With so many sweeteners out on the market, it can be challenging to know which is best. Some will provide lower calories, some will provide other nutrients, and some will be much sweeter than sugar. In this article, we will discuss the different types of sweeteners, both natural and artificial. We will also cover the benefits and risks of sweeteners, how much to safely include, and how to track sweetener intake in a kidney-healthy diet.
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Table of Contents
What are Sugars?
Sugars are a type of carbohydrate. Carbohydrates are essential for our health. They are the first choice of energy for our body and brain.
There are different types of sugars, based on their chemical structure. We won’t dive too much into the science behind the different sugars, but will give you a quick breakdown here.
Monosaccharides are the simplest form of sugar. These are:
- Glucose (otherwise known as dextrose)
These are easily absorbed into the bloodstream. That means nothing needs to be broken down to be used.
The next “level” of sugar is disaccharides. These are made from monosaccharides.
- Sucrose (made from glucose and fructose)
- Lactose (made from glucose and galactose)
- Maltose (made from two glucose)
- Trehalose (made from two glucose, but connected differently than maltose)
These are also easily broken down in the body into their two sugar parts.
These types of sugars are the naturally occurring sugars in many foods. The different types of sugars provide different levels of sweetness.
This is why some foods will taste naturally sweeter than others – for example, milk (which has lactose) versus grapes (which have fructose).
Lactose is considered the least sweet, whereas fructose is the most sweet.
Many sweeteners today are compared to the sweetness level of table sugar. Later in the article, you’ll see how some other sugars and sweeteners compare to table sugar sweetness.
What are Added Sugars?
According to the Food & Drug Administration (FDA), added sugars are defined as:
“sugars that are added during the processing of foods (such as sucrose or dextrose), foods packaged as sweeteners (such as table sugar), sugars from syrups and honey, and sugars from concentrated fruit or vegetable juices.”
In other words, added sugars mean exactly what it states – the amount of sugar that is added to a food item.
There are different types of added sugars. These added sugars can be either natural or artificial.
How to Calculate How Much Added Sugar You’re Eating
There’s just a little bit of math required to determine how many calories or grams of added sugar you’re eating per day.
1 gram of sugar = 4 calories = ¼ teaspoon
Knowing this information, you can convert back and forth between the grams or calories consumed.
Label Reading for Added Sugars
Let’s say you read a food label for a chocolate bar. The nutrition label will include the amount of total sugar and added sugar.
This is found just under the total carbohydrates.
Both are included but will not be the same. This is because the chocolate and milk ingredients contain natural sugars.
It also has added sugars to sweeten the candy bar more than the natural sugars do.
In the example above, we see there are 22 grams of total sugar, and of those 22 grams, 20 grams are added sugar.
Let’s start with the total sugars.
This bar provides:
22 grams OR
88 calories (22 multiplied by 4 calories per gram)
OR 5.5 teaspoons of sugar (22 divided by 4 grams per teaspoon)
Which number you track will depend on how you want to look at it.
The Daily Value (DV) shows the added sugars from this bar provide 40% of the daily allowance.
Remember, the daily allowance based on a 2,000-calorie diet is 200 calories from added sugars.
This bar provides 88 calories, which if we take 88 divided by 200, equals 44% (they rounded down).
These days, there are many options for how to track your nutrients.
We are big fans of Cronometer*. Cronometer is a comprehensive food diary that includes many features specifically helpful for kidney patients.
Cronometer also allows users to track not just total sugars, but added sugars and sugar alcohols.
How much sugar is okay for kidney patients?
Many wonder if sugar is okay to eat while on a renal diet. Like other nutrients, sugar is acceptable and sometimes encouraged to include in a renal diet.
This is especially helpful when finding a new renal diet that not only protects against further kidney damage but is enjoyable as a new lifestyle.
Recommended Amount of Added Sugars Per Day
The Dietary Guidelines for Americans recommends that anyone over the age of 2 years old keep added sugar allowance of 10% or less of their total calorie intake per day.
For example, a person eating a 2,000-calorie diet should consume no more than 200 calories from added sugars.
The American Heart Association recommends a standard number of calories from added sugar for most people.
AHA recommends men limit their added sugar intake to no more than 150 calories per day (or 9 teaspoons or 36 grams).
Women are recommended to limit to no more than 100 calories per day, or 6 teaspoons or 25 grams per day.
What happens when you eat too much sweetener?
A person can experience a range of issues when eating too much sweeteners. The reaction depends on the type of sweetener.
Increased Blood Sugars
It’s normal and expected to have a rise in blood sugars when eating. However, a person can have high blood sugars more often or last longer with too much sugar and sweeteners in the diet.
Normal blood sugars, after eating, are expected to be around or below 140 mg/dL two hours after eating.
Diarrhea, Bloating, and GI Upset
Too much sweetener, either with natural or artificial sweeteners, can result in upset stomach, diarrhea, and bloating.
There is even potential for changing our gut microbiome – the bacteria balance in our digestive system.
