Wellness Wednesday: The Great Debate - Sugar vs Artificial Sweeteners

On today's Wellness Wednesday post, I answer one of my most frequently asked questions - which is healthier, sugar or artificial sweeteners. As you'll see, the sugar vs artificial sweeteners debate distracts from the real problem, that we should be eating less of both. 

Sugar Versus Artificial Sweeteners

Happy Wellness Wednesday y'all! My most recent Wellness Wednesday posts have been about the psychology of eating and non-nutrition aspects of wellness, so I'm excited to share a post on nutrition science. Today, I'm answering what one of the top five most frequently asked questions in my practice: artificial sweeteners or sugar?

The debate between sugar vs. artificial sweeteners is a heated one and has been ever since saccharin was approved by the FDA in the 50s. You can find dietitians, nutritionists, doctors, scientists, health writers, and overly opinionated facebook friends who post 2,347 articles a day on both sides of the debate.

I've been meaning to post on this topic for a long time. After reading The Evidence Supports Artificial Sweeteners Over Sugar, a recent New York Times article, I knew I had to clear things up. I hope you'll give it a read, but if not, here's the gist. The author, a pediatrician and professor, claims artificial sweeteners are a healthier choice because science shows they do not cause cancer, a reason commonly cited for avoiding them.

Technically, he's right. It's unlikely artificial sweeteners cause cancer. Save for one concerning study linking sucralose (splenda) to leukemia in mice, I haven't seen any other convincing evidence that artificial sweeteners cause cancer, and it's not for lack of research.

Still, I hold issue with the article. Although the science is right, his conclusion isn't. Artificial sweeteners may not cause cancer, but that doesn't make them safe.

People don't use artificial sweeteners to prevent cancer. They choose them to manage blood sugar and lose or manage weight. There's pretty convincing evidence artificial sweeteners do neither. We'll come back to that.

The debate between artificial sweeteners and sugar is a moot point. When it comes to your health, neither is beneficial, both are safe if consumed in small amounts, and incredibly dangerous if consumed in excess. Let's take a look at the science:


  • When it comes to sugar, we're eating an astounding amount. The average adult consumes 22 teaspoons a day. Compare that to the American Heart Association recommendations to limit added sugars to 6 teaspoons daily for women and 9 teaspoons daily for men. Even more tragic? The average child eats a whopping 32 teaspoons daily.
  • All calories aren't equal. Sugar isn't filling, so any calorie from sugar will likely be on top of the other calories you're eating. That's a big part of the reason why eating too much sugar is so strongly linked to overweight and obesity.
  • Forget cholesterol. Sugar is the real danger when it comes to heart disease. Added sugars cause inflammation and damage to arterial walls, essentially the first step in the heart disease process. A large study in 2014 showed people who eat the most sugar have almost double the risk of heart disease compared to those who eat the least.
  • Sugar has a profound impact on brain health, contributing to anxiety and depression through inflammation and by affecting hormones and neurotransmitters.
  • Artificial sweeteners may not cause cancer, but sugar sure does. Eating too much sugar causes inflammation and high insulin levels, both linked to cancer, especially of the pancreas, breast and colon.

Artificial Sweeteners:

  • Despite being calorie free, artificial sweeteners are linked to weight gain in several large and well designed studies.There are many proposed mechanisms. Artificial sweeteners seem to enhance appetite, contribute to sweet cravings by training taste buds to sweeter flavors, and confuse the bodies natural mechanisms for regulating caloric intake. And of course, there the psychological effect - when you're eating diet food, that totally means you can eat more...right???
  • In the short term, artificial sweeteners don't raise blood sugar. But long term, artificial sweeteners are linked to a higher risk of type 2 diabetes. Although artificial sweeteners don't break down into glucose, the super sweet taste (some are thousands of times sweeter than sugar!) confuses the body, causing it to release insulin, the hormone that controls blood sugar. Excessive insulin release can lead to insulin resistance/glucose intolerance.
  • I keep preaching the importance of a healthy gut flora, like, on a daily basis. But did you know artificial sweeteners may lead to an imbalance of gut bacteria (which also seems to effect glucose tolerance).
  • Artificial sweeteners taste absolutely awful. This is probably my biggest reason for avoiding them.

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So, what do I tell my clients? While both sugar and artificial sweeteners are two of the least nutritious and most dangerous foods we can consume, neither are toxic. Either can be consumed in small amounts without problem. That said, I encourage clients to stick with a (key word) small amount of the real thing, preferably from unrefined sugars like honey, pure maple syrup or coconut sugar. These sugars contain some nutrients, have slightly less of an effect on blood sugar and taste sweeter so you'll use less.

There are only a few cases in which I recommend artificial sweeteners. Both stevia extract and Swerve, a zero calorie sweetener made from erythritol, seem to be fairly safe. If a client is really stuck on low cal, that's what I recommend. It hasn't been researched, but I wonder if stevia has an effect on sweet cravings (being much sweeter than sugar) and if erythritol (being a sugar alcohol) affects gut bacteria, which is why I don't recommend them universally. Also, I think there's good research showing for someone who is morbidly obese and consumes a significant amount of sugar (i.e. multiple cans of regular soda/day plus sweets), switching to artificial sweeteners can help promote weight loss and serve as a "bridge" as they change eating habits.

The takeaway message? No matter what you choose, less is more. For more help cutting back and understanding what moderation is when it comes to sweets, check out my Tame Your Sweet Tooth guide, available for purchase in the nutrition shop. It includes strategies for eating less sweets while enjoying them more as well and delicious recipes for low and no added sugar treats!