Glycemic Index: How Artificial Sweeteners Rank, Plus the Best Ones for People With Diabetes

It’s widely known that sugar is best enjoyed in small amounts. This awareness has led to a rise in the number of sugar substitutes on the market. From Splenda to stevia to monk fruit, there are many options available, including sweeteners that are lower on the glycemic index (GI). 

While GI isn’t the only factor to consider, it can help you choose the best sweetener for people with diabetes by showing how it may affect blood sugar. Read on to learn which low-GI sugar substitutes and artificial sweeteners are recommended for people with diabetes.

What is the glycemic index?

The glycemic index (GI) is a way to measure how quickly a food raises blood sugar. 

When you eat foods containing carbohydrates (carbs), your body breaks them down into glucose. Glucose is the simplest form of sugar, and it’s also the body’s main energy source. Foods high in sugar or fast-digesting carbs can cause blood sugar to rise quickly. These are considered high-GI foods.

On the other end of the spectrum, foods that cause a slower and more gradual rise in blood sugar are considered low-GI foods. These foods may be especially helpful for people with diabetes or prediabetes who want to manage their blood sugar levels. 

The GI ranking system looks like this:

• Low GI: foods with a GI of 1 to 55

• Medium GI: foods with a GI of 56 to 69

• High GI: foods with a GI of 70 and up

The GI of plain glucose has a score of 100, which represents the fastest possible rise in blood sugar. 

Sugar substitutes and glycemic index

There are three main types of sugar substitutes, and each one affects the glycemic index differently. 

• Natural sweeteners: Natural sweeteners come from plants or natural sources. Examples include honey, maple syrup, stevia, and monk fruit. The GI for natural sweeteners ranges from about 60 (for honey) to zero (for stevia or monk fruit). 

• Artificial sweeteners: Artificial sweeteners — like aspartame or sucralose — are made by chemically changing or combining different molecules in a lab. They’re much sweeter than sugar, but have zero calories. Their GI is zero. 

• Sugar alcohols: Sugar alcohols are carbohydrates that are used as sweeteners. Some occur naturally in fruits and vegetables, but most are made from other sugars. People often lump them in with artificial sweeteners, but technically they’re in their own category. Their GI is usually lower than most natural sweeteners, but not zero. 

EXPERT PICKS: WHAT TO READ NEXT

• Is stevia a good sweetener? Find out how stevia stacks up to other sweeteners and whether or not it’s a good alternative to sugar.

• Natural sugar versus refined sugar: Learn about the differences between sugar types — and which one you should use.

• Managing your diet with diabetes: Check out this list of best foods you should eat (and what to avoid) if you have diabetes.

Are low-glycemic sweeteners healthier?

Typically, foods with a low to medium GI are considered healthier than those with a high GI. So, when it comes to natural sweeteners, a low-GI sweetener may be a healthier alternative to refined table sugar — especially if you have prediabetes or diabetes. 

Other sugar substitutes are more complicated. Since sugar alcohols and artificial sweeteners have lower GIs, you might expect them to be healthier options.

But research tells a different story. Some studies suggest that long-term use of artificial sweeteners is actually linked to a higher risk of heart disease, stroke, and Type 2 diabetes — despite their low GI. And people who consume a lot of sugar alcohols — like xylitol and erythritol — are more likely to have heart disease. So, a low GI alone doesn’t necessarily make a sugar substitute healthy.

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Which sweeteners are best for people with diabetes?

There isn’t one “best” sweetener for everyone. But based on current research, the best sweeteners for people with diabetes may be natural options with a low glycemic index. These can add sweetness without causing large spikes in blood sugar.

Stevia (Truvia, Stevia in the Raw)

Stevia comes from the leaves of the stevia plant, native to South America. It can be 50 to 300 times sweeter than table sugar. Some people experience a bitter aftertaste. Stevia has no calories, so it has a GI of zero.

Pure stevia isn’t linked to any health risks, but it’s important to check labels. Many products add erythritol or other ingredients as a bulking agent. People with diabetes who consume large amounts of erythritol may be twice as likely to have a stroke or heart attack. So pure stevia is a better choice. 

Monk fruit (Lakanto, Monk Fruit in the Raw)

Monk fruit, or luo han guo, comes from a fruit native to China. It’s 250 times sweeter than table sugar. Like stevia, it sometimes contains other ingredients like erythritol, so read the ingredients closely. 

Monk fruit also has a GI of zero. Like stevia, it won’t raise blood sugar levels. Check the ingredients here as well to make sure there aren’t extra additives. 

