Popular Sugar Alternatives – Paleo Dentist’s Perspective

Do you realize that sweet foods were a rare delicacy for our ancient ancestors? Nowadays, the situation has changed. Today, we have an unlimited supply of sugary foods and beverages at our disposal.  Natural sweeteners can be used effectively in moderation to provide the sweetness that most people crave.  Below are the best natural sweeteners ranked in order based on a low glycemic index and additional health benefits.

As many of us may know, glucose is the one of the primary unit in the study of metabolism.  However, there are certain dangers involved with consuming too much glucose. Those threats mostly require elevated blood sugar and insulin which trigger fat accumulation, cellular inflammation, insulin resistance and even cancer.

There are some natural sweeteners that are indeed healthier alternative to processed sugar and high fructose corn syrup.




Stevia is a very popular low-calorie sweetener. It is extracted from the leaves of a plant called Stevia rebaudiana. This plant has been grown for sweetness and medicinal purposes for centuries in South America.

There are several sweet compounds found in Stevia leaves, the main ones are Stevioside and Rebaudioside A. Both are many hundred times sweeter than sugar, gram for gram.

Stevia tastes sweet but has virtually no calories and considered safe for dental health. There are some studies in humans showing Stevia to have health benefits.




Erythritol is another low-calorie sweetener which is a form of sugar alcohol that is found naturally in certain fruits. However, if you’re buying powdered erythritol, then it will most likely be made via an industrial process.  Erythritol doesn’t spike blood sugar or insulin levels and has no effect on biomarkers like cholesterol or triglycerides. It is absorbed into our bodies from the intestine but eventually excreted by the kidneys unchanged.

It contains just 0.24 calories/gram, or about 6% of the calories as sugar, with 70% of the sweetness. Studies show that erythritol is very safe and would not cause tooth decay. However, similar as with other sugar alcohols, it can lead to digestive issues if somebody consumes too much at a time.

We wouldn’t say that erythritol is “healthy” – but it certainly doesn’t appear to be harmful in any sense and seems to be better tolerated than the vast majority other sugar alcohols.




Xylitol is a sugar alcohol with sweetness similar to sugar. It contains 2.4 calories per gram or about 2/3rds of the caloric value of sugar. Xylitol seems to have some benefits for oral health, reducing the risk of cavities and dental decay. Oral bacterial activity is reduced in the presence of xylitol.

However, as with other sugar alcohols, it can cause digestive side effects at high doses. The takeaway message is if you have a canine in your home, then you might want to keep xylitol out of the house as it is known to be highly toxic to animals, especially dogs.

Xylitol is dentist’s favorite sweetener and personally I think it is the best sweetener in small amounts for dental health.



This sweetener, known as Yucon syrup has recently gained popularity as a weight loss supplement after the findings of one study that proven significant weight loss in overweight women.  It is harvested from the Yacon plant, which grows natively in the Andes in South America. It is very high in fructooligosaccharides, which serves the function just like soluble fibers that feed the good bacteria in the intestine.  Do you know that fructose is another simple sugar that is found in nature in fruits, honey, and plant/tree nectar?  This is metabolized differently than glucose and can cause even more dangerous effects when consumed in excess.

Most plant-based sweeteners such as agave nectar are extremely high in fructose.  Agave was thought to be a safe sweetener until health researchers found out the dangers of it’s nearly 80% fructose content.

I personally do not recommend it due to risk of tooth decay just as much as consuming sucrose.




There are several traditional sweeteners that health-conscious people often eat instead of sugar. Unlike honey, table sugar lacks minerals and vitamins they draw upon the body’s nutrients to be metabolized into the system. Honey has more calories than sugar, but it’s also sweeter. You may find you need less honey than sugar to get the desired sweetness. Honey will definitely cause tooth decay and this is not a dentist recommended sweetener if you are trying to prevent tooth decay.

There are an only a handful of people who might want to avoid sugar-based sweeteners altogether. Those groups of individuals include the binge eaters, food addicts, and people who are on a very low-carb, ketogenic diet.

Other people can consume sugar in small amounts without any harm. It is still empty calories and will still be bad for your dentition, but it surely won’t jeopardize your metabolism, causing others chronic symptoms like fatty liver or end up destroying your health. Don’t forget, honey is carbohydrates, composed primarily of fructose and glucose. It is used as an ingredient in a lot of prepackaged foods and beverages. It can result in weight gain if overused. No matter which type you prefer, any kind of honey can spike blood sugar levels.


Lo Han Extract


It is also called monk fruit extract.  The monk fruit plant grows native in Northern Thailand.  One significant benefit that Lo Han has is that it contains low sugar content and a shallow glycemic index which is ideal for diabetics.  It gets the majority of its sweetness from a glycoside nutrient called mogrosides.

It will not cause tooth decay and it is also one of my personal favorite sweetener.




Lower in calories and rich in minerals and vitamin B, lucuma is often used in South America as both a flavoring agent and immune-booster, according to experts. Lucuma is most similar to brown sugar regarding taste and can be substituted for it in most recipes by doubling the amount. So, if you use one teaspoon of sugar in a recipe, you’ll want to use just 2 teaspoons of Lucuma would suffice.

It really shines in recipes that contain fat, such as ice cream or smoothies. It also helps stabilize the blood sugar and has anti-inflammatory properties. So, you can savor a caramel flavor without a blood sugar crash.  It may not cause tooth decay but it is not readily available.




This substitute for white sugar has been around since 1879, is 300X sweeter than sugar and remains that way, even when heated, so it’s good for tea or coffee. But it can have a metallic aftertaste. And individuals are starting to get so used to saccharin’s intense sweetness that you begin to crave sugary treats. Saccharin has been attributed to bladder cancer in rats and it can be carcinogenic.


Acesulfame K

Acesulfame K-sugar-alternative

Undoubtedly, Acesulfame Potassium does not contribute to tooth decay. How do we know that? Many studies show that microorganisms in the oral cavity do not metabolize acesulfame potassium and, therefore, won’t convert it into plaque or harmful acids that cause dental decay. However, it is known to disturb gut bacteria and known to have neurotoxic problems.



Aspartame is composed of aspartic acid and phenylalanine. Although they are amino acids that occur in nature, aspartame is known to be toxic.  It can cause headaches and disturbs gut flora. It will not cause tooth decay, however, I do not recommend it due to its potential toxic effects.

Whenever your body processes aspartame, part of it is broken down into methanol, which toxic in large quantities.  Methanol is naturally created by the body and is also found in abundance in fruit, fruit juice, fermented beverages, and some vegetables




Sucralose is made by removing three oxygen atoms from sucrose and substituting three chlorine atoms. It doesn’t cause tooth decay, however, it is known to be toxic to gut health and can be neurotoxin.

**Saccharin, Sucralose and Aspartame can upset the balance of intestinal flora and cause glucose intolerance in mice and some humans tested.

There are numerous other sweeteners available, however, I personally believe that xyiltol, monkfruit extracts, and erythritol is most safe kinds for dental health as well as maintaining healthy glycemic control.


  1. https://www.ncbi.nlm.nih.gov/pubmed/26192983
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296175/
  3. https://link.springer.com/article/10.1007/s00284-007-9076-6
  4. http://www.nature.com/bdj/journal/v219/n1/full/sj.bdj.2015.542.html
  5. http://dx.doi.org/10.1080/10286020903048983
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