What is the healthiest sugar substitute? That is the question so many people want answered, and I understand why. It would be wonderful if there were a single, clean answer, especially for those of us with a sweet tooth who have heard repeatedly about the perils of sugar consumption.

But the question is a bit of a trap, because the honest, science-supported answer is more layered than naming one winner. In this post, the final one in my blood sugar series, I want to walk you through the main categories of sweeteners, what each one does in the body, and my professional take on each. More importantly, I want to give you the one habit that matters more than any sweetener ranking: learning to recognize which sweeteners are in the foods and beverages you choose to consume.

If you are just joining the series, you may want to start with how blood sugar regulation works in Part 1, how dysregulation progresses in Part 2, the two levers that support healthy blood sugar in Part 3, and how to use the glycemic index and glycemic load in Part 4. Sweeteners are the last piece of that bigger picture.

Why Sweetener Use Matters More in Midlife

As we covered earlier in this series, insulin sensitivity declines during the menopause transition as estrogen falls. For those of us in midlife, that means our bodies have to work harder to manage blood glucose than they used to. Sweeteners, even the ones marketed as healthy, often add to that blood glucose load, and they all keep our palates calibrated to want more sweetness.

As I’ve said numerous times before: I love dessert. And the reality is that my body simply cannot handle as much sugar or other natural sweetener as it could in decades past. That became undeniable last year, when my A1c edged into the prediabetic range for the first time ever. It was the result of an enormous amount of stress, the extra desserts and treats I was leaning on to cope with that stress, and the fact that it was my first year in postmenopause, all at once. I had to make changes to the way I was eating and the way I was managing my stress, to bring my blood glucose numbers back within a healthy range, while still being able to enjoy the occasional dessert or sweet treat.

Here is what I want you to hear in that: the goal for women in midlife is not avoiding all sweet foods forever, nor is it to suffer the consequences of having unregulated blood glucose. The goal is to understand what is happening in our bodies now and how different sweeteners affect the bodies we have, so we can make informed choices about how to nourish ourselves in this phase of life. Because you deserve the wellness that comes with this approach.

Artificial Sweeteners as a Sugar Substitute

Before I tell you the impact that they have in the body, let’s first answer the question, “What are artificial sweeteners?” These are the fully lab-created sweeteners, meaning they are not derived from natural products. They are often packaged with fillers including maltodextrin and silica. They include sucralose (brand name: Splenda), saccharin (brand name: Sweet’N Low), aspartame (brand name: Equal), acesulfame potassium (brand name: Sweet One), along with a few less common ones.

This is the one category where I will give you a clear position: I think all artificial sweeteners are best avoided, if at all possible. They significantly distort our expectation of sweetness, which tends to drive even stronger cravings. They do not trigger the brain’s reward center the way caloric sweetness does meaning we are more likely to overeat them, and research suggests they can blunt the satisfaction we would otherwise get from natural sweeteners and naturally sweet foods that are consumed afterward. They disrupt the gut microbiome. They must be processed by the liver. And regular use has been associated with higher body weight, not lower, compared with people who do not use them.

If you currently use and enjoy them, I understand this habit could be hard to change, and there is no shame in where you are. At the same time, if you take only one thing from this entire post, I encourage you to work toward removing artificial sweeteners, even if you change nothing else.

Sugar Alcohols as a Sugar Substitute

First, a quick clarification, because the name confuses almost everyone: sugar alcohols are not alcoholic and have nothing to do with alcoholic drinks. The word “alcohol” simply refers to a shared piece of molecular structure. Sugar alcohols include xylitol, erythritol, sorbitol, and maltitol.

Sugar alcohols do have some genuine upsides. They contain fewer calories than sugar, they have a smaller impact on blood glucose than sugar or most natural sweeteners, and some of them support the oral microbiome in ways that reduce tooth decay (which is why you see them in gum).

But they still are not given a free pass. Because we do not digest them well, they can cause bloating and a laxative effect for many people. They are lower in calories but not calorie-free, so they can still contribute to weight gain if overeaten, and they can raise blood glucose if consumed in large amounts.

