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Medicine LibreTexts

4.7: Sugar Substitutes

  • Page ID
    21120
  • Learning Objectives

    • Discuss the pros and cons of consuming foods and beverages that contain sugar substitutes.

    Due to the potential health consequences of consuming too many added sugars, sugar substitutes have replaced them in many foods and beverages. Sugar substitutes may be from natural sources or artificially made. Those that are artificially made are called artificial sweeteners and must be approved by the FDA for use in foods and beverages. The artificial sweeteners approved by the FDA are saccharin, aspartame, acesulfame potassium, neotame, and sucralose. Stevia is an example of a naturally derived sugar substitute. It comes from a plant commonly known as sugarleaf and does not require FDA approval. Sugar alcohols, such as xylitol, sorbitol, erythritol, and mannitol, are carbohydrates that occur naturally in some fruits and vegetables. However, they are industrially synthesized with yeast and other microbes for use as food additives.

    The FDA requires that foods disclose the fact that they contain sugar alcohols, but does not require scientific testing of it. (Though many of them have undergone studies anyway.) In comparison to sucrose, artificial sweeteners are significantly sweeter (in fact, by several hundred times), but sugar alcohols are more often less sweet than sucrose. Artificial sweeteners and Stevia are not digested or absorbed in significant amounts and therefore are not a significant source of calories in the diet. Sugar alcohols are somewhat digested and absorbed and, on average, contribute about half of the calories as sucrose (4 kilocalories/gram). These attributes make sugar substitutes attractive for many people—especially those who want to lose weight and/or better manage their blood-glucose levels.

    Benefits

    Consuming foods and beverages containing sugar substitutes may benefit health by reducing the consumption of simple sugars, which are higher in calories, cause tooth decay, and are potentially linked to chronic disease. Artificial sweeteners are non-nutrients though not all are completely calorie-free. However, because they are so intense in sweetness they are added in very small amounts to foods and beverages. Artificial sweeteners and sugar alcohols are not “fermentable sugars” and therefore they do not cause tooth decay. Chewing gum with artificial sweeteners is the only proven way that artificial sweeteners promote oral health. The American Dental Association (ADA) allows manufacturers of chewing gum to label packages with an ADA seal if they have convincing scientific evidence demonstrating their product either reduces plaque acids, cavities, or gum disease, or promotes tooth remineralization. There is limited scientific evidence that consuming products with artificial sweeteners decreases weight or improves blood glucose control1.

    Health Concerns

    The most common side effect of consuming products containing sugar substitutes is gastrointestinal upset, a result of their incomplete digestion. Since the introduction of sugar substitutes to the food and beverage markets, the public has expressed concern about their safety. The health concerns of sugar substitutes originally stemmed from scientific studies, which were misinterpreted by both scientists and the public.

    In the early 1970s, scientific studies were published that demonstrated that high doses of saccharin caused bladder tumors in rats. This information fueled the still-ongoing debate of the health consequences of all artificial sweeteners. In actuality, the results from the early studies were completely irrelevant to humans. The large doses (2.5 percent of diet) of saccharin caused a pellet to form in the rat’s bladder. That pellet chronically irritated the bladder wall, eventually resulting in tumor development. Since this study, scientific investigation in rats, monkeys, and humans have not found any relationship between saccharine consumption and bladder cancer. In 2000, saccharin was removed from the US National Toxicology Program’s list of potential carcinogens2.

    Aspartame is made by joining two amino acids (aspartic acid and phenylalanine) together. When digested, it is broken down to aspartic acid, phenylalanine, and methanol. People who have the rare genetic disorder phenylketonuria (PKU) have to avoid products containing aspartame. Individuals who have PKU do not have a functional enzyme that converts phenylalanine to the amino acid tyrosine. This causes a build-up of phenylalanine and its metabolic products in the body. If PKU is not treated, the build-up of phenylalanine causes progressive brain damage and seizures. The FDA requires products that contain aspartame to state on the product label, “Phenylketonurics: Contains Phenylalanine.”

