Sugars and Sweeteners: What the Evidence Says
Last reviewed October 18, 2026 · How we grade evidence
In plain words: Added sugar of any kind is worth cutting, and HFCS is no worse than table sugar. Zero-calorie sweeteners aren't poison, but they aren't a proven health upgrade either. Water, milk and unsweetened drinks are the simplest everyday choice.
Two ideas get mixed up a lot online: that one kind of sugar is uniquely bad, and that diet sweeteners are "as bad as sugar." Neither holds up well.
On sugars: trials comparing equal amounts find high-fructose corn syrup acts much like table sugar.1 What matters is how much added sugar a family eats in total. The Added Sugars line on the Nutrition Facts label is the best quick guide.
On sweeteners: no study has tested whether sweeteners are "as bad as sugar" for health. A large French study linked heavy use to slightly higher heart risk (about 9% overall), but it can't show cause and effect.2 The WHO's 2023 guideline advises against relying on sweeteners for weight control because they show no long-term benefit.3 And a careful 2022 trial found some sweeteners (saccharin and sucralose) worsened blood-sugar responses in some people, while others (aspartame, stevia) did not.4
Sweeteners at a glance
| Ingredient | Our take | Evidence | US products* |
|---|---|---|---|
| High-Fructose Corn Syrup (HFCS) | An added sugar, about the same as table sugar. Cut total sugar instead. | Moderate | 30,263 |
| Aspartame | Not shown to cause weight gain; WHO calls it a "possible" cancer hazard. Avoid if PKU. | Moderate | 4,351 |
| Sucralose (Splenda) | Changed gut bacteria and blood sugar in some people. Fine occasionally; don't bake with it. | Moderate | 11,727 |
| Acesulfame Potassium (Ace-K) | Population studies show weak links; Europe reaffirmed safety in 2025. | Limited | 8,897 |
| Saccharin (Sweet'N Low) | Not a cancer risk for people. May nudge blood sugar in some. Occasional use is fine. | Moderate | 135 |
| Stevia (Steviol Glycosides) | One of the best-studied sugar substitutes. Watch for blends with erythritol. | Moderate | 7,928 |
| Monk Fruit Extract | Probably fine, but thinly studied. Most products are mostly erythritol. | Very limited | 2,880 |
| Erythritol | Not proven harmful, not proven harmless. Go easy if you have heart or clotting risk. | Limited | 3,179 |
| Sugar Alcohols (Sorbitol, Maltitol and More) | Gas and diarrhea are common, especially for kids. "Sugar-free" isn't automatically better. | Moderate | 8,646 |
| Xylitol | Fine in gum and toothpaste. Go easy on big amounts if heart risk. Keep away from dogs. | Limited | 1,004 |
| Maltodextrin | A fast-digesting starch, like a bit of sugar. Matters most for diabetes. | Limited | 44,097 |
Number of US packaged foods in USDA's Branded Foods database whose ingredient list names it. See each page for details.
A simple plan for families
- Make water and milk the everyday drinks.
- Treat soda and juice drinks, diet or regular, as occasional.
- If someone is cutting back from regular soda, a diet drink can be a stepping stone. Then taper.
- In packaged foods, compare Added Sugars per serving.
- Go easy on "sugar-free" candy for kids. Sugar alcohols can cause tummy trouble.
Are diet sweeteners as bad as sugar?
Not proven. The evidence supports a weaker statement: sweeteners aren't a proven long-term health or weight fix. Regulators still approve each one at normal intakes, and Europe actually raised the safe limits for acesulfame potassium (2025) and saccharin (2024).56
Frequently asked questions
Which sweetener is the safest?
Purified stevia has the most reassuring mix of human trials and safety reviews. But for everyday drinks, water is better than any sweetener.
Are artificial sweeteners as bad as sugar?
That's not proven. Sweeteners don't raise blood sugar the way sugar does, but they also aren't proven to help long-term weight or health. The WHO advises against relying on them for weight control.
Is HFCS worse than cane sugar?
Not meaningfully. Both are added sugars with a similar fructose-glucose mix.
Are sugar alcohols safe for kids?
In small amounts. Kids get gas and diarrhea at lower doses than adults.
Sources
- Effect of fructose instead of glucose or sucrose on cardiometabolic markers: a systematic review and meta-analysis of isoenergetic intervention trials. Nutrition reviews, 2021. PubMed 33029629 · doi:10.1093/nutrit/nuaa077
- Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort. BMJ (Clinical research ed.), 2022. PubMed 36638072 · doi:10.1136/bmj-2022-071204
- WHO advises not to use non-sugar sweeteners for weight control (May 15 2023). Link
- Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance. Cell, 2022. PubMed 35987213 · doi:10.1016/j.cell.2022.07.016
- Re-evaluation of acesulfame K (E 950) as food additive. EFSA journal. European Food Safety Authority, 2025. PubMed 40309404 · doi:10.2903/j.efsa.2025.9317
- Re-evaluation of saccharin and its sodium, potassium and calcium salts (E 954) as food additives. EFSA journal. European Food Safety Authority, 2024. PubMed 39553702 · doi:10.2903/j.efsa.2024.9044
This guide is for general education. It is not medical advice and does not replace advice from your doctor, pediatrician, allergist or registered dietitian. If you think you or your child reacted to a food, talk to a health professional. Research changes; we review these pages when new evidence or rules come out. Last reviewed October 18, 2026. Spotted an error? Email [email protected].