Is There a Safe, Low-Calorie Sweetener?

Image Credit: Lisa Brewster / Flickr. This image has been modified.

Is There a Safe, Low-Calorie Sweetener?

The natural sweetener erythritol does not appear to carry the adverse effects associated with other low and non-caloric natural and artificial sweeteners and may actually have antioxidant potential. For a while it was only available in Japan but now it’s becoming more accessible. It’s found naturally in pears and grapes, but industrially we have yeast make it for us. It doesn’t cause cavities and hasn’t been implicated in some of the disorders tied to other sweeteners such as fibromyalgia (see my video Aspartame-Induced Fibromyalgia), preterm birth (Diet Soda and Preterm Birth), headaches, hypertension, brain disorders, and platelet disorders (see A Harmless Artificial Sweetener).

What about stevia? The jury is finally in. The reason it’s been such a long time coming is that research out of Japan in the ’90s found that steviosides, the active ingredient in stevia, appeared totally harmless, but in the guts of rats intestinal bacteria transformed steviosides into something called steviol, which is toxic, causing a big spike in mutagenic DNA damage (see the graph in Is Stevia Good For You?). So the question was do we have those same rat bacteria in our guts, and it turns out we do. So we now know that when we eat stevia, mutagenic compounds are produced in our colons and absorbed into our bloodstream. The only remaining question was how much.

In the World Health Organization’s evaluation of food additives, they consider up to 4 mg/kg of body weight safe. So that’s 1.8 mg per pound. If you multiply your ideal weight in pounds by 1.8, that’s about how many milligrams of stevia compounds you should stay under on an average daily basis. As long as one consumes less than, say, two stevia-sweetened beverages a day, stevia can be considered harmless. Erythritol may be even better than harmless, though, as you can see in my 2-min. video Erythritol May Be a Sweet Antioxidant.

There are two caloric sweeteners that are health-promoting—can you guess which ones? Check out The Healthiest Sweetener for a comparison of agave nectar, blackstrap molasses, brown rice syrup, corn syrup, brown sugar, date sugar, honey, maple syrup, raw cane sugar, and turbinado sugar.

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

43 responses to “Is There a Safe, Low-Calorie Sweetener?

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  1. So, if you weigh 150 pounds, you should consume no more than 270 mg of stevia per day.

    A small serving-sized packet of “Wholesome Organic Stevia” from Wholesome Sweeteners is 1 gram, or 100 mg.

    That means one can only consume roughly 1/4 (1/3.7 more precisely) of a small packet a day, if I’m figuring this correctly.

    That’s not a lot. It seem like the best thing to do is just not use the stuff.

      1. Thank you for the clarification and correction of my flawed assumption. And thank you for providing a wealth of important information on nutrition that can really impact our lives.

  2. These blog posts are incredibly helpful in synthesizing the information you have in your videos — thank you!

    One thing I’ve been mulling over is the relationship between inflammation, antioxidants, and cancer. I have a vague sense that antioxidants are anti-inflammatory, as well as being anti-carcinogenic. Are the best cancer-fighting agents also the best inflammation-fighting agents, or are there some compounds that are better at reducing inflammation than inhibiting cancer growth? Have you explained this on your site, or would you in a future blog post? Many thanks.

    1. Yeah, what ABOUT Xylitol? I rarely see Xylitol even mentioned in these kinds of comparisons. As a chronic yeast sufferer, it’s the only sweetener I’ll use. I’ve tried Stevia in its various forms, and can never get it right in a recipe .. and it always leaves a weird aftertaste. Teaspoon for teaspoon, Xylitol can be used exactly like regular table sugar, it’s all natural, fights bacteria and is low on the glycemic index (perfect for diabetics). The only thing it won’t do is caramelize. I always purchase an organic birch sourced type. NOW brand uses corn for theirs, and no where on the bag does it claim to be organic. People complain that it’s poisonous to dogs. But I would never think of giving my dog the sugary sorts of things I use it to make anyway. In fact, we avoid sugar like the plague around here. I rarely use Xylitol, but when I get a sugary itch, it’s the only sweetener I like that I’m certain isn’t going to poison ME in some way.

  3. As always, thank you Dr. Greger for timely information. I beg to differ with the number of servings or stevia sweetened drinks mentioned. I typically use 1 of the little spoons that come in KAL brand stevia, which is 42 mg. At 210#, I can eat 378 mg per day which is exactly 9 servings. I don’t drink 9 servings of anything but water per day, so I’m safe, but I can see where a 40# 5 year old could be at risk. Then again I don’t know of many 5 year olds eating stevia, so maybe this is moot.

