All about the subs for sugar

We all know that Americans consume too much added sugar. But we also consume an increasingly large amount of artificial (non-nutritive) sweeteners including sucralose (Splenda), aspartame (Nutrasweet) and saccharine.

Is it any better to replace sugar with these sugar substitutes? The controversy over sugar substitutes rages with some experts claiming that calorie-free sweeteners increase our sweet-tooth and cause weight gain and may even be unsafe. Today, we will take a look at the pros and cons of common sugar substitutes.

The potential benefit of sugar substitutes is that they can help reduce caloric intake. Two recent studies found that by replacing one sweetened drink per day with water or sugar-free soda, weight gain was reduced in Dutch children and in U.S. teens.

Because American teens consume three times more soda than what was provided in the trial, the impact on weight could be even greater if children and teens replaced all of their sweetened beverages with non-caloric alternatives.

However, in the real world, people feel entitled to more food when they consume diet foods, which can negate any potential caloric reduction (imagine enjoying extra slices of pizza with generous meat toppings along with a pitcher of guilt-free diet soda).

Thus, sugar substitutes, when we know we are consuming them, rarely result in caloric reduction or weight loss. In fact, some experts believe that they increase our appetite and can even cause weight gain.

The research is mixed: Recent randomized human trials show that sugar substitutes can help prevent weight gain while other studies (but no randomized human studies but rather mostly epidemiological and rodent studies) report sugar substitutes result in weight gain.

Another reason some people choose to use sugar substitutes is if they are counting carbohydrates.

The American Heart Association and the American Diabetes Association both support the use of sugar substitutes in place of added sugars as this may facilitate a lower caloric intake and weight loss. Diabetics often need to closely monitor their carbohydrate intake at each meal and snack in order to control blood sugar. If they replace sugar with sugar substitutes, they can consume additional food without exceeding their carb quota, and thus could choose to eat an apple or some other source of carbohydrates in addition to the soda or sweet rather than having to choose between them.

What’s safe?

But for those of us without the need to closely monitor our carbohydrates, should we consume real sugar or sugar substitutes? The sugar substitutes available in the U.S. have been tested and found to be safe when consumed within the acceptable daily intake levels established by the Food and Drug Administration.

However, some individuals may be consuming much larger amounts than estimated. In addition, some critics contend that some of the sugar substitutes are unsafe even at lower levels.

Many diet foods and beverages use a mixture of sugar substitutes rather than a single artificial sweetener. Thus, if you are concerned about the safety of any of the sweeteners, you have to examine the ingredient list frequently and closely, as the ingredients may change over time.

For example, diet Pepsi just recently switched its artificial sweetener from aspartame to a mixture of aspartame and acesulfame K.

Sucralose (Splenda) is made from sugar (sucrose) by replacing three hydroxyl (OH) groups with chlorine molecules. According to rodent studies, sucralose appears to reduce the good bacteria in the gastrointestinal tract and thus is suspected by some scientists of causing inflammatory bowel disease. Whether this is the case in humans is unproven. However, moderation in terms of consumption of sucralose — and all sugar substitutes — is likely the best policy.

Aspartame (NutraSweet, Equal, Natra Taste) consumption remains the most controversial of the sugar substitutes as it has been linked to cancer in several rodent studies. Higher risk of lymphoma and leukemia has been demonstrated in rats fed very high doses of aspartame.

However, the methodology of these studies has been widely criticized. A five-year human study found no safety issues but may not have been long enough to identify increased cancer risk.

Aspartame is not heat-stable and therefore should not be used in baking. Foods and drinks with aspartame tend to lose sweetness during storage.

Anecdotal reports claim that aspartame may cause headaches and neurological problems, but these are unsubstantiated. Others worry about metabolism of the methyl ester that binds the amino acids in aspartame into methanol, a poison, and whether that might cause disease. However, fruit juices contain far more methanol than aspartame.

Saccharine (Sweet‘N’Low, SugarTwin, DiabetiSweet) is considered to be safe for humans. Early rodent studies found an increased risk of bladder cancer, especially in male rats given high doses. But we now know that this was due to a mechanism that does not occur in humans due to species differences and therefore warning labels are no longer required on saccharine.

Some doctors recommend avoiding saccharine during pregnancy, as it does get transported to the fetus, but no ill effects have been reported.

Asulfame K, or Ace-K (Sunnet, Sweet One) has had somewhat limited animal testing to substantiate its safety. Some scientists remain concerned that it may be mildly carcinogenic. Asulfame K is added along with aspartame to many diet products in the marketplace. Asulfame K is heat-stable and maintains its sweetness over time.

Neotame is made from aspartame, but with minor chemical changes and unlike aspartame, is safe for people with phenylketonuria. It is rarely used but may be found in foods and beverages but not in packets. Neotame appears to be safe and is more stable than aspartame.

Tagatose (Naturlose) is a low-carbohydrate sweetener similar to fructose that occurs naturally in mushrooms and can be manufactured from lactose in dairy products. It is poorly absorbed and can cause diarrhea in excess.

Stevia extracts (Rebaudioside A or Reb-A) (SweetLeaf , Sun Crystals, Good & Sweet, Pure Via, Truvia) are derived from the leaves of Stevia rebaudiana, a South American shrub.

It is available in liquid, packets and bulk. Stevia may interact with certain blood pressure or diabetic drugs, causing hypoglycemia or hypotension.

Women who are pregnant or nursing should probably avoid using stevia as there is little information on its safety during pregnancy.

The takeaway

The bottom line is sugar substitutes may benefit diabetics or dieters by reducing added sugar intake but only if you do not overcompensate by consuming additional foods.

Ultimately, what matters is the diet as a whole, not any one food or beverage. Despite some lingering questions on artificial sweeteners, they are likely safe when used in moderation. But so is good old-fashioned white table sugar when consumed in moderation.

Sharon Himmelstein, Ph.D., M.N.S., R.D., teaches nutrition at Central New Mexico Community College. She can be reached at sharonh@cnm.edu.>