In their book “Kinderernährung – Expertenwissen für den Alltag” (German only), Swiss nutrition experts Dr George Marx and Andrea Mathis give a comprehensive overview of the wide-ranging and often controversial topic of child nutrition. We translated a selection of their insights and publish their findings on this blog to make them available to a wider audience. Please find the links to further posts of this series at the end of this contribution.

Headlines such as “Sugar – a drug”, “Is Sugar a Toxin?” or “Fight the Sugar Bombs” follow us at every turn. Sugar is a treat which has an addictive nature. Here we present possible alternatives to sugar.

Natural Sweetness

As an alternative to table sugar, there is a large selection of other sweeteners such as honey, agave syrup/juice concentrate, maple syrup, date syrup, cane or coconut blossom sugar, rice syrup or apple and pear juice concentrate, among others. They contain natural sweetness and in terms of sweetening ability, they are similar to sugar or somewhat sweeter. With regard to the energy content, they are comparable to sugar and therefore only a limited alternative to sugar. Attention should be paid to fair-trade, organic products.


Honey is a liquid or creamy to solid substance which consists primarily of fructose and glucose. Honey also contains trace amounts of other types of sugar, proteins, enzymes and vitamins. The color of honey varies from yellow to brown. The taste depends on the flower nectar collected. The sweetening ability is indicated with a factor of 1.2 in comparison to table sugar, and thus a smaller amount is needed to obtain the same sweetening ability. When purchasing, attention should be paid to fair trade and – even better – regional honey.

Sweetening beverages with honey or coating the nipples with honey before breastfeeding has long been considered obsolete, since the bacteria or spores in unprocessed honey can damage the infant’s gastrointestinal tract which is still immature. For this reason, honey should not be given to children until after the first birthday. There is no longer any risk in this regard in older children and adults. Honey contains many anti-inflammatory enzymes, which is why the effect appears to have a certain value in flu-like (viral) infections.

Sugar Substitutes

Sugar substitutes, also known as sugar alcohols, have a somewhat lower sweetening ability than table sugar. They belong to the group of food additives and have 2.4 kcal per 100 g. Sugar substitutes are easy to identify. Their names end in “ol” (erythritol, isomaltitol, lactitol, maltitol, mannitol, sorbitol, xylitol). Fructose, which is also a sugar substitute, is an exception to this nomenclature.

Sugar substitutes are obtained synthetically from starches (such as fungi, algae, rowan berries, birch and beech bark, etc.) and from various types of sugars. Their taste, volume and consistency are very similar to that of sugar. With the exception of maltitol, sugar substitutes are metabolized without insulin and only partially absorbed in the gastrointestinal tract. If excessive quantities are consumed, they can cause discomfort such as bloating and diarrhea. In children, this discomfort occurs often after only small amounts have been consumed. Sugar substitutes are found most frequently in chewing gum, candies and sweets.

Table. Sugar substitutes and their characteristics

Name/E numberSweetening abilityPotential to cause cavities
Xylitol (E 967)100No
Erythritol (E 968)70No
Maltitol (E 965)90No
Maltitol syrup (E 965)80No
Sorbitol (E 420)60Yes
Isomalt/isomaltitol (E 953)40No
Lactitol (E 966)30–40No
Mannitol (E 421)30–40Yes

Fruit Sugar (Fructose)

Fructose exists in nature primarily in fruits, some vegetables, and honey. It is a simple sugar, tastes sweet, is odorless and colorless, and its sweetening ability is somewhat higher than that of table sugar. Fructose constitutes half of table sugar. In most cases, fructose is consumed in the form of table sugar.

Fructose and fructose syrup are regularly used in the food industry. Fructose is added to many sweet drinks as a sweetener, particularly in the US. Excessive consumption of fructose can cause abdominal pain, bloating, and diarrhea. Fructose is by definition a sugar substitute.

Photo: Nadja Lenherr

Photo: Nadja Lenherr


Sweeteners are also food additives. They are synthetically manufactured and have a powerful sweetening ability which is up to 13,000 times higher than that of table sugar. They have practically no calories and do not harm the teeth. They are not carbohydrates and do not require insulin for metabolization. Most sweeteners are absorbed in the intestine, not metabolized, and eliminated with the urine. The most common approved sweeteners are neotame, saccharine, steviol glycosides, sucralose, thaumatin, acesulfame K, aspartame, cyclamate and neohesperidin. Because of the frequent aftertaste or flavor of sweeteners, the food industry combines sweeteners with one another.

Sweeteners are found most often in beverages, desserts, chewing gum and milk products. Since possible health risks of artificial sweeteners have been discussed for years, there are maximum permissible daily doses in the EU which are based on the ADI (= acceptable daily intake) value. The amount of sweeteners (aspartame, cyclamate, saccharine) is indicated in milligrams per kilogram body weight. The permitted daily dose of aspartame is 40 mg/kg body weight; for cyclamate it is 7 mg/kg body weight and for saccharine, 5 mg/kg body weight. The maximum daily dose of artificial sweeteners is quickly reached in children. In a child weighing 15 kg, the daily dose is already exceeded with 4 dl of a beverage sweetened with cyclamate.

It has not been able to be demonstrated to date that sweeteners lead to a reduction in or a stabilization of body weight. It has also not been able to be shown that it helps reduce cravings, as is frequently postulated. As a general rule, sugar substitutes and sweeteners are not recommended for children.

Stevia/Steviol Glycoside

In recent years, this wonder plant has attracted a great deal of attention. Stevia, also known as sweetleaf, is a South American perennial which has been used for centuries for sweetening or as a medicinal plant. Its leaves are 30 to 45 times sweeter than table sugar. The safety of the stevia plant with regard to health has not been fully proven and for this reason, stevia leaves may not be marketed in the EU as a food or for sweetening foods. However, it is used in the form of steviol glycosides. These sweeteners are extracted from the stevia plant and are about 300 to 400 times sweeter than table sugar. They have been declared safe and have been approved by the European Food Safety Authority (EFSA).

Conclusion: ‘Less Is More’

Aim for a balanced, varied diet. Sugar or other natural sweeteners should be deliberately reduced. When possible, sugar substitutes and artificial sweeteners should be avoided. Ensure proper dental hygiene.


Please feel free to download this tasty, healthy and easy-to-prepare recipe which will soon be a favorite of your children!

Please check out the other posts of our series here:


Dr. med. George Marx, Andrea Mathis, BSc in Nutrition and Dietetics
Kinderernährung – Expertenwissen für den Alltag

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