The Middlesex-London Health Unit is currently under a province-wide Stay-At-Home Order
COVID-19 Info | Information sur la COVID-19 | COVID-19 Self-Assessment | COVID-19 Lab Results

Middlesex-London Health Unit

Inner Nav

Sugar Substitutes and Artificial Sweeteners

The World Health Organization recommends adults and children reduce their free/added sugar intake to less than 10% of their total energy intake (approximately 50 g or 12 teaspoons depending on total energy) per day.1 For further health benefits, a reduction to less than 5% of their total energy intake (approximately 25 g or 6 teaspoons depending on their total energy intake) is recommended.2 On average, Canadians consume approximately 110 g or 26 teaspoons of sugar per day, which amounts to ~21% of their total energy intake.2 Many people will turn to sugar substitutes or ‘artificial sweeteners’ to help reduce their sugar intake.

Which sugar substitutes are available in Canada?

Health Canada has approved several sugar substitutes, including both artificial sweeteners and intense sweeteners obtained from natural sources, for use in Canada following rigorous safety assessments.3 The sugar substitutes listed below are safe when consumed in amounts below the Acceptable Daily Intake (ADI).3

Sugar Substitute
Common/Brand Name
Forms & Uses
Acceptable Daily Intake

Sugar alcohol4

sorbitol, xylitol, mannitol, lacitol, isomalt, erthritol

Added to some pre-packaged foods, drinks and liquid medications

Consuming over 10 g per day may cause gas/bloating, diarrhea, GI distress. Contain a small amount of calories.

Acesulfame Potassium (Ace-K)4

Not available for purchase as a single ingredient

Added to packaged food and drinks.

15 mg/kg body weight


Equal®, NutraSweet®, private label brand

Added to some pre-packaged food and drinks; also available as a table-top sweetener

40 mg/kg body weight


Sucaryl®, Sugar Twin®, Sweet’N Low®, private label brand

Available as a table-top sweetener; not allowed to be added to food and drinks

11 mg/kg body weight



Available as a table-top sweetener; not allowed to be added to food and drinks

5 mg/kg body weight



Added to some pre-packaged food and drinks; also available as a table-top sweetener; can be used to substitute sugar in baking and cooking

9 mg/kg body weight

Steviol glycosides4

Stevia-based sweeteners such as: Stevia, Truvia®, Krisda®, Pure Via®

Added to some pre-packaged food and drinks; also available as a table-top sweetener

4 mg/kg body weight

*individuals with phenylketonuria should avoid aspartame due to the presence of phenylalanine


Use of Sugar Substitutes during Pregnancy and Lactation

When consumed within the Acceptable Daily Intake (ADI), sugar substitutes are safe during pregnancy and lactation, in moderation.4 It is important that foods made with sugar substitutes do not replace more nutritious options.4

Use of Sugar Substitutes in Infants and Children

Sugar substitutes are not recommended for infants and children.5 Food and drinks containing sugar substitutes may replace more nutritious options that are required to promote optimal growth and development.5

Alternatives to Sugar and Sugar Substitutes

Generally, an individual will use sugar substitutes to help reduce the amount of sugar in their diet. There are other ways that an individual can reduce the amount of sugar in their diet and these should be encouraged by healthcare providers.

  • Individuals should be encouraged to read food labels to look for sources of sugar and sugar substitutes. Hidden sources of sugar include white sugar, beet sugar, raw sugar, brown sugar, agave syrup, honey, maple syrup, barley malt extract or fancy molasses, fructose, glucose, glucose-fructose (also known as high fructose corn syrup), maltose, sucrose or dextrose, fruit juice concentrates and purée concentrates. Choose unsweetened food products, like non-dairy beverages, oatmeal, applesauce, and nut butters.
  • Use fruit to naturally sweeten foods. Fruits can be added to plain yogurt, smoothies, and baked goods.
  • Decrease the amount of sugar added during baking. Reducing the amount of sugar used by up to one third usually does not affect the final product. Use sugar-free spices, like cinnamon, nutmeg, clove and ginger, or extracts, like vanilla, almond, maple, orange or lemon. Fruits, like raisins, dried apricots, dates and bananas, and fruit purées can also be used to add sweetness.
  • Avoid sugar-sweetened beverages or beverages with artificial sweeteners by choosing water most often. Fruits and vegetables can be used to flavour water.

Sugar Substitutes and the Gut Microbiome

While further research is needed before changes to recommendations are suggested, there is research emerging that sugar substitutes may affect our gut microbiome.6 Sugar substitutes may interact with the gut microbiome and produce significant metabolic effects despite lack of metabolism, which could result in health concerns.6

Date of creation: December 23, 2017
Last modified on: October 3, 2018


1World Health Organization. (2015). Guideline: Sugars intake for adults and children. Retrieved from
2Langlois K and Garriguet D. (2015 July 17). Sugar consumption among Canadians of all ages. Retrieved from
4Unlock Food. (2018August 16). Facts on Artificial Sweeteners. Retrieved from
5Health Canada, Canadian Paediatric Society, Dietitians of Canada and Breastfeeding Committee for Canada. (2015, January 19). Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months. Retrieved from
6Suez J et al. (2015). Non-caloric artificial sweeteners and the microbiome: findings and challenges. Gut Microbes. 6(2): 149-155.