Updated 19th March 2024

Are sugar alternatives actually healthy?

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Adults consume an average of 17 teaspoons, about 68 grams, of added sugar every day.

Added sugars include white or brown table sugar and things like honey, syrup, molasses, juice concentrates, and juices. 

The Dietary Guidelines for Americans encourages adults to limit their added sugar intake — it should make up less than 10% of all the calories consumed. 

So, if an adult takes in 2,000 calories a day, it’s recommended that they consume less than 12 teaspoons, or 48 grams, of sugar.

Sugar itself isn’t the enemy, especially when it occurs naturally in your foods. But eating too much added sugar is linked to negative health effects like heart disease, diabetes, cavities, and obesity. 

At ZOE, we run the largest nutrition science research program in the world. And we don’t believe in restrictive dieting or completely cutting out foods. Foods are meant to be enjoyed.

With our personalized nutrition program, you can learn how your body responds to different foods and how to eat for your body and long-term health goals. 

So, rather than trying to find sugar shortcuts or alternatives, focus on enjoying your sugar in moderation. The occasional sweet indulgence can still be part of a healthy, balanced diet.

Read on to learn what the latest science says about sugar substitutes, including artificial sweeteners, natural sweeteners, and sugar alternatives. 

Artificial sweeteners

Artificial sweeteners are common in diet drinks and low-calorie desserts, but they’re also in many other processed foods, such as breakfast cereals, chewing gum, and condiments. 

The most common artificial sweeteners are:

  • aspartame 

  • acesulfame potassium (Ace-K)

  • saccharine

  • sucralose 

Some people believe that artificial sweeteners are a  healthier alternative to sugar, but there’s a fair bit of controversy about them. 

Very few long-term studies on artificial sweeteners and human health exist, and so far, the evidence is mixed.

What scientists do know is that your body doesn’t metabolize all artificial sweeteners in the same way. There are key differences between these sweeteners, and this makes studying their effects much more complex.

Do they aid weight loss?

Some proponents claim that artificial sweeteners help with weight loss because they provide no calories. 

And some evidence does suggest that they may help reduce your calorie intake if they replace calorie-laden sugary items like sodas. But it may not be so simple.

Data from a recent review of 164 studies suggest that artificial sweeteners on their own may not satisfy your brain in the same way sugar does. 

This, some researchers believe, could increase your desire to eat, but studies have produced mixed results.

Do artificial sweeteners affect the gut microbiome?

Another concern about artificial sweeteners involves their possible effects on your gut microbiome — the trillions of bacteria and other microbes that live in your gut. 

Most of the available evidence is from animal studies, and the relevant studies in humans are typically small and short-term. 

But the most recent evidence suggests that artificial sweeteners, especially sucralose, could have a negative effect for some people, depending on the makeup of their gut microbiomes. 

By increasing numbers of harmful gut bacteria and decreasing numbers of beneficial gut bacteria, sucralose may make it more difficult to for your body to control blood sugar. 

So, although artificial sweeteners might seem like a healthy swap for sugar, it’s likely to be much more complicated. There are still a lot of unanswered questions about how these compounds affect our health.

Natural sweeteners

Given all the controversy around artificial sweeteners, many people have turned to plant-based options, like stevia or monk fruit.

But are these really any healthier than table sugar? Let’s dive into the evidence.


Stevia is a zero-calorie sweetener made from the leaves of the Stevia rebaudiana, or candyleaf, plant. 

Inside these leaves are sweet-tasting compounds called steviol glycosides. 

Stevioside and rebaudioside-A are the two main glycosides in stevia leaves, and both are 200–300 times sweeter than sucrose, or table sugar.

Stevia is generally regarded as safe by the United States Food and Drug Administration (FDA), but the effects of steviol glycosides on our health are still unclear.

One meta-analysis from 2019 concluded that steviol glycosides might help lower blood pressure. But the researchers explain that the effect is fairly small, and more research is needed.

Meanwhile, it's still up for debate whether swapping stevia for table sugar may help with weight loss.

In a 2019 study that included 154 participants with obesity, researchers compared the effects of rebaudioside-A and other low-calorie sweeteners with the effects of table sugar on body weight and other health parameters. 

After 12 weeks, the sucrose (table sugar) group of participants had gained an average of 1.85 kilograms — roughly 4 pounds. 

The weight of those consuming rebaudioside-A wasn’t significantly different from their starting weight. So, they didn’t gain weight, which seems like a positive result for stevia.

