People looking to reduce their intake of added or free sugars have several alternatives to table sugar, but not all sweeteners work in the same way or carry the same nutritional profile.
The World Health Organization recommends limiting free sugars to less than 10% of total daily energy intake for adults and children, with a further reduction to below 5% offering additional health benefits. Free sugars include those added to foods and drinks, as well as sugars naturally present in honey, syrups and fruit juices.
Here are five commonly used alternatives and what is known about them.
Stevia
Stevia-based sweeteners are made from steviol glycosides, compounds derived from the stevia plant. They are much sweeter than table sugar, so only small amounts are needed.
The U.S. Food and Drug Administration distinguishes highly purified steviol glycosides used as sweeteners from crude or whole-leaf stevia extracts. The agency has not objected to the use of certain highly purified steviol glycosides as sweeteners.
Stevia can have a distinctive aftertaste, which may affect how it is used in drinks or cooking.
Xylitol
Xylitol is a sugar alcohol used in products such as sugar-free chewing gum, sweets and toothpaste. FDA information lists xylitol among the sugar alcohols used as sugar substitutes and notes that these sweeteners are generally lower in calories than sugar.
Xylitol is also associated with dental health because it does not promote tooth decay in the same way that ordinary sugar does.
Research has examined another possible use. A Cochrane review found moderate-quality evidence that xylitol given through chewing gum, lozenges or syrup reduced the occurrence of acute middle-ear infections among healthy children in several trials. The evidence was inconclusive for children with respiratory infections or those prone to repeated ear infections.
That evidence does not mean xylitol should be considered a general treatment or prevention method for ear infections.
Erythritol
Erythritol is another sugar alcohol. FDA information identifies it as a sugar substitute and notes that sugar alcohols generally contain fewer calories than traditional sugar and do not promote tooth decay in the same way.
It is commonly found in reduced-sugar foods and drinks. Its sweetness is lower than that of table sugar, so products may use it in combination with other sweeteners.
Research into possible long-term health effects of erythritol is continuing. The FDA said in 2023 that studies suggesting cardiovascular effects did not establish a causal link between erythritol consumption and the outcomes observed.
Honey
Honey is often described as a natural alternative to refined sugar, but natural does not mean it is free of sugar.
WHO classifies the sugars naturally present in honey as free sugars. Its guidance therefore includes honey among the sources of sugar that people should limit.
Honey can be used to sweeten foods such as oatmeal, tea and other dishes, but replacing table sugar with honey does not remove free sugars from the diet.
For people with diabetes, the American Diabetes Association notes that regular sweeteners, including sugar, honey and syrups, contain carbohydrates that can raise blood glucose.
Maple syrup
Maple syrup is another commonly used sweetener and is often marketed as a more natural alternative to refined sugar.
Like honey, however, maple syrup still contains free sugars. WHO includes sugars naturally present in syrups within its definition of free sugars, meaning maple syrup should not be treated as a sugar-free option.
Its distinctive flavor means some people may use less of it when sweetening foods, but the amount used still matters when considering overall sugar intake.
The bigger picture
The choice of sweetener depends on what someone is trying to change. Some alternatives can reduce the amount of sugar or calories used in a food, while others, such as honey and maple syrup, remain sources of free sugar.
WHO also advises against relying on non-sugar sweeteners as a long-term strategy for weight control or reducing the risk of noncommunicable diseases. Its 2023 guidance recommends reducing free-sugar intake through broader dietary changes rather than depending on non-sugar sweeteners for weight management.
For most people, reducing the overall amount of sweetened foods and drinks, while choosing whole foods such as fruit, vegetables and other minimally processed foods, is a more useful approach than simply replacing one sweetener with another.
