Sugar, natural sweeteners and artificial sweeteners compared: What a nutritionist wants you to know

The question I get asked more than almost anything else in the clinic is some version of the following — “Is coconut sugar actually better for me than regular sugar?” or “should I be using stevia instead of sugar?” or “are artificial sweeteners going to give me cancer?”

The sweetener aisle has become a minefield of health claims and can leave many feeling confused.

Some sugars can seem like the healthier choice. Coconut sugar, brown sugar, rice malt syrup, agave — these are what I call these the “health halo” sugars.

They sit on health food store shelves looking wholesome, but chemically, your body doesn’t know the difference between a teaspoon of coconut sugar and a teaspoon of white table sugar. They are still primarily sucrose or a glucose-fructose combination, and they still spike your blood sugar.

Coconut sugar contains trace amounts of minerals including iron, zinc and potassium, and a little inulin fibre, which very marginally slows glucose absorption.

But realistically we are talking about trace amounts — you would need to eat an unrealistic quantity to get any real meaningful nutritional benefit.

My recommendations are maple syrup and honey but only ever in a serving size. Maple syrup has some antioxidants, and raw honey has some antibacterial properties. They are natural and come from trees and bees.

My rule with patients and my books is that these can be part of a balanced diet in small amounts. The truth and bottom line is that moderation and total added sugar intake across your day still matter more than which sugar you chose.

Then there are the natural, non nutritive sweeteners. This category includes stevia and monk fruit, which are both plant-derived sweeteners that are hundreds of times sweeter than sugar, so you use a tiny amount, and they contain virtually no calories or carbohydrates.

These are genuinely useful tools, particularly if you’re managing insulin resistance, type 2 diabetes, or simply trying to reduce your overall sugar intake without giving up sweetness altogether.

A few caveats I always need to mention include that many commercial stevia and monk fruit products are blended with fillers like erythritol or dextrose to bulk them out and improve texture, so check the ingredient label rather than assuming “stevia” on the front means pure stevia.

Some people also find stevia leaves a bitter or metallic aftertaste, which is individual and worth testing before committing to it. Overall though, in their pure forms, these are the sweeteners I’m most comfortable recommending for regular use.

Now to artificial sweeteners including aspartame, sucralose and saccharin. These are lab-made, intensely sweet and calorie-free. The evidence here is genuinely mixed, and I think it’s important I’m upfront about that rather than giving you a definitive verdict the science doesn’t yet support. Regulatory bodies including FSANZ and the FDA maintain that these are safe within set daily intake limits, and decades of research haven’t shown clear harm at normal consumption levels.

That said, some newer research has raised questions about how artificial sweeteners might affect gut microbiome diversity and, in some studies, glucose tolerance, though findings are inconsistent and often based on higher doses than most people would realistically consume.

There’s also a behavioural piece I see often in my clinic in which some people compensate for the “saved” calories by eating more elsewhere, which defeats the purpose entirely.

My honest take is to avoid them completely and I would never recommend any beverage or product that contained them especially when you can get the same result from stevia and monk fruit.

Then there’s the sugar alcohol family that includes erythritol, xylitol, sorbitol and maltitol which sit in a bit of a grey zone between “natural” and “processed”.

They are derived from plant sources but manufactured through a fermentation or hydrogenation process, and they have a partial calorie count and a much gentler effect on blood sugar than regular sugar, which is why you’ll see them in a lot of “keto” and “no added sugar” products. The main issue I see with sugar alcohols as a group is their impact on digestion.

Xylitol, sorbitol and maltitol aren’t fully absorbed in the small intestine, so eating too much can cause bloating, gas and a laxative effect, which is your gut’s way of telling you it’s had enough. I avoid products with sugar alcohols all together and won’t ever recommend them.

I would suggest the real goal is reducing your overall reliance on sweet tastes over time, so your palate recalibrates and you need less of everything. We are constantly turning over our taste buds and you could do this in 30 days.

When you want sweetness, my advice is pure stevia or monk fruit, small amounts of natural sugars like maple syrup or honey when you want the real thing and are tracking your overall intake.