Wellness Wednesday: The Great Debate - Sugar vs Artificial Sweeteners

On today's Wellness Wednesday post, I answer one of my most frequently asked questions - which is healthier, sugar or artificial sweeteners. As you'll see, the sugar vs artificial sweeteners debate distracts from the real problem, that we should be eating less of both. 

Sugar Versus Artificial Sweeteners

Happy Wellness Wednesday y'all! My most recent Wellness Wednesday posts have been about the psychology of eating and non-nutrition aspects of wellness, so I'm excited to share a post on nutrition science. Today, I'm answering what one of the top five most frequently asked questions in my practice: artificial sweeteners or sugar?

The debate between sugar vs. artificial sweeteners is a heated one and has been ever since saccharin was approved by the FDA in the 50s. You can find dietitians, nutritionists, doctors, scientists, health writers, and overly opinionated facebook friends who post 2,347 articles a day on both sides of the debate.

I've been meaning to post on this topic for a long time. After reading The Evidence Supports Artificial Sweeteners Over Sugar, a recent New York Times article, I knew I had to clear things up. I hope you'll give it a read, but if not, here's the gist. The author, a pediatrician and professor, claims artificial sweeteners are a healthier choice because science shows they do not cause cancer, a reason commonly cited for avoiding them.

Technically, he's right. It's unlikely artificial sweeteners cause cancer. Save for one concerning study linking sucralose (splenda) to leukemia in mice, I haven't seen any other convincing evidence that artificial sweeteners cause cancer, and it's not for lack of research.

Still, I hold issue with the article. Although the science is right, his conclusion isn't. Artificial sweeteners may not cause cancer, but that doesn't make them safe.

People don't use artificial sweeteners to prevent cancer. They choose them to manage blood sugar and lose or manage weight. There's pretty convincing evidence artificial sweeteners do neither. We'll come back to that.

The debate between artificial sweeteners and sugar is a moot point. When it comes to your health, neither is beneficial, both are safe if consumed in small amounts, and incredibly dangerous if consumed in excess. Let's take a look at the science:


  • When it comes to sugar, we're eating an astounding amount. The average adult consumes 22 teaspoons a day. Compare that to the American Heart Association recommendations to limit added sugars to 6 teaspoons daily for women and 9 teaspoons daily for men. Even more tragic? The average child eats a whopping 32 teaspoons daily.
  • All calories aren't equal. Sugar isn't filling, so any calorie from sugar will likely be on top of the other calories you're eating. That's a big part of the reason why eating too much sugar is so strongly linked to overweight and obesity.
  • Forget cholesterol. Sugar is the real danger when it comes to heart disease. Added sugars cause inflammation and damage to arterial walls, essentially the first step in the heart disease process. A large study in 2014 showed people who eat the most sugar have almost double the risk of heart disease compared to those who eat the least.
  • Sugar has a profound impact on brain health, contributing to anxiety and depression through inflammation and by affecting hormones and neurotransmitters.
  • Artificial sweeteners may not cause cancer, but sugar sure does. Eating too much sugar causes inflammation and high insulin levels, both linked to cancer, especially of the pancreas, breast and colon.

Artificial Sweeteners:

  • Despite being calorie free, artificial sweeteners are linked to weight gain in several large and well designed studies.There are many proposed mechanisms. Artificial sweeteners seem to enhance appetite, contribute to sweet cravings by training taste buds to sweeter flavors, and confuse the bodies natural mechanisms for regulating caloric intake. And of course, there the psychological effect - when you're eating diet food, that totally means you can eat more...right???
  • In the short term, artificial sweeteners don't raise blood sugar. But long term, artificial sweeteners are linked to a higher risk of type 2 diabetes. Although artificial sweeteners don't break down into glucose, the super sweet taste (some are thousands of times sweeter than sugar!) confuses the body, causing it to release insulin, the hormone that controls blood sugar. Excessive insulin release can lead to insulin resistance/glucose intolerance.
  • I keep preaching the importance of a healthy gut flora, like, on a daily basis. But did you know artificial sweeteners may lead to an imbalance of gut bacteria (which also seems to effect glucose tolerance).
  • Artificial sweeteners taste absolutely awful. This is probably my biggest reason for avoiding them.

