Natural vs. Artificial Sweeteners

By Trisha Howell, MSH, RD, LD/N, IFMCP

Natural sugar in the form of sugar cane and beet sugar has a rich history dating back to the 18^th century, when it was first introduced in our diets in the form of processed foods. It wasn’t until 1957 that artificial sweeteners entered the market. Understanding how the body metabolizes, absorbs, or stores these sweeteners is essential for overall health.¹ Let’s crack the code on the differences of natural sugar, other natural sweeteners, and artificial sweeteners for overall health and wellbeing!

Types of sugar

Sugars are a type of carbohydrate providing calories that are quickly digested and absorbed by the body in the small intestine.² Naturally occurring sugars do not have a different caloric value than commercially produced sugars.³ When the body metabolizes sugar, it provides 4 calories per gram with no added nutritive value. When consumed, these dietary sugars, also known as glucose, are either quickly absorbed in the bloodstream in the form of a single monosaccharide or broken down from two linked monosaccharides, known as a disaccharide, in order to be absorbed.² Glucose is used by cells for energy or stored in the liver or muscles as glycogen.²

Monosaccharides (quickly absorbed)	Sources	Disaccharides (need to be broken down for absorption)	Sources
Fructose	Naturally occurring: honey, molasses, agave, dried fruits, fruits, and fruit juices	Sucrose (table sugar) = glucose + fructose	Naturally occurring: fruits, vegetables, and grains
Galactose-same sources as disaccharide as they both are derived from dairy products.	Dairy primary source: milk, ice cream, milk puddings, hot chocolate, eggnog, macaroni and cheese, yogurt, pancakes, milk chocolate, cottage cheese, and mashed potatoes	Lactose (milk sugar) =  glucose + galactose found in dairy products	Dairy primary source: ice cream, milk puddings, hot chocolate, eggnog, macaroni and cheese, yogurt, pancakes, milk chocolate, cottage cheese, and mashed potatoes
Glucose	Naturally occurring: honey, agave, molasses, dried fruit, fruits, fruit juices, and sweet corn	Maltose (malt sugar) =  glucose + glucose	Naturally occurring: produced by plants when grains and seeds germinate

Where sugars are found^3,4 

Sugars are found naturally in dairy, fruit, starchy vegetables and honey. They are also added to foods and beverages such as cookies, candy, soda, and other types of sweetened beverages. Check that ingredient list closely! Generally, if the ingredient ends in ose, it is a form of added sugar.

Added Sugar in Food	Hidden Sources of Sugar in Food
Brown sugar	Barbeque sauce
Coconut sugar	Bread
Evaporated cane juice	Coconut flakes (unless unsweetened)
Dextrose	Coffee drinks
Fructose/high-fructose corn syrup	Crackers
Glucose	Frozen dinners
Honey	Granola bars or “energy bars”
Invert sugar—table sugar but much sweeter	Instant oatmeal
Maltose	Ketchup
Molasses	Peanut butter or nut butters
Rice syrup	Nut milks (unless unsweetened)
Sucanat—sugar cane that is less processed	Pasta sauce

Types of natural sugars and sugar alcohols to use sparingly^5-7

All types of sugar can be addictive.⁵ They can trigger the body to crave more sugar, but the physiological effect of naturally occurring sugar is not as pronounced due to the fiber content in fruits and vegetables.⁵ There are seven sugar alcohols (erythritol, isomalt, lactitol, maltitol, mannitol, sorbitol and xylitol) used as sugar substitutes in the food and beverage industry. All but erythritol can be associated with dental caries, bloating, gas if consumed in large quantities due to slow and incomplete absorption in the intestine.^6-7 All sugars should be consumed sparingly. If consumed, use natural sugar. 

