The love of sweetness is a biological taste and desire– it’s one of the 5 basic tastes and we are usually exposed to it as babies. However, health issues linked to sugar have been increasing throughout the years, linked with the rates of obesity, type 2 diabetes and tooth decay. Therefore, the food industry has developed sugar alternatives, which are often much sweeter, but lower or equal in calories to sugar.

There is a long standing debate as to whether these artificial sweeteners are any better than sugar, and if they can help reduce the risk of obesity and other health related diseases.  There are many sugar substitutes available on the market today. Are they healthy? Which one do we choose? This is what you will find out today.

What are sugars?

Sugar is usually referred to as sucrose. It is a sweet disaccharide (a double sugar molecule) obtained from sugar cane and, in temperate climates, from sugar beet. It has no minerals, vitamins or bioactive compounds. Its excess in the diet contributes to many disorders and ailments: tooth decay, the development of overweight and obesity, lipid disorders, diabetes, certain cancers and neurodegenerative diseases. Therefore, it is recommended to reduce the intake of sugar in the diet, reducing the percentage of calories in the diet coming from sugar to no more than 10%. [1]

What is a sweetener?

Sweeteners, or sugar substitutes, are chemical compounds that can occur naturally in nature (natural sweeteners) or are obtained through chemical synthesis (artificial sweeteners). Their main advantage is that they have significantly fewer calories than traditional sugar. Sugar substitutes are also not fermented by bacteria in the mouth, so they do not cause tooth decay. [2]

Types of sweeteners and characteristics 

[2], [3], [4], [5]

Sweetener Characteristics
Xylitol It is also known as birch sugar. It occurs naturally in fruit and vegetables and in mushrooms. About 50% of birch sugar is broken down in the large intestine.

Xylitol is most commonly used as a sweetener in chewing gum or tooth strips, and has a low glycaemic index (GI=8). Xylitol is also found in nature in many fruits and vegetables: raspberries, plums, strawberries, cauliflower and in mushrooms. Its sweetness is comparable to sugar (sucrose). The daily recommended intake should not exceed 45g/day.

This sweetener is fermentable in the intestine, so excess can cause gastrointestinal problems such as diarrhoea, excessive gas and, in extreme cases, vomiting. It is heat-resistant, so it is ideal as an addition to cakes or desserts.
Please note that xylitol is very harmful to animals, including pets like dogs!

Stevia Or rather, steviol glycosides. It is a zero-calorie sweetener and has a sweetness approximately 300 times greater than sugar. Stevia has no calories and, in addition to its high sweetness, there are also trace amounts of micro- and macronutrients.

This sweetener is recommended for diabetics because it has no effect on blood glucose and carbohydrate metabolism, and has a low glycaemic index.

Stevia is used in the production of sweets including ice cream, reduced-calorie drinks. Fresh stevia leaves make an excellent addition to salads. Dried, powdered leaves are used to sweeten coffee, juices, tea, drinks, desserts.

In addition, it has antiviral, antioxidant properties. It is heat-resistant, so it can be added to foods that are subjected to heat treatment. Stevia is not digested in the digestive tract. The daily recommended dose is 4 mg/kg b.w./day.

Erythritol It is a naturally occurring substance found in fruit, vegetables and mushrooms, as well as in fermented beverages. Interestingly, only 10% of erythrol is absorbed into the digestive tract. It is hardly metabolised by our tissues at all. Virtually the entire amount of erythrol delivered to our body is excreted in the urine.

Scientific studies show a positive effect in lowering blood pressure. It is very low in calories (0.2-0.4 kcal/1g). It does not raise blood glucose levels. Its glycaemic index is 0, so it is recommended for diabetics.

Consuming too much at once can lead to abdominal pain, diarrhoea, gas and bloating. The recommended maximum dose per day is up to 30g.

Sweeteners and health

Most sweeteners are recommended for diabetics due to the fact that they do not cause an insulin spike. On the other hand, it is always important to consult your consultant and a dietitian, before increasing your sweetener intake. The human microbiome is not fully understood. At present, there are many scientific publications showing that certain sweeteners may increase the ability of bacteria to adhere to intestinal epithelial cells. In particular, saccharin, sucralose and aspartame are mentioned. Some bacteria in the microbiome gain pathogenic properties and may reduce the viability of small intestinal epithelial cells. [6]


Increased symptoms regarding the ever-increasing prevalence of obesity and its concomitant metabolic diseases have prompted a reduction in the intake of sugars in the daily diet and thus the use of sugar substitutes. Although most sweeteners are considered safe and well tolerated, their effects on glucose intolerance, activation of sweet taste receptors and changes in the composition of the intestinal microflora are controversial and it is still important to remember to use them in moderation, as excess sweeteners can have a laxative effect.

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By Martyna Slotwinska, dietitian intern, revised by Reema Patel, Registered Dietitian at Dietitian Fit & Co.