Gastroenterologist: Beneficial vs. Harmful to the Intestine
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Gastroenterologist Ranks Popular Sweeteners for Gut Health: White Sugar Scores Lowest
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California-based Dr. Palaniappan Manickam, known as Dr. Pal or “Gutman,” assesses common sugar alternatives,revealing surprising insights into their impact on metabolic health and teh gut microbiome.
Published December 26, 2025
The Rising Demand for Sweetener Clarity
As consumers increasingly seek alternatives to traditional sugar, navigating the complex landscape of sweeteners can be overwhelming. A 2023 report by the Grand View Research estimated the global sugar substitutes market at $24.84 billion, projecting a compound annual growth rate (CAGR) of 5.6% from 2024 to 2030. This growth underscores the need for clear, evidence-based guidance on sweetener choices.
Addressing this confusion, Dr. Palaniappan Manickam, a gastroenterologist practicing in California, recently shared a concise ranking of popular sweeteners via an Instagram video.His assessment focuses on the impact of each sweetener on gut health,blood sugar levels,and overall metabolic function.
Dr. Pal’s Sweetener Ranking: A detailed Breakdown
Dr.Pal emphasized that sweeteners aren’t created equal, with varying effects on blood glucose, insulin response, and the gut microbiome. His ranking, presented on a scale of 1 to 10 (1 being the worst, 10 the best), provides a quick reference for consumers.
| Sweetener | Dr. Pal’s Score (out of 10) | Key Considerations |
|---|---|---|
| White Sugar | 1 | Purely refined; causes notable blood glucose and insulin spikes. |
| Brown Sugar | 3 | Contains molasses, but metabolic impact is similar to white sugar. |
| Honey | 5 | Contains antioxidants,but still raises blood sugar; quality varies greatly. |
| Maple Syrup | 6 | Contains some minerals, but still a sugar source; moderate impact on blood sugar. |
| Agave Nectar | 4 | High in fructose; potential negative impact on liver health. |
| Stevia | 8 | Natural, zero-calorie sweetener; minimal impact on blood sugar, but can cause digestive issues in some. |
| Monk Fruit | 9 | Natural,zero-calorie sweetener; minimal impact on blood sugar; generally well-tolerated. |
| Allulose | 7 | Rare sugar with minimal impact on blood sugar; may cause digestive discomfort in large quantities. |
Why White and Brown Sugar Rank Lowest
Dr. Pal unequivocally placed white sugar at the bottom of the list, assigning it a score of 1 out of 10. He explained that its highly refined nature leads to rapid spikes in both blood glucose and insulin. These spikes contribute to insulin resistance over time, increasing the risk of Type 2 diabetes and cardiovascular disease.
Brown sugar, while containing trace minerals from molasses, received only a slightly better score of 3. Dr. Pal clarified that the metabolic effect of brown sugar is almost identical to that of white sugar, offering minimal health advantages.
The top Tier: Stevia and Monk Fruit
According to dr. Pal, Stevia and Monk Fruit stand out as the most favorable options. Both are natural, zero-calorie