Artificial sweeteners^8,9

The use of artificial sweeteners is on the rise. The most common ones are aspartame, acesulfame, sucralose, and saccharin, which are known to heighten our taste for more sugar because they taste even sweeter than table sugar. They are classified as food additives. According to the Center for Science and Public Interest, artificial sweeteners are nonnutritive, have potential toxic byproducts, and increase the desire for something sweet, thereby increasing sweet cravings. Its recommendation is to avoid them completely.⁹

Recommended sugar intake¹⁰

According to the American Heart Association (AHA), Americans consume an average of 77 grams of sugar per day, which equals 308 “empty” calories.¹⁰ This increased consumption of added sugars in the US diet has led the 2015-2020 Dietary Guidelines for Americans to recommend limiting added sugars to no more than 6 teaspoons of sugar (25 g) or 100 calories daily for women and 9 teaspoons (37.5 g) or 150 calories daily for men.¹⁰

To help achieve a healthy eating pattern, these guidelines on added sugars suggest the following:¹⁰

• Reducing portions of sugar-sweetened beverages, drinking these beverages less often, and choosing beverages low in added sugars
• Choosing beverages with no added sugars
• Limiting or decreasing portion size of grain and dairy-based desserts and sweet snacks
• Choosing unsweetened or no-added-sugar forms of canned fruits, fruit sauce, etc.

How to interpret information on sugars on a food label¹¹

Tomato sauce—not all are created equal

Think you know what you’re reaching for when you add that homestyle sauce? Think again! If the serving size is ½ cup or 4 ounces, that could equate to ~ 7 grams of sugar (almost 2 teaspoons of added sugar) per serving in a standard jar sauce. Watch that label!

Tips to limit sugar intake

• Read labels for added sugars in the ingredients section. The first ingredient listed is the most abundant according to weight.
• Choose foods that have naturally occurring sugar such as dairy, fruit, and starchy vegetables
• Aim for filtered water in place of sweetened beverages
• Choose fresh fruit for desserts or dessert toppings
• When eating out, ask for nutrition information to choose foods with the lowest sugar content

It is important to know the difference between natural and artificial sweeteners, as they have been shown to play a role in many chronic health-related issues.^2-4 Taking a lifestyle medicine approach through dietary intervention and supportive behavior modification techniques can decrease the adverse effects of both natural and artificial sweeteners to achieve healthy eating patterns.

References:

1. History of sugar. Sugar history website. http://www.sugarhistory.net/who-made-sugar/history-of-sugar/. Accessed October 19, 2020.
2. Grant MS et al. Defining and interpreting intakes of sugars. Am J Clin Nutr. 2003;78(suppl):815S–26S.
3. Johnson RK et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2009;120:1011-1020.
4. Yang Q et al. JAMA Intern Med. 2014;174(4):516-524.
5. Falbe J et al. Potentially addictive properties of sugar-sweetened beverages among adolescents. Appetite. 2019;133:130-137.
6. Loveren CV. Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects? Caries Res. 2004;38:286–293.
7. Bieleski RL. Sugar Alcohols. Plant Carbohydrates I. Encyclopedia of Plant Physiology. Springer, Berlin, Heidelberg. 1982:158-192.
8. How sweet it is: All about sugar substitutes. https://www.health.harvard.edu/blog/artificial-sweeteners-sugar-free-but-at-what-cost-201207165030. Accessed October 25, 2020.
9. Chemical Cuisine. Center for Science in the Public Interest website. https://www.cspinet.org/eating-healthy/chemical-cuisine. Accessed October 25, 2020.
10. How much sugar is too much? American Heart Association website. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/how-much-sugar-is-too-much. Accessed September 28, 2020.
11. Changes to the Nutrition Facts Label. Food and Drug Administration website. https://www.fda.gov/food/food-labeling-nutrition/changes-nutrition-facts-label. Accessed August 24_, 2018.

Trisha Howell, MSH, RD, LD/N, IFMCP Howell is a certified Functional Medicine nutritionist who completed her master’s and undergrad in nutrition and health sciences with the University of North Florida and registered dietitian training with the University of Northern Colorado. She is board-certified in Functional Medicine with the Institute for Functional Medicine. She has over 20 years of experience delivering personalized medicine in academia, nonprofits, and her private practice for individuals, groups, the community, and corporations. This focus led her to become the founding dietitian at the Cleveland Clinic Center for Functional Medicine, the only one of its kind in the world. Howell joined Metagenics 3 years ago as a practice specialist with FirstLine Therapy®.