There is also newer research worth that makes me wonder if they are a sugar substitute worth using. Studies from the Cleveland Clinic have found a correlation between higher blood levels of erythritol and xylitol and an increased risk of cardiovascular events like heart attack and stroke, along with laboratory evidence that these sweeteners can promote blood clotting. I want to be precise here (because accuracy matters to me): this research shows correlation, not established causation, and there is legitimate scientific debate about it (in part because our bodies also make small amounts of erythritol on their own). Still, it is one more reason to be thoughtful with sugar alcohols, even though they do not spike blood sugar the way most natural sweeteners do.

Processed “Natural” Sweeteners

These are the sweeteners that originate somewhere in nature but are then significantly altered… the kind of ingredients you would not typically buy in the baking aisle to use at home, but that show up constantly in packaged foods and bottled beverages. Think high-fructose corn syrup, glucose syrup, inverted sugar, and dextrose.

This is a diverse group with diverse effects, and I could not give you the complete picture without this turning into a textbook. But a few patterns are worth noting. Some of these “natural” sweeteners skip much of the digestive process and therefore raise blood glucose very quickly. Some interfere with your metabolism by reducing satiety, your sense of fullness, which can increase appetite. Some promote increased fat storage. And many are so heavily processed that they are essentially the definition of an ultra-processed ingredient, and they tend to travel in the company of other ultra-processed ingredients.

High-fructose corn syrup deserves a special call out, because its structure is part of the problem. It is manufactured so that the fructose and glucose are not bound together, which means they need little to no digestion and are absorbed rapidly. The high load of free fructose has been tied directly to weight gain, insulin resistance, higher triglycerides, and decreased satiety.

Natural Sweeteners

These are sweeteners in roughly the form nature provides, with only basic processing like filtering, drying, or heating. Within this group there is an important split.

Nutritive natural sweeteners provide calories. These include honey, maple syrup, agave, and all the forms of sugar (white, brown, raw, cane, and so on). They raise blood sugar; they can contribute to cavities; and like all sweeteners they release dopamine in the brain’s reward center, which, depending on your individual tendencies, can drive overconsumption as you chase that reward. They also keep your taste buds tuned to expect more sweetness.

That said, the more natural and less processed these sweeteners are, the more they tend to offer alongside their monosaccharides. Raw honey retains polyphenols, flavonoids, and antioxidants that are lost when honey is heavily processed. Real maple syrup carries minerals like calcium, magnesium, potassium, and zinc, and its sugars are bound together, so they require some digestion rather than simply flooding the blood stream. So if you are going to use a nutritive sweetener, the more natural the better, and always sparingly.

One fructose-specific caution: sweeteners high in fructose, like agave, put an extra burden on your liver, which has to convert that fructose to glucose before your body can use or store it.

Non-nutritive natural sweeteners provide essentially no calories. The two you will encounter most are stevia leaf and monk fruit extract. They do not raise blood glucose directly, which is a real advantage. However, they are often packaged or used with fillers of another type of sweetener which will raise blood sugar. And probably more importantly: they are intensely sweet. Stevia is on average 300 times sweeter than sugar, so while it is not spiking your blood glucose, it is powerfully reinforcing your expectation of sweetness, which nudges you toward other foods that will raise your blood sugar. They are certainly better metabolically than artificial sweeteners, yes, but not a free pass from the palate problem.

A Word on the “Rare Sugars”: Allulose and Friends

No sweetener is getting more buzz right now than allulose, so it deserves a closer look. Allulose (you may also see it on labels as d-psicose, an older name for the same molecule) is a “rare sugar,” a type of natural sweetener found in tiny amounts in foods like figs, raisins, and maple syrup, that is now produced commercially. D-tagatose is a related rare sugar you may occasionally see as well.

