January 2015 Issue

Alternative Natural Sweeteners
By Judith C. Thalheimer, RD, LDN
Today's Dietitian
Vol. 17 No. 1 P. 18

Learn more about the most popular products on store shelves and what the science says about their nutrient content and safety profiles.

The USDA estimates that the average American consumes more than 22 teaspoons of added sugars per day.1 This overabundance of sweets has been linked to weight gain and the development of insulin resistance, fatty liver, type 2 diabetes, and cardiovascular disease.1,2 Scientists have developed noncaloric artificial sweeteners in an attempt to satisfy the public's sweet tooth without stretching their waistbands, but the safety and impact of these chemicals are hotly debated in research journals and the popular press. People are increasingly looking for more healthful natural alternatives to the refined white granules we typically think of as sugar.3 The truth is that natural doesn't necessarily mean healthful. Nutrition professionals should be fully informed about alternative natural sweeteners, old and new, to help clients make choices that meet their personal and health care needs.
Following is a discussion on some of the most popular natural, alternative sweeteners available today and their nutrient content, safety profiles, and positive and negative health effects.

Bees make honey from the nectar of flowering plants. The color, flavor, and antioxidant content of honey depend on which flowers provide the nectar. This fact accounts for the more than 300 varietals of honey found in the United States.4,5 While honey contains several different sugar molecules, it's primarily composed of fructose and glucose.5 Honey is known to have antioxidant, antimicrobial, and soothing effects, and the World Health Organization and American Academy of Pediatrics recommend it as a natural cough remedy for children older than 1.4

In a 2007 study by a Penn State College of Medicine research team, buckwheat honey reduced nighttime coughing and improved sleep quality in children with upper respiratory infection better than the cough medicine dextromethorphan or no treatment.6 Honey can be used in dressings, marinades, and slaws, or stirred into a cup of tea.5 This rich, sticky natural sweetener may harbor the bacteria that causes infant botulism, so it should never be given to children younger than 1.7

Maple Syrup
One of the most popular sweeteners on the market is maple syrup.8 Made by boiling down the sap of maple trees, this sweet syrup has been consumed in North America for centuries.8 Depending on the grade, maple syrup is about 50% glucose and 50% fructose, like table sugar.5 Maple syrup contains more minerals than table sugar, particularly manganese and zinc.8 It also has small amounts of polyphenols, which are antioxidants that help reduce inflammation.5 This 100% natural sweetener may raise blood sugar more slowly than table sugar.8 In addition to pancakes and French toast, maple syrup pairs well with pork or in a fall-inspired vinaigrette.5

Agave Syrup
Agave syrup has been growing in popularity since the early 2000s.9 More processed than many people realize, this pale to dark amber liquid sweetener is made by treating the nectar of agave plants with enzymes or heat to break down the plant's complex carbohydrates into fructose and glucose.10 Agave syrup is 11/2 times sweeter than table sugar and also has 11/2 times more calories.11 It has trace amounts of iron, calcium, potassium, and magnesium, and is a popular vegan substitute for honey.12 Less viscous than honey, agave syrup dissolves more easily in liquids, making it a nice option for sweetening smoothies and drinks.13

While most natural caloric sweeteners are a roughly 50/50 mix of the sugars glucose and fructose, agave syrup is 90% fructose (compared with 55% in high-fructose corn syrup).9,12 Since fructose doesn't cause blood sugar spikes, it was initially believed that agave was a good choice for people with diabetes. However, research indicates that consuming too much fructose has serious health implications, leading the American Diabetes Association to list agave, like all other sugars, as a sweetener to limit.11

One way to limit sugars is to try a noncaloric natural alternative such as stevia. The stevia plant, also known as sweet leaf or honey leaf, is a shrub originally grown in South America.14,15 The extract made from this plant's leaves is about 200 times sweeter than table sugar.16 This intense sweetness comes from glycosides, sugars bound to nonsugar substances.3,17 Glycosides can't be metabolized in the human body, so stevia doesn't provide any calories.14

Early animal studies indicated there might be health concerns associated with consuming stevia extracts, but newer data suggest that stevia has no adverse effects on human health.14,18 In light of this, the FDA granted generally recognized as safe (GRAS) status to highly refined stevia preparations such as Reb A, a purified stevia glycoside, but whole-leaf stevia and crude extracts aren't FDA-approved.15 Watchdog groups such as the Center for Science in the Public Interest say that Reb A probably is safe, but they're pushing for additional long-term testing.16 Preliminary studies have looked at the potential for using stevia glycosides as dietary supplements to aid in controlling blood sugar and blood pressure and fighting cancer, but more data are needed.18

Purified stevia leaf extract is being used in some sodas, sports drinks, bakery items, and other mainstream products.15,16 It's also available for home use in tabletop packets, liquid drops, dissolvable tablets, spoonable products, and baking blends.15 Stevia has a bitter aftertaste, so it's almost always found blended with a caloric sweetener such as dextrose.