However, in this 12-week study, participants had to drink at least 1.25 liters (2.2 pints) of a sweetened drink containing sugar or an artificial sweetener every day. 

This suggests that stevia might only prevent weight gain if it’s swapped for 1.25 liters of sugary soda every day. 

Plus, studies that didn’t involve soda found no evidence that stevia affects body weight.

At the same time, some lab and animal studies have suggested that stevia might benefit your microbiome by increasing the diversity of beneficial gut bacteria, but it’s unclear if these findings would translate to humans.

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Monk fruit

Another popular “natural” sweetener is monk fruit extract. It comes from the fruit of the Siraitia grosvenorii plant, but it’s more commonly known as Luo Han Guo or monk fruit. 

The sweetness comes from compounds called mogrosides. Depending on the fruit's maturity, different mogrosides have different levels of sweetness. Some can be over 550 times sweeter than regular table sugar.

The FDA considers monk fruit extract safe. But the European Food Safety Authority’s panel on food additives and flavorings advises that more research is needed.

There are limited studies on how monk fruit impacts our health. Given the limited data, the health effects of monk fruit extract remain unknown.

Sugar ‘alternatives’

When you’re trying to cut back on sugar, you may think choosing an alternative sweetener is a healthier option. Many “healthy” recipes will call for alternatives like:

  • honey

  • molasses

  • coconut or palm sugar

  • maple syrup

  • agave nectar

  • dates

It’s tempting to think that these are healthier options than white or brown table sugar — but in reality, they’re still sugar. 

Some of these options go through less processing than table sugar, and they might still contain trace amounts of minerals.

But in the end, our bodies still break most down into glucose, just like regular sugar.

Certain sweeteners, like agave nectar, are broken down a little differently

Agave nectar is mostly made of a type of sugar called fructose. When your body processes fructose, it doesn’t immediately go into your blood like glucose does. It has to travel to your liver first.

But once it’s there, your liver converts it into glucose. 

Like any sugar source, these sweeteners are great to enjoy in moderation. But, unfortunately, they’re not a healthier alternative.

Sugar as part of a healthy diet

Our research at ZOE, in collaboration with leading academic institutions, shows that how your body responds to food is unique to you. Even identical twins have different responses to exactly the same food. 

So, there isn’t a one-size-fits all answer to how much sugar to eat and which sugar is best. 

And, as you may have guessed, the key is moderation.

Feel free to enjoy the occasional sweet treat as part of an overall healthy diet that includes plenty of:

  • vegetables

  • fruits

  • lean proteins

  • legumes

  • whole grains

  • nuts and seeds

  • healthy fats

ZOE’s personalized nutrition program includes an at-home test, and the results will show you how your blood sugar and blood fat levels respond to what you eat and what shape your gut microbiome is in.

With this information, we help you discover the best foods for your body — and how to eat what you love to support your long-term health goals.

You can take our free quiz to get started. 


Many of us eat more sugar than experts recommend. And this can negatively affect our health in the long run. 

It’s tempting to think that artificial or natural sugar substitutes are healthier, but it’s just not that simple.

Artificial sweeteners are everywhere, but it’s not clear whether they can really support weight loss. They may also change some people’s gut microbiomes for the worse.

And although health authorities consider natural sweeteners like stevia and monk fruit safe, there hasn’t been much research into their long-term effects.

Sugar alternatives like honey, maple syrup, and coconut sugar are still sugars.

You may prefer the taste, and some undergo less processing than table sugar — but they aren’t any healthier. 

Instead of searching for a sugar shortcut, focus on eating an overall balanced and healthy diet, and enjoy your favorite sweets in moderation.


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Artificial sweeteners: A place in the field of functional foods? Current opinion in Clinical Nutrition and Metabolic Care. (2012). https://journals.lww.com/coclinicalnutrition/Abstract/2012/11000/Artificial_sweeteners__a_place_in_the_field_of.13.aspx

Dietary Guidelines for Americans, 2020–2025. (n.d.). https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials

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Effect of the natural sweetener, steviol glycoside, on cardiovascular risk factors: A systematic review and meta-analysis of randomised clinical trials. European Journal of Preventive Cardiology. https://pubmed.ncbi.nlm.nih.gov/25412840/ 

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Safety of use of monk fruit extract as a food additive in different food categories. EFSA Journal. (2019). https://efsa.onlinelibrary.wiley.com/doi/full/10.2903/j.efsa.2019.5921

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Trends in use, pharmacology, and clinical applications of emerging herbal nutraceuticals. British Journal of Pharmacology. (2019). https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bph.14943

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