The appeal of these is real. Allulose tastes and behaves much like sugar in baking, has almost no calories, and, unlike sugar, does not meaningfully raise blood glucose. Some research even suggests it may improve aspects of blood sugar regulation, and a few studies indicate people may lose weight while using it as a sweetener and it might increase GLP-1 levels.

So why am I not declaring it the answer? A few reasons. Much of the favorable research studies allulose in bodies where an imbalance already exists, in the context of obesity, type 2 diabetes, or high-fat/high-fructose diets, rather than asking whether a generally healthy person benefits from adding it. Plus, one study showed that it can lower HDL and another questioned its effect on the gut microbiome. As well, I have not yet found good evidence on how it affects the brain’s reward center or the hunger hormones leptin and ghrelin, which are central to the whole sweetness-and-craving story. And philosophically, I keep coming back to one question: why reach for a workaround that lets us keep eating the same way, instead of changing what we eat to be more nourishing overall?

There is also a humbling bit of history here. When artificial sweeteners first arrived, they were greeted as a miracle… sweetness without consequences. We have spent decades learning otherwise. I am not saying allulose will follow that path. I am saying it is new, it is mostly studied in comorbid states, and a little caution would serve us well. By all means stay curious about it. Just hold the enthusiasm loosely while experience and science catches up.

What the WHO Finally Said Out Loud about Sugar Substitutes

In 2023, the World Health Organization released a guideline recommending against using non-sugar sweeteners for weight control or to reduce the risk of chronic disease, after a systematic review found no long-term benefit for body fat and signals of possible harm. Their suggested path forward was essentially to lower the overall sweetness of the diet rather than swap in substitutes.

I will admit a small, satisfied laugh here, because this is what functional and integrative dietitians have been saying for a long time. It is reassuring to see a major body arrive at the same place.

Two honest caveats about the guideline: First, the WHO guideline explicitly states that it does not apply to people who already have diabetes; that more complex analysis was beyond its scope. And second, it focuses on non-sugar sweeteners and does not cover the caloric sugar alcohols. So it is not the whole story, but it is meaningful validation of the central idea in this post: the goal is less sweetness overall, not a better substitute.

The Real First Step: Read Every Label

Here is where all of this lands, and it is simpler than choosing the “healthiest sugar substitute.” The single most empowering habit you can build is to start recognizing which sweeteners are in the foods you already eat.

Because the truth is that sweeteners go by dozens and dozens of names, and they hide in foods you would never expect: ketchup, barbecue sauce, bacon, sausage, bread, bottled dressings, flavored yogurt, granola bars, and plenty of “healthy,” “zero-calorie,” and “keto” snacks. Plus, there are often several different sweeteners in a single product.

So the most concrete, empowering thing you can do is read every ingredient list. You do not need to memorize the chemistry or learn all the names. You just need to start noticing what is actually in your food and drinks. Once you can see it, you can begin to make informed choices about whether or not to continue including a particular product in your diet. And remember the real goal: not a perfect replacement, not the single healthiest sweetener, not lifelong avoidance, but gradually lowering how much sweetness you expect, especially in foods that were never meant to be desserts.

To make that habit easier, I have pulled together a reference list of the many names sweeteners hide behind, so you can spot them on any label without memorizing a thing. You can grab it below.

Download it free: https://offers.feedyourintention.com/sweeteners-list

When Sugar Cravings Won’t Budge

Want to hear some good news about cravings? All of your taste buds turn over roughly every three weeks. That means within about three weeks of consciously reducing the sweetness in your diet, you can genuinely shift what you expect food to taste like. Less sweetness starts to taste right.

That said, if you have made a real effort to reduce sweeteners for at least three weeks and the cravings are still loud, that is your body communicating with you. A persistent, unyielding desire for sweetness may indicate something else is going on: in your gut, in your metabolism, or in the emotional and psychological layers of how you relate to food.

Rather than white-knuckling your way through that struggle, please consider asking for support. Finding the root cause of what is standing between you and the wellness you want is exactly the work I do with clients. If you would like to explore what that kind of support could look like for you, you are welcome to book a free 15-minute consultation.

