Are they bad for you?

One thing you’ve probably been hearing a lot about is how bad sugar is for you. This is true given the amount of it that most of us taken in daily. As an alternative, there are many artificial sweeteners available to use instead. However, are these actually better for you than sugar? Do they have other risks that you should be concerned about?

Artificial SweetenersWhen you hear the words artificial sweeteners, you probably think of Splenda (sucralose), Sweet’N Low (saccharin), Equal (aspartame), Sweet One (acesulfame K) or Newtame (neotame). All of these have been approved by the Food and Drug Administration (FDA). They’ve also approved one natural low-calorie sweetener, Stevia. Foods, like grains, vegetables, fruits, milk, meat and oils, are considered nutritive because they provide nourishment. Products that are added to foods and don’t provide any nourishment are non-nutritive. Sugar substitutes fall into this category because they’re use instead of regular table sugar (sucrose). They came into being because researchers discovered them by accident. They were working developing chemicals for another purpose, but discovered that it tasted sweet. The use of nonnutritive sweeteners started because the food industry was looking for a way to reduce cost, but has continued as a way for companies to offer products with less calories, which has become in high demand in recent years. In fact, between 1999 and 2004 there were over 6,000 new products containing artificial sweeteners created. Nowadays, they’re everywhere, to the point that most people are consuming them without even knowing it. These foods and beverages are typically marketed as “sugar-free” or “diet.” Artificial sweeteners are also known as intense sweeteners since they’re many times sweeter than sugar. They’re widely used in processed foods, including soft drinks, powdered drink mixes, baked goods, candy, puddings, canned foods, jams, jellies and dairy products. Some can even be used in baking or cooking, but not all of them because, unlike sugar, they don’t provide bulk or volume. One downside that some people notice is that they can leave an aftertaste. It can be very confusing when discussing sugar substitutes. The terminology used is often open to interpretation. Some manufacturers call their sweeteners “natural” because they’re derived from naturally occurring substances, but they’re often actually processed or refined.

The safety of artificial sweeteners isn’t clear cut, which is why there is a split in the medical community regarding their use. There are few people who can resist the taste of sweet foods. So, artificial sweeteners seem like a great way to be able to enjoy sweet things without the extra calories that typically come with it. This could lead to weight loss, which lowers your risk of heart disease and diabetes. For this reason, the American Heart Association (AHA) and American Diabetes Association (ADA) have cautiously approved them in place of sugar in hopes of combating obesity, metabolic syndrome and diabetes. All of these are risk factors for heart disease. While many blame the rise in obesity in our country on sugar, others point out that not only has our intake of sugar increased, but so has our intake of artificial sweeteners. This is why it shouldn’t be surprising that the Multiethnic Study of Atherosclerosis found that daily consumption of diet drinks to be associated with a 36% greater risk for metabolic syndrome and a 67% increased risk for type 2 diabetes. Critics further elaborate that artificial sweeteners can cause a variety of health problems, including cancer. In addition, animal studies suggest that they may be addictive. In one study, rats were exposed to cocaine, then given a choice between cocaine or saccharin, most chose saccharin. Another concern is that companies are blending different sweeteners together. This blending presents a whole new set of problems. Since the products are considered safe on their own, research has not been done, nor is required to be done, on the combinations of sweeteners. This means that there’s no way of knowing what happens to the chemicals after they’re combined or how our bodies process that combination. Critics feel that this is an unnecessary risk.

Artificial sweeteners all under the regulation of the FDA. As a result, we assume that they’re safe, but this really depends on your definition of safe. Sweeteners fall under the Generally Recognized as Safe (GRAS) list or as food additives under the 1958 Food Additives Amendment to the Federal Food, Drug, and Cosmetic Act. The FDA states, “Regardless of whether the use of a substance is a food additive use or is GRAS, there must be evidence that the substance is safe under the conditions of its intended use.” This means that “safe” is based upon a reasonable certainty in the minds of competent scientists that the substance is not harmful under its intended conditions of use. The specific data and information that demonstrate safety depend on the characteristics of the substance, the estimated dietary intake and the population that will consume the substance. For a substance to be considered a GRAS, the available data and information about the use of the substance are known and accepted widely by qualified experts. Another way to receive GRAS status is that the substances have such a lengthy history of common use in food that they’re considered generally safe. For each artificial sweetener, the FDA has established an acceptable daily intake (ADI), which is the maximum amount considered safe to consume each day. These are set at very conservative levels. In order to be approved by the FDA, short-term studies were done to rule out the risk for cancer; however, no longitudinal studies have been completed, so we really don’t know what effect these chemicals will have on individuals over many years. Let’s take a closer look at these alternative sweetener options.

