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The Truth About Sugar & Sweeteners

Although experts generally agree that all types of sugar are unhealthy in excess, no independent research indicates whether high-fructose corn syrup or sugar is worse, or whether artificial sweeteners are any better.

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When New York Mayor Michael Bloomberg announced in May 2012 his proposal for the first citywide ban in the United States on the sale of sugary drinks that are larger than 16 ounces at restaurants and other public facilities, it was yet another salvo in the ongoing debate over the health effects of sugar, high-fructose corn syrup (HFCS) and artificial sweeteners.

Bloomberg’s proposal came after Harvard researchers released in March 2012 their findings that men who drink one sugar- or HFCS-sweetened beverage per day had a 20 percent increased risk of heart disease regardless of their age, diet, family history or alcohol/tobacco use. The Harvard results were announced 1 month after four doctors published an editorial in the science journal Nature that called for all types of sugar and HFCS to be regulated the way that alcohol or tobacco is, due to the connection between sugar and HFCS to obesity and other health problems.

We spoke with 10 independent health experts, and they all agreed with the preponderance of scientific evidence that any sugar and HFCS is bad for you. But they also agreed that it isn’t easy to avoid sugars or sweeteners, or even to wean yourself off them, because 80 percent of the 600,000 items that are in U.S. grocery aisles contain some form of added sugar or sweetener.

Furthermore, no one can agree which artificial sweeteners are better—or if any are beneficial at all. Depending on with whom you speak, virtually all types of sugars and sweeteners either are praised or linked to some sort of chronic condition. We found no independent research that proves that any of them are healthy, unhealthy or even moderately safe in a specific amount. Aside from the old saw against excess, finding any advice adds up to a pile of crystal confusion.

SICKENINGLY SWEET? Of all of the types of sugar and sweeteners that are on the market, HFCS and its trade group, Corn Refiners Association (CRA), certainly received the most sour publicity in the past 5 years. HFCS has been linked to diabetes, liver damage, obesity and heart problems. A 2009 report by Institute for Agriculture and Trade Policy, which promotes sustainable food systems, found that some beverages and food that contained HFCS also included detectable levels of mercury.

The latest data that we found indicates that as a result of the negative publicity, sales of HFCS to manufacturers fell by 9 percent in 2009 from 2007, according to Credit Suisse, which is a research-analysis company. ConAgra, Gatorade, Nabisco and Pizza Hut are just a few of the companies that since replaced HFCS with sugar in some of their products. (ConAgra reintroduced a Hunt’s ketchup that has HFCS in 2012 after the demand for its HFCS-free version wasn’t as high as it had expected.)

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CRA launched a $30 million damage-control campaign in 2008. In an attempt to salvage HFCS’s image, CRA petitioned Food and Drug Administration in 2010 for permission to label its products “corn sugar.” FDA ruled against the petition in May 2012, saying the name change could mislead people who can’t tolerate fructose and that the term “corn sugar” has been used to describe dextrose for at least 30 years.

Still, the experts with whom we spoke say just because HFCS might be bad for you doesn’t mean that plain sugar is any better. Marion Nestle, who is a professor in nutrition, food studies and public health at New York University, concurs with many who say that too much of any type of sugar is a bad thing.

“Sugars of any type have calories and are best consumed in small amounts,” she tells us.

ARTIFICIAL OR ARTIFICE? If diets that are high in HFCS and sugar can lead to diabetes, heart disease and obesity, then it makes sense to consume artificial and natural sweeteners, such as the ones that are found in noncaloric diet sodas, right? Not so fast.

The 2012 Harvard study that linked sugary soft drinks to heart disease found no similar link regarding artificially sweetened soft drinks. But in July 2012, American Diabetes Association and American Heart Association announced that existing scientific evidence is “inconclusive” on whether artificial and natural sweeteners truly cut calories, reduce the amount of added sugars that an individual consumes or help you to lose weight.

NOT SO SWEET. World Health Organization recommends no more than 200 calories of sugar (as much as in one 16-ounce soda) per day.

NOT SO SWEET. World Health Organization recommends no more than 200 calories of sugar (as much as in one 16-ounce soda) per day.


A 2011 study by University of Texas Health Science Center studied 474 diet-soda drinkers over 10 years and found that the subjects who drank two or more diet sodas every day gained five times as much weight as the subjects who avoided diet sodas altogether. In a separate study that also was published in 2011, the center found that because artificial sweeteners don’t have any calories, they won’t satisfy your appetite in the way that traditional sugars do. But they’ll slow your metabolism and trigger you to eat more. Therefore, you might gain weight from consuming artificial sweeteners more easily than you would gain from consuming sugars. Nestle says she isn’t aware of any convincing evidence that proves that artificial sweeteners help people to lose weight.

