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Coming to Terms With Sugar Substitutes

By on October 9th, 2013 Categories: Uncategorized

If you’re trying to eat only healthy things, you already know to avoid sugary drinks like soda, lemonade, sweetened iced tea, and frothy coffee confections. But what does that leave you? Just plain water, seltzer/club soda, tea, and coffee. These options may seem a lot less exciting, especially if you believe you have an incurable sweet tooth.

I’m sure this is why many people end up hooked on diet drinks. I have a friend who can’t imagine life without a six-pack of diet cola every single day. Another friend orders her morning latte with sugar-free vanilla syrup, and yet another drinks diet sweet tea for an afternoon caffeine boost. Several of my relatives have diabetes and are experts at finding any and all artificially sweetened candies, drinks, and food products.

They’re hardly alone. About half of Americans report consuming low- or no-calorie sweeteners, mainly in soft drinks. Incredibly, Diet Coke is now the second most popular soda on the market, after regular Coke.

Drinks — and foods — containing sugar substitutes can satisfy a powerful sweet craving without a lot of calories. But how much do you know about the ingredients used to make these things taste sweet? What exactly are they, and are they really safe? And, does using sugar substitutes actually help you lose weight?

The basics of alternative sweeteners

Even though both alternative sweeteners and real sugar taste sweet, they differ in almost every other way. (For more information on the role of sugar and high-fructose corn syrup on your health, you can read Sugar: Should You Worry About It?) There are two main categories of no-calorie and low-calorie sugar substitutes: non-nutritive sweeteners and polyols.

Non-nutritive sweeteners

  • Non-nutritive sweeteners (NNS) include the artificial sweeteners aspartame (Equal), acesulfame potassium (Sunett), neotame (Nutrasweet), saccharin (SweetN Low), and sucralose (Splenda). These are man-made chemicals.
  • NNS also include sweeteners extracted from fruits or leaves of plants, such as luo han guo (monk fruit concentrate) and stevia (an herb extract).
  • NNS contain very few calories or no calories at all. Honey and agave syrup aren’t considered NNS because they have as many calories as sugar.
  • NNS are many times sweeter than table sugar or high fructose corn syrup, so only tiny amounts are needed to equal the sweetness of sugar. (Packets of these sweeteners are usually bulked up with some filler.)
  • NNS can be added to hot or cold drinks. You can buy them in stores to add to your food when cooking or baking.


  • Polyols, also called sugar alcohols, include sorbitol, maltitol, mannitol, xylitol, and erythritol.
  • Despite the name, they don’t contain alcohol. Part of their chemical structure resembles sugar and part resembles alcohol, but they actually come from carbohydrates.
  • Polyols occur naturally in some fruits and vegetables but they are typically manufactured to make enough for commercial use.
  • Polyols are found in processed foods like toothpaste, gum, mouthwash, and in sweet foods like ice cream, cookies, and pie that claim to have no sugar added.
  • They tend to be slightly less-sweet than sugar and have fewer calories. Polyols add bulk and texture, as well as sweetness, and also help food stay moist.
  • If you eat a lot of polyols, they act like a laxative and can cause gas, bloating, and diarrhea. Erythritol is less likely than the other polyols to have this effect.

All of these sugar substitutes work by exciting the brain’s sweetness receptors. In doing so, they may sideswipe receptors for bitterness, leaving behind a distinctive aftertaste. In an effort to improve their overall taste, food manufacturers sometimes combine polyols and non-nutritive sweeteners in foods. While sugar also excites the brain’s sweetness receptors, research suggests that it binds more readily to the sweet receptors in your mouth than sugar substitutes do, which is why sugar doesn’t have a bitter aftertaste.

Are they safe?

The U.S. Food and Drug Administration (FDA) regulates non-nutritive sweeteners and polyols as food additives. Additives on the FDA’s Generally Recognized as Safe (GRAS) list are approved to be used in foods and beverages. The decision to place an additive on the GRAS list is based on FDA review of scientific research or a long history of use without known negative effects. The agency doesn’t require human safety testing for food additives in the way that it does for medicines.

Over the years, there’s been a lot of discussion on whether the FDA’s review process for sugar substitutes is thorough enough. The Center for Science in the Public Interest, a nonprofit watchdog and consumer advocacy group, says some sweeteners, such as acesulfame and aspartame, haven’t been tested enough. It also calls saccharin unsafe because of a possible link to bladder cancer.

But most scientists haven’t found any reason for alarm. The National Cancer Institute has found “no clear evidence” that artificial sweeteners are linked to cancer risk in humans. In particular, the agency says that although studies in rats showed more cases of urinary bladder cancer from saccharin in high doses, studies examining how the substance works in humans show that the results apply only to rats. Plus, humans tend to use only small amounts of saccharin.

The Academy of Nutrition and Dietetics says that sugar substitutes can be consumed in moderation as part of a balanced and varied diet. The acceptable daily intake, as determined by the FDA, allows for at least six cans of diet soda or nine artificial sweetener packets per day, and sometimes much more, depending on the type of sugar alternative used. The acceptable daily intake amount is designed to be 100 times less than the smallest amount that may lead to health risks.

How do they affect your body?

Most people consume foods and drinks with sugar substitutes because they’re trying to eat less sugar or lose weight (or both). Both the American Diabetes Association and the American Heart Association support the ideas, saying that replacing added sugars in drinks and other foods with non-nutritive sweeteners can help people lose weight and keep it off.

