What is the most harmless sugar substitute?

December 24, 2025 •

5 min read

Following a recent study that linked the sugar alcohol erythritol to an increased risk of heart attack and stroke, many consumers are re-evaluating their choices. Amid growing skepticism, finding the most harmless sugar substitute has become a top priority for those seeking a sweet taste without compromising their well-being.

Quick Summary

This article compares the safety profiles of popular natural, novel, and artificial sweeteners, offering guidance to help you find the least harmful option.

Key Points

Purified Stevia Extract: Derived from a plant, purified stevia extract is a zero-calorie sweetener with GRAS status from the FDA and does not raise blood sugar.
Pure Monk Fruit Extract: Sourced from the monk fruit, this zero-calorie sweetener is intensely sweet and has a strong safety history in traditional use, also holding GRAS status.
Caution with Blends: Many stevia and monk fruit products are mixed with sugar alcohols like erythritol, which has been linked to increased heart event risk.
Avoid Controversial Artificials: Artificial sweeteners such as aspartame and sucralose have been associated with concerning health risks in various studies.
Choose Whole Foods First: The healthiest approach to sweetness is prioritizing whole foods like fruits and dates, which provide beneficial nutrients and fiber.
Read Labels Carefully: Always check the ingredients list for hidden sugar alcohols, even in products marketed as natural or zero-calorie.

Understanding the Complex World of Sweeteners

In the journey toward a healthier lifestyle, many people turn to sugar substitutes to reduce their calorie and sugar intake. However, the market is flooded with options, each with its own benefits and potential risks. From plant-derived extracts to synthetic chemicals and sugar alcohols, the sheer volume of choices can be overwhelming. The critical distinction lies in understanding how each type is metabolized by the body and what, if any, side effects are associated with it.

The Rise of Novel Sweeteners: Stevia and Monk Fruit

Novel sweeteners are derived from natural sources but are highly refined to extract their sweet compounds. The most popular in this category are stevia and monk fruit, both of which are non-nutritive (contain zero calories) and do not impact blood sugar levels, making them a safe choice for people with diabetes.

Stevia: A Closer Look

Derived from the leaves of the Stevia rebaudiana plant, stevia's sweetness comes from compounds called steviol glycosides. Purified stevia extracts have a long history of use and are classified as "Generally Recognized as Safe" (GRAS) by the FDA. While it offers a calorie-free sweetness, some individuals notice a mild, licorice-like or slightly bitter aftertaste, particularly in higher concentrations. It is important to check ingredient labels, as some stevia products are bulked with sugar alcohols that can cause digestive issues.

Monk Fruit: A Contender for the Most Harmless Sugar Substitute

Monk fruit, or luo han guo, gets its intense sweetness from antioxidants called mogrosides, which are extracted from the fruit. Similar to stevia, pure monk fruit extract provides zero calories and does not affect blood glucose. The FDA also considers monk fruit extract to be GRAS, and centuries of traditional Chinese use suggest a strong safety profile. However, a major issue arises with commercially available products: many are blended with other sweeteners, most commonly erythritol, to reduce costs and improve flavor. Consumers must read labels carefully to find pure, unadulterated monk fruit extract.

Artificial Sweeteners and Sugar Alcohols: Proceed with Caution

This category includes many of the oldest and most widespread sugar alternatives, but they are increasingly under scrutiny due to emerging research.

The Erythritol Warning

Erythritol is a sugar alcohol found naturally in some fruits, but most commercially used erythritol is produced industrially. For years, it was a popular choice due to its low-calorie content and mild flavor, but recent findings from the Cleveland Clinic have sounded the alarm. A study found that high circulating levels of erythritol are associated with an increased risk of major cardiovascular events like heart attack and stroke, prompting caution, particularly for individuals with existing heart disease risk factors.

The Case Against Older Artificial Sweeteners

Other well-known artificial sweeteners also have concerning data. Aspartame, for instance, has been linked to cancer in certain animal studies and some human observational data. The World Health Organization's International Agency for Research on Cancer classified it as "possibly carcinogenic to humans". Sucralose, commonly known as Splenda, has been associated with leukemia in mice and potential disruption of the gut microbiome. These findings, along with others, highlight the importance of approaching these sweeteners with a degree of prudence.

Natural but Caloric Sweeteners

For those who prefer less refined options and aren't strictly avoiding calories or carbs, sweeteners like honey, maple syrup, and dates are available. These natural products contain vitamins, minerals, and antioxidants, but they still contain sugar and can raise blood glucose levels. Moderation is key for all sweeteners, but especially for these caloric natural options.

