Dr Hilda Ganesen

Female Family Physician

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Sugar substitutes

Artificial sweeteners and other sugar substitutes are fund in many different foods.  These foods are marked ’sugar free’, or ‘diet'.

So how do we make sense of these sugar substitutes?

Sugar substitutes are considered any sweetener that you use instead of regular table sugar (sucrose).

There are four main categories:



Artificial sweeteners

Sugar alcohols

Novel Sweeteners

Natural Sweeteners

Acesulfame potassium

(Sunett, Sweet one)


Stevia extracts

Agave nectar


(Canderal,Equal, EquiSweet)

Hydrogenated starch hydrolysate


Date Sugar




Fruit juice concentrate


(Sweetex, Hermesetas)








Maple syrup















  1.  Artificial sweeteners
  • These are synthetic sugar substitutes but maybe derived from naturally occurring substances including herbs and sugar itself.
  • These are intense sweeteners and are many times sweeter than regular sugar.
  • It is often preferred as it does not add calories to your diet.
  • You will need a fraction compared with the amount of sugar you would normally use for sweetness.
  • It is widely used in processed foods, soft drinks, sweets, canned foods, jams, jellies and dairy products
  • Recent studies have shown that artificial sweeteners may actually disturb the normal bacteria in the gut and contribute to diabetes via various metabolic pathways. (Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514:181-186. Abstract)
    • Acesulfame potassium: 0 calories
      • This nonnutritive artificial sweetener was first approved by the Food and Drug Administration (FDA) in 1988, meaning it now has a 22-year track record in which no problems have surfaced.
    • Aspartame: 0 Calories.    Found in :Drinks, gum, yogurt, cough medicine 
      • One of the most studied artificial sweeteners, aspartame has been accused of causing everything from weight gain to cancer. 
        However, since being approved by the FDA in 1981, studies have found no convincing evidence and the FDA, the World Health Organization, and the American Dietetic Association say aspartame in moderation poses no threats.  The CSPI feels differently, and gave it their lowest ranking in a review of food additives. People with phenylketonuria, an inherited genetic disorder, should avoid it.However, pre-market testing was sparse. Hoescht, the manufacturer of the chemical, ran a few long-term animal studies that showed it might be linked to cancer (although animal studies don’t always translate to humans).In 1996, the Center for Science in the Public Interest (CSPI) urged the FDA to require better testing, but for now it seems to be safe in moderation.
    • Neotame: 0 calories.
      • The newest on the market, this artificial sweetener was approved by the FDA in 2002. 
        It is between 7,000 and 13,000 times sweeter than table sugar depending on what it is added to, and is produced by the same company that makes aspartame. Neotame is one of the only nonnutritive sweeteners to get the seal of approval from the CSPI, but it is rarely used in everyday products.


  1. Sugar alcohols
  • Sugar alcohols (polyols) are carbohydrates hat occur naturally in fruit and vegetables but they can also be manufactured.
  • They are not considered as intense sweeteners because they are not sweeter than sugar
  • They DO contain calories but are lower in calories than regular sugar
  • One of the benefits of the sugar alcohols is that they do not contribute to tooth decay and cavities
  • When eaten in large amounts, usually more than 50 grams sugar alcohols have a laxative effect, causing bloating, intestinal gas and diarrhoea.


  1. Novel Sweeteners
  • These are a combination of various types of sweeteners
  • Tagatose and trehalose are considered novel sweeteners because of their chemical structures.
  • Tagatose is a low carbohydrate sweeteners similar to fructose that occurs naturally but is made from lactose in dairy products.
  • Trehalose is found naturally in honey and mushrooms.


  1. Natural Sweeteners
  • Natural sweeteners are sugar substitutes that are often promoted as healthier options to table sugar and other sugar substitutes. However these natural sweeteners also under processing and refining including agave nectar.
  • It contains more fructose than table sugar, which, according to a recent study, means it is less likely to cause a spike in blood sugar but could be more likely to reduce your metabolism and insulin sensitivity.
  • They are sometimes referred to as added sugars in foods
  • Although it may seem healthier than table sugar, they are not very different from that of table sugar.  They often end up as glucose and fructose in the body
  • Use these sparingly
    • Agave Nectar: 20 calories per teaspoon
      • The nectar is a product of the agave cactus, and its taste and texture are similar to honey.
        It doesn’t contain as many antioxidants as honey, but it contains approximately the same amount of calories. Agave, however, is sweeter than sugar, so proponents suggest you can use less to get similar sweetness.
    • Honey : 21 calories per teaspoon.  Found in Cereals , baked goods and teas.
      • Honey contains trace amounts of vitamins and minerals, and studies suggest it may not raise blood sugar as fast as other sweet products.(It’s generally better for the body to have a slow and steady rise in blood sugar after eating, rather than a dramatic spike.) Honey, however, does contain calories and should be used as sparingly as any other full-calorie sweetener.
    • Stevia leaf extract: 0 calories
      •  Derived from the stevia plant, stevia leaf extract, also called rebiana, is deemed the natural alternative to artificial sweeteners.
        Although crude stevia extracts are not approved by the FDA, refined stevia products such as Truvia gained a Generally Regarded As Safe (GRAS) approval from the FDA in 2008. In 2013, the consumer advocacy group Center for Science in the Public Interest said it "considers rebiana, a natural high-potency sweetener obtained from stevia, to be "safe," though deserving of better testing."