Sugar vs. artificial sweeteners -- which is healthier? It's complicated

"Sugar-free" isn't always best. Artificial sweeteners might be worse than sugar in the long run for some people.

Amanda Capritto
8 min read

Which one do you go for?

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When you sit down for brunch, which packet of sweetener do you reach for to sprinkle in your coffee -- the pink, the blue, the yellow or the green? Those packets contain saccharin, aspartame, sucralose and stevia, respectively. Sometimes, restaurants also stock brown packets (raw sugar) and, of course, white packets (table sugar, or sucrose). 

If you love sweet foods and drinks but try to keep your sugar intake low, you've probably used one alternative sweetener or another. If you're of the mind that natural is always better, you may stick to regular table sugar, raw sugar or other natural sugars. 

Whichever you currently prefer, you've probably wondered about the best way to satisfy your sweet tooth. In this guide to alternative sweeteners and sugar, I examine the available science on the pros and cons of sugar substitutes, and how they stack up to the real thing.

Types of alternative sweeteners


Splenda is one of the best known artificial sweeteners. Its scientific name is sucralose.


Before diving into sugar versus sugar alternatives, it's helpful to know what alternative sweeteners actually are -- there are three types of alternative sweeteners, all with their own uses, benefits and drawbacks. 

Artificial sweeteners are what most people typically think of when considering sugar alternatives: Splenda (sucralose), Sweet'N Low (saccharin), Equal (aspartame) and Sweet One (acesulfame K). Another, called Newtame, uses a less popular sweetener called neotame.  

These sweeteners can be 200 to 700 times sweeter than table sugar (sucrose) and they have zero calories, which is why they're called non-nutritive sweeteners. The only exception is aspartame, which does have calories, but the amount is often considered negligible because you need very little aspartame to achieve an intensely sweet taste in foods and drinks. 

Sugar alcohols are a type of carbohydrate that occurs naturally in plants, but they can also be man-made in labs. Most sugar alcohols are processed from sugars and starches through a chemical manufacturing process.

They do contain some calories, although not as many per gram as sugar. Some sugar alcohols you may have seen on food labels include sorbitol, erythritol, maltitol and xylitol: They're really common in sugar-free gum, protein bars, low-calorie ice cream and other processed foods, especially diet foods. You can also find some sugar alcohols in dental products, like toothpaste and mouthwash.

They're called sugar alcohols because their chemical structure resembles both sugar and alcohol, but despite the name, these low-calorie sweeteners don't contain ethanol, the type of alcohol that leads to intoxication. 

Novel sweeteners include newer sugar alternatives that are difficult to place in the above two categories. The most recognizable example: stevia. Stevia, or rather stevia extract, is a popular plant-based sweetener with almost no calories. It doesn't have a chemical structure like artificial non-nutritive sweeteners, nor sugar alcohols -- so it hovers in novel sweetener limbo. 

Other novel sweeteners include monk fruit extract (a zero-calorie sweetener that comes from a fruit native to China) and tagatose (an artificial sweetener that is actually less sweet than table sugar).

The Food and Drug Administration considers all of the above sugar alternatives as "high-intensity sweeteners," and they all come with several pros and cons. 

Read more: Want to eat less sugar? Try this instead of quitting cold turkey

Benefits of sugar alternatives


Sugar alternatives have several benefits, such as that they promote good dental health. 

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Sugar alternatives may be one of the most scrutinized food additives around. Like any food additive, they must be approved for consumption in the US by the FDA. The FDA currently recognizes many sugar alternatives as safe, and research suggests that they can offer health benefits, especially when used for specific purposes, such as keeping diabetes under control. 

Can help with weight loss or maintenance

If you're looking to curb your calorie intake to lose weight, but don't want to give up sweet foods and drinks, sugar substitutes can help: You get the taste you desire, but without the calories. 

Recent research has reanalyzed this logic and suggests that alternative sweeteners may not always help with weight loss efforts (more about this under drawbacks on alternative sweeteners below), but for people who are cognizant of their overall food and drink consumption, low- or zero-calorie sweeteners can aid in weight loss.  

If you are trying to lose weight, it's important that you don't inadvertently replace these calories elsewhere. Having a diet sweet tea instead of a regular sweet tea, for example, may lead you to eat more calories because you "saved" some by drinking the diet beverage.

Read more: 8 ways eating too much sugar is bad for your health

Help to keep blood sugar under control

Sugar substitutes can help people with diabetes satisfy cravings without causing spikes in blood sugar. Several studies show that non-nutritive sweeteners, particularly sucralose, do not mess with blood sugar or insulin.

A 2012 statement from the American Heart Association and American Diabetes Association says that non-nutritive sweeteners can help people reduce their sugar intake and overall calorie intake when used with good judgment, although the benefits won't apply if you overcompensate and get too much sugar from other foods.

Good for oral health

If one thing is for sure, sugar alternatives can help with dental health. Cavities form when bacteria in your mouth ferment sugar, which creates acid. The acid wears down your teeth, eventually breaking through the enamel and causing a cavity. Since sugar substitutes don't contain sugar, they can help prevent the tooth decay process.  

Sugar alternative drawbacks


Equal is another popular alternative sweetener. The original version uses aspartame, a non-nutritive sweetener that's been scrutinized for decades because of reported side effects, such as digestive symptoms. The science on aspartame and potential side effects is still conflicting. 