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So, what do I tell my clients? While both sugar and artificial sweeteners are two of the least nutritious and most dangerous foods we can consume, neither are toxic. Either can be consumed in small amounts without problem. That said, I encourage clients to stick with a (key word) small amount of the real thing, preferably from unrefined sugars like honey, pure maple syrup or coconut sugar. These sugars contain some nutrients, have slightly less of an effect on blood sugar and taste sweeter so you'll use less.

There are only a few cases in which I recommend artificial sweeteners. Both stevia extract and Swerve, a zero calorie sweetener made from erythritol, seem to be fairly safe. If a client is really stuck on low cal, that's what I recommend. It hasn't been researched, but I wonder if stevia has an effect on sweet cravings (being much sweeter than sugar) and if erythritol (being a sugar alcohol) affects gut bacteria, which is why I don't recommend them universally. Also, I think there's good research showing for someone who is morbidly obese and consumes a significant amount of sugar (i.e. multiple cans of regular soda/day plus sweets), switching to artificial sweeteners can help promote weight loss and serve as a "bridge" as they change eating habits.

The takeaway message? No matter what you choose, less is more. For more help cutting back and understanding what moderation is when it comes to sweets, check out my Tame Your Sweet Tooth guide, available for purchase in the nutrition shop. It includes strategies for eating less sweets while enjoying them more as well and delicious recipes for low and no added sugar treats!

Wellness Wednesday: Fat, Protein & Carbs - Understanding Macronutrients

Although I like to focus on food, rather than nutrients, fat, protein and carbohydrate are confusing topics for many people. Get simple, rational and realistic answers to all your questions about the role macronutrients play in the diet and how to figure out what eating pattern is right for you. 

There must have been something on Dr. Oz, because lately I've gotten a ton of questions about fat, protein and carbs, namely, people wanting to know which one is best. With various talking heads praising the benefits of diets ranging from paleo to ketogenic to 80/10/10, it's no wonder there's confusion. Even though I like to think of food as food, not as nutrients, I think understanding the basics of the macronutrients - fat, protein and carbs - is important for digesting (pun intended) all the different diet advice you hear.

So, I decided to write a post to answer all those FAQs! If you have a question you don't seen included, let me know in the comments and I'll be more than happy to answer it for you.

First of all, what are fat, protein and carbohydrates?

Fat, protein and carbs are three macronutrients. All macronutrients break down to provide energy, or calories. The term "macro" means large, meaning these nutrients are needed in large amounts. This is opposed to micronutrients, like vitamins and minerals, which are equally important, but only needed in small amounts for health.

Fat is a compound made from fatty acids. Besides being a rich source of energy, fats play many essential roles in the body. Fat is needed to absorb fat-soluble vitamins, including vitamins A, D, E and K. The body also needs fat to form hormones. Fats also supports healthy skin and hair and is essential to brain health, since the brain is made of 60% fat.

Amino acids are the building blocks of protein. Most people are aware that protein is needed to build muscle, but it has many other functions as well. Protein is sometimes called the action molecule, since proteins carry out the duties specified by genes and as enzymes.

Carbohydrate is made of sugar. Not table sugar, but the chemical compounds monosaccharides and disaccharides. It is the main source of energy for the body. It's also a component of many structures within the body including RNA and DNA.

Where are fats, proteins and carbohydrates found?

Generally speaking, most foods contain a combination of macronutrients, rather than being made of only fat, protein or carbs. For example, although carbohydrate is the main macronutrient in kale, it also contains protein and even a small amount of fat. But as a general rule of thumb, these are the foods most associated with each macronutrient.

FAT // butter, oils,meat, fish, poultry, eggs, dairy, avocado, nuts & seeds, olives

Most nutritious choices: extra virgin olive oil, nut oils (i.e. peanut, walnut, etc), fatty fish, coconut oil, avocado, nuts & seeds, olives, grassfed/pastured and organic animal foods

CARBOHYDRATES // grains (both whole and refined), vegetables (both starchy and nonstarchy), dairy, beans, fruit, added sugars

Most nutritious choices: intact whole grains, starchy vegetables, nonstarchy vegetables, beans, fresh whole fruit

PROTEIN // meat, fish, poultry, eggs, nuts & seeds, dairy, beans, tofu/tempeh, meat alternatives

Most nutritious choices: beans, nuts & seeds, fatty fish, pastured eggs, tofu/tempeh, grassfed and organic animal foods

How much fat, protein and carbs should you eat?

