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Over the years, sugar has gained a reputation as public enemy number one when it comes to holistic health. Its overconsumption has been linked to a range of chronic conditions, including diabetes, heart disease and obesity. For many, the solution lies in switching to sugar substitutes, but not all sweeteners are created equal. Understanding the differences is key to choosing the right alternative, and as is often the case, consuming these in moderation is also important.
This is according to Marlene Ellmer, from Vergelegen Dietitians – a long-standing partner of Mediclinic Vergelegen. Ellmer and her team provide both in- and out-patient dietary support across the Mediclinic group, working closely with patients in intensive care, high care and general wards. As part of a multi-disciplinary approach, they complement the work of Mediclinic’s admitting specialists with expert nutritional advice.
“Sweeteners can be a helpful tool if you’re cutting back on sugar – especially for people with diabetes, those trying to lose weight, or anyone looking to prevent tooth decay,” Ellmer explains. “The important thing to remember is that using sweeteners isn’t a free pass to eat more sweet foods, as this can counter any positive results that come from cutting out traditional sugar. However, when used as recommended and in moderation, they are generally recognised as safe alternatives.”
Sugar types decoded
The public is constantly reminded of the negative effects of excessive sugar consumption – and for good reason. However, as Ellmer explains, not all sugars are inherently bad. For instance, the sugar found in sugary drinks and processed foods is called sucrose. Extensive national and global research confirms that high sucrose intake is associated with poor metabolic outcomes.
Naturally occurring sugars, such as fructose in fruit and lactose in dairy products, are different. These sugars are accompanied by fibre and nutrients, which help the body process them more effectively. “So, while sugar isn’t inherently evil, it becomes ‘ugly’ when overconsumed – especially in the absence of nutritional balance and other imperative micro and macronutrients.”
Artificial sweeteners: pros and cons
Artificial sweeteners are often much sweeter than sugar – sometimes up to 100 times – but contain no calories or usable energy. They typically pass through the digestive system without being fully absorbed.
Commonly found in ‘diet’ or ‘zero’ soft drinks, sugar-free gum and various processed foods, artificial sweeteners are generally considered safe. However, over-usage is not usually recommended, and some people do report a metallic or unpleasant aftertaste. Examples include saccharin, acesulfame, aspartame, neotame and sucralose.
Natural sweeteners: know your options
Natural sweeteners are derived from plant or fruit sources and vary widely in how they affect the body. Some, like stevia, are significantly sweeter than regular sugar but do not raise blood glucose levels. Others, like honey or agave, contain calories and can impact blood sugar levels.
These sweeteners are often used in products marketed as healthier alternatives, but not all are suitable for people with diabetes. Popular natural options include stevia, agave syrup and monk fruit extract.
The lowdown on sugar alcohols
Sugar alcohols have grown in popularity in recent years, though they’ve long been used in products like sugar-free sweets and diabetic-friendly items. These are a type of carbohydrate that the body only partially absorbs, resulting in fewer calories and a milder impact on blood sugar.
They are generally less sweet than regular sugar and are considered a useful alternative in moderation. However, excessive consumption can lead to digestive issues such as bloating, gas or diarrhoea. Common examples include sorbitol, erythritol, xylitol and mannitol.
Sweetener safety: what’s true?
For some, sweeteners remain a cause for concern, especially due to ongoing debate around potential links to cancer. According to the International Agency for Research on Cancer (IARC), certain sweeteners like aspartame are classified as “Possibly carcinogenic to humans”.
Research, however, is inconclusive, and most health authorities agree these sweeteners are safe when used in moderation and manufactured to appropriate standards.
As Ellmer concludes: “The same principle that applies to any kind of food also applies to sweeteners: ‘everything in moderation.’ Natural options like stevia and xylitol are often better choices because they come from plant sources and have a smaller effect on blood sugar levels.
However, not everyone reacts to food products the same way. That’s why it’s a good idea to talk to a healthcare professional to figure out what works best for your body and your health goals.”