  4. Dr. Greger,
    I know you have many people asking questions concerning the healthfulness of many different obscure foods and ingredients but can you please try and get the straight dope on coconut palm sugar? It is the hottest sweetener on the natural food scene these days and the sellers are making many health claims as usual. I’d love to find out if it is really low glycemic and nutritious as claimed when you can find some info. Thanks in advance!

    1. The healthiest sugar would be date sugar as this is simply ground up dates so it is still considered a whole plant food. I cannot say the same for coconut palm sugar as I am assuming this is more processed.

  5. What about stevia plants? Like the plant itself? I keep reading about stevia this, stevia that, but it’s always in regards to the processed, crystalized fake sugar form of itself. I want to know how bad it is to make sun tea with a few leaves of stevia in it to give it some sweetness?

    I plan on getting one, and I keep reading research that begs to differ if it’s bad or not. It’s like 50/50 from what I’ve read. Honestly I know not all plants are good for you, but the plant doesn’t seem THAT bad so long as you don’t go and chow down the whole thing like a salad lol.

    If some one knows, please let me know :3

    1. I also grew a stevia plant. The leaves were sweet to the bite, but putting them in my smoothie seemed worthless. I tried to steep them with my tea and it didnt’ seem to do much. Shortly after I began using it I read or heard SOMEWHERE that the leaves were either nephrotoxic, hepatotoxic, or neurotoxic. I apologize I do not have my facts to quote. I cant remember where I heard it. My sources are of course Dr. Greger, Food Babe, Dr Alan Goldhamer, Dr. Joel Furhman, Dr. John McDougall. I also listen to the Food Summit when it comes around every year. I just can’t remember where I heard it and what the BIG problem was. I did let my plants die off, though. But that’s just my take. That I can’t quote back for you. Sorry.

  6. Regarding caloric sweeteners, I would still like you to report on raw honey, which has a significantly lower glycemic index score. And there are many websites that suggest it reduces allergies if you consume local raw honey. So, can you gather some research about raw unprocessed honey and its benefits and detractions?

  7. With the information about Stevia, I would expect there might be some evidence, in the populations who have used Stevia as a basic sweetener for many years, of ailments and morbidity rates related to higher levels of Stevia use. Is there such data? How do members of these groups use Stevia? Within the levels identified above?

    Thank you for the helpful information in this article. I don’t see many responses to questions, but will check back a couple of times in the next two weeks.

  8. I’ve seen others asking as well, so, in the event you just need a big enough audience asking….I would be so grateful if you were able to post on Coconut Nectar. There are a few forms out there, the nectar (sap) crystals and they even make coconut aminos and vinegar. I don’t use a ton of added sweeteners but I do use some and would love to know if all (or anything) I’ve read about this product is actually true- especially if it really contains all the beneficial amino acids it claims. Thank you for doing what you do!!!

  9. Dr. Greger,
    I am eternally indebted to you for the swath of information you have supplied via your website. I read from it everyday, sometimes multiple times a day. Thank you.
    I have a question about Erythritol and Monk fruit. I watched your video on erythritol and told my mom about it, who has lost 90lbs through eating a more plant-based diet and is getting her diabetes under control. You said your preferred sweetener was erythritol. What are your thoughts on Monk fruit? Is Monk fruit better, worse, more or less processed? Also, many brands of erythritol are made from corn, not fruits, unfortunately, and may be GM. What brand do you use? Thank you for the information.

    1. Congratulations on your families improving health. Weight loss is primarily about calorie density and exercise. Resources such as Jeff Novick’s DVD, Calorie Density: How to Eat More…, and Doug Lisle’s presentation available on YouTube, How to Lose Weight without losing your mind, are excellent places to start. For type two diabetes, Neal Barnard’s book on reversing diabetes is excellent. Remember the “upstream” cause of type two diabetes is the fats in the diet which cause insulin resistance and cellular mitochondrial dysfunction. Insulin helps the glucose get into the cell and the mitochondria burn the glucose. Sugar in limited quantities is not as much a problem except for the fructose which the liver converts to fats among other things. So I use vegan sugar/brown sugar and erythritol on the rare occasions that I use it. I would avoid all artificial sweeteners for the reasons that you have seen in Dr. Greger’s videos. All natural sweetness comes from glucose, fructose or sucrose aka table sugar. Jeff Novick’s DVD ties exercise into calorie density. Exercise is helpful for a variety of reasons but the key is less fats… no animal products and avoid processed oils.

    2. Monk fruit is a caloric sweetener. It is made from juice, therefore not a whole food and nutritionally inferior to date sugar or molasses. It would probably be on par with the various natural syrups. Erythritol is probably more processed but also has less calories.

