean). It’s about 20,000 times sweeter than sugar. Okayed for use by the USFDA but because it’s made with aspartame, it’s on my “avoid” list (see aspartame, below).
Aspartame – Brand names NutraSweet, Equal, Sugar Twin. Made from the amino acids aspartic acid and phenylalanine. Again, the USFDA says over 100 studies have proven it safe, but see point #5 below. In addition, Harding Medical Institute (and many other doctors) consider aspartame to be a neurotoxin.  Definitely on my to be avoided list.
Erythritol – A sugar alcohol manufactured firstly by enzymatic breakdown of starch from corn to generate glucose. Glucose is then fermented with yeast or some other fungus to produce erythritol. This is one of the better ones – it’s easy to digest, and low on the glycemic index. Okay to consume in moderate amounts if it’s ORGANIC because of the prevalence of GMO corn. Dr Michael Greger at NutritionFacts.org has put compiled some helpful information on erythritol in his video “A Harmless Artificial Sweetener”.  According to Dr Greger, erythritol is the one sugar substitute that he considers to be safe enough for his family. It rates a thumbs up from me as well.
Lactitol – A sugar alcohol manufactured from whey, a by-product of cheese making. Said to be safe by government authorities. I found several studies indicating that it was being used as a remedy for constipation.  Many sugar alcohol sweeteners do have a laxative effect, being very poorly absorbed. If you already have gut issues or are on a low-FODMAP diet, this one is better off avoided. If you suffer with constipation, it might not be a bad one for you (TIP: for chronic constipation, look into colonic hydrotherapy and even emotional healing because this is often the result for people who have a difficult time letting things go – but that’s a whole other topic!).
Maltitol – A sugar alcohol manufactured through the hydrogenation of maltose, which is obtained from the enzyme conversion of starches, often from corn. Seems innocuous enough, but it rates pretty high on the glycemic index, can cause gut problems, and there’s that corn connection – if maltitol is made with GMO corn, it’s not safe for consumption.
Mannitol – A sugar alcohol manufactured through the hydrogenation of fructose, which is formed from either sucrose (table sugar) or starch. It also occurs naturally in certain things like strawberries, watermelon, peaches, mushrooms, celery, onions, and a few other food sources. It is low on the glycemic index, but being a sugar alcohol, it is very poorly absorbed and can cause gut issues, including diarrhea. If you already have gut issues or on a low-FODMAP diet, it’s better off avoided.
Monk fruit extract – Comes from the plant Siraitia grosvenorii. Brand names Nectresse, Monk Fruit in the Raw, PureLo. It’s up to 400 times sweeter than sugar, but quite low on the glycemic index. The sweetness of monk fruit comes from phytochemicals known as mogrosides, which the body processes differently than sugars like fructose and sucrose. No carbs, no calories, completely natural. That’s a big yes if used in moderation.
Neotame – Brand name Newtame. Made from aspartic acid, phenylalanine, a methyl ester and what is known as a neohexyl group. It’s similar to aspartame but created to only release small amounts of phenylalanine. Neotame is up to 13,000 times sweeter than sugar and low on the glycemic index, but caution is warranted. Harding Medical Institute called it a neurotoxin like aspartame . A 2018 study on mice  found that it altered their gut microbiome, reducing the diversity of beneficial gut bacteria and increasing more harmful bacteria. In her book “Sweet Poison – How The World’s Most Popular Artificial Sweetener Is Killing Us – My Story” , Dr. Janet Hull states “Neotame contains all the dangerous elements found in aspartame and more…” This one gets a big thumbs down.
