Natural Non-Caloric Sweeteners versus the Synthetics: What is the best choice?

By Yusuf Saleeby
Published: Jan 09, 2014 12:52 AM GMT / 
Updated: Jan 09, 2014 12:52 AM GMT

Natural Non-Caloric Sweeteners

By Yusuf Saleeby, MD

It is widely appreciated that the over consumption of caloric sweeteners is a bad idea for a healthy diet. While some can tolerate simple sugars better than others, avoidance of too many simple carbohydrates in our SAD (Standard American Diet) is probably a good idea to avoid the eventualities of obesity, metabolic syndrome and type 2 diabetes (T2DM). Among the caloric sweeteners there are some good and bad choices, they will be enumerate here before listing some safe alternative non-caloric or low-caloric sweeteners. I will touch briefly on what is commercially available in the realm of synthetic non-caloric sweeteners and why they are not a smart choice.

So to start off with, our typical point of reference, sucrose (table sugar) should top the list of typical caloric/carbohydrate sweeteners. Bad if over consumed for several reasons; no real nutritional value, very high glycemic index and load. The glycemic index (GI) is a number between one and 100 given to a carbohydrate-rick food that is based on average increase in blood glucose levels after that food is consumed. The glycemic load (GL) is a number based on the GI with a single unit approximating the effect of consuming a gram of glucose.

Heavy handed on adding too much sucrose into your daily diet and you are sprinting along to becoming a diabetic. A 10-gram dose would yield a GI of 65 and a GL of 7.1,2

Then there is honey, and for a few reasons it is better than plain table sugar as it hosts several beneficial sugars and substances imparted by its creator the honey bee. Given this as a preferred sweetener it still holds a hefty glucose load that a diabetic or someone with insulin resistance may find unappealing. Honey varies upon type with levulose (D-fructose) concentrations in the mid 30% to as high as low 50s%. Glycemic index can range from 35 to 58 and glycemic loads from as low as 6 to as high as 12 from a 25-gram serving.3 Fructose or levulose found in fruit as a natural sugar has a much lower GI (11 to 23 depending on the source) when compared with high-fructose corn syrup.1,4 High-Fructose Corn Syrup (HFCS) is the bane of nutritionists, yet the favorite son of the food industry sweeteners, it is used heavily commercially in the USA as it has a greater shelf life and stability and is rather inexpensive. While not banned in the European Union which is a misconception, there are production quotas and quite frankly this sweetener has not been embraced by EU food producers as it has in America. This aversion is likely due to the fact that it has a very high GI/GL and raises questions about obesity and diabetes in society. One can experience GI's as high as 115 or more from a standard serving size of dessert laced with HFCS (24%) with a GL of 10 as one study reports.5,6 The overuse of this sweetener may be responsible for the obesity issues in industrialized countries.

A moment spent on artificial sweeteners before we proceed. While sugars and simple carbohydrates may be harmful for the waste line and also increasing our risk for DM, artificial sweeteners may be more dangerous. Why artificial sweeteners are dangerous is because of a few traits they all have. They are sometimes thousands of times sweeter than sugar and thus it is theorized can spark a genetically programmed preference for sweet stuff in our brains, causing us to over eat. They fool our hormonal system into thinking ''sugar'' is on the way and cause a spike in insulin levels which drive circulating carbohydrates into fat storage. They interfere with metabolism in the liver as they are foreign substances and slow down or distract if you will, our metabolism, thus leading to obesity. In one animal study, laboratory rats fed artificial sweeteners for a period of two weeks ate more, metabolisms was slowed and despite eating fewer calories overall, they gained 14% more body fat.7 Then there are the cancer concerns with many artificial sweeteners. Most notably bladder cancers reported as far back as the 1970s.8 The top four ''toxic'' artificial sweeteners today are Aspartame/Neotame, Aceslulfame-K, Sucralose and Saccharin.

Aspartame contains phenylalanine and aspartic acid (both amino acids) and methanol. It has been associated with nausea, flare ups of irritable bowel syndrome (IBS), neurological disorders. The methanol component is converted to formaldehyde when metabolized which is a known liver, renal and neuro-toxin. At high temperatures phenylalanine is broken down into diketopiperazine (DPK) a known carcinogen. Aceslulfame-K is a potassium salt containing the known carcinogen methylene chloride. This substance has been shown to lead to multiple cancers and may result in hypoglycemia. Sucralose contains chlorinated sugars and may result in the reduction of good bacteria in the gut, and if overused, increases are seen in serum glucose and insulin levels.9,10,11,12 Saccharin contains benzoic sulfimide and this substance has a long history of bladder cancer at least in rats.8

Whether it is pink, blue or yellow colored single dose packets you fancy, my advice is to stay away. It may be safer in the long run to use the white (sugar) or brown (raw sugar) packs in your coffee. Better yet, consider one of the non-caloric ''natural alternatives".

