Sugar vs. sweeteners: Why less is always best

by Kaiser Permanente |

Sweet treats and sugary drinks seem to surround us. Even many of our favorite fruits are high in sugar — mangoes and grapes being among the highest.1 But the problem is when people consume too much sugar, it can increase their risk of health problems like weight gain, diabetes, cardiovascular disease, and dental cavities.2 Plus, a recent study showed that consuming artificially sweetened soft drinks can lead to a higher risk of stroke and dementia.3 So where do we begin when deciding what to do about all the sweet stuff? The first step is understanding the different kinds of sugar.

Natural vs. added sugar

Natural sugar is a type of simple carbohydrate found in some foods and drinks. Many healthy foods, like dairy products, vegetables, and fruit, contain natural sugars like lactose and fructose, which provide the body with 16 calories, or “energy,” per teaspoon, according to the FDA.4 These foods that contain natural sugars also provide essential nutrients that nourish your body and help prevent disease.5

But when sugar is added at the manufacturing stage, like with many fruit juices and sliced breads, it adds calories, but it does not add any other essential nutrients. And the body digests those added sugars very quickly, making them a poor source for sustained energy.2 One common example of a chemically produced added sugar is high-fructose corn syrup, which is made from corn. All kinds of added sugars can be found in foods you might not expect, so it’s a good idea to check your food labels.

Soft drinks, fruit drinks, flavored yogurts, cereals, cookies, cakes, candies, and processed foods are the top sources of added sugar, or sugar that doesn’t occur naturally, in the American diet.6 But added sugar also exists in less obvious things like breads, sauces, and salad dressing.

So many sweeteners

Of course, sugar has the added benefit of tasting good, so when people want the flavor but also want to control how much they’re getting, they turn to sweeteners. Some people use artificial sweeteners like Sweet’N Low or natural sweeteners like honey, but are they all created equal?

Surprisingly, their nutritional values aren’t that different. Here are a few basics about household sweeteners.

Refined sugar

When many people think of sugar, they think of cane sugar, also known as refined sugar, table sugar, or sucrose, which is made by processing sugar cane and sugar beets. Like natural sugar, refined sugar has about 16 calories per teaspoon.4

Sugar substitutes

Sugar substitutes are synthetic artificial sweeteners, like NutraSweet and Sweet’N Low, that often contain few or no calories. Because they taste several times sweeter than refined sugar, they’re sometimes called “intense sweeteners.”

Natural sweeteners

Natural sweeteners like honey, molasses, and coconut sugar may seem like healthier choices than refined sugar. Yet in reality, they aren’t much different — your body processes honey and sugar the same way since they are nutritionally similar.7

Less is best

Ultimately, whether you choose cane sugar, a sugar substitute, or a natural sweetener, the key is to use less. According to the American Heart Association, women should consume no more than 6 teaspoons of added sugar per day, and men should consume no more than 9 teaspoons.8

Some easy ways to consume less sugar include reading food labels for sugar in its many forms, keeping it out of your home, and trying recipes that leave out all the added sugar. For example, instead of buying a pint of ice cream, make your own frozen banana whip with just bananas, unsweetened almond milk, and a splash of vanilla. Keep in mind that even natural sugars can increase your chance of cavities,4 so moderation is still key.

FoodData Central, U.S. Department of Agriculture, accessed January 29, 2020.

5 Reasons Why Sugar is Bad for You,, April 1, 2019.

Matthew P. Pase et al. Sugar- and Artificially Sweetened Beverages and the Risk of Incident Stroke and Dementia: A Prospective Cohort StudyStroke, American Heart Association, April 20, 2017.

“Sugars,”, accessed January 9, 2020.

Natural vs. Refined Sugars: What’s the Difference? Cancer Treatment Centers of America, August 9, 2016.

The Sweet Danger of Sugar, Harvard Health Publishing, November 5, 2019.

Artificial Sweeteners and Other Sugar Substitutes,, September 25, 2018.

Added Sugars, American Heart Association, April 17, 2018.