Saccharin – Brand names Sweet Twin, Sweet ‘N Low, NectaSweet. It comes in four forms: acid saccharin, potassium saccharin, sodium saccharin and calcium saccharin. It is made by combining methyl anthranilate (found in many fruit juices) with one of these four forms of saccharin. Saccharin is up to 700 times sweeter than sugar and has no calories. Approved for use by the USFDA. One 2008 study  found that in rats who were exposed to cocaine, and then given a choice between oral saccharin or intravenous cocaine, most chose saccharin. A 2018 study with rats  showed that given the choice between heroin and saccharin, the rats would choose saccharin. So it may be rather addictive. Further, a 1983 review of studies on saccharin  had this to say “A benefit-risk evaluation for saccharin showed few, if any documentable benefits from the use of saccharin and much genuine uncertainty concerning the potential risks for ingestion by man. This element of genuine uncertainty as to the extent of human risk posed to man is the crux of saccharin’s past and its foreseeable future.” Further, a 2017 animal study  found that saccharin caused inflammatory markers to rise in the gut of the test animals, induced liver inflammation and unfavorably altered their gut microbiome. That’s a big “NO” from me.
Sorbitol – A sugar alcohol manufactured from corn and various fruits, being synthesized via glucose reduction in which an aldehyde group (CHO) is converted into a hydroxyl group (OH). The body breaks sorbitol down with sorbitol dehydrogenase, an enzyme which converts sorbitol to fructose. The liver then converts fructose into glucose. Sorbitol is very low on the glycemic index, but being a sugar alcohol, can cause gut problems due to poor or no absorption, and may have a laxative effect. If you already have gut issues or are on a low-FODMAP diet, it’s better off avoided. Even if you don’t have gut issues, use it with caution.
Stevia leaf extracts – From the leaves of the plant Stevia rebaudiana. Brand names Truvia, PureVia, Enliten, SweetLeaf. Stevia rates low on the glycemic index, and it is 300 times sweeter than sugar. Banned for awhile in the USA because some big companies convinced the USFDA that it should be banned (we can guess why). Organic stevia made from the leaves of the plant is safe for consumption if used in small quantities. A 2018 animal study  found that stevia helped to lower cholesterol levels. Stevia is better than most of these sugar substitutes but it does come with a warning, though, so please see what I have to say about stevia in my 2014 article Are Artificial Sweeteners Safe? Stick with organic, pure stevia, not the processed stuff.
Sucralose – Brand name Splenda, Canderal. Made by replacing three hydrogen-oxygen (OH) groups on a sugar molecule with three chlorine (Cl) groups. A small 2014 clinical trial  found that Sucralose increased blood glucose and insulin levels and decreased insulin sensitivity in obese people. In addition, a 2008 animal study on sucralose  found that it altered the gut microbiome by decreasing beneficial bacteria by up to 50 percent, and 12 weeks after the study, the beneficial bacteria had not recovered. That essentially means that even after sucralose intake had stopped, the gut microbiomes of the animals studied were still negatively impacted. This study also found that sucralose may make certain orally administered drugs less effective by enhancing expression of enzymes that metabolize the drugs. Lastly, one of the promoted uses of sucralose is to use it in baking and cooking to replace sugar and reduce calories. It is supposed to be heat resistant, but two studies [17,18] demonstrated that when it is heated to high temperatures (such as you would in baking), sucralose degrades and releases harmful chloropropanols (considered toxic and possible carcinogenic). So sucralose is a big NO from me.
Xylitol – A sugar alcohol manufactured most often from either birch tree bark or in the lab from xylose, a wood-based sugar. It is also found in minute quantities in some fruits and vegetables. Xylose is hydrogenated into a raw form of xylitol. You’ll find it as an additive in a lot of different foods including chewing gum, desserts, syrups, jams, and even in some vitamins and supplements. Being a sugar alcohol, our bodies don’t completely digest xylitol, and if you have too much of it it can have a laxative effect, as well as some other gut disturbances. A 2019 review of studies  showed that xylitol had a number of beneficial properties, including improving bone mineral density, easing constipation, acting as a prebiotic, had benefits for weight management, and interestingly, modulating the immune system in animals. Xylitol stimulated innate and acquired immunity, mainly against bacterial infections. Here’s the deal though – all of the authors of the study were employees of DuPont Nutrition & Biosciences. DuPont manufactures and markets xylitol. Let’s just say xylitol is reasonably okay, but not my favorite sugar substitute.