Saccharin is probably the best researched sweetener because it has been around for over 100 years. It’s also known as Sweet and Low, Sweet Twin, Sweet’N Low and Necta Sweet. It doesn’t contain any calories nor raise blood sugar levels. It’s 200 to 700 times sweeter than table sugar (sucrose), but has a bitter aftertaste. The ADI is 5 mg/kg of body weight. Often, it’s used in tabletop sweeteners, baked goods, jams, chewing gum, canned fruit, candy, dessert toppings and salad dressings. Saccharin is considered the safest of the five FDA-approved artificial sweeteners. The two main cons are that it’s a potential carcinogen and it might cause allergic reactions in those who can’t tolerate sulfa drugs because it belongs to a class of compounds known as sulfonamides.

Aspartame, or Nutrasweet, Equal and Sugar Twin, was discovered 1965, but didn’t come to market in 1981 after being tested in over 100 scientific studies. It’s made up of two common amino acids, aspartic acid and phenylalanine. Both of these are building blocks for conventional foods, like protein and natural flavor molecules. Initially, it was used in tabletop sweeteners, chewing gum, cold breakfast cereals, gelatins and puddings. In 1983, in was allowed to be in carbonated beverages. By 1996, the FDA approved its use as a “general purpose sweetener,” which means it can now be found in more than 6,000 foods. It does contain calories, but because it is 160 to 220 times sweeter than sucrose, only very small amounts are needed for sweetening products. This means that the caloric intake is typically negligible. The FDA has set the ADI at 50 mg/kg of body weight. Even though its popular, aspartame is one of the most controversial artificial sweeteners. The big issue is that it doesn’t get metabolized by the human body, which is why it can’t be consumed by people with the metabolism disorder PKU (phenylketonuria). In fact, by 1998, aspartame products were the cause of 80% of complaints the FDA received about food additives. Some symptoms associated with the complaints include headache, dizziness, change in mood, vomiting or nausea, abdominal pain/cramps, change in vision, diarrhea, seizures/convulsions, memory loss and fatigue. It’s also thought to cause depression, cancer and increase hunger.

Sucralose is most well-known for its claim to be made from sugar. It’s 600 times sweeter than sucrose. It was given approval for use as a general-purpose sweetener in 1999 and is currently found in over 4,500 products, including foods that are cooked or baked. The ADI is set at 5 mg/kg of body weight. Its name is misleading because the suffix -ose is used to name sugars, not additives and sucralose is definitely not a sugar despite the marketing hype. Sucralose is made when sugar is treated with trityl chloride, acetic anhydride, hydrogen chlorine, thionyl chloride, and methanol in the presence of dimethylformamide, 4-methylmorpholine, toluene, methyl isobutyl ketone, acetic acid, benzyltriethlyammonium chloride and sodium methoxide. It’s something that could never be found in nature. The presence of chlorine is thought to be the most dangerous component since it’s considered a carcinogen and has been used in poisonous gas, disinfectants, pesticides and plastics. When sucralose is used alone, it provides essentially no calories. However, to make Splenda, it’s combined with dextrose and maltodextrin. These increase bulk and are carbohydrates that do have calories. So, this means that one cup of Splenda has 96 calories and 32 grams of carbohydrates, even though the label claims that it’s a no calorie sweetener. Since it’s so widely used, it can be possible to consume 1 cup or more each day. If you consume an additional 100 calories a day, at the end of year you will have gained 10 additional pounds!

