by Tayla Holman

Sugar often gets a bad rap, leading many of us to seek alternatives when we want a sweet treat. But sugar-free options aren't always the healthier choice. Let’s take a look at the effects of artificial sweeteners on the body and whether they are better or worse for you than sugar.

What are artificial sweeteners?

Artificial sweeteners are ingredients that sweeten or enhance the flavors of foods or drinks. They're also called sugar substitutes, non-nutritive sweeteners or non-sugar sweeteners (NSS). Most are created in a lab from chemicals to mimic sugar. They're often sweeter than table sugar (sucrose), which comes from plant sources. That means less is needed to get the same level of sweetness as sugar.

Artificial sweeteners can be found in many foods, such as soft drinks, baked goods, candy and canned foods. Many people use NSS to reduce their sugar intake. Generally, artificial sweeteners add few or no calories to foods and drinks. They usually don't raise blood sugar levels either. However, they have no nutritional value.

Artificial sweeteners go by many different names on nutrition labels. Common artificial sweeteners include:

  • Aspartame
  • Acesulfame potassium (Ace-K)
  • Sucralose
  • Neotame
  • Advantame
  • Saccharin

Sugar alcohols are another alternative to table sugar. Some occur naturally in fruits and vegetables; others are produced industrially. Sugar alcohols include:

  • Sorbitol
  • Xylitol
  • Lactitol
  • Mannitol
  • Erythritol
  • Maltitol

Sugar alcohols have slightly fewer calories than sugar. They don't cause sudden increases in blood glucose, making them a good option for people with diabetes or prediabetes.

Plant- or fruit-based NSS include stevia, luo han guo (Swingle fruit or monk fruit extract) and thaumatin. Natural NSS also include honey, maple syrup and molasses.

Do artificial sweeteners affect your health?

Although sugar substitutes are generally safe, exercise caution. As with sugar, use them in moderation. It's especially important to be careful with NSS if you have existing health conditions. More research is needed to understand the long-term effects of artificial sweeteners on the body, but they may not be the healthy alternative to sugar most people think they are.

A recent study found that erythritol was linked to an increased risk of heart attack and stroke. People with existing risk factors for heart disease were twice as likely to have a heart attack or stroke if they had the highest levels of erythritol in their blood. Risk factors for heart disease include diabetes, high blood pressure and obesity. The study also found that adding erythritol to platelets contributed to heightened blood clot formation. Blood clots can break off and travel to the heart, causing a heart attack. They can also travel to the brain and cause a stroke.

While it might be tempting to use artificial sweeteners to aid weight loss, they might actually do the opposite. A review of 37 studies on artificial sweeteners found that they're associated with a number of health issues, including weight gain and obesity. They were also associated with a higher incidence of high blood pressure and metabolic syndrome.

The World Health Organization (WHO) recommends against using NSS for weight control and diet-related noncommunicable diseases. WHO found evidence that long-term use of NSS can lead to an increased risk of type 2 diabetes and cardiovascular diseases. The organization recommends reducing sugar intake by choosing unsweetened products or foods with naturally occurring sugars, such as fruit.

Is sugar better than artificial sweeteners?

If artificial sweeteners can negatively affect your health, is it better to use regular sugar instead? It depends. Too much of either isn't good for you, but many healthy foods contain natural sugars. These include fruits, vegetables, milk and whole grains. The problem tends to lie with added sugars, which are added to processed foods or beverages. Besides natural NSS like honey, added sugars include but aren't limited to:

  • Cane juice
  • Corn syrup and high-fructose corn syrup
  • Dextrose
  • Maltose
  • Lactose
  • Fructose

According to the Dietary Guidelines for Americans, sugar should make up less than 10% of your total daily calories. So, if you consume 2,000 calories a day, try to keep your sugar intake to no more than 200 calories.

If you're trying to reduce your sugar intake, whether from natural sugar or artificial sweeteners, be sure to read the nutrition label. Limit added sugars and look for ingredients with "sugar" or "syrup" in the name. You'll also want to steer clear of ingredients ending in "ose." Ingredients are listed in order of quantity, so pay attention to sugar or artificial sweeteners that are high up on the ingredient list. Talk to your doctor if you have any concerns about your sugar intake.