Medically reviewed by Dr. Tro Kalayjian and Dr. Laura Buchanan
Reviewed by Amy Eiges, Certified Health Coach
A sugar substitute can make it easier to enjoy a familiar drink or recipe while reducing sugar. Choosing one takes more than finding “keto,” “natural” or “zero sugar” on the package. The sweetening ingredient, the finished blend and the amount you use all matter.
Originally published October 8, 2018.
Watch the full presentation: Understanding Low Carb Sweeteners, Replacements — Dr. Tro (50:40)
From the Mastering Low Carb course. Presentation title: Impact of Sweeteners on Overall Health.
Start with three questions:
- What is it replacing? Replacing sugar in your usual coffee is a different decision from adding several sweetened snacks to your day.
- What is actually in the product? Monk fruit or stevia on the front may describe only one ingredient in a larger blend.
- How does it work for you? Consider taste, digestion, hunger and whether the food helps you follow the way you want to eat.
Look beyond the glycemic index
Glycemic index, or GI, compares blood-glucose responses to a standardized amount of digestible carbohydrate. It can help describe a carbohydrate-containing food, but it does not account for the amount you put in a cup or recipe. A low GI also does not establish a sweetener's overall health effects. How GI is measured.
Look at the ingredient list and the serving size together. A powder may need a carrier to make a very small amount of an intense sweetener easy to measure. Dextrose and maltodextrin contribute carbohydrate, but their place in an ingredient list does not tell you that one packet will necessarily cause a large glucose rise.
For example, current U.S. Equal Original packets contain dextrose with maltodextrin, aspartame and acesulfame potassium. Splenda Original packets contain dextrose, maltodextrin and sucralose. Sweet’N Low combines saccharin with a dextrose carrier. Other products from these brands can have different formulas. Equal · Splenda · Sweet’N Low.
Use the package you are buying to check ingredients; older photographs may show an earlier formula. Also remember that U.S. nutrition labels allow rounding for a small labeled serving. “Zero calories” does not always mean absolutely none in a larger quantity, and it is not the same as “zero carbohydrate.” FDA label guidance.
Understand the main options
| Option | What to know when choosing it |
|---|---|
| Stevia and monk fruit extracts | Concentrated extracts provide sweetness with very little volume. Many retail products blend them with erythritol, allulose or other ingredients. Follow the specific product's directions rather than assuming a cup-for-cup substitution. |
| Erythritol | A sugar alcohol used alone and in blends. It differs from other sugar alcohols in its handling and calorie contribution. Its glucose effects do not settle the separate cardiovascular questions discussed below. |
| Xylitol | Another sugar alcohol, with a different calorie contribution and evidence base from erythritol. Some people report a greater glucose rise with xylitol than with other substitutes; use your experience to inform your choice. Keep it away from dogs: xylitol is poisonous to them. |
| Maltitol and other sugar alcohols | They are not interchangeable with erythritol. Digestive tolerance and glucose effects differ; maltitol can cause gas, bloating or diarrhea. A “sugar-free” label does not remove the need to check the ingredients and amount. |
| Allulose | A sugar with a different metabolic and U.S. labeling treatment from ordinary sugar; it is not a sugar alcohol. It remains in Total Carbohydrate even when excluded from Total Sugars and Added Sugars under FDA guidance. Products may contain allulose alone or in a blend. |
| Other intense sweeteners | Aspartame, saccharin and sucralose are different ingredients, often sold in formulated packets or liquids. Check the full product and its label directions, rather than treating a brand name as a pure ingredient. |
Sugar alcohols do not all turn slowly into glucose or supply the same number of calories. They differ in absorption and metabolism, and larger amounts can affect digestive comfort. Start with an amount you tolerate and reconsider a product that repeatedly causes discomfort. FDA sugar-alcohol overview · Allulose labeling.
In a small acute trial in people with type 2 diabetes, allulose modestly reduced the immediate blood-sugar response to a glucose drink. In a separate small 12-week study in people with type 2 diabetes, allulose did not improve glucose regulation or body composition; an immediate response does not establish a lasting metabolic benefit. Noronha and colleagues, 2018 · Preechasuk and colleagues, 2023.
Low sugar content also does not mean an ingredient has no biological effects. A two-week randomized study found that some non-nutritive sweeteners changed glucose responses and gut microbes in healthy adults, with responses differing among people and sweeteners. That is a reason to be specific about the ingredient and context. Suez and colleagues, 2022.
A newer 30-day randomized trial in healthy, lean adults found reduced estimated insulin sensitivity after sucralose capsules, alongside changes in gut microbes and meal-test responses. The result adds to the evidence that the ingredient, dose and way it is used matter; it does not show that all sweeteners or all sugar-replacement strategies have the same effects. Romo-Romo and colleagues, 2025.
Brand names are a starting point
These U.S. examples were checked in September 2026. Formulas change, so recheck the package when you buy it again.
- Lakanto: its Classic product with erythritol combines erythritol and monk fruit; the separate Classic with Allulose combines allulose and monk fruit. Classic with erythritol · Classic with allulose.
- Swerve: current Granular includes erythritol and allulose; Confectioners includes erythritol and tapioca starch; Brown includes erythritol, allulose and other ingredients. These are different blends. Choose the form specified by your recipe. Granular · Confectioners · Brown.
