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'Doctor, which artificial sweetener should I use?'- Dr. Mishra answers

M3 India Newsdesk Feb 10, 2019

In the Sunday Series we bring to you another popular article from our archives where Prof. Dr. Sundeep Mishra picks  ups a common patient query about the use of artificial sweeteners.

While it was assumed that artificial sweeteners being low in calories would be helpful in glycaemic control in diabetics, the use of aspartame and sucralose instead of decreasing blood sugar actually causes paradoxical postprandial hyperglycaemia with accompanying postprandial hyperinsulinaemia, possibly increasing insulin resistance.

Sugar-free artificial sweeteners have been considered beneficial for diabetics as well as obese individuals wherein they can provide sweetness to food without elevating blood sugar levels or adding calories.

A little history on sweeteners

Saccharin was discovered by an American German scientist Fahlberg who while working with compound radicals and substitution products of coal tar, forgot to wash his hands after working long in his lab and found that his bread was inordinately sweet and the napkin holding it was even sweeter!

Interestingly, saccharin a non-nutrient sweetener found its use as a low-cost substitute for refined sugar during the World War I & II when due to agricultural crisis sugar production was falling. Since then several sugar-free substitutes have become available: aspartame, neotame & sucralose are a few refined products but stevia, yacon syrup, maple syrup and of course honey are some of the natural products.

Not only are these sugar-free sweeteners available as syrup, pellets, sachets for use as sweeteners of food products but they can be found in more than 6000 food products across the globe, particularly cola-drinks and are now more commonly consumed than imagined.

Closer home, a study conducted in Lucknow, revealed that even in children of age group 6 to 10 years, consumption of artificial sweeteners exceeded Accepted Daily Intake (ADI) by 54% (due to consumption of ice candies and crushed ice).

Efficacy in diabetes

A large meta-analysis of prospective studies involving ≈40,000 cases revealed that artificial sweeteners could actually increase the risk of diabetes mellitus (rather than decreasing it).

More importantly, there seems to be a gradation of risk depending upon year of consumption and amount consumed per day. The latest ACC/AHA guidelines also recommend a word of caution with the use of artificial sweeteners as a means of calorie restriction.

Artificial sweeteners in food products

Food Stuff Constituent Artificial Sweeteners
Diet Coke/Coca Cola Zero Aspartame & acesulfame K
Coca Cola Life Cane sugar + Stevia
Diet Pepsi Aspartame/sucralose
Sugarless cookie Acesulfame K & sucralose
Chocolate syrup Acesulfame K & sucralose
Chewing gum Aspartame & acesulfame K
Sugar-free Indian sweets Aspartame, acesulfame K or sucralose
Pan masala Saccharin
Sweet supari Cyclamate-saccharin mixture
Ice candies & crushed ice Saccharin

Safety concerns regarding sweeteners

Several efficacy and safety concerns have come to light with the use of these agents.

  • Cyclamate was the first artificial sweetener to be banned due to risk of carcinoma
  • Saccharin (still used in ice candies, crushed ice and particularly pan masala) was found associated with cancer in rats and therefore possibly cancerous in human
  • One prospective study has found that artificial sweetener aspartame consumption could increase the risk of lymphoma & leukaemia in men

Information on popular sugarfree sweeteners that are commercially available

Sweetener X times sweeter than sugar Brand Name Accepted Intake (g/kg/day) Possible Side Effects
Saccharin 300 Sweet N' Low 50 Bladder cancer
Aspartame 200 Equal 15 Insulin resistance, chronic fatigue, brain tumour
Acesulfame 200 Sweet One 18 Carcinogenic
Sucralose 600 Splenda 5 Insulin resistance, DNA damage
Stevia 150 Truvia/Pure Via 4 Not known


How about natural products?


  • Raw honey is considered a superfood and contains not only carbohydrates but is packed with enzymes, antioxidants, iron, zinc, potassium, calcium, phosphorous, vitamin B6, riboflavin and niacin
  • One tablespoon of honey has 64 calories which is less than a banana but more than 1 tablespoon of sugar (49 calories), but honey is much sweeter than sugar and therefore much less amount is required for the same sweetness
  • Glycaemic index of honey is also lower than plain sugar because of lower fructose content and numerous minerals
  • Honey contains 40% fructose, 30% glucose plus water, pollen and minerals an abundance of magnesium and potassium, while sugar contains practically nothing other than carbohydrates; 50%, fructose and 50% glucose


  • It is a very popular 0 calorie, 0 carbohydrate sweetener extracted from the leaves of a plant called Stevia rebaudiana which has many sweet compounds, but the main ones are stevioside and rebaudioside A
  • Both compounds are hundred times sweeter than sugar, gram for gram
  • The body of scientific evidence reveals that purified stevia leaf extract has no adverse effects in humans and is safe for the general population at the levels used in foods and beverages

The main problem with stevia is the bitter after-taste of the product. Furthermore, while stevia is available as liquid drops, packets, dissolvable tablets and baking blend, but the matter of fact is that most data pertains to purified leaf extract only.

Maple Syrup

  • Native to North America, maple syrup is made from boiled-down maple tree sap, and contains calcium, potassium, and zinc
  • Rich with antioxidants (the more dark the syrup, the more anti-oxidants) 1 tablespoon has 52 calories
  • Maple syrup has much lower fructose content than agave (another natural sweetener), adds a pleasant flavour to foods, and is great for baking.

Coconut sugar

  • Coconut sugar aka coconut palm sugar/coco sap sugar/coconut crystals is made from the sweet nectar of flower buds of the coconut palm
  • It is a good source of potassium, iron, and vitamins and although it provides the same number of calories and carbohydrates as regular sugar, it has a lower glycaemic index


  • Agave nectar aka agave syrup is a natural liquid sweetener made from the juice of the agave cactus 
  • One tablespoon of agave has 60 calories but like honey it has a low glycaemic index and less amount is required (than sugar) because it is much sweeter

Unfortunately, it is high in fructose which might affect the hormone leptin and could contribute to overeating and weight gain. It is sold in light, amber, dark, and raw varieties.

Real fruit jam

  • Berries, stone fruit, apples, pears, and grapes are great replacements for sugar in recipes if no extra sugar is added

Caloric content of major natural sweeteners

Sweetener Calories/Tablespoon
Sugar 49
Raw Honey 64
Maple Syrup 52
Coconut Sugar 45
Agave 60
Mixed Fruit Jam ≈45
Stevia 0





Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The writer, Dr. Sundeep Mishra is a Professor of Cardiology.

This article was origianly published on 11.10.18

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