Monk Fruit
The monk fruit, also known as luo han guo, has been used in south China for centuries as a remedy for cough and sore throats, a longevity aid, and a sweetener.19 Monk fruit extract is 200 times sweeter than table sugar, and it has no calories, since, like stevia, it gets its sweet taste from glycosides.3,16 The FDA has declared monk fruit extract to be GRAS.20 It's already being used in some packaged foods and is available in sweetener blends for home use.

While research is preliminary, monk fruit sugar may have more going for it than just its calorie-free sweetness. In 1996, Shi and colleagues found that monk fruit extract shows antioxidant activity against free radicals and lipid peroxidation.21 In 2009, research found that monk fruit and monk fruit extract stimulate insulin production.22 It's also being examined as a cancer fighter.23 More research is needed on this relatively new player on the sweetener shelf, but monk fruit appears to be a safe, natural alternative to caloric sweeteners.16

Coconut Palm Sugar
Named one of the "Top 10 Culinary Trends of 2015" by FoodNavigator-USA.com, an online newsletter for the food and beverage industry, coconut sugar is an up-and-coming natural alternative to watch.24 Made from boiling down the nectar of coconut plant flowers, this sweetener is 70% to 80% sucrose (the disaccharide in table sugar) and has the same number of calories as table sugar.5,24 It has some minerals and other nutrients, but the amount of nutrients in a serving is minimal.24 This sweetener is described as having a nutty flavor that doesn't taste like coconut and is recommended as a substitute for brown sugar in food preparation.5 There's limited research to date on this new sweetening option.5

Date Sugar
Also gaining popularity in the sweetener lineup is date sugar. Date sugar isn't an extract. It's simply dried dates ground into a fine powder, so it has the nutrients of whole dates, including potassium, calcium, and antioxidants.5 The amount of fiber in a teaspoon of date sugar, however, is negligible.25 In a 2009 study of 12 different sweeteners, date sugar had the highest antioxidant content, 500 to 600 times more than table sugar.26 The main drawback to this sweetener is that it doesn't melt, so its uses are somewhat limited.26 Replacing brown sugar in recipes, such as banana bread and bar cookies,5 or sprinkling some on yogurt or fruit are suggested uses for this very sweet product.

Decisions, Decisions
With all of these options, and more, to choose from, deciding what sweetener to use can be a challenge for health-conscious consumers. "Whether something is a good choice or not often depends on the outcome being assessed," says Andrew Bremer, MD, PhD, a program director for the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases. "One could say, for example, that agave nectar may be better than sucrose for people with diabetes because it doesn't raise blood sugar as much, but that's just one metric of many," Bremer says. "The fructose in agave nectar and other sweeteners doesn't raise blood sugar, but it may contribute to liver disease and cause other important adverse metabolic outcomes."

Fructose is used alone as a sweetener in some processed foods, but it also represents about 50% of most other caloric sweeteners (exceptions are dextrose and corn syrup, which are 100% glucose, and agave syrup, which is 90% fructose).

Kimber Stanhope, PhD, a researcher at the University of California, Davis, is a leading expert on the metabolic effects of sugars. "Unlike glucose, fructose is metabolized exclusively in the liver," Stanhope says. "Therefore, when we consume too much fructose, the liver turns some of it into fat. This can lead to fatty liver, which increases the risk of diabetes, and can also lead to higher LDL cholesterol levels, which increases the risk of heart disease." High-fructose diets also may increase insulin resistance, triglyceride levels, inflammation, and the risk of metabolic syndrome.27 Fructose may not raise blood sugar, but it certainly has other effects worth considering. Choosing a sweetener for a specific health effect, such as blood sugar impact, therefore, may not be the best way to go. "Different sugar molecules have different properties and different effects, so it's not always appropriate to look at only one outcome—for example, a transient rise in blood sugar—and say to our patients, 'use this product over that,'" Bremer says.

Satisfying the Sweet Tooth
The key, as with so many things, is moderation. "There's strong evidence that definitely suggests that Americans need to decrease their sugar consumption," Stanhope says. The American Heart Association recommends that women get no more than 100 kcal/day from added sugars, and men no more than 150 kcal/day.1 Even low- or no-calorie sweeteners aren't the whole answer, since the foods in which they're found typically aren't the most nutritious choices.