Artificial sweeteners also might be addictive, according to a 2011 study by University of Bordeaux in France. Researchers found that rats always picked the artificial sweetener when they were given a choice between an artificial sweetener and cocaine. In fact, even cocaine-addicted rats chose the artificial sweetener.

If the image of artificial-sweetener-addled rats isn’t enough to give you pause, consider that three primary artificial sweeteners—acesulfame potassium, aspartame and saccharin—also have been linked to cancer, according to Center for Science in the Public Interest, which is an advocacy group for health issues and food safety.

Furthermore, a 2011 study by University of Miami’s Miller School of Medicine found that people who drank one diet soda every day had a 61 percent higher chance of having a heart attack or stroke.

Questions persist about artificial sweeteners’ links to Alzheimer’s disease, autism, chronic fatigue syndrome, lupus, multiple sclerosis and Parkinson’s disease, according to American Association of Occupational Health Nurses.

STEVIA ON STAGE. Consumers who want to avoid traditional sweeteners can choose agave nectar (found in chocolate, ice cream and snack bars), erythritol (found in grapes, melons and pears), monk fruit (found in some cereals and granolas) and tagatose (found in dairy products).

But the latest trendy favorite that’s among alternative sweeteners is stevia, which is a plant that’s indigenous to Paraguay. Stevia was banned from use as a sweetener in the United States in 1991 by FDA, which made its decision based on an anonymous safety petition. However, in 2008, FDA approved rebaudioside A, which is an extract of stevia, as a food additive.

That decision allowed Merisant and PepsiCo to introduce PureVia, and Cargill and Coca-Cola to release Truvia. Both of these noncaloric sweeteners are made from processed stevia plants and are marketed by the companies as “natural” sweeteners. 

But all of the experts with whom we spoke question how “natural” they really are. PureVia includes dextrose, which is a simple sugar, for added flavor. And Truvia contains erythritol, which is a fruit-derived sugar, to improve its taste. Granted, these are natural sweeteners, but they don’t occur naturally in stevia. In other words, PureVia and Truvia are refined products.

Of course, FDA has no definition of the word “natural,” so companies can use the term whenever they wish. And in the case of PureVia and Truvia, the marketing has helped them to muscle into territory that previously was controlled by the primary artificial sweeteners.

Truvia appears in at least 30 products and trails only Splenda (sucralose) in artificial-sweetener sales in the United States, according to SymphonyIRI Group, which is a market-research company. PureVia hasn’t sold as briskly, and Merisant is trying to market it for its lower price. A 40-packet box of Truvia typically sells for $7 on Amazon, while a 40-packet box of PureVia is offered for $3.50.

However, as with all sugar and sweeteners, concerns persist about the safety of rebaudioside A. No expert could point us toward any scientific research on the safety of rebaudioside A that wasn’t funded by the companies that produce and distribute the products that include either sweetener.

And, believe it or not, the presence of processed stevia plants in a product doesn’t mean that the product is free of other sweeteners. Experts tell us that manufacturers typically add acesulfame potassium, aspartame, neotame, sucralose, sugar and even HFCS to improve the taste of stevia products. In other words, these “natural” products are heavily refined synthetic formulations that carry the same health concerns as other types of sugars and sweeteners do.

THE SAFEST PATH? With all of the uncertainty that’s hanging over HFCS, sugar, artificial sweeteners and even stevia, how can you best satisfy your sweet tooth?

Dr. Cate Shanahan, who is a family practitioner, recommends that you avoid sweets for at least 2 weeks and then stick to the natural sugar that’s in fruits to satisfy sugar cravings. However, she says sweetness is so addicting that it’s tantamount to being addicted to drugs.

“Nobody I know who has had weight problems from eating sweets has had lasting weight-loss success without losing their addiction to sweetness first,” she says.

Other experts, such as Nestle and Dr. Janette Sherman, who is trained in internal medicine and toxicology, agree that excess sugar should be avoided. They advise patients to look under “total carbohydrates” on an ingredient label. Unless the product contains raisins or other dried fruits, you can assume that any listed amount of sugar has been added.

World Health Organization recommends that added sugars should make up no more than 10 percent of your daily caloric intake. Therefore, for someone who is on a typical 2,000-calorie diet, no more than 200 calories (or 50 grams) should be sugars, Nestle said. That’s equivalent to 16 ounces of soda per day.

“Nobody worries about a gram or two here or there,” Nestle says. “It’s the large amounts that matter. That means limiting sodas, candy and desserts.”

That’s the same advice that you’ll get from Department of Agriculture. Unfortunately, most Americans consume 440 calories of sugars—more than twice the recommended amount—per day, according to USDA and Centers for Disease Control and Prevention. That’s reason for crystal concern.

Martha Rosenberg writes about public health. Her work has appeared in The Boston Globe, Chicago Tribune and Los Angeles Times.

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