The real deal or artificial?

When it comes to buying sweetener in the grocery store, your choices are nearly unlimited.

You'll find bags of plain white sugar, found in sugar bowls across America. There's brown sugar, light and dark. And don't forget the small packages of artificial sugars in a rainbow of colors from pink and blue to yellow and green.

While they all do the same job, each has a different role. Artificial sugar has no calories or carbohydrates and is often the first substitute people make when trying to cut calories or carbs.

While some recent studies have questioned the safety of artificial sugars, sugar substitutes are still recommended by most medical professionals for people with diabetes and those trying to lose weight, said Laurie Shank, RD, LDN, a registered dietitian specializing in bariatrics at St. Luke's University Health Network.

She noted that while the FDA has declared all artificial sweeteners sold in the United States to be "Generally Recognized as Safe," she does hear frequent questions about the safety of artificial sugars.

"I do have many patients who are concerned about the health risks associated with artificial sugars. That's a subject that is still being further researched," she said.

"There's no definitive proof that it causes any ill effects, and they have been generally regarded as safe. But at the same, artificial sweeteners are still a pretty new invention."

It's important for people to weigh their current health needs against any concerns they might have when reaching for a sweetener, added Shank.

"When you weigh the pros and cons associated with the health risks of diabetes and obesity against the health risks of artificial sugar, I would recommend the artificial in most cases," she said.

"Switching from real sugar to artificial sweeteners can cut several hundred calories from a person's daily diet. That can have a big impact on a person's blood sugar or weight."

Some recent studies suggest that using artificial sugars does not always lead to better health, and may in fact increase the risk of weight gain, Type 2 diabetes, and cardiovascular problems.

Shank noted that these studies were smaller, done with only a few participants, and that research must be done on larger groups to know if its findings will hold true for the general population. Scientists will also want to see these results repeated in multiple studies before they can come to any type of conclusion.

Of course, sugar and artificial sweeteners aren't only found in the baking aisle. Baked goods, candies, sports drinks, sweetened sodas and more all contain added sugar and calories or their calorie-free equivalent. Keep your entire diet in mind when making choices about sugar.

"There is absolutely too much real sugar, generally speaking, in our diets," said Shank. "We need carbohydrates for energy in our bodies. However the refined sugar that we get in our diets, we don't need any of that."

She noted that while monitoring your sugar intake is important if you're facing a problem such as diabetes or obesity, sugar isn't the only thing to watch for. Also keep an eye on overall calories and fat.

"Stick to the basics. Stick to your fresh unprocessed foods, like fresh fruits and vegetables and fat-free dairy products. You're not going to get much added sugar that way," said Shank. "The packaged, more processed foods tend to have more sugar and fat and calories than nonprocessed food."

She encouraged people to check nutrition labels on prepackaged foods, and to watch out for added sweeteners in ingredient lists.

When it comes to choosing a "real" sugar, it's a matter of preference and taste. There isn't much difference between regular table sugar and alternatives such as honey.

"They're all sources of concentrated sugar and calories, whether it's honey or maple syrup or table sugar. It's all sweet, simple sugar," she said.

Shank has noted a growing popularity in naturally occurring low-calorie sweeteners, such as the brand Stevia.

"With the stevia plant, the leaves are naturally sweet. It doesn't have the same impact on blood sugar and doesn't have the calories of cane sugar," she said.

For the ultimate sugar substitute, turn to naturally sweet fruits. Shank recommends replacing up to one-half of sugar in baking recipes with applesauce or prune purée to lower the baked good's sugar content.

If a recipe calls for one cup of sugar, try using one-half cup of sugar and one-half cup of applesauce.

It's a sweet compromise, and you might not even miss the extra sugar.

What about fruit?

It's common to think that when you cut sugar from your diet, it's also time to ditch the fruit.

Not necessarily.

"Fruits do have sugar in them. It is a naturally occurring sugar," Shank said.

Unlike the sugar found in soda, baked goods and candies, the natural sugar and carbohydrates found in fruits almost always come with fiber, which typically helps your body handle sugar more easily.

Fiber leads to lower blood sugar spikes and keeps you feeling full longer. Fruit also contains antioxidants and important nutrients, unlike soda and candy.

A medium-sized piece of fruit contains about 15 grams of sugar.

"Compare that to pasta, where you can easily be getting 60 grams of carbohydrates without fiber or the nutrients in a piece of fruit," she said. "You're choosing the more nutritious option."

There's a wide variety of fruit juices. Some are better than others.

"If you're struggling with out of control blood sugars or obesity, go for the lower calorie versions," said Shank.

Lower-calorie fruit juices are typically made with artificial sugars or no added sugar.

If you're active or not looking to lose weight, it's OK to treat yourself to a 4-ounce serving of regularly sweetened fruit juice, she said, noting that some nutrients (including fiber) can be lost in the process of turning fruit into juice.

"It's typically better to go for the fresh fruit. You're getting fiber as well, which is generally lacking in most Americans' diet," said Shank.