What are the myths and facts about all those sugar substitutes out there? Are they harmful or more beneficial? Is it worth risking the calories or should I choose the sugar substitute in my coffee? These are all common questions that come up during my counseling sessions with patients surrounding the sugar or artificial sweetener debate. As more sugar substitutes (nonnutritive sweeteners) which contribute little or no carbohydrate energy are marketed, the confusion increases about the various choices out there, or whether it is best to choose the sweetener option that contributes calories (nutritive sweetener) such as honey, sugar, or sugar alcohols (polyols) that contribute less energy per gram. Various blogs, consumer groups, and news articles are quick to try to sway you in one direction or the other, but they often leave out important pieces of information. As long as you have the facts, the choice is yours.
There are a few pieces of basic information to keep in mind: nutritive sweeteners do contribute calories/energy since they are a form of carbohydrate. They are either found naturally in sources such as fruit (fructose), vegetables or dairy (lactose) or added to food for use in processing or baking such as sugar (sucrose). The difference between a nutritive sweetener that contributes calories and a nonnutritive sweetener is the actual structure of the molecule. Carbohydrates are metabolized and used a certain way by the body. Because a nonnutritive sweetener such as Splenda® or Sweet n Low® is structurally different, it is not metabolized the same way as a carbohydrate and therefore is not considered to provide energy to the body.
Many nonnutritive sweeteners are used in combination. They are either not metabolized, not absorbed, require very little amounts, or are rapidly metabolized and excreted, which is why they contribute no calories. Nonnutritive sweeteners do not have the same functional properties as sugar, and will therefore differ in the way they are used for purposes such as baking. Because it takes a very small amount to provide much sweetness, they are not used in high amounts, and are actually consumed by the population on average in amounts much less than what is even recommended for the acceptable dietary intake. Since nutritive sweeteners do contribute energy, individuals who are on a calorie restricted diet may want to consider nonnutritive sweetener options so that they can get more of their energy from other sources than added sugar, or they may choose a sugar substitute in order to lessen calorie consumption altogether.
In cases of diabetes, sugar consumption will influence blood glucose control, as it is the amount and timing of carbohydrate consumption that affects an individual’s ability to control diabetes through diet and exercise. Therefore, individuals with diabetes may benefit from using a nonnutritive sweetener in order to control blood sugar, which can have further implications. As of 2012, there are seven nonnutritive sweeteners approved for use in the U.S: saccharin (Sweet’N Low®), sucralose (Splenda®), stevia (Truvia®), acesulfame K (Ace K, Sunnett®, Sweet One®), aspartame (NutraSweet®), neotame, and luo han guo (monk fruit extract).1
So what about the safety argument of sugar substitutes or other nonnutritive sweeteners? The above named nonnutritive sweeteners are all considered Generally Recognized as Safe (GRAS), a category that is regulated by the Food and Drug Administration (FDA) and is adequately shown to be safe under the conditions of its intended use, or unless the use of the substance is otherwise excluded from the definition of a food additive.2 Sufficient and quality scientific evidence is required in order for a substance to be considered GRAS.
Unlike any type of supplement that you take, the FDA does require research and toxicology studies on nonnutritive sweeteners. Nonnutritive sweeteners are safe to consume when following within the daily intake levels of the FDA. Now that you know not just anything is thrown on the shelf and called an “artificial sweetener,” you may wonder about the results of new studies that are coming out examining other aspects of nonnutritive sweetener use. In a 2012 position paper by the Academy of Nutrition and Dietetics, it was stated that consumers can enjoy a range of nutritive and nonnutritive sweeteners as part of a healthy meal plan when consuming them within the guidelines of current federal nutrition recommendations such as the Dietary Reference Intakes.1 According to the National Cancer Institute’s Surveillance Epidemiology and End Results program, artificial sweeteners have been studied as a risk factor for bladder cancer, but the associations (if they exist) are weak.3
There are some theories that nonnutritive sweeteners may affect the body’s ability to regulate energy intake and lead to higher calorie consumption and affect appetite and weight gain. However, there is limited evidence to support this. Some individuals do not like the bitter or metallic aftertaste of artificial sweeteners, or they are more sensitive to the gastrointestinal effects of certain sweeteners such as sugar alcohols. In that case, they may prefer using nutritive sweetener options. Other people may be more prone to dental caries, and since any fermentable carbohydrate can promote tooth decay, they may benefit from choosing nonnutritive sweetener options.
As the research on the highly debated topic continues, the choice whether to use a nonnutritive sweetener option is yours based on your dietary goals, habits, and health status. There is no conclusive evidence that nonnutritive sweeteners are more or less beneficial than traditional added sugars if looking at it from an independent view with no other factors at play. A recent review published in the journal of Nutrition concluded that although nonnutritive sweeteners can be a useful aid for certain indications, only minimal amounts of both sugar and nonnutritive sweeteners should be consumed for optimal health.4 It appears that our longstanding rule of moderation wins again.
So next time you’re stuck choosing between your options, consider your goals, preferences, and facts. And remember that there’s a lot more science behind the options than what the media may tell you.
©Adrienne Hatch, MS, RD, LD/N
- Academy of Nutrition and Dietetics. Position of the academy of nutrition and dietetics: Use of nutritive and nonnutritive sweeteners. Journal of the Academy of Nutrition and Dietetics 2012; 112: 739-758.
- U.S. Food and Drug Administration. Generally recognized as safe (GRAS). Available at: http://www.fda.gov/Food/IngredientsPackagingLabeling/GRAS/. Accessed July 21, 2013.
- National Cancer Institute Surveillance Epidemiology and End Results Program. Urinary bladder, racial/ethnic patterns of cancer in US, 1988-1992. Available at: http://www. seer.cancer.gov/publications/ethnicity/bladder.pdf – 2008-08-29. Accessed July 21, 2013.
- Shankar P, Ahuja S, Sriram K. Non-nutritive sweeteners: Review and update. Nutrition 2013 July 8 [online only]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23845273.