The Healthiest Sugar to Eat, Bake With and Mix Into Your Tea, According to a Dietitian

A recent study that found a link between sugar substitute erythritol and heart attacks has left most of us confused about what sugar to reach for—so we asked a registered dietitian what to do.

To reduce our sugar consumption, many of us have switched to sugar substitutes, which are plant-based or chemical substances that sweeten the flavour of foods and drinks without additional calories. But, as you’ve probably noticed, such substitutes constantly make headlines for being linked to health concerns. Most recently, a February 2023 study published in the journal Nature Medicine found that people who had a high concentration of erythritol (a sugar substitute loved by the keto set) in their blood were more likely to have a stroke or heart attack. The findings triggered many of us to frantically google if our go-to sugar alternatives, like Stevia, Truvia and Splenda, contain erythritol—and left us confused about what we should opt for.

Does this mean we’re better off switching back to plain old table sugar? Not quite. Added sugars, like the aforementioned table variety, have also been linked to equally serious health problems—like high blood pressure, inflammation, diabetes, obesity and fatty liver disease—all of which increase your risk for heart attack and stroke.

(Related: Here’s What Sugar Does to Your Skin

“It doesn’t matter if you eat white sugar, brown sugar, honey, fruits, or syrups—they all break down in the body into simple sugars and increase your blood sugar in pretty much the exact same way,” says Anisha Gupta, a registered dietitian in Mississauga.

Most of us consume more sugar than health pros recommend. Ideally, we should have no more than 24 grams of sugar per day, according to the Heart and Stroke Foundation—but that’s not as much as it may sound. For reference, a single KitKat bar contains 22 grams of sugar. Plus, sugar creeps into even the most unsuspecting foods we eat, like pasta sauce and peanut butter, says Gupta, making it even easier to surpass that 24 grams-per-day recommendation.

Confused about which sugar to reach for? We are too. So we sat down with Gupta to get things straight.

Is there really zero health difference between brown and white sugar?

They’re pretty much the same, except brown sugar is less processed than white sugar—which may or may not bother you. Brown sugar also has more of an earthy taste to it, so instead of choosing it for believing it’s a healthier option for you, choose it just for its taste. For example, I like to use brown sugar when I make muffins.

Surely, natural sugars like maple syrup, honey, and fruit sugars are a bit healthier than white and brown sugar, right?

There isn’t that much of a difference. They’re all going to increase your blood sugar in the exact same way. Honey is helpful when you have a sore throat, since it contains antioxidants [which have an anti-inflammatory, soothing effect]. But you can also get antioxidant benefits from other foods in your diet. Instead of worrying about the healthiest sugar, be more mindful of how much sugar you’re consuming overall in your diet.

(Related: 12 Easy Food Swaps to Reduce Your Sugar Intake

Even manuka honey? It’s known for boasting so many health benefits!

Sugar is sugar! You can get those benefits from other foods, too.

Okay, so same thing with coconut sugar?

Yeah, pretty much the same thing. Researchers have found it does have some extra healthy properties, like vitamin C and more potassium than white sugar. So for those reasons, coconut sugar can be seen as a great choice. But again, how much coconut sugar are you actually having? A banana gives you a great amount of potassium, having an orange gives you a great amount of vitamin C. So do you really need to substitute your white sugar for coconut sugar, which is generally a little bit more expensive than white sugar? Even looking at the glycemic index [which is the number given to each food on how quickly it will increase your blood sugar] between coconut sugar and white sugar, it’s not that different.

What are your thoughts on artificial sugar?

About the recent study on erythritol, I’m not really concerned. The headlines have jumped the gun and made conclusions where there shouldn’t be. The study shows a correlation, but not a causation, between erythritol and heart disease. The participants in the study were already at higher risk for heart disease, meaning that the results may not apply to everyone. There isn’t enough research right now to suggest that this sugar substitute should be eliminated. There is definitely room for more research on erythritol as well as other sugar substitutes. My recommendation is the same as always, enjoy the sweetener you like, but be mindful of how much you are consuming.

Do you ever recommend artificial sugar to clients?

It depends on the person. There are limits as to how much you can consume. Diabetes Canada has made recommendations based on the science we currently have [you can view those here], but you’d have to be consuming a lot to be even close to surpassing those recommendations.

I suggest limiting sweeteners during pregnancy, as there is still not a lot of research around how they can really impact a baby’s development. I also suggest avoiding sweeteners to anyone with phenylketonuria, digestive distress or an allergy to sulfonamides, and children under 2.

On the other hand, if you’re a diabetic person who has high blood sugar, sugar substitutes can be valuable because they can make a difference in your health as they can help lower your blood sugar level.

So, sugar substitutes are safe in small amounts. Is there any other concern around them we should know about?

The sweetness from artificial sweeteners can trick your body into thinking it’s getting a blood sugar rise, but they don’t actually raise your blood sugar. So what happens is you end up getting more sugar cravings later on, which means you may end up eating more sweets.

What about fructose? Do we really have to be worried about sugar from fresh fruit?

Fruit offers so many additional benefits that you don’t really need to worry about the sugar that’s in it. Fruit also has fibre, which helps the body digest food more slowly, so sugar from fruit will be absorbed more slowly too. That means when you eat a fruit, your blood sugar will rise gradually like a hill and come down slowly—instead of spiking and dropping—so you feel better than you would if you ate something like a cookie. There’s no need to avoid fruit because of the sugar content. No one is diabetic or has heart disease or obesity because they’ve eaten too much fruit.

So, in summary, eat the sugar you want but be mindful of how much you consume?

Exactly. Food should be fun. Enjoy it. Be mindful of your sugar intake and reduce it when it’s convenient to do so.

This interview has been edited and condensed for clarity.

Next: The Healthiest Milk for Your Coffee, According to Registered Dietitians