Despite some sweeteners being low-calorie, there is still a risk that consuming too much can result in weight gain.
This can be caused simply because a person may feel like they can eat more since the sweetener itself doesn’t provide calories.
However, other nutrients and ingredients can still contribute to total calorie intake.
This all being said, there is still room to include sweeteners in a renal diet. The main understanding is that these sweeteners are to be used in small amounts and in moderation.
Decreased Taste Sensitivity
It’s been observed that those using too many artificial sweeteners may have a decreased taste response to sugar.
This may be due to the very high level of sweetness that comes from artificial sugars. Some are up to 20,000 times sweeter than table sugar. (More on that later in the article.)
Let’s dive into the natural sugars and sweetener options for a renal diet.
Natural Sugars and Sweeteners for Kidney Disease
There are plenty of natural sweeteners that are safe for kidney patients. Here’s a list of sweeteners to choose from.
- White sugar
- Brown sugar
- Agave nectar
- Maple syrup
- Coconut sugar
- Powdered sugar
All of these are safe to use within the moderation discussed, or based on your dietitian’s own guidelines. Keep in mind that these types of sweeteners will raise blood sugars.
While these sweeteners do contain sugar, they can also provide other benefits when used in place of sugar or sugar substitutes.
Blackstrap molasses, for example, is a good source of iron.
Honey has many proven benefits. It’s known to be a good source of antioxidants, reduces allergies, used as an antimicrobial.
Honey has also been used as a treatment for illnesses including;
- Wound care
- Neurological disease
- Gastrointestinal diseases
- Cardiovascular diseases
Maple syrup also has been shown to have similar benefits.
Just one tablespoon of maple syrup has 33% of our manganese needs. Manganese is important for bone health.
High Sugar Fruits
The best sweetener for kidney disease is fruit. Fruits are naturally sweet but also provide other nutrients like fiber, vitamins, minerals, and antioxidants.
Some fruits are naturally sweeter and can be used as sugar substitutes in recipes.
Examples of fruit that can be used as sweeteners include:
One of the best reasons to use fruits as natural sweeteners in a renal diet is that they provide fiber along with natural sugars.
This is why fruits are some of the best sweetener for kidney disease.
Fiber is important for slowing down the absorption of sugars into the bloodstream.
In fact, getting enough fiber each day has been shown to help with diabetes control.
However, there are other natural sweeteners for kidney disease. Many will not raise blood sugars.
Next, we will cover some of the natural sweetener products available in grocery stores.
Allulose is a naturally occurring sugar. It can be found in raising, figs, maple syrup, brown sugar, molasses, and wheat.
It is slightly less sweet than table sugar – about 70% as sweet.
Allulose is nearly calorie-free, at less than 1 calorie per gram (compared to table sugar at 4 calories per gram).
It does not have a significant impact on blood sugar levels.
Many companies use allulose as part of their sugar substitute products.
Common sweeteners of this include Stevia ®, Truvia®, PureVia®, and Enliten®.
These are typically 200 to 400 times sweeter than table sugar.
These sugar substitutes are generally zero-calorie. They also do not tend to impact blood sugars, making them a good choice for diabetes.
Luo Han Guo
These sweeteners use monk fruit. Examples include Nectresse®, Monk Fruit in the Raw®, and PureLo®.
These are 100 to 250 times sweeter than table sugar.
These natural sweeteners are typically zero calories and do not have an effect on blood sugars.
Commonly known as Talin®, this sweetener is 2,000 to 3,000 times sweeter than table sugar.
While thaumatin contains calories (4 calories per gram), it does not impact blood sugars.
There are many brands of erythritol sweeteners available. Some of the most popular include Swerve ®, Lakanto ®, and NOW Foods ®.
Erythritol sweeteners are considered sugar alcohols. They are also considered artificial sweeteners but are generally recognized as safe.
Many companies that use other sweeteners, like monk fruit, also use a base of erythritol.
Erythritol is a zero-calorie sweetener and does not affect blood glucose levels.
Xylitol is a natural sugar alcohol. It is found in plants. It has about 40% fewer calories than table sugar, with 2.5 calories per gram.
Examples of brand names include XyloSweet ®, Lite&Sweet ®, Xyla ®, Global Sweet ®.
Best Artificial Sweetener for Kidney Disease
While there are plenty of natural sweeteners that can be included, there are also artificial sweeteners that can be used as well.
These sweeteners are considered artificial because they are created by combining molecules that do not naturally combine this way.
This does not mean that they are unsafe. It’s food science!
Artificial sweeteners that are considered safe by the FDA include:
This group of artificial sugars does have a small amount of calories. Examples include Nutrasweet ®, Equal ®, and Sugar Twin ®.
Aspartame products are about 200 times sweeter than table sugar. It does provide the same amount of calories per gram of table sugar (4 calories per gram). However, with being sweeter, less is typically required.
Aspartame is a safe sweetener for diabetics as it does not affect blood glucose levels.
In July 2023, the World Health Organization (WHO) released a statement that stated aspartame as a “possible carcinogenic.” What this means is there may be an association between use of aspartame and cancer.