Acesulfame K was approved 1988, but most people are not even aware that they’re consuming it. It’s listed in the ingredients on the food label as acesulfame K, acesulfame potassium, Ace-K or Sunett. It’s often used as a flavor-enhancer or to preserve the sweetness of sweet foods since it’s 200 times sweeter than sucrose. The ADI is set at up to 15 mg/kg of body weight. A concerning factor is that acesulfame K contains the carcinogen methylene chloride and long-term exposure to this can result in headaches, depression, nausea, mental confusion, liver problems, kidney issues, visual disturbances and cancer. Many critics feel that it shouldn’t be used until further testing has been completed, but the FDA has not required that these tests be done so far.

Neotame is a new version of aspartame that was approved in 2002. It’s chemically related to aspartame but doesn’t have phenylalanine dangers. In addition, it’s much sweeter than aspartame with a potency of approximately 7,000 to 13,000 times sweeter than sucrose. It’s being promoted as a flavor enhancer as well. The ADI at 18 mg/kg of body weight. There are some apprehensions about its safety because not only did it enter the market more discreetly than the other artificial sweeteners, but its website claims that there are over 100 scientific studies to support its safety; however, these reports aren’t readily available to the public. The thought is that since it’s chemically similar to aspartame, it might cause the same problems.

Besides the five artificial sweeteners and sucrose, there are other ways to sweeten your foods. Natural sweeteners are sugar substitutes that are often considered healthier options than sugar or other sugar substitutes. They typically go through refining and are sometimes known as “added sugars” since they’re added to foods during processing. The FDA generally recognizes them as safe and they include fruit juices/nectars, honey, molasses and maple syrup. They can be used in a variety way both at home and in processed foods. Even though they may seem healthier than sugar, their vitamin and mineral content isn’t significantly different, so they can still add calories. Another category are novel sweeteners. These are hard to fit into a particular group because of what they’re made from and how they’re made. One example is Stevia. So far, the FDA has approved highly refined stevia preparations as novel sweeteners but hasn’t approved whole-leaf stevia or crude stevia extracts. Another novel sweetener is tagatose because of its chemical structure. It’s a low-carbohydrate sweetener similar to fructose that occurs naturally, but is manufactured from the lactose in dairy products. Monk fruit extract, which is a zero-calorie sweetener that comes from a fruit native to China, is an additional novel sweetener.

Sugar alcohols (polyols) are carbohydrates that occur naturally in certain fruits and vegetables, but can also be manufactured. Contrary to their name, they’re neither sugars nor alcohols. However, their chemical structures resemble both. The sweetness of sugar alcohols varies from 25% to 100% as sweet as sucrose. Since they can be less sweet than sucrose, they aren’t considered intense sweeteners. So, this means that they have calories, but it’s less than the amount in sugar. Sugar provides 4 kcal/gram, whereas sugar alcohols provide an average of 2 kcal/gram. They’re used mainly in processed foods and other products in order to add sweetness, bulk and texture to food. To make foods sweeter, they’re often combined with artificial sweeteners. You might see it on food labels as “sugar alcohol” or list by a specific name, such as sorbitol, mannitol, xylitol, erythritol, isomalt, lactitol, hydrogenated starch hydrolysates (HSH) and maltitol. Since they’re carbohydrates, they can raise blood sugar levels. However, your body doesn’t completely absorb them, so their effect on blood sugar is less than that of other sugars. This is helpful in reducing glycemic response, decreasing dental cavities, and lowering caloric intake. If you eat too much of them, you can have bloating, gas and diarrhea. According to the American Dietetic Association, if you take in greater than 50 grams/day of sorbitol or greater than 20 grams/day of mannitol, you could have diarrhea.

