When it Comes to Sweeteners, “Natural” Doesn’t Always Mean “Healthier”

by Nate Widom

Americans average 126.4 grams of sugar daily—about 2.5 times the FDA’s recommended limit—including tons of added sugars.¹ Recently, public awareness has shifted towards reducing added sugars and artificial sweeteners, opting instead for “natural” alternatives like honey, monk fruit, and stevia. So many people believe that, by modifying a typically sugary food to incorporate natural sweeteners like maple syrup, they can magically turn it into a “health food”. But the reality is not quite that simple. While these options are generally more nutritious, they are still forms of added sugar and should be limited. I spoke with Registered Dietitian Jeannie Versagli about the importance of being mindful of all sugars, including natural ones, and how to sweeten treats while minimizing health risks.

The Sugars

To begin, we must explain sugars, a type of carbohydrate. They get a bad rap, but they’re necessary for our bodies. Every time you eat carbohydrates, the body turns them into glucose (sugar) for fuel.² Though glucose is an essential energy source, having too much can result in a blood sugar spike. Repeated blood sugar spikes strain the pancreas and cause inflammation, resulting in diabetes, cardiovascular disease, and other adverse outcomes over time. Foods containing added sugars are more likely to cause blood sugar spikes, whereas foods where sugars are naturally found (think fruits, veggies, dairy, and grains) aren’t linked to serious health consequences and are recommended in any healthy diet. This is primarily because of their differences in fiber content.

Foods that naturally contain sugar often also contain some fiber, which helps the body regulate its glucose levels. “When sugar gets in the gut, the fiber recognizes it and says, ‘Hey, I’m gonna take some of that glucose and keep it,’ Jeannie explains. “[Fiber] just acts as a magnet, so it doesn’t allow all that [glucose] to go into the body at one time.”

This is where Jeannie sees a lot of clients adding sweet substances derived from plants to their foods, thinking it’s safe. After all, if sugar from fruit is generally fine, shouldn’t that also apply to honey, maple syrup, and fruit juice? Not always.

Jeannie explains that the body processes all carbohydrates in the same way. “Whether it comes from a fruit or vegetable, the body doesn’t know any different,” she says. Every time sugar enters your system, you’ll experience a temporary rise in blood sugar. A slow, gentle rise and decline isn’t an issue, but intense ones, or “spikes,” can lead to initial discomfort and many problems over time. And while “natural” sugars like maple syrup are minimally processed and have some nutritional benefits, they also contain little to no fiber, making them more likely to spike your blood sugar.

Foods like apples, oats, barley, nuts, and beans are best for blood sugar control. They’re rich in soluble fibers, which convert into a gel-like substance upon consumption, slowing down digestion and lessening spikes. On the other hand, insoluble fibers are foods like whole grains which help food pass more quickly through your body.

“Fiber is not digestible, so as it travels through the intestinal tract into the colon, it allows some of the sugar to be absorbed,” Jeannie continues. “So, it minimizes the blood sugar spike.” For example, let’s compare a fruit cup vs. a slice of cake.
Fruit contains fiber, which will reduce the impact of the fruit’s sugar on your body. Cake is not only fiberless, but also full of table sugar, which has a tendency to spike blood sugar levels. Besides fiber, the fruit cup has several other essential nutrients, too. The slice of cake will have almost none, and Jeannie would call it “empty calories.”

Sugar Substitutes

Most of us want our treats a little sweeter without setbacks. Looking to limit added sugar in their diets, many turn to sugar substitutes to add flavor to foods and drinks. Sugar substitutes can be classified into three broad categories, all of which come with their own drawbacks:^2,3

Artificial Sweeteners (the “tame’s”):
Examples: Advantame, Aspartame, Neotame, Saccharin, Sucralose
These lab-created sweeteners are low-calorie and up to 700 times sweeter than sugar. However, Jeannie warns against using them due to their harmful effects on the gut microbiome, links to weight gain, and the cravings for sweets they can produce.

Sugar Alcohols (the “tol’s”):
Examples: Erythritol, Isomalt, Maltitol, Sorbitol, Xylitol
These are also created in a lab, but usually from sugar itself. Current research doesn’t link most alcohols to adverse health effects. But while low-calorie, Jeannie doesn’t recommend these because many are known to cause digestive issues.

Novel Sweeteners:
Examples: Stevia, Monk Fruit, Allulose
These are derived from plants. They’re low in calories and don’t lead to weight gain and blood sugar spikes. However, they are not well researched, and many products include undesirable ingredients, like Erythritol (a sugar alcohol), in the mix.

Erythritol, a popular sugar alcohol, is common in novel sweetener products like stevia and monk fruit. While it’s the one major sugar alcohol not linked to digestive issues, it’s been found in early research to raise cardiovascular risk, increase oxidative stress in blood vessel cells, and impair blood vessel dilation and blood flow.^3,4

Putting Sugars into Context: The Glycemic Index

Jeannie acknowledges that some popular natural sweeteners are healthier than traditional table sugar, but to varying degrees. For optimal health, it’s essential to understand the sweeteners you are using and if they’ll promote blood sugar spikes. Getting to know the Glycemic Index and where different foods fall on it is a great starting point.