"Just because it's sweetened with an alternative doesn't mean it's good for you," says Joan Salge Blake, MS, RDN, LDN, a spokesperson for the Academy of Nutrition and Dietetics. "Most of the sweets in our diet are beverages or grain-based foods like baked goods. We need a lot less of both of these in the American diet."

That doesn't mean sweet-tasting foods are off the menu altogether. Experts studying the impact of sugars on our health point the finger at added sugars, no matter where those sugars come from or how they are (or are not) processed. Salge Blake recommends satisfying that sweet tooth with naturally sweet foods. "Let's eat more fruits," Salge Blake says. "Grilling pineapples and peaches caramelizes the sugars for a rich, delicious sweetness. Try baked apples with a sprinkling of cinnamon or roast or poach some pears. Instead of eating a combination of refined grains and added sugars, we can eat these naturally sweet, delicious, nutrition-packed, healthful alternatives."

Stanhope says, "We have turned sugars into a staple. We need to get back to the idea that sugar is a treat."

Changing habits to cut back on sweetened foods, adding more naturally sweet foods to their diets, and using natural sweeteners that suit their personal needs and tastes in moderation can help health-conscious consumers meet their goals.

— Judith C. Thalheimer, RD, LDN, is a freelance nutrition writer, a community educator, and the principal of JTRD Nutrition Education Services.

How to Substitute Alternative Sweeteners5,13


For 1 cup of table sugar, use:


Agave syrup

3/4 cup

Per cup of sugar replaced: Reduce liquid by 2 T and lower oven temperature by 25° F.

Maple syrup

3/4 cup

Per cup of sugar replaced: Reduce liquid by 2 T.


3/4 cup

Per cup of sugar replaced: Reduce liquid by 2 T and lower oven temperature by 25° F.

Date sugar

2/3 cup

Does not melt. Use along with other sugar when baking.

Coconut sugar

1 cup



1 cup

In baking, don't replace more than one-half of the sugar in the recipe with stevia sweetener, per InTheRaw.com.

Monk fruit

1 cup

In baking, don't replace more than one-half of the sugar in the recipe with monk fruit sweetener, per InTheRaw.com.


1. Added sugars add to your risk of dying from heart disease. American Heart Association website. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Added-Sugars-Add-to-Your-Risk-of-Dying-from-Heart-Disease_UCM_460319_Article.jsp. Updated February 20, 2014.

2. Stanhope KL, Havel PJ. Fructose consumption: recent results and their potential implications. Ann N Y Acad Sci. 2010;1190:15-24.

3. Pawar RS, Krynitsky AJ, Rader JI. Sweeteners from plants — with emphasis on Stevia rebaudiana (Bertoni) and Siraitia grosvenorii (Swingle). Anal Bioanal Chem. 2013;405(13):4397-4407.

4. The sweet truth behind honey. National Honey Board website. http://storyofhoney.com/press_kit_docs/NHB_Story_of_Honey_Press_Release.pdf. Updated November 12, 2014.

5. D'Agrosa L. Buyer's guide to natural sweeteners. Eating Well website.

6. Honey proves a better option for childhood cough than OTCs. Pennsylvania State University website. http://news.psu.edu/story/192001/2007/12/03/honey-proves-better-option-childhood-cough-otcs. Updated March 19, 2009. Accessed October 26, 2014.

7. Botulism—general information. Centers for Disease Control website. http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism/. Updated April 25, 2014. Accessed October 20, 2014.

8. Gunnars K. Maple syrup: healthy or unhealthy? Authority Nutrition website. http://authoritynutrition.com/maple-syrup/

9. Jamerson A. Does agave spike blood sugar? SFGate website. http://healthyeating.sfgate.com/agave-spike-blood-sugar-4143.html

10. Myths and truth. The International Organic Agave Alliance website. http://theioaa.com/newsroom/articles/madhavas-agave-nectar/. Updated April 2, 2010. Accessed November 15, 2014.

11. Horton J. The truth about agave. WebMD website. http://www.webmd.com/diet/features/the-truth-about-agave. Updated July 22, 2014. Accessed October 2014.

12. Barnes L, Nichols N. The truth about "natural" sweeteners. SparkPeople website. http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1203&page=3

13. Sweeteners. Whole Foods website. http://www.wholefoodsmarket.com/recipes/food-guides/sweeteners

14. Schardt D. Sweet nothings. Center for Science in the Public Interest website. http://www.cspinet.org/nah/05_04/sweet_nothings_canada.pdf. May 2004.

