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Are ‘Natural’ Sweeteners Healthier Than Sugar?

Stevia, sugar, pollen and honey

If you’re looking to improve nutrition and cut your sugar intake, you may have considered alternative natural sweeteners. But there’s a lot to keep in mind when choosing these sweeteners.

A recent study links some sweeteners containing erythritol to a higher risk of heart attack, stroke and blood clotting. More research is needed, but the findings are cause for caution.

“Natural sweeteners have become more appealing than sugar because they are less processed and may contain more nutrients and provide healthy benefits,” says University Hospitals registered dietitian Elizabeth Traxler, RD, LD“Based on the latest study results, it may be best to consume sweeteners that contain erythritol in moderation until we know more.”

The Basics of Sugar

Many healthy foods – fruits, vegetables, whole grains and milk – contain natural sugars. Excess or added sugars are the real problem.

Sugarcane and beet sugar are the two main crops used for table sugar and most natural sweeteners. They contain two types of sugar: fructose and sucrose. The body processes those sugars into glucose for energy. But because sugarcane and beet sugar are highly processed, these sweeteners don’t contain many nutrients, vitamins, minerals or bioactive components such as antioxidants. Stripped of their nutrients, cane and beet sugar provide only extra calories.

The health benefit from different types of sweeteners depends on how you are eating it. No matter the source, keep in mind that an excess of calories, especially from “added” sugars (those that do not occur naturally in food), is associated with obesity, diabetes, heart disease, high blood pressure and other chronic health problems.

Natural Alternatives to Refined Sugar

With those basics in mind, here are some natural sweeteners you can consider as substitutes for conventional sugar.

Sugar Alcohols: Erythritol and Xylitol

Erythritol and xylitol are low calorie sweeteners. Sugar alcohols are considered natural because they are derived from plants, but they are chemically reformulated for use. They taste much like conventional sugar, but can leave a mild aftertaste. They don’t spike blood sugar or insulin levels and don’t cause tooth decay like other types of sugar. However, they are poorly digested and may cause digestive distress if consumed in excessive amounts.

Erythritol may be linked to an increased risk of heart attack, stroke, and blood clotting, according to a new study published in Nature Medicine. More research is needed to understand the risks. In the meantime, it’s best to use caution when choosing how much or how often to use erythritol.


Stevia is a plant leaf extract. Because it is hundreds of times sweeter than conventional sugar, very small amounts are needed for intense sweetness. This zero-calorie sweetener has a low glycemic index, so it doesn’t impact insulin or blood sugar levels. While that makes it a good sweetener for weight management and diabetes, it may trick the body into wanting more.

While high-purity stevia is considered safe when consumed in moderate doses, many product manufacturers mix stevia with erythritol. Use caution when choosing how much or how often to use it.


Agave is a plant nectar. Like stevia, agave is extremely sweet and is only needed in small amounts. It has a lower glycemic index because of its high fructose content, which means it won't spike blood sugar. Agave nectar may also benefit gut health, thanks to its prebiotic activity. However, studies have shown that the high fructose content can increase triglycerides and the risk of fatty liver disease. It may also leave you craving more if you aren’t careful to limit your intake.

Coconut Sugar

Coconut sugar comes from the sap of coconut trees. It is evaporated into a crystalline product and is similar to brown sugar in texture and flavor. It has a lower sucrose content and is considered a lower glycemic sweetener. It has good nutritional profile with vitamin C, B vitamins and antioxidants.

Date Sugar

Date sugar and syrup are high in sugar, but are less processed and therefore retain some of the fiber, minerals and antioxidants of dates.

Monk Fruit

Monk fruit extract is a zero-calorie, low glycemic index sweetener. It is high in antioxidants, offers possible anti-cancer effects, and has a favorable effect on blood glucose regulation.

Many product manufacturers mix monk fruit with erythritol, so use caution when choosing how much or how often to use it.

Fruit Puree

Fruit puree is a great sweetener alternative as a topper for dishes or for baking. Blending ripe fruits such as apples, pears or bananas provides a nutritious sweetener with fiber, nutrients and water.


Honey has a high moisture content and, especially when unprocessed, a varied nutritional profile containing minerals, vitamins, proteins and other valuable nutrients. It is an antimicrobial and its antioxidants fight inflammation.

Maple Syrup

Pure maple syrup has many nutritional benefits due to its antioxidant and cancer-fighting properties. Maple syrup contains a compound that slows down its blood sugar absorption, which may be good for people with diabetes. Darker syrup may have more nutritional benefits than lighter products.

Brown Rice Syrup

Brown rice syrup is produced from breaking down rice into a syrup. It is considered a healthier alternative to HFCS because it has no fructose and most of the sugar is glucose, readily available to the body for energy. Brown rice syrup has a high glycemic index. A few studies have shown it contains trace amounts of arsenic, though it’s still considered safe for consumption in moderation.

Blackstrap Molasses

Blackstrap molasses comes from sugarcane or sugar beet juice, but is boiled down further than standard molasses. Rich in iron, B vitamins, potassium, magnesium, calcium, and antioxidants, it may support immunity and fight inflammation. Blackstrap has a lower glycemic index and more bitter taste than regular molasses.

The Bottom Line

Natural sweeteners are considered healthier than conventional sugar because these sweeteners usually contain more vitamins, minerals, antioxidants and other bioactive molecules that may be healthful. However, just because they have more nutrients than conventional sugar does not mean that frequent consumption of these sweeteners is encouraged. It’s important to practice moderation as most of these sweeteners contain other ingredients.

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The Clinical Nutrition Department at University Hospitals provides comprehensive nutrition services to improve the health and quality of life for patients. Learn more.