Cookies, pies, and candies abound in office spaces, social gatherings, and in local shops. Advertisements for sugary foods and drinks are inescapable. While the American Institute for Cancer Research recommends limiting sugar-sweetened beverages and eating plant-focused diet, breaking the habit of seeking out sugary sweet foods can be challenging. Sugar substitutes (also called artificial sweeteners and non-nutritive sweeteners) could be one way to kick the habit. 

Eating and drinking sweet foods releases dopamine, the “reward” or “pleasure” hormone. This may be why we are typically drawn to eat something sweet when we are feeling down, unhappy, or bored. It is not fully understood whether eating and drinking sugar substitutes have a similar effect on the body’s hormones that control mood and craving, how they may affect overall digestion, or in what ways they alter the make-up of your gut microbiome. However, we do know that sugar substitutes do not affect blood glucose in the same way as table sugar. This is why sugar substitutes appear to be a good option for people with blood sugar regulation issues or other metabolic disorders, such as diabetes or fatty liver disease, who want to add a little sweetness to their coffee or tea.

Understanding Sugar Substitutes and Their Safety 

The United States Food and Drug Administration (FDA) regulates sugar substitutes (non-nutritive sweeteners) and establishes safe levels for daily consumption. According to the FDA, six artificial sweeteners (made from chemicals, plant extracts, and/or herbs) and three fruit- and plant-based sweeteners (e.g., monk fruit, stevia) are “Generally Recognized As Safe” (GRAS). GRAS sweeteners are safe to consume within specific daily limits, all of which are much higher than an average person would consume (see image below).  

Another alternative to table sugar is a group of sweeteners called “sugar alcohols” (e.g., erythritol, sorbitol, xylitol). Sugar alcohols are usually less sweet, lower in calories, and do not affect blood glucose in the same way as table sugar. These are commonly found in “sugar-free” candies and chewing gum and are considered safe by the FDA. 

Some research has linked the use of specific non-nutritive sweeteners with negative health outcomes. In 2023, the International Agency for Research on Cancer labeled aspartame as “possibly carcinogenic to humans”. While concerning, the conclusion was based on limited evidence, and the FDA’s acceptable daily intake (roughly 9 or more cans of aspartame-sweetened sodas for someone weighing 150lbs) was not changed. Erythritol (a sugar alcohol) has also received increased scrutiny following a 2023 article, but the FDA’s recommendations have not changed. Still, some studies have suggested possible health benefits, even suggesting that using sugar substitutes may encourage healthier lifestyle choices. However, stronger research is needed to prove a direct connection. 

The Bottom Line: Should You Use Sugar Substitutes? 

In summary, current evidence shows that sugar substitutes are generally safe and do not directly cause harm to people. If you need to consume less sugar due to health conditions like type 2 diabetes or are trying to cut back for other reasons, consider using sugar substitutes in moderation. Each sweetener has a different level of sweetness, and each one is much sweeter than table sugar (see image below). Sugar alternatives may affect blood sugar differently as well. Water and unsweetened drinks, like tea, coffee, and water infused with fruit or herbs, are still the best choices and what you should aim to drink most often. If you are seeking help in finding the right sugar substitute for you, consult a registered dietitian. 

References & Resources: 

• Aspartame and Other Sweeteners in Food. U.S. Food & Drug Administration. February 27, 2025. Accessed March 13, 2025. https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food

• Aspartame and Cancer Risk – What You Need to Know. American Institute for Cancer Research. July 14, 2023. Accessed March 13, 2025. https://www.aicr.org/resources/blog/aspartame-and-cancer-risk-what-you-need-to-know/

• Aspartame hazard and risk assessment results released. World Health Organization. July 14, 2023. Accessed March 13, 2025. https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released

• Jia H, Bernard L, Chen J, et al. Serum metabolomic markers of artificially sweetened beverage consumption. The Journal of Nutrition. 2024;154(11):3266-3273. doi: 10.1016/j.tjnut.2024.09.024

Blake Langley, ND, LAc is a clinical researcher at the Fred Hutchinson Cancer Center specializing in studying how integrative therapies can support cancer survivors. Blake is the principal investigator of a clinical trial on acupressure and a co-investigator on multiple health-promotion studies across multiple cancer types.