• Dr. Hansra

Smart & easy swap: Cut down on added sugar by trying one of these natural zero calorie sweeteners



An excess of added sugars is a major cause (along with other factors) of obesity in the United States (1). It is estimated that US population still consumes more than 300% of the recommended daily amount of added sugar (1). This alarming consumption of added sugar (and other dietary and lifestyle factors) are fueling the American obesity epidemic. In general the American Heart Association (AHA) recommends limiting daily sugar consumption to 25 g/day for an adult woman and 37.5 g/day for an adult man (2). A particular problem is the consumption of sugary drinks and its strong relationship to obesity in adults (2) and children (3). Also, sugary drinks including soft drinks can contribute to cancer risk (4), increase risk of type 2 diabetes (5), and heart disease (5) independent of obesity risk. Why not drink diet soft drinks instead? One study found that consumption of both sugar sweetened and artificial sweetened soft drinks was linked to health risks (4).


Getting rid of excess calories consumed in drinks is an easy way to cut down on calories and lose weight. It is best to drink plain water if possible. Also if you drink multiple sugary drinks per day it is common sense to cut down to no more than one per day. It is best to make small sustainable changes to your diet rather than large drastic ones as these small changes will be more likely to stick in the long term. Also, you should carefully examine your diet, read labels, and see how much sugar you are consuming and what else you can swap. For example, sweeten your morning coffee or late night desserts with a natural sugar substitute. This could potentially save you thousands of calories per year which translates to many pounds lost. Let's look at an example.



Lets do the math:

  • A 16 oz. bottle of sweetened iced has 170 calories per serving (all due to added sugar)

  • Let's say you drink one iced tea per day that's 170 calories x 7 days per week x 52 weeks per year = 61880 calories per year on a one sweet iced tea per day habit!

  • Since 3500 calories = 1 pound you would be carrying around an extra 17.6 pounds per year on a 1 sweet iced tea per day habit!

  • If you used a natural sugar substitute then you could lose 17.6 pounds!

  • This is a perfect example of "The little things add up to something big when trying to lose weight"




"Think small when trying to lose weight" -Dr. Damien Hansra MD

There are so many sugar alternatives out on the market. Some sugar substitutes and alternatives have an unpleasant aftertaste or they are not derived from natural sources. The two sugar substitutes I personally use are Swerve and Allulose because they taste just like sugar and they are derived from natural sources. This is not a comprehensive review on sugar alternatives but rather an introduction to sugar alternatives and dietary concepts related to their usage. Using a sugar alternative is not a substitute for a healthy diet and it will not cure obesity but it might get you on the right path. Like all things, sugar substitutes can have the potential to cause side effect especially when consumed in excess. Think of sugar alternatives simply as a tool in an armamentarium of resources to help you lose weight.


Swerve sweetener is a calorie-free sugar replacement made from natural ingredients (6,7). This is in contrast with other sweeteners that are artificial like aspartame, saccharin, and sucralose (6). I like using Swerve as it tastes and measures the same as sugar and it does not have the bitter aftertaste of stevia and monk fruit extracts. Also, Swerve comes in brown sugar, granular, and confectioner varieties. I typically use Swerve for baking breads, cookies, and muffins. Swerve is made from three ingredients: erythritol (from corn), oligosaccharides (root vegetables), and natural flavor (from citrus) (6,7). Swerve is good because it does not have any calories and it does not raise your blood sugar or insulin levels and can therefore help with avoiding weight gain (6-10). Swerve can cause certain people to experience digestive upset so avoid it if you experience this. In general swerve is safe to consume in low to moderate amounts (6). This is a rather new product on the market and like all things in medicine the data and reporting changes with time and new information including new side effects may emerge.


Allulose (or d-Allulose) is a rare sugar used as a substitute sweetener very closely chemically related to fructose (or d-fructose, sugar found in fruits) (11). Allulose is a kind of low energy monosaccharide sugar naturally existing in some fruits in very small quantities (11). It has about 70% the sweetness of table sugar or sucrose with 0.2 Kcal/g which represents 95% reduction in calories compared to table sugar (11). For some reason all the packaging on Allulose says it has 0 calories so I'm not sure where the discrepancy lies. I prefer to use Allulose because its tastes just like table sugar in terms of mouth feel and its just a little bit less sweet than table sugar which I enjoy. Also, I am intrigued by reports of favorable health benefits such as increased fat burning effects (12), blood sugar and insulin control (13), weight loss (14), and anti-inflammatory effects (14). Therefore, Allulose may potentially act as a functional sweetener meaning it actually enhances health. Again, everything should be used in moderation and you should not exceed more than what is recommended on the label. One study found that high doses of Allulose resulted in increased rates of nausea, diarrhea, stomach upset, and headaches (15). Also, in theory Allulose in high doses could drop your blood sugars so don't consume this product (or any) more than what is recommended or if you take medications that affect your blood sugar. With any new product or food always try a little bit first to see how you feel. Like all things in medicine I would like to see more long term and larger studies to be conducted to fully evaluate the risks/benefits. As it sits the these products appear safe when consumed in the suggested amounts and the benefits outweigh the risks of table sugar (obesity, cancer, diabetes, heart disease). I prefer to use Allulose over Swerve as it has more research behind it and also Allulose has potential health benefits.