Frequently Asked Questions

What is the healthiest sugar substitute?

There is no single healthiest sugar substitute, which is exactly why the question can lead you down an unfruitful rabbit hole. If you are going to use any type of sweetener, a minimally processed natural sweetener used sparingly is generally a better choice than an artificial sweetener or a heavily processed one. But every sweetener, even the calorie-free ones, keeps your palate calibrated to expect sweetness. The more useful goal is to gradually lower how much sweetness you expect overall, rather than searching for a perfect sugar substitute.

Are artificial sweeteners safe?

In my professional view, artificial sweeteners are the one category worth avoiding if you can. They distort your expectation of sweetness and tend to increase cravings; they do not satisfy the brain’s reward center the way caloric sweetness does; they can disrupt the gut microbiome; and regular use has been associated with higher body weight rather than lower. If you use them now, there is no shame in that, but working toward removing them is a worthwhile goal, even if you change nothing else.

Is sucralose bad for you?

Sucralose, best known by the brand name Splenda, is an artificial sweetener, and it falls squarely in the category I suggest avoiding if you can. It does not raise blood glucose, which is often how it gets marketed, but the concerns lie elsewhere. Sucralose distorts your expectation of sweetness in ways that tend to increase cravings, and research has linked artificial sweeteners as a group to disruption of the gut microbiome and, with regular use, to higher body weight rather than lower. There is also evidence that heating sucralose, as happens in baking, can generate undesirable compounds. None of this means a single diet soda is a crisis, but as a daily habit, sucralose is one I encourage people to move away from, even if they change nothing else.

What is the healthiest type of sugar?

If you are going to use sugar, the less refined versions have a slight edge, because they retain trace minerals and beneficial compounds that white sugar has had stripped away. Real maple syrup carries minerals like manganese and zinc, raw honey contains antioxidants and polyphenols, and less-processed options like coconut sugar, date sugar, and blackstrap molasses hold onto more of their original plant nutrients than white or brown table sugar (brown sugar, by the way, is usually just white sugar with molasses added back in). That said, I want to be honest with you: from your body’s blood sugar perspective, sugar is still sugar. All of these raise blood glucose; all of them feed a taste for sweetness; and the mineral differences, while real, are small. So “healthiest” here means a marginally better choice among sweeteners, not an indicator that one type actively supports your health. The bigger win is using any of them less often.

Why do I crave sweets so much, and how do I stop?

Some craving is simply learned: the more sweetness you are used to, the more you expect. The encouraging news is that your taste buds turn over about every three weeks, so consistently reducing sweetness can genuinely recalibrate your palate in that window. If you have cut back meaningfully for three weeks and still have strong cravings, that can signal something deeper: in your gut microbiome, your metabolism, or your emotional relationship with food. That is worth exploring with support rather than pure willpower.

Conclusion

There is no perfect sweetener waiting to be discovered, and chasing one tends to keep us focused on substitutes instead of on the simpler shift that actually helps: expecting less sweetness over time. Artificial sweeteners are worth leaving behind. Everything else lives on a spectrum, and the appropriate place for each in your diet depends on your body, your goals, and the season of life you are in.

In midlife especially, when your body is managing real hormonal change, this is not about restriction or willpower. It is about understanding what is happening so you can choose with intention. The most powerful next step is simply to start reading labels and noticing what is there. With that awareness, you can start making choices about how to adjust your intake.

This wraps up my blood sugar series. I hope you now have a clearer framework to support your blood sugar levels, whether you are in perimenopause, postmenopause, or another season entirely. Take what resonates. Leave what doesn’t. Your body and your experience are the best guides you have.

Want to take that first step towards recognizing all the sweeteners in your food and drinks? My free reference, The 200+ Names of Sugar Substitutes, gives you a complete list of sweeteners, including ingredient and brand names.

Download it free: https://offers.feedyourintention.com/sweeteners-list

Photo by Stephanie Dunne.

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