Logically, this seems to make sense. After all, one 12-ounce can of regular cola contains about 130 calories, mostly from high fructose corn syrup, while a diet cola contains zero calories. Still, research hasn’t shown that sugar substitutes actually make us eat fewer calories or lose weight, especially over the long term. Their calorie-free sweetness may even trick the body into craving real sugar.

Foods and drinks sweetened with NNS and polyols do give people with diabetes a relatively safe way to satisfy a sweet tooth. NNS don’t raise blood glucose levels; polyols do, but they affect blood sugar less than sugar because the body doesn’t completely absorb them. NNS and polyols also don’t cause tooth decay like sugar does.

Making the choice for yourself

Even though no-calorie and low-calorie sugar substitutes are considered safe based on current scientific evidence, you may still be concerned about them. I know I am — especially the non-nutritive sweeteners that are man-made chemicals.

I don’t consider the Academy of Nutrition and Dietetics and the FDA’s safe number of daily servings of artificial sweeteners (six to nine servings) to be “moderate use.” Plus, one of the most effective ways to get to and stick to a healthy weight is to cut out and get used to foods and drinks without a sweet taste. Even people with a strong sweet tooth can adapt to this change. I used to be a daily Diet Coke drinker; before that, TAB — remember that drink? But after my own diagnosis of breast cancer, I made a commitment to living and eating in healthier ways. Each thing I eat or drink is an opportunity to nourish my body and take care of myself. So before I eat or drink something, I try to ask myself: is this going to be helpful, harmless, or harmful? If I can’t stick to just helpful foods and drinks, then I’m willing to go harmless, but I don’t want to eat potentially harmful items. I see artificial sweeteners as unnecessary, not helpful — and potentially harmful. That’s mostly because they make weight management more difficult, not easier. Plus, I just don’t trust the current assumptions that they’re probably OK.

So, if you’re interested in eliminating or limiting the use of artificial sweeteners, here’s what I do:

  • Go back to water, tea, and coffee. Add a squeeze of lemon or lime to your water. Try a new flavor of tea or flavored coffee.
  • Try seltzer or club soda. One of my favorite drinks is a tall glass of cold club soda or seltzer water with a splash of cranberry juice (just enough to make it light pink), a handful of berries or some orange slices. Add some muddled lime or basil leaves — or just use those as a garnish. You also can use a twist of lemon. Many seltzer companies now offer flavors such as vanilla, pomegranate, and cranberry.
  • Avoid sweet mixers for your cocktails or mixed drinks. Opt for a Virgin Mary made with just tomato juice and horseradish. Or use lime or grapefruit juice, or other non-sweet or even bitter mixers. You also can switch drinks and gradually reduce the sweetness in them over time. For example, salted or sour drinks often require more sugar to taste good. So, instead of a margarita, try a minimally sweet mojito. (As always, remember that drinking alcohol raises risk of breast cancer and recurrence. We recommending having only two or fewer drinks per week to keep your risk as low as you can.)
  • Take full advantage of the natural sugars already in delicious fruits and vegetables by roasting them. The roasting process enhances the natural sweetness in foods such as apples, sweet potatoes, red or yellow onions, beets, and carrots. Did you know that about two-thirds of taste comes from smell? So if you warm your food, you’ll experience more flavor from the fragrant vapors coming from the warmed food. I slice whatever food I’m roasting, wipe a cookie sheet or roasting pan (my favorite is a cast iron pan) with a little olive oil, sprinkle a little kosher salt on the food, and put the pan in a 425-degrees oven for about 25 minutes, then drop the temperature down to 350 degrees for another 20 minutes. The time depends on how thick your slices are. Every 15 minutes, I shake the pan and half-way through I turn over the slices. I pile up apples or pears in a cast iron pan like a deep pie and never shake or flip them. Root vegetables last a long time, so you can buy them in bulk and have them once a week.
  • A piece of ripe raw fruit or a small piece of dark chocolate can satisfy a sweet craving without adding a lot of calories to your diet. Another way to tame a sweet tooth is bread and chocolate. Just smear a small amount of melted dark chocolate or sprinkle finely chopped or grated chocolate onto a thin slice of toasted baguette (it just melts right on!). This is delicious.
  • If you’re baking, try using mashed bananas or dates in place of sugar and instead of a sugar substitute.
  • Seek out foods with less sugar. Different brands of granola or yogurt, for instance, can have very different amounts of added sugars. You may not even taste the difference. It’s actually quite easy to make granola with only a little bit of sugar and oil. Adding raisins or small pieces of other unsweetened dried fruit can give it a sweet and chewy kick. Don’t add too much dried fruit because it’s high in calories. If I’m buying granola, my favorite brand is Back to Nature. (Be aware that some “reduced sugar” products contain NNS and polyols. Check the label to find out.)

In recent years, I’ve used strategies like these to reduce the amount of sugar I eat without turning to sugar substitutes. Over time, I’ve found that I crave sweet foods less than I used to — an unexpected but welcome side effect! Do you use any strategies like these to manage how much sugar you eat or drink?

Marisa Weiss, M.D. is the founder, president, and chief medical officer of Breastcancer.org, the world's most trafficked online resource for medically reviewed breast health and breast cancer information, reaching over 14 million visitors per year. A breast cancer oncologist with over twenty years of active practice in the Philadelphia region, Dr. Weiss is regarded as a visionary advocate for her innovative and steadfast approach to informing, empowering, and treating patients with breast cancer.


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