Non-nutritive sweeteners, sugar alcohols and novel sweeteners definitely have their advantages, as evidenced above. They have potential pitfalls, too -- not everything about those colorful calorie-free packets is so sweet.

May disrupt your gut health

Research has shown that some artificial sweeteners (saccharin and sucralose), as well as stevia, can change the composition of your gut. If sweeteners reduce the number of good bacteria and hamper the growth of good bacteria, you may wind up with an imbalanced gut, which can lead to symptoms like cramping, gas and bloating. 

This 2019 review of studies suggests that some sweeteners can have negative effects while others, specifically sugar alcohols, may have positive effects. Research in animals has also shown negative changes to gut bacteria after consumption of artificial sweeteners, though more research is needed in humans to determine the true long-term effects of sugar alternatives on gut health.

Can cause digestive upset

Whether or not sweeteners disrupt your gut microbiome, they are known to cause unpleasant digestive symptoms. Most of this evidence is anecdotal, beginning decades ago with complaints about cramps after consuming aspartame

Though more studies are needed to determine the relationship between alternative sweeteners and digestive distress, research does note that some digestive symptoms may be due to changes in the gut bacteria or the way that alternative sweeteners move through your digestive tract. 

For now, it's best to monitor your symptoms, if any, when you consume different sweeteners (and stay away from the ones that cause distress). 

Read more: The FODMAP diet: How it can fix your digestive issues

Can actually increase cravings for sweets

Alternative sweeteners may have few or zero calories, but that doesn't mean your sugar cravings will stop. Research points out that the desire for sweet foods doesn't depend on the origin of the sweetness, and that people can develop cravings for sweet foods even in the absence of calories, likely because that combination -- sweet taste and zero calories -- confuses your body and disrupts appetite regulation

In one eyebrow-raising animal study, rats were allowed to choose between saccharin-sweetened water and intravenous cocaine, and the vast majority (94%) chose sweetened water. The authors note that the same preference was observed with sugar-sweetened water, so it can't be said that artificial sweeteners are more addictive than sugar -- just that sweetness in general can be highly addictive. 

Linked to long-term weight gain

Some research suggests that artificial sweeteners, despite having few or no calories, may lead to weight gain when consumed frequently over time. One study even showed that drinking artificially sweetened soda coincided with an increase in waist circumference nine years later. 

Another found that people who used non-nutritive sweeteners had a larger increase in BMI than people who didn't consume non-nutritive sweeteners at an eight-year follow-up, except among people who exercised regularly.

The reasoning behind this isn't clear, but researchers think it may have to do with metabolic changes induced by alternative sweeteners or because of compensatory behavior -- that is, thinking things like, "I drank a diet soda so I can have extra cake." 

Sugar alternatives vs. real sugar


For some people, real sugar might actually be the better option.

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Now you know the pros and cons of sugar alternatives, how do they stack up against real sugar? When making your decision between sugar and artificial sweeteners, take into account your primary goal. Here's a rundown of whether sugar or its alternatives are best in relation to various health and fitness goals: 

  • Short-term weight loss: Artificial sweeteners.
  • Long-term weight loss: The research is fuzzy -- artificial sweeteners may only work in the long term if you're very cognizant of your overall calorie intake and don't compensate with other foods for the "lost" calories in artificially sweetened foods and drinks. 
  • Body recomposition: If you're trying to build muscle, there's nothing wrong with a bit of sugar. If you're trying to lose fat, you'll need to pay more attention to your sugar (and calorie) intake, so artificial sweeteners might make fat loss easier. 
  • Blood sugar control and diabetes management: Artificial sweeteners.
  • Oral hygiene and cavity prevention: Artificial sweeteners.
  • Gut health and prevention of digestive symptoms: Real sugar, but in moderation.
  • Mood and focus: Usually, artificial sweeteners can help you avoid the crash and ensuing fatigue that comes with high-sugar snacks. 

The takeaway


A little bit of sugar won't hurt you, especially in the form of fruit. If you have a medical condition that may be affected by sugar intake, talk to your doctor about consuming proper portions.

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The current consensus is that scientists just don't know enough about the long-term effects of sugar alternatives -- artificial sweeteners, sugar alcohols or novel sweeteners -- to make definitive claims that they are good or bad, or whether sugar or alternatives are better in the long term. 

Both sugar and sugar alternatives are OK to eat in moderation -- what truly matters is that you make smart food choices based on your current health status and medical conditions, as well as how sugar or alternative sweeteners make you feel. 

It's probably a good idea, for example, to stay away from sugar alcohols if you get the laxative effect. Likewise, you may want to avoid table sugar if you tend to get sugar headaches or if you have diabetes. 

Also consider where your consumption of sugar and sugar alternatives comes from -- and how much you consume. The sugar in one or even two bananas is nothing to worry about, especially because of the fiber, vitamins and minerals you get along with the sugar. But eat six bananas in a day, and you might wind up with a tummy ache. 

Similarly, eating a protein bar made with sugar alcohols probably won't hurt you. But two, three or more in a single day may lead to side effects like bloating, gas or diarrhea. 

If you're worried about the harmful effects of either -- sugar or alternatives -- a good rule of thumb is that whole food is usually better. Choose an apple over apple juice; choose fresh-squeezed lemonade over a zero-calorie lemonade mix; choose homemade granola over store-bought. 

Most of all, choose whatever best suits your health needs.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.