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Jan 19, 2024

Erythritol, sucralose, aspartame and natural sweeteners: What to know

The food industry adds dozens of different sugar substitutes to processed foods

The food industry adds dozens of different sugar substitutes to processed foods to make them sweeter. Each has a different chemical structure, intensity and impact on the human body.

Which sugar substitute is best? The answer isn't obvious.

Personal preference plays a role. Some people can't tolerate the aftertaste of certain sweeteners.

The use is also relevant. Erythritol is better for baking than many others because its level of sweetness is close to sugar's; other sweeteners are much more intense and can only be used in small quantities.

IN DETAIL: Why research can't quite say whether sugar substitutes are healthy

At this point, it's hard to distinguish among sweeteners in terms of their health effects, because there hasn't been enough research. Here's what research says about some of the most common ones:

Aspartame has been the leading alternative sweetener since the early 1980s, so it's been the subject of the most research, said Dr. Walter Willett, a nutrition researcher at the Harvard T.H. Chan School of Public Health.

"Compared to sugar, this has less effect on body weight and mortality risk," he said, and it's "almost certainly better than sugar."

Aspartame got a bad reputation decades ago from a controversial mouse study that showed an increase in cancer among the animals that consumed a lot of the sweetener, said Kimber Stanhope, a research nutritional biologist at the University of California, Davis.

The mice used as controls in that study actually had a below-average rate of cancer, Stanhope said, making the aspartame-eating mice seem worse off.

The findings have never been confirmed and no one has ever explained how the sugar substitute might have caused cancer, yet "there are still consumers and even scientists who are passionately sure that aspartame is damaging to health," she said.

(The National Cancer Institute has found no solid evidence connecting any of the sweeteners with an increased risk for cancer.)

Stanhope's own research as well as studies from others support the safety of aspartame, she said, and the cost of another long-term study would be prohibitive and unnecessary.

"I've never seen one sustained aspartame study that showed a negative effect," she said.

Sucralose is structurally very similar to sugar so it has a very pleasant sweet taste.

Willett said he's long been concerned about sucralose because people consume it in large amounts and it is not absorbed as it travels through the gastrointestinal tract.

"This is very likely to modify the microbiome with unknown consequences," he said.

Acesulfame potassium, despite its name, provides very little of the essential mineral potassium. It keeps its sweetness at high temperatures, making it useful for baking. And it's often blended with other sweeteners like sucralose or aspartame to mask the bitter aftertaste it has if used alone.

A 2017 study showed that acesulfame potassium disturbed the gut microbiome of mice if eaten over a month, and led to weight gain in male, but not female mice.

Saccharin can have a metallic aftertaste, which explains why the word saccharine is used to mean "overly sweet" or "cloying."

As with Ace-K, mouse studies have shown that saccharin disturbs the microbes of the gut, potentially increasing the risk for diabetes and irritable bowel syndrome.

There's no reason to think that honey or other natural sweeteners are really any different than sugar, several experts said.

Honey

Honey is 80% sugar, though the National Honey Board points to some potential health benefits. A review of previous studies, published last fall from the University of Toronto, showed that eating honey was associated with lower fasting blood glucose, total and "bad" LDL cholesterol, triglycerides, and a marker of non-alcoholic fatty liver disease. Results differed by the source of the honey and by processing.

At least people tend to use honey sparingly, rather than "guzzling 200 calories worth of it," Sylvetsky said, so any harms are likely limited.

Stevia

Stevia, which is 100- to 300-times sweeter than sugar, is made from the leaf of a plant related to asters and chrysanthemums. Studies suggest it can lower blood sugars and blood pressure, and act as a diuretic, so it might interact with some medications.

Monk fruit

Monk fruit is showing up more and more in the U.S. food supply, Sylvetsky, said, but most health and metabolic research has focused on artificial sweeteners.

Although they're natural, British physiology researcher Havovi Chichger expects monk fruit and stevia trigger the body's sweetness receptors, just as artificial ones do.

Zero-calorie erythritol is naturally found in small quantities in the human body and in some fruits, vegetables, cheese and beer. Among the newest and least studied of the sugar substitutes, it is often added to products as part of a low-carbohydrate, ketogenic diet.

Rats who consumed erythritol lost weight and survived longer, the ideal result for a sugar substitute, Stanhope said. In a review of other research published in January, Stanhope and her co-author found no evidence of negative health effects from erythritol.

But a study published in late February suggested there might be a link between erythritol consumption, blood clots and heart disease. Researchers from the Cleveland Clinic examined blood from 1,157 volunteers undergoing cardiac risk assessment, looking for chemical signatures for those who had a heart attack, stroke or died over the next three years. High blood concentrations of erythritol were associated with bad outcomes. Read more about this study here.

Contact Karen Weintraub at [email protected].

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.