So for natural, non-caloric sweeteners we have a few to choose. Let’s start out with one of my most commonly recommended. Stevia, (Stevia rebaudiana) a plant grown in South America for years, and was little know until about 10-years ago in the USA. It is now one of the safest non-caloric sweeteners and gaining market share. Even in my neck of the woods (South Carolina), it may become a cash crop for local farmers as they are devoting increasingly more acreage to cultivate this herb for commercial production. As demand grows, local farmers may embrace this plant, an alternative to planting tobacco.13 The agent in stevia that causes the sweetness is Rebaudioside A (Reb-A for those folks in the industry). "The steviol glycosides meet purity criteria established by the JECFA (WHO). The clinical studies show that they have no effect on either blood pressure or blood glucose response, indicating stevia sweeteners are safe for use by individuals with diabetes. Recent studies, including human studies on intake, metabolism and toxicity, support the safety of stevia sweetener." according to Dr. Kirtida Tandel in a 2011 published report.9 Still it is not without some detractors that not it can cause nausea and bloating in some and since it is related to ragweed, there is the theoretical concerns about allergic reactions for those sensitive to the Asteraceae family of plants.16 Also there are the potential interactions with medication, glucose lowering medications, blood pressure lowering medications and lithium. Stevia can make sulfonylurea blood glucose meds and some blood pressure medications more effective. On the other hand it may hamper lithium clearance by the kidneys.17-19 When using this sweetener, too much may leave you with a little bit of a bitter taste.

Monk fruit also know as Buddha fruit has the scientific name of Siraitia grosvenorii. Cultivated in southern China and Thailand, this fruit has been used medicinally in those cultures for centuries to treat diabetes and obesity. It has sweetness 300-times that of table sugar and is very low in caloric content. It is considered generally regarded as safe (GRAS) by the FDA. Additional health benefits of this sweetener are that monk fruit contain mogrosides and research has shown them to be good antioxidant in nature and have some anticancer effects.20,21 Apparently mogrosides also inhibit the Epstein-Barr virus implicated in mono and chronic fatigue.22 As a natural sweetener with much lower caloric content compared to sugar, this is a viable alternative for those restricting their calories and those with insulin resistance or diabetes.

Lastly one of my favorite non-caloric sweeteners also claiming the title of an adaptogen herb is Jiaogulan or Gynostemma pentaphyllum. This particular plant discussed in a chapter of my book Wonder Herbs: A guide to three adaptogens (Xlibris, 2006). Jiaogulan is a vine in the cucumber family cultivated in the southern regions of China, some areas of Vietnam, Korea, Thailand and Japan. It is a powerful antioxidant and has the usual health promoting attributes of adaptogenic herbs. This herb has been used in traditional Chinese medicine for centuries and was researched by Dr. Tsunematsu Takemoto in the 1980s as a safe low caloric sweetener. Dr. Takemoto had early interests in the monk fruit before turning his attention to Jiaogulan, studying this plant for years.23,24 To take advantage of the sweetness of this herb in addition to the health benefits of reported hypoglycemic effects, lipid lowering and anti-cancer, you will need to steep it as if making a tea.25-29 Over steep beyond 5-minutes will bring out the bitterness. I recommend using Jiaogulan in a mix of loose tea (Camellia sinensis or herbal teas like chamomile or rooibos or others) or even in your coffee. Adding a pinch of this loose tea right into the coffee maker with your favorite grinds is one good way to sweeten your morning coffee and add additional health benefits. A powder extract version is not yet commercially available as a table top sweetener.

Another new natural sweetener in the pipeline is called Tagatose is in use in the EU, Australia, New Zealand and Korea but not currently in the USA. While it is natural, it is not readily absorbed in the GI tract, thus the low caloric content (about 38% of the calories of sucrose). It is categorized as GRAS. With a GI of only 3, it is now under the watchful eye of the PepsiCo and Yoplait companies as possible low caloric sweeteners for their commercial food production catering to the calorie conscious consumer.9

Erythritol usually found in combination with stevia in the Cargill product Truvia is another rather safe and low calorie alternative. Erythritol is a naturally occurring sugar alcohol that is a byproduct of the fermentation of glucose by the yeast M. pollinis. While nearly non-caloric it is about 75% as sweet as table sugar. It is FDA regarded as GRAS and has a very low GI/GL ranking as a sweetener. Large doses can have a cathartic property as this sugar is not well absorbed in the gut and acts as an osmotic laxative, so be careful with overindulging. However, it is less likely to cause bloating as seen with maltitol, sorbitol and lactitol sugar alcohols.30 Erythritol is not usually found as a stand-alone sweetener, but rather in combination with others such as monk fruit or stevia.

So the take home message here is that table sugar in large quantities is unhealthy, putting you at risk for DM, obesity and metabolic syndrome. The commercial artificial sweeteners, while non-caloric, harbor certain health risks and may be considered toxic in a natural healthy diet and in the end may not protect us from diabetes as once postulated or promised. The risks of their toxicity must be weighed against the benefit of not contributing calories. The lesser of the two evils is probably the lowest GI/GL natural sugars available as in honey and some natural fruit sweeteners. However, your best bet is a natural non-caloric or low caloric sweetener found in commercially available stevia or monk fruit or the adaptogen herb jaiogulan.


Yusuf Saleeby, MD is an integrative physician, health writer and regular contributor to American Fitness magazine. He can be reached for comment at His practice web site is:



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Non-Caloric Sweeteners: Lots of choices, some of my recommendations for safe alternatives to sugar from Dr. Saleeby's Blog Jan, 2014.

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