15. Stevia and sugar substitutes. WebMD website. http://www.webmd.com/diet/stevia-sugar-substitutes. Updated July 31, 2014. Accessed October 2014.

16. It's sweet…but is it safe? Center for Science in the Public Interest website. http://www.cspinet.org/new/201312311.html. Updated December 31, 2013. Accessed October 2014.

17. Glycoside. The Free Dictionary website. http://medical-dictionary.thefreedictionary.com/Glycosides

18. Gunnars K. Stevia—A natural sweetener with proven health benefits. Authority Nutrition website. http://authoritynutrition.com/stevia/

19 Dharmananda S. Lua han guo: sweet fruit used as sugar substitute and medicinal herb. Institute for Traditional Medicine website. http://www.itmonline.org/arts/luohanguo.htm. Updated January 2004. Accessed October 2014.

20. GRAS notices—GRN No. 301. US Food and Drug Administration website. http://www.accessdata.fda.gov/scripts/fdcc/?set=GRASNotices&id=301&sort=GRN_No&order=DESC&startrow=1&type=basic&search=luo

21. Shi H, Hiramatsu M, Komatsu M, Kayama T. Antioxidant property of Fructus Momordicae extract. Biochem Mol Biol Int. 1996;40(6):1111-1121.

22. Zhou Y, Zheng Y, Ebersole J, Huang CF. Insulin secretion stimulating effects of mogroside V and fruit extract of luo han kuo (Siraitia grosvenori Swingle) fruit extract. Yao Xue Xue Bao. 2009;44(11):1252-1257.

23. Konoshima T, Takasaki M. Cancer-chemopreventive effects of natural sweeteners and related compounds. Pure Appl Chem. 2002;74(7):1309-1316.

24. Watson E. Matcha, regional grains, coconut sugar & cannabis cuisine: what are the top 10 culinary trends for 2015? FoodNavigator website. http://www.foodnavigator-usa.com/Manufacturers/Sterling-Rice-Group-predicts-top-10-food-trends-for-2015. Updated October 24, 2014. Accessed October 27, 2014.

25. Date sugar. Bob's Red Mill website. http://www.bobsredmill.com/date-sugar.html

26. King M. Date sugar wins as the healthiest sweetener. Examiner.com website. http://www.examiner.com/article/date-sugar-wins-as-the-healthiest-sweetener. Updated August 25, 2013.

27. Oz M. Agave: why we were wrong. The Dr. Oz Show website. http://blog.doctoroz.com/dr-oz-blog/agave-why-we-were-wrong. Updated February 27, 2014. Accessed October 2014.


Jalapeño Honey Vinaigrette

Serves 9

1/2 cup sliced or chopped unpeeled English cucumber
1/4 cup grapeseed or flaxseed oil
2 T white wine vinegar
Juice of 1 lime (2 T)
1 shallot
1 small jalapeño pepper with some seeds
1 T honey or agave nectar
1 T fresh cilantro leaves (optional)
1/4 tsp sea salt, or to taste
1/4 tsp freshly ground black pepper, or to taste

1. Place all the ingredients in a blender. Cover and purée.
2. Adjust seasoning to taste.

* Use immediately or store covered in the refrigerator for up to one week.

Nutrient Analysis per serving (2 T)
Calories: 70; Fat: 6 g; Carbohydrates: 3 g; Dietary fiber: 0 g


Maple and Mustard Roasted Root Vegetables

Serves 6

5 cups coarsely chopped or sliced root veggies of your choice: turnips, parsnips, rutabaga, carrots, potatoes, yams, beets, and/or golden beets
1/2 cup coarsely chopped onion or 20 pearl onions, peeled
2 T olive oil
1/2 tsp salt
1/4 tsp pepper
1/4 cup maple syrup
2 T Dijon mustard
1/2 tsp garlic powder

1. Preheat oven to 425° F.
2. Toss root veggies and onions with the olive oil, salt, and pepper on a baking pan.
3. Roast in oven for 20 minutes. Stir. Cook for another 30 minutes, stirring again halfway through.
4. Combine maple syrup, Dijon mustard, and garlic powder in a small bowl. Drizzle the maple mixture over veggies and mix to coat well.
5. Cook again until all veggies are soft and glaze starts to caramelize and brown.

Nutrient Analysis per serving (1 cup)
Calories: 221; Fat: 6 g; Carbohydrates: 39 g; Protein: 3 g; Dietary fiber: 6 g