"It is best to make small sustainable changes to your diet rather than large drastic ones as these small changes will be more likely to stick in the long term". -Dr. Damien Hansra MD

Using a sugar substitute is a good way to cut down on added sugar which over the long term can help you avoid the numerous risks associated with consuming too much sugar as highlighted above. With anything these products should be used in moderation and never consume more than what is recommended by the manufacturer. Using a sugar substitute should be thought of as a tool in an armamentarium of resources in your health and weight loss journey. Remember: The little things add up to something big when getting healthier so make many small realistic sustainable changes rather than large unrealistic unsustainable ones.


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References:


1. Faruque S, Tong J, Lacmanovic V, Agbonghae C, Minaya DM, Czaja K. The Dose Makes the Poison: Sugar and Obesity in the United States - a Review. Pol J Food Nutr Sci. 2019;69(3):219-233.

2. Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH, Sacks F, Steffen LM, Wylie-Rosett J, American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism and the Council on Epidemiology and Prevention.

Circulation. 2009 Sep 15; 120(11):1011-20.

3. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 2001 Feb 17;357(9255):505-8.

4. Hodge A M, et al. Consumption of sugar-sweetened and artificially sweetened soft drinks and risk of obesity-related cancers. Public Health Nutrition; 21(9): 1618-1626.

5. Malik V S, et al. Sugar Sweetened Beverages, Obesity, Type 2 Diabetes and Cardiovascular Disease Risk. Circulation. 2010 Mar 23; 121(11):1356-1364.

6. Healthline.com. Swerve Sweetener: Good or Bad? Swerve Sweetener: Good or Bad? (healthline.com). Accessed June 13th, 2021.

7. Swervesweet.com. Frequently Asked Questions. FAQs | Swerve (swervesweet.com). Accessed June 13th, 2021.

8. Noda K, Nakayama K, Oku T. Serum glucose and insulin levels and erythritol balance after oral administration of erythritol in healthy subjects. Eur J Clin Nutr. 1994 Apr;48(4):286-92.

9. Wen H, Tang B, Stewart AJ, Tao Y, Shao Y, Cui Y, Yue H, Pei J, Liu Z, Mei L, Yu R, Jiang L. Erythritol Attenuates Postprandial Blood Glucose by Inhibiting α-Glucosidase. J Agric Food Chem. 2018 Feb 14;66(6):1401-1407.

10. Niness KR. Inulin and oligofructose: what are they? J Nutr. 1999 Jul;129(7 Suppl):1402S-6S.

11. Jiang S, Xiao W, Zhu X, et al. Review on D-Allulose: In vivo Metabolism, Catalytic Mechanism, Engineering Strain Construction, Bio-Production Technology. Front Bioeng Biotechnol. 2020;8:26. Published 2020 Feb 3.

12. Kimura T, Kanasaki A, Hayashi N, Yamada T, Iida T, Nagata Y, Okuma K. d-Allulose enhances postprandial fat oxidation in healthy humans. Nutrition. 2017 Nov-Dec;43-44:16-20.

13. Franchi F, Yaranov DM, Rollini F, et al. Effects of D-allulose on glucose tolerance and insulin response to a standard oral sucrose load: results of a prospective, randomized, crossover study. BMJ Open Diabetes Res Care. 2021;9(1):e001939.

14. Hossain A, Yamaguchi F, Matsuo T, Tsukamoto I, Toyoda Y, Ogawa M, Nagata Y, Tokuda M. Rare sugar D-allulose: Potential role and therapeutic monitoring in maintaining obesity and type 2 diabetes mellitus. Pharmacol Ther. 2015 Nov;155:49-59.

15. Han Y, Choi BR, Kim SY, et al. Gastrointestinal Tolerance of D-Allulose in Healthy and Young Adults. A Non-Randomized Controlled Trial. Nutrients. 2018;10(12):2010. Published 2018 Dec 19.




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