  10. I have been using inositol as a sweetner. I was taking inositol for anxiety but since I have been on a plant based meal plan for 4 months, I no longer need it. It is a bit sweet and it works for me. I am currently using up my old stock but wondering if I should continue to buy as a sweetner or switch to date sugar or erythitol?

    1. There’s probably no problem with continuing to use it as you know how your body responds to it. If you are planning on making a switch I would opt for the more natural type of sweetener like dates vs the alcohol based sweeteners. I think this is a question of personal preference.

  11. If you have cancer, most alternative practitioners say all sugar is bad for you–that it feeds the cancer cells. Does this apply to DATES and ERYTHRITOL as well? Dr. McDougall, however, says there is no evidence that sugar promotes cancer. I love dates and you have said they might even rate as the “perfect food.” Are they still bad to eat if you have cancer?

  12. What about sweet drops? It is the liquid stevia in the glass dropper bottle. I have heard so many mixed things about different forms of stevia, I don’t know what to believe.

    1. Hi Sativa,
      I am one of the medical moderators here :)

      Can you work out how much stevia is in the dropper bottles and fall under the safe amount (1.8 x wt in lbs)?
      I know a LOT of people who use huge portions of these droppers and would most likely go over this, so I advise caution! Can you use a more natural sweetener like fruit? What are you sweetening?

  13. A lot of discussion recently about erythritol as it’s being used in many low calorie ice creams these days. There is, however, a new line of products that is low in sugar (6g of sugar or less per serving) and doesn’t use any sugar substitutes: Revele Whipped Gelato. If you’re looking for a sweet treat low in calorie without erythritol, check it out!

    1. Hopefully this is an unnecessary observation, but remember that so-called “spikes” in blood sugar level are normal, up to a point. It is the extreme or excessive spikes you should be concerned about – consult your physician
      “Spikes” will occur any time you eat anything, and in my personal experience do not even require eating. I noticed that my first morning reading was often higher than one taken the previous evening (hours after eating) and my doctor suggested that was due to the body calling for blood sugar as it “geared up” for the day. The rise was never huge but was certainly puzzling until we considered that possibility.

      If you are under the impression that glucose level can be kept stable and stationary all the time, you may want to consult an expert in the field for guidance.

  14. Hi this is Dr. Daniela Sozanski, PhD Natural Medicine and Moderator with Agave nectar has one of the highest sucrose concentrations amongst all sugars of about 85%; while it is marketed for its low glycemic index, its long term effects are not positive; while glucose is used in the entire body, the liver is about the only organ capable of processing sucrose, which, when in large quantities it is forced to convert into fat. This is believed to contribute to resistance to insulin which is one of main staples of type two diabetes.
    Dr. Greger has a video where the nutritional value of agave nectar is shown to be in about the same league as white sugar.
    Also keep in mind that the commercial agave nectar is a processed syrup from the fruit, by methods related to those used for production of corn syrup
    I hope this helps. Daniela

  15. Hi Dr Greger,
    Thank you so much for your diligence.
    I’ve looked up all your stevia videos and blogs. This was the most recent. What I’m wondering is about using ground whole-food stevia leaves, not those awful extracts. I didn’t hear or read in any of your stuff where that distinction was made. My son (28) thinks it tastes too green, but I like putting it in smoothies or teas, as a whole food. Does any of the research address that?
    Thank you again.

  16. FiddamentRN,

    Your son might actually prefer the new derivative mixtures of stevia rebaudiosides. The original versions were indeed pretty awful.

    Most of the current sweetener companies have found that different combinations of the extracts are much more palatable and don’t have the bitter aftertaste. Yes they are processed food additives, no question there. However if that what makes the difference and he consumes a more WFBP diet it may be a consideration.

    You will see a number of these products in the marketplace: containing combinations of the rebaudiosides from stevia. Look for A through F and M noted on their labels.

    They do taste different than the original versions, by a wide margin.

    Dr. Alan Kadish moderator for Dr. Greger

    1. Hi Dr Kadish,

      Now, I’m confused. But first, some clarification: I meant to say that *I do *like the whole ground stevia leaf. I wanted to know if it is a green light food, since it’s WFPB, but if I understand you correctly, if it gets me to eat more other WFPB, it’s a big factor. All the info I found on about stevia, only talks about the refined/extract versions, I’d still like to know about the whole leaf version, if it’s available.

      Other clarification: My son, who doesn’t like the whole leaf stevia, eats a very high green-light WFPB diet without any stevia. He’s the one who actually got me to pay attention to my food and health.

      Thank you very much, Jeannine

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