I hate this question, because honestly, I don't know, nor does anyone else. According to the Daily Reference Intakes developed by the Institute of Medicine, this is the percentage of calories from each macronutrient recommended in healthy diets:


PROTEIN: 10-35%

FAT: 20-35%

As you can see, these are pretty wide ranges. A larger, more active person with higher calorie needs aiming for 65% carbohydrates would have much higher needs than a smaller, less active person aiming for 45%. Then, to mix it up even further, calorie needs are pretty close to impossible to estimate, and change on a daily basis based on sleep, activity levels and stress.

Also, these percentages are debatable. Various diets recommend ranges higher and lower than these basic recommendations and some people not only survive, but thrive on these eating patterns. For example, the low fat, vegan diet recommended by Dr. Ornish is so successful at treating and reversing heart disease that it's one of the few dietary interventions covered by insurance. But, it's higher in carbohydrate and lower in fat and protein than the those ranges. And the ketogenic diet, successfully used to treat epilepsy in children, contains almost no carbohydrate and a whopping 85% fat.

Here's my take: for most people, the majority of your calories should come from carbohydrates. It's the body’s main source of energy, plus, carbohydrates are found in the actual foods we should be eating the most of - plants. Although different things might increase our needs for different nutrients, for example, recovering from an injury or surgery would increase protein needs.

That said, I don't recommend counting grams of carbs, protein, fat, or even calories for that matter. We eat food - not nutrients. Counting grams of fat, protein and carbs, even when an online food diary is doing the math for you, is distracting, tedious and promotes disordered eating habits. Aim for balance within meals, practice some gentle nutrition, and over time, you’ll get the right amount for you.

Which is best - fat, protein or carbohydrates?

That depends on what you mean. If you're asking which nutrient we should be eating most of, for the majority of people, that's carbohydrate (from nutritious, unprocessed plants of course!). Plants should be the bulk of what you eat, and plants all contain carbohydrate, so it makes sense. But are carbs healthiest? Or is it fat or protein?

We all need adequate amounts of fat, protein and carbohydrate for our body to function and feel it's best. A well-balanced meal contains fat, protein and carbs. Each plays different roles in the body and are essential for health. So, I would say fat, protein and carbohydrates are all equally important.

But then there's the question of what's right for you. Different people with different bodies and different activity levels and different genetics thrive on different macronutrient balances. For example, I feel my best when I'm getting plenty of fat and carbs in my diet. Because of that, I tend to emphasize foods that contain these macronutrients. That's why I love things like avocado on sprouted grain bread, cook with copious amounts of olive oil, and snack on fruit with nut butter on an almost daily basis (that is, if my hubs doesn't get to the nut butter first :) )

And that's not to say I eat high fat/carb every day, or exclusively eat high fat/carb foods. I choose foods I enjoy that make me feel good. Some days I might eat higher in protein and start the day with a tofu and veggie scramble and end with roasted salmon on a bed of greens. It depends on what I want and often times, what I have on hand.

Although a registered dietitian can give you guidance by looking at your health, activity levels and other factors, only you know what balance is right for you. And you can learn this by tuning into your body with mindfulness. Slow down when you eat. Pay attention to how you feel not just while you're eating, but afterwards. Don't be afraid to experiment with your diet, not with the aim of losing weight, but to see how you feel. It's one thing to try a low carb diet to drop pounds (a strategy that generally backfires) but reducing your carb intake to see how you feel might help you determine a pattern of eating that works for you.

Prescribing to the the rigid rules dictated by diets forces you to ignore your individual needs. The human body has evolved to adapt to a variety of diet patterns - that's arguably the reason we've become so successful as a species. As a whole, there's no one right diet or eating pattern. Maybe one day we'll get to the point where a simple blood test or cheek swab will tell you exactly what's right for you to thrive and feel your best, but science isn't there yet. Even if it was, the test wouldn't take into account what foods you love and bring you joy, something I think is equally important for health and wellbeing.

The moral of the story? Pay more attention to what your body is telling you than macronutrients.

Kapeesh? What other lingering questions about protein, fat and carbs do you have?