- NOW xylitol: the source-linked product lists xylitol as its ingredient. It is not calorie-free. Read the current package's precautions as well as its nutrition information. Product information.
- SweetLeaf drops: these are liquid formulations, with concentrations and flavors that differ. Use the directions on the exact bottle; a universal drop count will not fit every product. SteviaClear product information.
- Pyure: its stevia packets use an erythritol/stevia blend, while its Plant-Based Sweetener combines allulose, monk fruit and stevia without erythritol. Stevia packets · Plant-Based Sweetener.
- Whole Earth: the U.S. Stevia & Monk Fruit Blend jar also contains erythritol. Check its conversion directions rather than using the same amount as another blend. Current jar.
Sweetness, cravings and weight loss
Context remains useful: consider what a sweetener helps you replace and how the finished food affects your eating. It can be a practical bridge away from sugar. In the year-long SWEET trial, adults using sweeteners and sweetness enhancers in a reduced-sugar diet maintained modestly more weight loss than those avoiding them. The trial evaluated a dietary approach with multiple products; it did not rank every sweetener. Pang and colleagues, 2025.
Appetite findings also depend on what is compared. In one acute experiment, sucralose produced greater hunger than a sugar-sweetened drink, but hunger did not differ from water. Separately, the six-month Sweet Tooth Trial found no difference in sweet preference or body weight between groups assigned different levels of dietary sweetness. These results do not support a universal claim that all sweeteners inevitably cause cravings or weight gain. Chakravartti and colleagues, 2025 · Čad and colleagues, 2026.
Your own pattern still matters. If a particular low-carb sweet helps you follow your plan, that can be useful. If it repeatedly leaves you hungry, uncomfortable or eating more than you intended, consider a different product, a smaller amount or a break from it. You do not need to ignore that experience because other people respond differently.
Erythritol: what has changed since the original guide
Erythritol and xylitol raise questions beyond their effects on blood sugar. The 2023 erythritol study linked higher fasting blood levels with later cardiovascular events. Those levels were not a direct measurement of how much sweetener participants ate: the body can also make erythritol. The original paper combined that observational work with laboratory experiments and a small ingestion study measuring blood concentrations. Original study, human metabolism study.
Subsequent experiments tested ingestion and platelet responses directly. In 2024, ten healthy volunteers showed increased platelet responsiveness after a single 30 g erythritol drink; ten who drank glucose did not show the same change. A separate ten-person experiment found increased platelet responsiveness after 30 g xylitol. These are biological findings worth taking seriously. They did not measure how often heart attacks or strokes occur with regular use. Erythritol experiment · Xylitol study.
A five-week randomized pilot in adults with obesity found no significant effects of erythritol or xylitol on the vascular measures, glucose tolerance or abdominal fat it studied. Those are useful findings, but the study did not test platelet responsiveness or clinical cardiovascular events. The studies ask different questions. Five-week trial.
Newer metabolic research also reinforces the distinction between a blood marker and an eaten ingredient. In a 2026 analysis of the POUNDS Lost trial, changes in circulating erythritol tracked changes in metabolic health; the study did not assign people to consume or avoid erythritol. It cannot settle the dietary question. Heianza and colleagues, 2026.
The practical interpretation is to keep glucose effects, digestive tolerance and cardiovascular evidence separate. A reassuring glucose reading does not answer every health question, and the current evidence does not supply a proven personal “safe dose” or an event-risk estimate for each serving.
Dr. Tro's original clinical perspective
The original guide included this clinical experience and approach:
In my clinic, we have successfully used these products as a bridge to real food, and we will continue to do so because our evidence is also strong.
I don’t intend to change our messaging other than emphasizing that the ideal and goal is REAL food… and keeping the sweet foods to only as needed. This has been our messaging all along and continues to be the case.
— Dr. Tro Kalayjian, original erythritol note
Using sweeteners in recipes
Sweetness is only one part of baking. Sugar also supplies bulk and affects texture, moisture and browning. A few drops of an intense sweetener cannot automatically replace a cup of sugar. Granulated, powdered and brown substitutes are designed for different uses; pure allulose and an allulose blend may behave differently in the same recipe.
ROSETTE’S founder and product developer Rosette Kalayjian described the recipe-development experience in the original article:
“When formulating our recipes, we experimented with a number of sweeteners and ended up using an erythritol and monk fruit blend. Other sugar substitutes did not bake very well, but this combo blend was easy to work into our low carb and sugar free recipes because it best matched the flavor of sugar and was closest to a one-to-one substitution ratio to sugar.”
“We were also happily surprised that with this particular combination, our palates were not hit with the bitter or cooling aftertaste that is common with sugar replacements. Best of all we have never had a spike in blood sugar after eating any of our no-sugar confections!”
Use the ingredient and form named in a tested recipe. Conversion guides can help with sweetness, but the exact blend still matters. The original guide linked to this low-carb sweetener substitution guide and conversion calculator.
Choose a substitute that works for the food or drink you are making and the way you want to eat. Keep the goal in view: a sustainable pattern of meals you enjoy, with sweet foods used when they help.
Adapted from ROSETTE’S Baking Mixes BETTER Blog.
The original guide also linked to Lakanto, Swerve, Sweet Leaf, Allulose, Pyure and Whole Earth. Use the current manufacturer pages above to check formulas; a retained shopping link is not a confirmation of current stock or price.
