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The Sweet Truth About Sugar Substitutes

August 22, 2013

Cakes, pies and cookies, oh my! Did you know that Americans consume 165 pounds of sugar each year? Along with this sweet habit comes an increased risk of diabetes, cancer, and obesity. In 2009, the American Heart Association recommended that women reduce their added sugar intake to less than six teaspoons (25 grams) per day, and men less than nine teaspoons (37 grams) per day. Just to put that in perspective, a 12-ounce can of regular soda contains about eight teaspoons of sugar. With these new recommendations, it’s no wonder sugar substitute use is on the rise. But how do you know which one is the safest for you and your family?

Artificial sweeteners

Artificial sweeteners are chemically manufactured molecules, which may be derived from naturally occurring substances (herbs or sugar itself), and added to sweetened foods and beverages in place of table sugar (sucrose). They are sometimes referred to as “intense sweeteners” as they can be thousands of times sweeter than sugar. Because of this, dextrose and/or maltodextrin (easily digested carbohydrates) are added to dilute the sweetness in food products.

Per FDA regulations, any food that has 5 or fewer calories per serving can be labeled as containing “0 calories.” However, if you have diabetes, you must count these starch-based sweeteners as part of your carbohydrate intake, since insulin is required for their metabolism.

There are five artificial sweeteners approved by the FDA for use in the U.S.: Acesulfame potassium (K), Aspartame, Saccharin, Sucralose, and Neotame (the newest). Possible health benefits include: improved weight control, improved blood sugar control, and they do not contribute to tooth decay. Numerous research studies have confirmed that artificial sweeteners are generally safe in limited quantities, even for pregnant women.

Like all other food additives, artificial sweeteners must undergo a rigorous approval process, during which an Acceptable Daily Intake (ADI) is set for each artificial sweetener. The ADI refers to a maximum amount considered safe to consume each day over the course of your lifetime. In most cases, the ADI is a level far greater than what most individuals would consume under normal conditions. Let’s take a look at the ADI for various kinds of artificial sweeteners:

SweetenerADI Times Sweeter than sugar
Acesulfame Potassium (K)15 mg/kg/d200
Aspartame50 mg/kg/d60-200
Saccharin5 mg/kg/d200-700
Sucralose5 mg/kg/d600
Neotame18 mg/day7,000-13,000
*mg/kg/d= milligrams per kilogram body weight per day

The Center for Science in the Public Interest has deemed sucralose and neotame as the safest artificial sweeteners. They state that aspartame is probably safe, but people who believe they suffer from headaches or other symptoms after consuming foods that contain aspartame should avoid it. People with the rare disorder phenylketonuria (PKU) can’t metabolize phenylalanine, and should avoid aspartame as well. This consumer advocacy organization does consider saccharin to be the most unsafe, citing a study done by the National Cancer Institute in 2003, which found “some evidence of an increased risk of bladder cancer, particularly for those who heavily ingested the sweetener as a table top sweetener or through diet sodas.” “Heavily” was defined as “six or more servings of sugar substitute, or two or more eight-ounce servings of diet drink daily.”

Sugar Alcohols

Sugar alcohols are carbohydrates that occur naturally in certain fruits and vegetables, but can also be manufactured. They are lower in calories than table sugar (sucrose), but about half of the carbohydrate is still digested, and must be counted towards calorie and carbohydrate intake. Despite their name, sugar alcohols are not actually alcoholic.

The benefits of sugar alcohols are that they do not contribute to dental cavities, may help with weight control, and although they do affect blood sugar levels somewhat, the impact is less than that of sucrose. However, high intakes of foods containing sugar alcohols can lead to gastrointestinal distress including gas, bloating, and diarrhea. The FDA requires any foods whose consumption would add excessive amounts of sugar alcohols (50 grams/day of sorbitol, 20grams/day of mannitol), be labeled with the statement, “Excess consumption may have a laxative effect.”

Common sugar alcohols include: arabitol, glycerol, sorbitol, mannitol, maltitol, erythritol, xylitol, isomalt, and lactitol. Sugar alcohols are typically used in “sugar-free” gums, candies, chocolate, cookies, ice cream, jams and jelly spreads. They can also be used in medications such as “sugar-free” cough syrup, cough drops, and even multivitamins.

Natural sweeteners

Due to health concerns with sugar substitutes, many people have turned to using natural sweeteners instead of table sugar. Although natural sweeteners, including honey, agave nectar, maple syrup, and juice concentrates, are promoted as healthier options, they often undergo processing and refining like table sugar, and vitamin and mineral content is not significantly different from that of sucrose.

Possible health benefits include antibacterial, antiviral, and antioxidant properties, however they still “act as sugar:” raising blood glucose levels, contributing to dietary added sugars and calories, and increasing risk for tooth decay. Agave nectar has been considered a “low glycemic index food,” meaning its slow digestion and absorption produces a gradual rises in blood sugar and insulin levels, potentially controlling appetite, delaying hunger, and reducing insulin levels and resistance.


The Stevia plant includes about 240 species of herbs and shrubs in the sunflower family, native to South America. The species, Stevia rebaudiana (commonly known as sweet leaf or just Stevia), has been used for hundreds of years as a sweetener. Stevia’s taste has a slower onset and longer duration than sugar, may have a bitter or licorice-like aftertaste in high concentrations, and has up to 300 times the sweetness of sugar. As with other artificial sweeteners, Stevia may help with weight control as it has an insignificant effect on blood sugars, but there is no evidence of an advantage. Highly refined stevia extracts may cause mild side effects, such as nausea or a feeling of fullness.

In 2006 the World Health Organization (WHO) evaluated experimental studies on the by-products of Stevia conducted on animals and humans and found no evidence of carcinogenic effects. Based on long-term studies, the WHO’s Joint Experts Committee on Food Additives has approved an ADI of up to 4 mg/kg/day. Stevia was originally only available as a "dietary supplement" in the U.S. until 2008 when the FDA granted Generally Recognized as Safe (GRAS) status to rebaudioside A (rebiana), one of the chemicals in Stevia that makes it sweet. This allowed it to be used as a “food additive.”

In 2012, the FDA released this statement: "FDA has not permitted the use of whole-leaf Stevia or crude Stevia extracts because these substances have not been approved for use as a food additive. FDA does not consider their use in food to be GRAS in light of reports in the literature that raise concerns about the use of these substances. Among these concerns are control of blood sugar and effects on the reproductive, cardiovascular, and renal systems." The FDA has approved GRAS status to sugar substitutes such as Truvia (Cargill and the Coca-Cola Company) and PureVia (PepsiCo and the Whole Earth Sweetener Company), both of which use rebaudioside A derived from the Stevia plant, as they say these products are not Stevia, but a highly purified product. Stevia is also available as a sweetener in Japan, South Korea, Malaysia, Taiwan, Russia, Israel, Mexico, Paraguay, Uruguay, Venezuela, Columbia, Brazil, Argentina, and the European Union.

The bottom line is, whichever sweetener you choose, the big “m” word comes into play…. MODERATION!