Decoding Sweeteners From Stevia To Coconut Sugar: The Good, The Bad, And The Ugly

Americans eat an average of 765 grams of sugar every five days—and much of it comes from not knowing where sugar is lurking or what alternative name it's going by! Compare that number to the year 1822, when Americans ate just 45 grams in the same time period. Every person eats and drinks 130 pounds of added sugar every year, an average of 3,550 pounds in a lifetime. That is equal to eating 1.7 million Skittles or an industrial-sized dumpster full of sugar.

While fruit and dairy provide natural sources of sugar, I’m talking about added sweeteners here. Wherever you look in the grocery store or restaurants, sugar and sugar substitutes are added to just about everything—it's in nut butter, condiments, kombucha, crackers, popcorn, and most everything else that comes in a package. These ingredients go by many names, even super-healthy-sounding euphemisms, so it can be hard to even recognize sugar in all its varying forms. 

What's someone interested in maintaining a healthy body and living green to do? As a functional medicine doctor, my job is not only to help make people healthy but also to provide useful recommendations for them to stay healthy. Not many people want to live a sugar-celibate life. So let's get practical.

I will share from my experience which sugar substitutes to avoid and those to be used responsibly, with caution and in small amounts. The good (decent), bad, and ugly of sweeteners, if you will. Get your fix, right here.

These sugar substitutes are the ones to avoid. The most common culprits and whose colorful packages you often see at any restaurant or coffee bar are:

I have written in the past about the link between artificial sweeteners and health problems. In addition to individual sensitivity issues to these chemicals, research demonstrates that artificial sweeteners can contribute to metabolic dysfunction1 (obesity, type 2 diabetes, etc.) and change the composition of our gut microbiota2. As our largest immune organ, messing with the gut can have a wide-reaching, negative impact on our health.

This artificial sweetener is so widely used it can be shocking to learn just how many products actually contain it; even foods that you wouldn’t think need sweetening. High-fructose corn syrup (HFCS) is found in salad dressing, other condiments, soda, candy, baked goods, certain yogurts, frozen processed foods, canned fruit, bread, juice, granola bars, coffee creamer, jams, jellies, and ice cream. This is not an exhaustive list.

HFCS is derived from corn starch (largely GMO corn) through an intensive chemical process that is anything but natural. Aside from being empty calories, HFCS and its higher proportion (higher than table sugar) of fructose is thought to be metabolized differently, and not in a good way.

By bypassing a key regulatory step3 in glycolysis, fructose is rapidly taken up by the liver. Research indicates4 that HFCS can negatively affect lipid metabolism and contribute to insulin resistance and diabetes. HFCS can also lead to another metabolic problem, leptin resistance, which contributes to weight gain and weight-loss resistance.

Because this sugar is from the agave plant and has a low glycemic index, a way of measuring how fast certain carbohydrates will raise your blood sugar, agave nectar is often touted as a healthier sweetener alternative. In my opinion, this is an overly simplistic way of determining whether a food is “bad” or not because you aren’t considering any other factors. Agave nectar is still high in fructose (like HFCS), and while human studies are lacking, theoretically, this fructose in high amounts over time could contribute to metabolic dysfunction like insulin resistance and fatty liver disease.

Also known as raw cane sugar or “sugar in the raw”, turbinado is not so “raw” and unrefined. This type of brown sugar, known for its large, amber-colored crystals, still undergoes processing, which removes soil, natural impurities, and most nutrients from the sugarcane. While it's still far less processed than refined white sugar and retains some of the original molasses, it's nutritional profile is similar to white sugar and thus, still not much better for you.

Also known as rice syrup or rice malt, this sweetener is made from the combination of brown rice and enzymes. The enzymes break down the starch, and then it is boiled down to create a syrup. The fermentation makes the sugars easier to digest. In addition to the high glycemic index of rice syrup, another issue is that sometimes barley enzymes are used, which contain gluten. Unless you are specifically looking for gluten-free brown-rice syrup, you could be unknowingly perpetuating health problems if you are sensitive to gluten. Commercial-scale brown rice syrups typically use enzymes from bacterial or fungal origins, instead of barley.

It is also important to note that arsenic can accumulate and be present in rice. Studies have shown5 that arsenic levels have been found to be high in organic brown rice syrup, which is used in a lot of different products6 from cereal and energy bars to formulas for toddlers. Make sure to limit your packaged products where this sweetener is used to decrease toxin exposure.

Stevia is derived from the Stevia rebaudiana plant (from South America), and the no-calorie sweet taste comes from two primary glycosides found in the plant, stevioside and rebaudioside. A zero-calorie low-glycemic sweetener that’s also natural?! It sounds almost too good to be true—and it kind of is. It all depends on what kind of stevia you are buying. 

Make sure you are getting raw organic stevia that is still in its green form. Otherwise, in other conventional stevia brands, which may be heavily processed, you may be exposing yourself to other chemicals added as preservatives. These stevia products are often combined with erythritol (and sugar alcohol), dextrose, and flavors. 

While the stevia plant has many properties and therapeutic potential to help with weight management and metabolic health, there’s the flip side to consider too. For example, a few studies show stevia's ability to impact hormones. And, preliminary animal research indicates that stevia may disrupt the balance of gut microbiota7, at least in rodents. More research is needed to understand this further.

We aren’t talking about your run-of-the-mill pancake syrup product. Instead, we are talking about 100% pure organic maple syrup. What makes this a much better alternative to traditional sugar is the fact that it actually contains a good amount of essential minerals like zinc and manganese (along with some calcium, potassium, and iron) and a variety of phenolic antioxidants (at least 24 different kinds). 