Allulose

Allulose is a naturally occurring sugar in foods like figs, raisins, and kiwis. It’s considered a rare sugar because it’s found in small quantities. Allulose is about 70% as sweet as sugar, but it’s much lower in calories. It has 10% of the calories of sugar. 

The GI of allulose is 1. This means it has a minimal effect on blood sugar levels. Some studies find that eating allulose with a meal may actually lower blood sugar levels after the meal, making it an especially good choice of sweetener for people with diabetes. 

Which sweeteners should people with diabetes avoid?

Even though many sugar substitutes have a low or zero glycemic index, not all of them are safe or ideal for people with diabetes. Some can still raise blood sugar, cause digestive issues, or carry other long-term health risks. Here are the main types to watch out for.

High-GI natural sweeteners

Natural sweeteners like honey or maple syrup have a lower GI than table sugar, but they can still cause spikes in blood sugar if eaten in large amounts. Some — like agave syrup — are also high in fructose, which may be harmful for liver health and blood sugar management. 

Sugar alcohols

Some sugar alcohols — like maltitol — can cause gas and problems with digestion. And others — like xylitol and erythritol — are linked to higher risk of developing heart attacks and blood clots. More research is needed to confirm this link. For now, the FDA notes that sugar alcohols are “generally recognized as safe,” but recommends moderation. 

Aspartame and saccharine

Artificial sweeteners like sucralose, aspartame, and saccharin don’t raise blood sugar directly. But research suggests they may affect insulin sensitivity, and may increase the risk of heart disease. The FDA has reviewed their safety for the general population, but they don’t specifically address their use by people with diabetes. 

Experts believe some artificial sweeteners may change the gut microbiome, which plays an important role in metabolism and blood sugar management.

The World Health Organization (WHO) also recommends avoiding sugar substitutes as a tool for weight loss, since evidence doesn’t show they help in the long run. 

List of sugars and artificial sweeteners ranked from lowest to highest glycemic index

Below are GI values for different types of sugar and artificial sweeteners.

Sugar

Sugar alcohols

*This isn’t a complete list of sweeteners but rather examples of the different types that exist.

How should you use the glycemic index to pick the healthiest sugar or sweetener?

It depends on your health goals. For example, if you have prediabetes or diabetes, you might consider a sweetener that’s on the lower end of the GI scale or even one with a GI of 0. 

If you’re looking for the “healthiest” sugar, maple syrup, coconut sugar, and molasses in moderation may be better choices, if they don’t cause your blood sugar to spike too much.

Apart from GI, though, serving size and portion size are also important. Put another way, how much you consume matters as much as the GI of an individual food. This is expressed as the “glycemic load” of a food. It might be healthier to consume a small amount of a higher-GI sweetener than a large amount of a lower-GI sweetener. 

And generally, it’s best to focus on the glycemic load of your whole plate or meal rather than the GI of an individual ingredient. For example, you could choose to add a low-GI sweetener to your coffee. But if you drink that alongside a glazed doughnut, then the glycemic load of your whole snack is still high. 

Other factors to consider when choosing the healthiest sweetener

Using GI or glycemic load may not be the only factors to consider when choosing a sweetener, though. Here are a few reasons why: 

• Your whole diet matters. You’re probably not eating a sweetener by itself. You may be mixing a sweetener into a beverage or food. And the nutrients in that beverage or food can control how fast your blood sugar increases. 

• Sweeteners differ. The GI value doesn’t give the full picture of a sweetener’s quality. Some higher-GI sweeteners — like coconut sugar or honey — are unrefined, whereas sugar alcohols and artificial sweeteners are processed.

• Diet and exercise are key. Your overall diet and lifestyle play a much bigger role on your health. Following a nutritious diet, exercising regularly, and getting quality sleep will have a bigger effect on your health than the sweetener you eat. 

• Your time matters. Calculating the GI and glycemic load can take a lot of work or be a lengthy process. 

If you’re not sure where to start to develop a well-rounded diet, work with a nutritionist or dietitian to come up with a plan that supports your individual health goals.

What are the healthiest sweeteners?

In short, it depends. Having certain health conditions may make some sweeteners healthier options than others. How much sweetener you eat can also make a difference in how it affects your body. 

Here’s a look at the benefits and risks of each sweetener type. Remember, regardless of the type, use sweeteners in limited amounts.

Benefits and risks of different sweeteners

Frequently asked questions

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Written by:

Samvida Patel, MNSP, INHC

Samvida Patel, MNSP, INHC, is a health editor at GoodRx. She is a nutritionist and integrative nutrition health coach with over 8 years of experience in health communications.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

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