However, the evidence is very limited. The WHO also doesn’t consider other factors like environment, genes, and lifestyle.
This does not mean that aspartame is unsafe or will cause cancer. As the statement and research shows, using aspartame is safe.
Otherwise known as Ace-K. Examples include Sunett® and Sweet One®.
Ace-K products are about 200 times sweeter than table sugar. It is a zero-calorie sweetener that does not impact blood sugar levels.
Note that these sweeteners contain potassium. One packet of these sweeteners contains about 10 milligrams of potassium.
This is a very, very low amount of potassium.
However, those on a potassium-restricted diet may want to use a different sweetener as potassium additives may impact blood potassium levels.
The common name for this sweetener is Splenda®.
It is about 600 times sweeter than table sugar. While sucralose is a zero-calorie sweetener, Splenda ® is not.
Splenda ® contains 4 calories per gram, similar to table sugar.
Sucralose can also impact blood sugars, so it’s important to limit it if you have blood sugar control issues.
Recently, sucralose has been touted in the media as being carcinogenic. This is not proven, as evidenced by multiple studies and research reviews.
Otherwise known as Newtame®.
It is about 7,000 to 13,000 times sweeter than table sugar.
Neotame is a zero-calorie sweetener and does not impact blood sugars.
This sweetener is the newest addition, approved in 2014.
It is considered 20,000 times sweeter than table sugar.
Some commonly known brands include Sweet and Low®, Sweet Twin®, Sweet’N Low®, and Necta Sweet®.
These can be 200 to 700 times sweeter than table sugar. It has the same amount of calories as table sugar. However, less is generally used due to the higher sweetness levels.
Saccharin can impact blood sugars, so it’s advised to be careful for those with blood sugar issues.
Table Comparison of Sweeteners
Below is a table to compare the different sweeteners discussed. This includes both natural and artificial sweeteners.
|Brand Name Examples
|Sweetness Level Compared to Table Sugar
|Blood Sugar Impact?
|Swerve ®, Splenda®, Wholesome®
|0.4 calories per gram
|Stevia ®, Truvia®, PureVia®, Enliten®
|200 – 400x
|Luo Han Guo
|Nectresse®, Monk Fruit in the Raw®, PureLo®
|150 – 250x
|2,000 – 3,000x
|4 calories per gram
|Swerve ®, Lakanto ®, NOW Foods ®
|60 – 70%
|XyloSweet ®, Lite&Sweet ®, Xyla ®, Global Sweet ®
|Similar sweetness level
|2.5 calories per gram
|Nutrasweet ®, Equal ®, Sugar Twin ®
|4 calories per gram
|Sunett®, Sweet One®
|Zero (4 calories per gram for Splenda®)
|7,000 – 13,000x
|Sweet and Low®, Sweet Twin®, Sweet’N Low®, Necta Sweet®
|200 – 700x
|4 calories per gram
Sweeteners Available Online
Many of the sweeteners discussed in this article are available for purchase online. Here are a few that you can find on Amazon.
- Splenda made with Stevia*
- Whole Earth ®*
- Truvia Granulated*
- Splenda Monk Fruit*
- Lakanto Baking Monk Fruit Sweetener*
- NOW Foods Organic Erythritol*
- Swerve ® Confectioners Sweetener*
- Truvia ® Liquid Sweetener*
It’s important to understand that sweeteners can be included in a renal diet. When it comes to the best sweetener for kidney disease, there are many choices that can be low-calorie and not impact blood sugars.
Natural sugars found in fruits like bananas, cherries, mangoes, and dates are a great way to naturally sweeten a recipe. They will also provide additional nutrients like fiber, vitamins, and minerals.
Other natural sugar sources like honey, maple syrup, and molasses can be included in a renal diet. They can also provide micronutrients and benefits like antioxidants.
Natural sweeteners can include products with steviol glycosides (like Stevia ®), luo han guo, thaumatin, erythritol, and xylitol. Many of these are zero-calorie sweeteners and have little impact on blood sugars.
Artificial sweeteners are easily available and safe to use in our diet. Examples of artificial sugars include aspartame, ace-k, sucralose, neotame, Advantame ®, and saccharin. Keep in mind that some artificial sweeteners may have calories or impact blood sugars, just like natural sugars.
When shopping for sweeteners, it’s important to look at the ingredients. Many sweeteners will contain multiple types of sugars.
Some may still provide calories, similar to table sugar. However, many are much sweeter than table sugar and can be used in smaller quantities.
No matter what you choose, enjoy it in moderation. Keeping added sugar – no matter what the source – is beneficial to kidney health. But enjoying just a little bit can add a dose of sweetness to life!
Jen Hernandez is a registered dietitian and board-certified specialist in renal nutrition. She has nearly a decade of experience with kidney disease patients in all stages - from stage 1 through kidney transplant. Jen writes on the blog of Plant-Powered Kidneys to help reach and teach more kidney patients about how they can enjoy more foods in a plant-based diet while protecting kidney health.