The 7 Major Downsides of Some Sugar Substitutes
1. They Can Mess With Your Brain – Some studies [20,21] suggest that artificial sweeteners cross the blood-brain barrier and can disrupt the function of the hippocampus. This can impair signals to parts of the brain that control feelings of hunger and satiety. This effect can sabotage ability to lose weight. Artificial sweeteners can cause us to eat more because after consuming them, the gut tells the brain that there is a lack of nutrition and that makes you hungrier. Plus artificial sweeteners may be addictive, as noted above.
2. They Can Mess Up Your Gut – In reference to the sweeteners that are not broken down well by our bodies, they can pull extra water into the large intestine and cause diarrhea. They can also sit there and ferment which can lead to bloating, gas, and poor fat absorption. Because these sweeteners are not properly broken down in the gut, they can also be used for food by bad bacteria and promote their health, which can kill off the healthier, more beneficial gut bacteria. Two studies found that artificial sweeteners could induce glucose intolerance in mice and in some humans by functionally altering the gut microbiome. This can increase the risk for type 2 diabetes.[22,23]
3. They Don’t Help You Lose Weight and May Lead to Diabetes and Heart Disease – Two reviews of medical studies [24,25] found that the data in both animals and humans suggested the effects of artificial sweeteners, rather than helping reduce insulin resistance and obesity, may instead be contributing to metabolic syndrome, the obesity epidemic and increased risk of heart disease. A 2009 study  found that daily consumption of diet drinks was associated with a 36 percent higher risk for metabolic syndrome and a 67 percent increased risk for type 2 diabetes.
4. They Mess With Your Taste Buds – Because artificial sweeteners are so intensely sweet in comparison with natural sugars, your taste buds can become accustomed to that, and that’s not a good thing. Nutritionists agree that those who have artificial sweeteners on a regular basis can become accustomed to their mega-sweetness and it can change the palate, thus decreasing enjoyment of foods that are good for you, like fruit and vegetables.
5. They Can Mess with Your DNA – A 2006 animal study  found that rats given high doses of aspartame were more likely to develop leukemia or lymphoma than the animals given sugar. To be fair, those high doses were a little unnatural because the animals were fed somewhere approximating the aspartame found in 2,000 cans of diet soda each day. In response to that, the same researchers conducted another study , in which the rats were exposed to quite low doses of aspartame in their feed – as low as 20 mg per kilogram of body weight – from the time they were fetuses until they died a natural death. The study results showed that aspartame was indeed carcinogenic, even at doses that fell within the acceptable daily intake, which in the USA is set at 50 mg per kilogram of body weight. The study found there was a significant dose-related increase in the rate of leukemia, lymphoma and even mammary tumors. Aspartame is particularly a problem, because aspartame is broken down into three different compounds: phenylalanine, aspartate and methanol. It is the methanol that is of most concern, because it can convert into formaldehyde, a known carcinogen. I talk a little more about aspartame in my article “Are Artificial Sweeteners Safe?” See especially the part about Gulf War soldiers. Additionally, a 2015 review of medical studies  involving nearly 600,000 participants concluded that heavy consumption of artificial sweeteners might indeed increase the risk of particular cancers including laryngeal, urinary, leukemia and non-Hodgkin’s lymphoma (but then the study authors stated that the results were inconclusive. Mmm-kay.)
6. They May Trigger Migraines – Several studies [30,31] have shown that people with a high intake of artificial sweeteners like aspartame can suffer with migraines.
7. Some Are Made From GMO Corn – Some sugar substitutes are made in part from GMO corn, which has been linked with many different health problems. For more information, see my article “We Must Avoid Genetically Modified Organisms”.
I think it’s clear that some sugar substitutes are better than others. If you feel some sort of digestive upset after eating consuming, say, sugar alcohols like xylitol or sorbitol and want to keep trying, just try monk fruit or stevia. And as with most things, having sugar substitutes in moderation is pretty important. If you’re a type 2 diabetic, I say give most of these sugar substitutes a big miss altogether, except for monk fruit. That one is great for diabetics. For my breast cancer thrivers, I believe monk fruit, organic stevia and organic erythritol are safe IN MODERATION.