With all this information, you’re probably wondering are artificial sweeteners better for you or not? On the positive side, sugar alternatives can help with dental health. Dental cavities come from when bacteria in your mouth ferment sugar. This creates acid that wears down your teeth, eventually breaking through the enamel and causing a cavity. Since artificial sweeteners don’t contain sugar, they can help prevent tooth decay. When it comes to short-term weight loss, artificial sweeteners can help as long as you don’t give in to the cravings for sweets. For long-term weight loss, the research isn’t available to know the impact. For those trying to control their blood sugar and manage diabetes, artificial sweeteners are a great tool. Since artificial sweeteners don’t cause the crash and ensuing fatigue that high-sugar snacks do, you’ll find that your mood and focus are more consistent. However, despite all of these positive benefits, scientists do know that how the human body and brain respond to artificial sweeteners is very complex. One consideration, is that they might alter the microbiome, or helpful bacteria that lives in your stomach, in ways that could promote glucose intolerance. Another theory is that artificial sweeteners “trick” the brain into craving other sources of simple sugars. The thought is that our bodies sense the sweetness of foods and expect the calories that come with them. When you consume products with artificial sweeteners, they don’t have the calories your body expects, so it continues to crave the calories. In addition, the sweetness without the calories interferes with the normal process of your intricate food reward pathway that drives our desire to eat. This disruption most likely results in an increased craving for sweets. If you give in to these cravings, it increases your overall caloric intake. This would offset any weight loss or health benefits. The AHA and ADA have added this caution to their recommendation supporting the use of artificial sweeteners. There are numerous research studies from the 1970s forward that show artificial sweetener consumption can lead to weight gain. The 1970 Nurses’ Health Study found weight gain over eight years in 31,940 women who consumed saccharin. In the early ’80s, the American Cancer Society looked at 78,694 women and found that after one year 2.7% to 7.1% more regular artificial-sweetener users gained weight compared to nonusers. A different study done in the 1980s (San Antonio Heart Study) followed 3,682 adults over eight years and discovered that those who consumed more artificial sweeteners had higher Body Mass Indexes (BMIs), and the more that they consumed, the higher the BMI was. Other studies tried replacing sugar-sweetened beverages with artificial sweetened ones. They didn’t find any differences in weight loss between the two groups. Since artificial sweeteners are hundreds to thousands of times sweeter than sugar, when we’re repeatedly exposed to them, it trains our brain and researchers think this may result in metabolic changes and thought process rationales, like, “I drank a diet soda so I can have extra cake.” An additional concern is the overstimulation of sugar receptors from frequent use of these hyper-intense sweeteners may limit tolerance for more complex tastes, which means if you routinely use them, you may start to find less intensely sweet foods less appealing and unsweet foods uneatable. Obviously, the word is out that sugar is bad for you, especially for children, this is why many products are geared to reduce the amount of sugar that children consume. Unfortunately, there aren’t any studies on the effects of artificial sweeteners and possible long-term consequences on children. This also applies to pregnant women and their unborn fetus. Even though none of the manufacturers say that either of these two groups shouldn’t consume them, many medical experts say that whenever possible, pregnant women and children to avoid artificial sweeteners.

For individuals, real sugar might actually be the better option, but it’s all in how it’s packaged. Sugar-containing foods that are in their natural form, such as whole fruit, tend to be highly nutritious because they’re nutrient-dense, high in fiber and low in glycemic load. These counterbalance the sugar in them. It’s important to be careful with refined, concentrated sugar because if it’s consumed in large amounts, it’ll rapidly increase blood glucose and insulin levels and increase triglycerides, inflammatory mediators and oxygen radicals. All of this raises the risk for diabetes, cardiovascular disease and other chronic illnesses. This is why, it’s essential to read the ingredients on a food label carefully. They’re listed in order of the amount used in the product. Sometimes manufacturers hide how much sugar there is by using lots of different kinds of sugar. The most common sources are brown sugar, corn sweetener, corn syrup, dextrose, fructose, fruit-juice concentrate, glucose, high-fructose corn syrup (HFCS), honey, invert sugar, lactose, maltose, malt syrup, molasses, raw sugar, sucrose and syrup. The key is making smart food choices based on your current health status and medical conditions, as well as how sugar or artificial sweeteners make you feel.

When it comes to your diet, it’s a balancing act because we need to get the right number of calories from the fats, proteins and carbohydrates we take in. It’s our responsibility to be aware of what we are consuming. It’s vital to limit your intake of foods that have high amounts of added sugars regardless of it being artificial or not. The two most essential things to remember is that whole food is better than processed food and moderation is key!