I can’t tell you how many times a week patients ask me about using the newer “natural source” sweeteners out on the market today. There’s a few of them and my patients are confused as to how beneficial they are.  They want to do the best thing for their health and know that too much sucrose (table sugar) in their diet can cause a number of serious health problems including obesity, diabetes and heart disease.

In the past they’ve turned to artificial sweeteners, but some of these have some serious health concerns. I’ve prepared this special 2-part report to help you become aware of the pros and cons of the various alternative sweeteners, both natural and artificial, that are available.

NATURAL SWEETENERS

In the last few years, several newer, “natural source” sweeteners have become available to the public like Stevia rebaudiana (various name brands), xylitol , erythritol, agave, and Lo Han Guo  and my patients are curious about them. Below are some commonly available natural-source sweeteners, their benefits and drawbacks.

Agave: Processed from the succulent desert plant, Agave Americanus.

• Pros: Has about the same calories as real sugar but is 90% fructose.  Low glycemic, with a rating of 20, it does not raise blood sugar like real sugar does.
• Cons: A fertility concern to reproductive-age women as it contains 2 strong estrogen-like steroids and available studies have shown that it can prevent conception and even cause abortion.  It may also be problematic to menopausal women as the strong phytoestrogenic components can up the risks for breast or ovarian cancer. I also do not advocate men using phytoestrogens as it can interfere with testosterone production. Also has a laxative property.
• My take: Perhaps safe as an occasional sweetener, but I feel there are too many possible hormone complications to use on a frequent basis. More studies are needed.

Erythritol: A sugar alcohol made from fermenting glucose with yeast, this sweetener exists naturally in many fruits.  It is used in chewing gum, baked goods, and beverages to sweeten.

• Pros: Many clinical and toxicology studies done show that it is considered safe for human consumption without side effect at several-times daily use in amounts much higher than anyone would likely consume.  Easy to digest, does not promote tooth decay or cancer, and is actually an antioxidant that helps fight free radical damage.
• Cons: Somewhat expensive when compared to other sweeteners. Often combined with other less desirable artificial sweeteners, as it is not very sweet on its own. May cause gas, bloating, and diarrhea if used in high amounts to gastric sensitive people. Type I diabetics may experience rise in blood sugar when using.
• My take: Because erythritol occurs naturally in many fruits, and based on its many human studies, I feel it can be a safe sweetener to use. That said, type I diabetics should closely monitor blood sugars with its use.  Erythritol mixed with Stevia (TruVia) or Lo Han Guo (Lakanto) is also available.

Honey: One of the oldest natural sweeteners known to man, made from honeybees, honey is a mixture of fructose, glucose and sucrose.

• Pros: Contains enzymes with antibacterial properties that can promote healing of wounds and ulcers. Some studies suggest that honey may reduce certain blood markers for heart disease likely because of its vitamin B content.
• Cons: Can raise insulin levels like sucrose, can cause allergic reaction in infants and sensitive adults.
• My take: Use in moderation. Diabetics and metabolic resistant patients should monitor insulin levels.

Lo Han Guo: Processed from S. grosvenori (monk) fruit that grows in China, Lo Han Guo has been used for centuries in Traditional Chinese Medicine for upper respiratory infections, sore throats, constipation and bowel conditions like enteritis. Contains “mogrosides” that are a combination of glucose and fructose and is very sweet, hence, its use as a natural sweetener.

• Pros: 150 times sweeter than sugar, can use less. No adverse effects in humans have been publicized.  Contains antioxidant properties slightly less than Vitamin E, anticancer properties similar to beta-carotene.
• Cons: No human trials are reported, but longevity of use in China and Japan without reported side effects in humans. However, it does have some laxative properties.
• My take: Like Stevia (see below), I think Lo Han Guo can be a safe sweetener to use. If you experience gastric upsets, you may need to adjust down your frequency of use.

Raw Sugar: Or, Turbinado, raw sugar is unprocessed white sugar given a “natural” or
“raw” marketing strategy that confuses people into thinking that it is somehow healthy for them. Chemically the same as regular white table sugar with a small amount of the natural brown molasses color left in and larger crystal size.

• Pros: Has slightly less calories than white sugar at 11 per teaspoon.
• Cons: Same as white sugar. Raises insulin levels, promotes tooth decay, contributes to obesity and heart disease to name a few.
• My take: Leave it on the shelf.

Stevia: Derived from the Stevia rebaudiana plants, this sweetener has been used in South America for centuries, in Japan for the last 40 years, and in the United States for the last 20 years, without reported human side effects and many clinical studies. In 2008, the FDA finally approved stevia as a sweetener instead of a “food additive”.

• Pros: 300 times sweeter than sugar – a little goes a long way. Does not raise insulin levels. Heat stable, can be used safely in cooking.  Blends easily with other sweeteners (see erythritol above). There are even Stevia sweetened sodas available (Zevia).
• Cons: It costs a little more than artificial sweeteners. Some brands can have a slightly bitter aftertaste that takes some getting used to. Some research studies suggest that certain components of stevia (steviol) may have “mutagenic properties” in relation to rat DNA. However, these findings were later found to be unwarranted in relation to humans and stevia did not pose a risk to humans unless over 2 lbs of it were consumed every day!
• My take: Stevia is what I recommend to my patients above other sweeteners. It’s safe and can help you break away from the health-damaging effects of sucrose.

Xylitol: Also a sugar alcohol form of sweetener found naturally in fruits. It has been used for years in diabetic-based food products including chewing gum, candies.

• Pros: Studies have shown that it can increase bone density, lower insulin levels, fight tooth decay and promote weight loss.
• Cons: Studies show that African American males may be prone to developing kidney stones from oxalate crystals in urine with higher uses of xylitol.  Like other sugar alcohols, it can cause diarrhea, gas, bloating consumed in excess.  It doesn’t work well in baked goods.  Dogs can have a life-threatening drop in blood sugar levels if they get hold of anything with Xylitol in it.
• My take: Xylitol has been used in Europe for over 40 years without real, noted side effects except for perhaps gastric upset in large quantities. Use in moderation.  If you are an African American male, switch to another sweetener. Keep from pets.

As I advise my patients, these natural-based sweeteners can add some sweet dimension to your diet. I recommend using in moderation, i.e., in your morning coffee, chewing gum, occasional sweet baked goods.  As noted, some have health drawbacks to consider before using.

Stay Well,
Mark Rosenberg, M.D.

Agave Nectar Pros and Cons, http://glutenfreeworks.com/blog/2011/02/18/agave-nectar-pros-and-cons/

Sugar Alcohols, http://www.ynhh.org/about-us/sugar_alcohol.aspx?source=sugar_alcohol.html

Heart Disease/Honey, http://www.bastyrcenter.org/content/view/483/