Comparison of Popular Sugar Substitutes


Sweetener Type	Example	Origin	Calories	Blood Sugar Impact	Potential Concerns	Notes
Novel Sweetener	Purified Stevia Extract	Stevia plant leaf	Zero	None	Aftertaste, often blended with sugar alcohols	GRAS status, very common
Novel Sweetener	Pure Monk Fruit Extract	Monk fruit	Zero	None	Often blended with erythritol, can be expensive	GRAS status, growing in popularity
Sugar Alcohol	Erythritol	Industrial fermentation	Very Low	None	Linked to cardiovascular events in high amounts	Commonly used as a bulking agent
Artificial	Aspartame	Synthetic	Very Low	Minimal	Possibly carcinogenic, linked to cancer in animal studies	Used in diet sodas and packets
Artificial	Sucralose	Synthetic	Zero	Minimal	Linked to leukemia in mice, gut microbiome issues	Very common brand: Splenda
Caloric Natural	Honey / Maple Syrup	Natural source	High	Raises blood sugar	High calorie and sugar content, moderation required	Contains some nutrients and antioxidants

Tips for Choosing the Most Harmless Option

Prioritize Whole Foods: The safest approach to sweetness is consuming it in its natural, whole-food form, such as from fruits and dates. Whole foods provide fiber, vitamins, and minerals that counteract some of the negative effects of concentrated sweeteners.
Read Labels Diligently: Pay close attention to the ingredients list. Opt for pure extracts of stevia or monk fruit. Many products labeled with these ingredients still contain erythritol or other unwanted additives.
Choose Pure Liquid Drops: Using pure liquid stevia or monk fruit drops is one of the most reliable ways to avoid unnecessary fillers and sugar alcohols.
Moderate All Sweetener Intake: No sweetener should be consumed without limit. While pure extracts are generally safe, encouraging an overly sweet palate can lead to greater cravings for sweetened foods.
Consult a Professional: If you have underlying health conditions like diabetes or heart issues, speak with a doctor or registered dietitian before incorporating any new sweeteners into your diet.

Conclusion: Making the Safest Choice

When considering what is the most harmless sugar substitute, purified stevia and monk fruit extracts emerge as the strongest contenders, provided they are in their pure form. They offer zero calories and do not affect blood sugar, earning them GRAS status from the FDA. The primary risk is not from the sweeteners themselves, but from common additives like erythritol, which have recently raised serious health concerns. By focusing on pure extracts, prioritizing whole foods, and reading labels carefully, consumers can enjoy sweetness while minimizing potential harm. Making an informed choice based on the latest scientific evidence is the most effective strategy for managing dietary sweetness safely.

For additional information on sugar alternatives and healthy eating strategies, Johns Hopkins Medicine offers helpful resources.

Frequently Asked Questions

Not necessarily. While the pure extracts are generally considered safe, many commercially available products blend them with other sweeteners like erythritol. You must read the ingredient label to ensure you are purchasing a pure extract without added sugar alcohols.

Erythritol has been a popular sugar alcohol, but a recent Cleveland Clinic study found that higher blood levels of it were associated with an increased risk of heart attack, stroke, and blood clots, especially in people already at risk for cardiovascular disease.

Natural sweeteners like honey and maple syrup contain antioxidants and minerals, but they are still high in calories and sugar and will raise your blood sugar levels. They should be consumed in moderation, just like regular sugar.

Look for liquid stevia or monk fruit extracts that have a very short ingredients list, ideally with only 'stevia extract' or 'monk fruit extract' and purified water. Blends will often explicitly list erythritol, dextrose, or other sugar alcohols.

The long-term safety of artificial sweeteners like aspartame and sucralose is controversial. While the FDA has approved their use within specific guidelines, some studies suggest potential links to health issues. Novel sweeteners like pure stevia and monk fruit generally have a better safety profile.

For natural sweetness, use whole foods like pureed dates, mashed bananas, or applesauce. These provide fiber and nutrients that help your body metabolize the sugars more slowly. They are excellent for baking or sweetening oatmeal.

No sugar substitute is entirely risk-free, and some side effects can be individual, such as aftertastes or digestive sensitivity. The safest approach involves an informed choice, considering your personal health profile, and reducing your overall dependence on intense sweeteners.