Substituting for Sugar

What You Need To Know About Artificial Sweeteners

The average American takes in 23 teaspoons of added sugar per day. Concerns about the impact of added sugars on health led to a smackdown on sugar from healthcare professionals and the media. Many of us look to sugar substitutes to provide the sweet taste we desire, in particular, sugar substitutes with little to no calories or energy.  

The U.S. Food and Drug Administration (FDA) refers to these low to no calorie sweeteners as non-nutritive sweeteners. The term artificial sweetener may be more familiar. The food industry often uses one or more artificial sweeteners in manufactured foods and beverages. Additionally, many of us add them directly to foods and beverages to improve the taste. 
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It is clear there is widespread use of artificial sweeteners but what do we know about the long-term effects to our bodies? This blog will describe artificial sweeteners and address commonly asked questions. If you were looking for information on natural sugar (or want to read both), check out our earlier blog The Lowdown on Added Sugar.

What is an artificial sweetener?
An artificial sweetener is one type of sugar substitute. Sugar substitutes are added to foods and beverages to provide sweetness. Some artificial sweeteners are marketed as “natural” even though they are highly processed or refined. This is because artificial sweeteners may be made from natural products. For example, sucralose is made from sugar sucrose. The structure of sucrose is changed to make something new that is no longer a sugar. The new sucralose molecule (sold as Splenda) is not broken down in our digestive tract so we do not get calories (energy) from it.  

Common artificial sweetener brand names include: Equal® (aspartame and acesulfame-potassium), NutraSweet® Neotame (neotame), Sweet N’ Low® (saccharin), and Splenda® (sucralose).

What is a sugar alcohol?
Another type of sugar substitute is a sugar alcohol (polyol). Sugar alcohols do not contain alcohol, as the name suggests. They are not sugars either. They are carbohydrates (one of the main nutrients our body needs) that can be found naturally in fruits and vegetables but some are manufactured. Our digestive tract does not break them down all the way. This means sugar alcohols provide calories and raise blood sugar but not as much as regular sugar.

​Sugar alcohols are not sweeter than sugar like artificial sweeteners. In fact, many are less sweet than sugar. They are often combined with artificial sweeteners in products to create the desired taste such as the stevia-based sweetener Truvia® (Erythritol). Sugar alcohols you may find in an ingredient list include: xylitol, mannitol, sorbitol, erythritol. When it makes sense, we share information about sugar alcohols but the focus will be artificial sweeteners.

Are artificial sweeteners like sugar?
Not entirely. When you eat or drink sugar it will raise your blood sugar. It tastes sweet, has no chemical aftertaste, provides calories (energy), adds bulk or structure to baked goods, and browns when cooked. Also, even though sugar browns, it still tastes sweet when heated to high temperatures.

Artificial sweeteners may taste as sweet as (or much sweeter than) sugar but they may vary in these other qualities:

• Blood sugar - Artificial sweeteners are not carbohydrates so they do not break down into glucose and do not raise blood sugar like sucrose and other sugars do.  
• After taste - Many artificial sweeteners have a chemical after taste.
• Heat stability - Some may be used in cooking and baking but not all of them.  For example, aspartame does not hold up to high heat and loses its sweetness.
• Structure in baked goods - Many artificial sweeteners do not add bulk to baked goods. Other ingredients (like sugar alcohols) may be added to brand name sweeteners so they work more like sugar. Check the label. You may need to adjust your recipe. 
• Calories (energy) - Most of the approved artificial sweeteners do not provide calories (energy). The exception is aspartame. It contains calories but since it is 200 times sweeter than sugar, you are not likely taking in enough of it to get much energy from it.

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Why do we use artificial sweeteners?
The main reason Americans choose artificial sweeteners is to lower our intake of added sugar and calories that come with it.

The American Heart Association (AHA) recommends cutting sugar to no more than 6 teaspoons per day for women and children and 9 teaspoons per day for men, and the Dietary Guidelines for Americans 2015-2020 recommend lowering added sugars to less than 10% of calories for the day. This has actually been in versions of the guidelines since 1980 but we continue to go well beyond the recommendations. 

The average American takes in 91 g of added sugar per day (over 16.5% of calories), which is equal to 23 teaspoons of table sugar. It may be worth another look at the methods we use to change habits. Restricting foods high in added sugars may backfire when low sugar diets may increase sugar’s appeal. At Let’s Move! STL, we believe that all foods fit!
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You do not need to cut out sugar completely to improve health, but large amounts of any one food or nutrient are not usually helpful. Research studies show an association between higher intakes of added sugar in the diet and the presence of certain diseases, like heart disease and diabetes. There aren’t clinical trials to show added sugar causes the diseases, but that has not prevented the harsh verdict that health professionals and the public have dealt out to sugar. Given the concerns about added sugars in the diet, the AHA and American Diabetes Association (ADA) suggest artificial sweeteners may be a way to meet the goal to lower added sugars. However, researchers at Columbia University recommend only short-term use, as a transition to less sugar, and caution against long-term use.