 Article: Additional Information About High Intensity Sweeteners Permitted for Use as Food in the United States – https://www.fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states
 Effect of the Artificial Sweetener, Acesulfame Potassium, a Sweet Taste Receptor Agonist, on Glucose Uptake in Small Intestinal Cell Lines – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516624/
 The artificial sweetener acesulfame potassium affects the gut microbiome and body weight gain in CD-1 mice – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5464538/
 Video: https://nutritionfacts.org/video/a-harmless-artificial-sweetener/
 Efficacy and tolerance of lactitol supplementation for adult constipation: a systematic review and meta-analysis – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103919/
 Effects of the Artificial Sweetener Neotame on the Gut Microbiome and Fecal Metabolites in Mice – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017827/
 Hull, J. (1999). Sweet Poison How The World’s Most Popular Artificial Sweetener Is Killing Us – My Story, Far Hills, NJ: New Horizon Press
 Intense Sweetness Surpasses Cocaine Reward – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931610/
 Heroin and saccharin demand and preference in rats – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548646/
 Saccharin: a toxicological and historical perspective – https://pubmed.ncbi.nlm.nih.gov/6353664/
 Saccharin induced liver inflammation in mice by altering the gut microbiota and its metabolic functions – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647777/
 Antihyperlipidemic efficacy of aqueous extract of Stevia rebaudiana Bertoni in albino rats – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064095/
 Sucralose affects glycemic and hormonal responses to an oral glucose load – https://pubmed.ncbi.nlm.nih.gov/23633524/
 Splenda alters gut microflora and increases intestinal p-glycoprotein and cytochrome p-450 in male rats – https://pubmed.ncbi.nlm.nih.gov/18800291/
 Sucralose, a synthetic organochlorine sweetener: overview of biological issues – https://pubmed.ncbi.nlm.nih.gov/24219506/
 Thermal stability and thermal decomposition of sucralose – https://www.scielo.br/pdf/eq/v34n4/a02v34n4.pdf
 Xylitol’s Health Benefits beyond Dental Health: A Comprehensive Review – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723878/
 Physiological mechanisms by which non-nutritive sweeteners may impact body weight and metabolism – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661139/
 The effect of non-caloric sweeteners on cognition, choice, and post-consumption satisfaction – https://pubmed.ncbi.nlm.nih.gov/25128835/
 Non-caloric artificial sweeteners and the microbiome: findings and challenges – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4615743/
 Artificial sweeteners induce glucose intolerance by altering the gut microbiota – https://pubmed.ncbi.nlm.nih.gov/25231862/
 The Association Between Artificial Sweeteners and Obesity – https://pubmed.ncbi.nlm.nih.gov/29159583/
 Artificial sweeteners and metabolic dysregulation: Lessons learned from agriculture and the laboratory – https://pubmed.ncbi.nlm.nih.gov/27387506/
 Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA) – https://care.diabetesjournals.org/content/32/4/688
 Results of long-term carcinogenicity bioassay on Sprague-Dawley rats exposed to aspartame administered in feed – https://pubmed.ncbi.nlm.nih.gov/17119233/
 Life-Span Exposure to Low Doses of Aspartame Beginning during Prenatal Life Increases Cancer Effects in Rats – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964906/
 Systematic review of the relationship between artificial sweetener consumption and cancer in humans: analysis of 599,741 participants – https://pubmed.ncbi.nlm.nih.gov/26202345/
 Migraine provoked by aspartame – https://agris.fao.org/agris-search/search.do?recordID=US8724688
 Formaldehyde, aspartame, and migraines: a possible connection – https://pubmed.ncbi.nlm.nih.gov/18627677/
About Marnie Clark
Hi I’m Marnie Clark, breast cancer survivor turned coach. I have 20 years of experience in natural medicine. In 2004/05 I battled breast cancer myself. You can see more about my journey on my page Breast Cancer Diary.
I’ve been healthy and recurrence-free since 2004 and in 2012 I became a Breast Cancer Coach because I became aware of the fact that whilst there is now a wealth of information on the Internet, much of it is confusing, conflicting, and sometimes just wrong!
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