And since it's sourced straight from tree sap it goes through minimal processing (often simply heating to evaporate the water) to reach its conventional form. The darker the maple syrup, the better, because it contains a higher amount of antioxidant activity8 according to studies in cell models. Regardless of these beneficial traits, remember maple syrup is still full of sugar, so moderation is key.

Straight from the honeycomb, this is one of the best natural options when you need to add a little sweetness to your life. I recommend you purchase it in its raw, unpasteurized, and unfiltered form to receive its benefits in its most natural state. Honey contains a wide range of phytochemicals, like phenolic acids and flavonoids, which have potent antioxidant properties to fight oxidative stress (involved in processes of aging and disease). 

The flavonoids of bee pollen also pack a punch, supporting your immune system9. I consider manuka honey from New Zealand to be the absolute best raw honey you can buy, and research has clearly demonstrated its antimicrobial properties10. While honey is still high in sugar (so use in small amounts), it’s better than refined sugar. When swapping for table sugar, honey has been shown to help improve key lipids11 associated with metabolic disease.

This sweetener is made by boiling the juice of sugar cane (or sometimes sugar beets) to concentrate it and result in sugar crystallization.. This refining process produces the dark, thick syrup we know as molasses. Full of phytochemicals, minerals (e.g. iron, potassium, magnesium, calcium, selenium), and vitamin B6—molasses is unique in that way. It's phenolic antioxidant properties12 have been shown in cell models.

A more concentrated version, blackstrap molasses, is considered to be an especially nutrient-dense form of molasses and is achieved by processing the syrup three times to remove as much sucrose as possible. Rich in iron, this mineral is important to help fight fatigue since it’s a critical component of all red blood cells.

Dates or date palms are sweet fruits that are completely unprocessed and can be eaten fresh or dried or pureed into a paste to add to many different recipes. Since they are naturally very high in fructose it is still important to keep their intake to a moderate amount. 

In addition to being a natural sweetener, dates contain fiber, a variety of antioxidants13, and several micronutrients (potassium, magnesium, copper, manganese, iron, and vitamin B6, amongst others). Thanks to the fiber in dates, they can help those struggling with constipation and help improve overall digestive health by increasing growth of beneficial bacteria14 in the gut.

Although fruit contains fructose, which is still a sugar to your body, it can be better than other types since it's naturally occurring in the fruit and not processed. Furthermore, the glycemic index for fructose is much lower than sucrose (think table sugar). Because of the other beneficial health properties that come along with fruit from vitamins, minerals, and a rainbow of antioxidant-boasting phytochemicals, it makes for a good alternative as long as it’s consumed in moderation. Look for 100% fruit juice or concentrate products that are not laden with additional sugar or additives. From berries to apples, you have choices.

Often found in “sugar-free” foods, sugar alcohols or polyols include sorbitol, mannitol, erythritol, maltitol, and xylitol (amongst others). While some sugar alcohols are found naturally in fruits and vegetables, most of these sweeteners on the market are derived through chemically processing (hydrogenating) sugars, like glucose from corn starch Unlike other sugar-free sweeteners that have zero calories, sugar alcohols can contain up to three calories per gram. Along with stevia, these sugar alcohols are still decent options for people looking for natural sugar-free options and lowering their calorie intake and glycemic load.

But they don't work for everyone. Polyols are the “p” in FODMAP, and some people, particularly those with IBS, require a low FODMAP15 dietary approach. Depending on the person and amount consumed, sugar alcohols can have a laxative effect and can flare up digestive problems16 like IBS and SIBO. Your body does not completely absorb these, and they end up fermenting in the large intestine, which can cause gas and bloating.

Like stevia and sugar alcohols, monk fruit sugar or luo han guo fruit is another low-carb sweetener option. It's fermented from the pulp of the fruit, which removes the sugars but leaves a residual sweet flavor. Used for hundreds of years in Asian countries where it is harvested, this “Buddha fruit” contains beneficial antioxidants called mogrosides. Because of this, our little friend monk has been used as a natural antioxidant 17and anti-inflammatory method for centuries in Chinese medicine. 

Useful for reducing calorie intake and minimizing glucose and insulin responses following a meal, monk fruit has practical health benefits18. You have to be aware of what kind of monk fruit sugar you are purchasing because some commercially available options have additives, so read the labels and stick with pure monk fruit. Similar to sugar alcohols like xylitol, too much luo han guo can trigger stomach issues in some sensitive individuals. Similar to stevia, the aftertaste of monk fruit sugar is a matter of personal taste and opinion.

These natural sweeteners are derived from the nectar inside the coconut blossoms (i.e., the coconut palm sap) of the coconut tree, not the coconut itself. Also called coconut palm sugar, this sweetener is a better option than regular sugar (“empty” calories). First, coconut sugar has a slightly lower glycemic index thanks to its inulin (prebiotic) fiber content. 

Additionally, this sweetener contains polyphenols with antioxidant properties, and some nutrients in modest amounts like zinc, potassium, and short-chain fatty acids. Coconut sugar delivers a mellow caramel taste, and organic versions are the best option in my opinion.

When my patients are looking to add sweetness to food I first recommend raw organic stevia, monk fruit, organic coconut sugar, maple syrup, molasses, and dates. With any of these, moderation is still important—no more than a couple tablespoons per day is ideal. The bad and ugly sweeteners should still be avoided as much as possible for thriving long-term health.

Like with anything, however, every person is very different, and for those with chronic health conditions even some of these decent sweeteners need to be avoided entirely or for a certain period of time. Make sure to work with a functional medicine doctor to determine your individual needs.