Are artificial sweeteners safe?
If by safe we mean “not toxic”, then, yes. All ingredients added to foods in the U.S. must be safe for us to eat. The FDA regulates food additives to ensure they are safe before they are added to foods and beverages.

The FDA gave the green light to use these artificial sweeteners as food additives: acesulfame-potassium, aspartame, advantame, neotame, saccharin, and sucralose.  
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Polyols are approved as well. Steviol glycosides (highly purified extracts from Stevia leaves) and Luo Han Guo fruit extracts (also known as monk fruit) are regulated differently and research was limited so we do not cover these sweeteners in this post.

There are numerous studies into the safety of acesulfame-potassium, aspartame, advantame, neotame, saccharin, and sucralose.  

Acesulfame-potassium - find it in frozen desserts, candies, beverages, and baked goods
Acesulfame-potassium (acesulfame-K or aceK) was approved in 1983 for use in foods and beverages and in 2003 as a general use sweetener (except meat and poultry).  There are over 90 studies to support its safety.

Advantame - 20,000 times sweeter than sugar
To find out if this sweetener was safe, the FDA reviewed 37 animal and human studies to look at toxicity to systems (immune, nervous, reproductive, and developmental).  They also reviewed studies that looked at whether this sweetener caused tumors in laboratory animals (carcinogenicity studies), studies that looked at how the sweetener was absorbed, broken down, and removed from the body (pharmacokinetic studies).  Then, Advaname was approved in 2014 as a general use sweetener and flavor enhancer in foods (except meat and poultry).  

Aspartame - safe for most of us
Aspartame, the nutritive (has calories) sweetener on the list, has the most research behind it.  Over 100 studies support its safety. You may see “cooking with aspartame not recommended” on the label. This doesn’t mean it is not safe for you to eat.  Aspartame doesn’t like heat and loses its sweetness so don’t add it to your baked goods. Aspartame is considered safe with the exception of those with a rare disease called phenylketonuria. Individuals with this disease cannot break down phenylalanine, an amino acid and building block of proteins. Aspartame contains it and those with phenylketonuria need to know about it so you will see a notice that it contains phenylalanine on the label.

Neotame - Brand name Newtame®
Neotame was approved in 2002 for use as a general purpose sweetener and flavor enhancer in foods (except meat and poultry). The results from over 113 animal and human studies were reviewed to look for signs of toxic effects on immune, reproductive, and nervous systems.

Saccharin - a bitter backstory
​Saccharin got a bad rap for a while because of studies in rats. This was in the 1970’s. Since then, there have been over 30 studies in humans and in 2000 it was removed from the list of carcinogens (substances that cause cancer).

How much of these sweeteners can I eat or drink?
Short answer: Check the FDA’s table for the ADI of your favorite sweetener.

Tell me more:  An acceptable daily intake, or ADI, is set for each sweetener.  This is the amount that is safe for you to eat or drink each day for the rest of your life.  The FDA sets the ADI low to be cautious (it is usually 1/100 of the maximum amount with no harmful effects seen in animal experiments).  

The ADI is the amount of sweetener in milligrams (mg) per kilogram (kg) of body weight so there is a little math to figure out how much that is of your preferred sweetener. For those who enjoy Splenda (Sucralose), a 160 pound person (73 kilograms) would need to eat/drink 365 mg sucralose or 26 packets of Splenda to get to the daily limit.  Find the ADI for your favorite sweetener in the FDA’s table.  

There are limited data for intake levels in the U.S. but a 2018 scientific review looking at global use of the major low- and no-calorie sweeteners, like sucralose, are well below the ADI for these sweeteners.  Keep in mind that food companies are adding artificial sweeteners to more and more products, including gum, toothpaste, protein bars, and tea bags.  You may use only a few packets of a sweetener each day and think your intake is low but are unknowingly eating or drinking large amounts. Fortunately, you can spot these sweeteners by name within the ingredient list for the food or beverage.

What happens if I eat or drink artificial sweeteners everyday?
Short answer: Artificial sweeteners are safe well beyond their ADI but we do not have a clear picture of how they affect our health when we use them over a long period of time.  
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Research is underway to find out how artificial sweeteners influence our risk for disease, gut health, hunger/fullness cues, taste preferences, and so much more. We will explore some common concerns and the current evidence in our blog next month… stay tuned! 

Bottom line: Artificial sweeteners are safe well beyond the acceptable daily limits.
For those that enjoy the flavor of an artificial sweetener, using them may make a beverage or food more delicious while you work toward goals to eat and drink less sugar.  

Since we do not have a clear picture of how they affect our health over time, it may be best to use them for only a short time until we have more research.  For more on the research, watch for next month’s blog!