The Glycemic Index (GI) scores how quickly a food will increase blood sugar. Checking a food’s GI will allow you to choose food that are less prone to causing blood sugar spikes. This is especially important because alternatives like honey and maple syrup can still spike blood sugar.

For reference, see the table. Every food with carbohydrates will have its own score, but we’re just highlighting common sweeteners here. The lower the number, the slower the spike. Low GI foods score under 55, medium score 56 – 69, and high score 70 and up.

Let’s say you’re making your own salad dressing and want to sweeten it. Honey has a glycemic index of 50, while table sugar scores 65. Sure, honey is better. But the point is that “those few nutrients aren’t going to [fully] control the blood sugar spike,” Jeannie says. “You’re still going to get the same effect.” Instead of honey, you can try monk fruit sweetener or stevia, but modifying the recipe to reduce the added sugar would be your best bet.

Glycemic Index of Common Sweeteners*

Sugars	Natural Sweeteners
Maltodextrin: 110	Molasses: 55
Glucose: 100	Maple Syrup: 54
High Fructose Corn Syrup: 87	Coconut sugar: 54
Corn Syrup: 75	Honey: 50
Sucrose (Table Sugar): 65	Agave Syrup: 11
	Stevia: 0
	Monk Fruit: 0

*Source: U.S. Dept. of Veteran Affairs, GoodRx, Health Central

Obviously, nutrients are found in some natural sweeteners. Take maple syrup, for example. It has manganese, zinc, and several antioxidants, but typical table sugar will not!5 But if your goal is to cut down on added sugar and lessen blood sugar spikes, maple syrup won’t help as much as you may think.

Fruit is essential in a healthy diet, but too much can cause spikes, especially in people with diabetes, if serving sizes are exceeded.
High-water, low-carb fruits, like watermelon, score high on the GI Index, similar to corn syrup or table sugar. Jeannie doesn’t say to avoid watermelon but advises monitoring portion sizes and pairing it with fibrous foods. Choosing lower GI fruits like cherries, strawberries, and pears works, too!

Glycemic Index of Common Fruit*

Cherries: 20	Oranges: 35	Blueberries: 53	Mangoes: 60
Strawberries: 25	Apples: 39	Raspberries: 53	Dates (dried): 62
Pears: 30	Prunes: 40	Bananas: 55	Raisins: 66
Figs: 35	Grapes: 45	Pineapple: 58	Watermelon: 76
Pomegranates: 35

*Source: Web MD

Did you know that fruit juice may cause serious blood sugar spikes? Juicing removes the fruit’s pulp, which contains fiber. It also takes an extreme amount of fruit to create one glass of fruit juice. This means you’re consuming a ton of sugar from a ton of fruit without any fiber.

Pair Your Foods with Fiber

We discussed that fiber slows down spikes, so pairing sugary foods and drinks with something high in fiber is another option. Fruit works, but so do veggies, nuts, and seeds.

Yogurt
If you add honey to your yogurt, toppings like berries, almonds, chia seeds, and grape nuts are optimal. Plus, you’ll get plenty of extra nutrients, too.

Barbecue sauce
Barbecue sauce is often full of added sugars. This grilling season, try topping your meats with grilled fruits, like mango, pineapple, and peach slices, instead.

Smoothies
Next time you’re prepping your mid-day smoothie, skip the added sweeteners and use more fruit instead, or add a dollop of unsweetened peanut butter to help balance the sugars.

Burgers
Loading your burger with lots of lettuce, tomato, and onion will help counteract the sugars in commercially-made buns and ketchup and help prevent a blood sugar spike.

Coffee
If you typically add sugar to your coffee, drinking your Morning Joe with a fibrous breakfast can help prevent a blood sugar spike. Try pairing it with eggs over a bed of greens or multigrain toast with avocado.

Look at Nutrition Labels

Some foods will have tons of added sugar and little to no fiber, unbeknownst to the general public. Jeannie cites common culprits such as cereals, ketchup, granola, crackers, dressings, and canned soups.

Sugar is addictive, and companies frequently add it to products like these so you’re more likely to buy them repeatedly. Therefore, looking at the fiber and sugar content on a nutrition label is suggested. With this info, you’ll be able to find healthier options that won’t promote a spike.

The Dietary Guidelines for Americans suggest added sugars should be less than 10% of daily caloric intake, about 50g or 200 calories in a 2,000-calorie diet. Meanwhile, the American Heart Association recommends limits of 37.5g for men and 25g for women.⁶

In Conclusion

Jeannie doesn’t advocate completely avoiding natural sweeteners altogether. Instead, she emphasizes the importance of moderation and mindful eating. Whole foods like fruits and vegetables offer sweet and essential nutrients, allowing you to enjoy satisfying flavors on a balanced diet.

This article has been reviewed by Jeannie Versagli, RD, LDN. Jeannie is a Registered Dietitian with the Academy of Nutrition and Dietetics, a national professional organization, and is licensed in nutrition with the State of Delaware.

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