    Regulation

    Prior to introducing any new artificial sweetener into foods, the artificial sweetener is rigorously tested and must be legally approved by the FDA. The FDA regulates artificial sweeteners along with other food additives, which number in the thousands. The FDA is responsible for determining whether a food additive presents “a reasonable certainty of no harm” to consumers when used as proposed. As part of the approval process, the FDA establishes Acceptable Daily Intake (ADI) levels for artificial sweeteners. The ADIs are the maximum amount in milligrams per kilogram of body weight considered safe to consume daily (mg/kg bw/day) and incorporates a large safety factor. For more details on sugar substitutes including each sweetener's ADI please refer to Table \(\PageIndex{1}\).

    Table \(\PageIndex{1}\): Sugar Substitutes
    Sweeteners with Trade Name Calories Source/Origin Consumer Recommendations Controversial Issues

    Aspartame

    • NutraSweet
    • Equal

    4 kcal/g

    Composed of two amino acids (phenylalanine + aspartic acid) + methanol.

    200 times sweeter than sucrose.

    ADI: 50 mg/kg body weight = 16 12 oz. diet soft drinks for adults.

    *Cannot be used in products requiring cooking.

    People with PKU should not consume aspartame.

    Children have potential to reach ADI if consuming many beverages, desserts, frozen desserts, and gums containing aspartame routinely.

    Saccharin

    • Sweet ‘n’ Low

    0 kcal/g

    Discovered in 1878. The basic substance is benzoic sulfinide.

    300 times sweeter than sucrose.

    ADI: 5 mg/kg body weight.

    *Can be used in cooking.

    1970s, high doses of saccharin associated with bladder cancer in laboratory animals. In 1977, FDA proposed banning saccharin from use in food

    • protest launched by consumer & interest groups
    • warning label listed on products about saccharin and cancer risk in animals until 2001 when studies concluded that it did not cause cancer in humans

    Acesulfame K

    • Sunnette
    • Sweet One

    0 kcal/g

    Discovered in 1967. Composed of an organic salt, potassium (K). Structure is very similar to saccharin’s.

    It passes through the body unchanged which means it does not provide energy.

    200 times sweeter than sucrose.

    ADI: 15 mg/kg body weight.

    Body cannot digest it.

    *Can be used in cooking.

     

    Sucralose

    • Splenda

    3.31 kcal/g

    First discovered in 1976. Approved for use in 1998 in the United States and in 1991 in Canada.

    Derived from sucrose in which three of its hydroxyl (OH) groups are replaced by chlorine (Cl−).

    600 times sweeter than sucrose.

    ADI: 5 mg/kg body weight.

    *Can be used in cooking.

     

    Stevioside

    • Stevia
    • Sweet Leaf

    N/A

    Derived from stevia plant found in South America. Stevia rebaudianan leaves.

    Classified as GRAS.

    Considered to be a dietary supplement and approved not as an additive, but as a dietary supplement.

    Used sparingly, stevia may do little harm, but FDA could not approve extensive use of this sweetener due to concerns regarding its effect on reproduction, cancer development, and energy metabolism.

    Sugar Alcohols

    • Sorbitol
    • Xylitol
    • Mannitol

    2–4 kcal/g

    Sugar alcohols.

    Sorbitol is derived from glucose.

    Less likely to cause tooth decay than sucrose.

    May cause diarrhea and gastrointestinal distress if consumed in large amounts.

    Key Takeaways

    • Due to the health consequences of consuming too many added sugars, sugar substitutes are widely used in many foods and beverages.
    • Consuming foods and beverages containing sugar substitutes may benefit health by reducing the consumption of simple sugars, which are higher in calories, cause tooth decay, and are potentially linked to chronic disease. However, the most common side effect of consuming products containing sugar substitutes is gastrointestinal upset, a result of their incomplete digestion.
    • Prior to introducing any new artificial sweetener into foods it is rigorously tested and must be legally approved by the FDA.

    References

    1. Toews I, Lohner S, Küllenberg de Gaudry D, Sommer H, Meerpohl JJ. Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ. 2019;364:k4718. doi:10.1136/bmj.k4718.
    2. National Cancer Institute. cancer.gov. Artificial Sweeteners and Cancer. http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners. Accessed June 15, 2020.