Sugar is in the spotlight as a key contributor not only to the obesity epidemic but also to chronic diseases, with the US Food and Drug Administration (FDA) for the first time proposing requiring food companies to list added sugars on the Nutrition Facts label. On average, US adults consume 14.6% of their calories from sugars not naturally occurring in food-in everything from sodas to snack foods, from cereals at breakfast to packaged entres at dinner.
At the same time, however, alternatives to sugar are under increased scrutiny. The Internet is abuzz with unsubstantiated fears linking artificial sweeteners to cancer, seizures, behavioral and cognitive problems and more. Questions have also been raised about whether non-caloric sweeteners might somehow nonetheless contribute to weight gain.
Whats a person with a sweet tooth to do? Safety concerns are out there, of course; many people are worried, says Susan B. Roberts, PhD, Tufts professor of nutrition and founder of the online iDiet weight loss program
According to the FDA, Food safety experts generally agree there is no convincing evidence of a cause-and-effect relationship between these sweeteners and negative health effects in humans. The FDA has monitored consumer complaints of possible adverse reactions for more than 15 years.
Roberts adds, Although they seem to be safe, that isnt to say it is good to guzzle them in unlimited amounts. A substitute for sugar without going overboard is probably the best thing for health and weight.
You may also be concerned about whether a non-caloric sweetener is natural. But that term-despite its popularity in food-product labeling-is only loosely defined and has never been shown to connote health benefits. The makers of sucralose, for example, point out that its actually made from natural sugar, but the sugar industry has spent millions in lobbying and lawsuits challenging sucraloses made from sugar claims. Stevia is touted as natural because its made from a plant leaf. But the only form of stevia the FDA has recognized as safe has been highly processed and purified.
Stevia is natural, Roberts notes, but in fact has had much less testing than artificial sweeteners such as aspartame.
FOUR CALORIES VS. ZERO: As for concerns that sugar substitutes might not deliver for weight loss, Roberts says, Although some studies suggest they might be more hunger promoting, given that sugar has so many calories and sugar is increasingly recognized as unhealthy itself, artificial sweeteners are looking like an increasing good bet for people who are working to control their weight.
The 2010 Dietary Guidelines Advisory Committee concluded, A few observational studies reported that individuals who use non-caloric sweeteners are more likely to gain weight or be heavier. This does not mean that non-caloric sweeteners cause weight gain; rather, that they are more likely to be consumed by overweight and obese individuals.
The math is pretty simple: Each gram of table sugar (sucrose), about one-quarter teaspoon, contains four calories. A 12-ounce can of non-diet soda, whether sweetened with sugar or high-fructose corn syrup, contains about eight teaspoons of added caloric sweetener, or 128 calories. Non-nutritive sweeteners, on the other hand, either pass through the body without being absorbed, contain zero calories, or deliver such intense sweetness that the tiny amounts used contribute essentially no calories.
Sugar substitutes generally dont raise blood-sugar levels, either, so they can be good alternatives for people with diabetes or pre-diabetes. (Sugar-free or no sugar added foods, however, are not necessarily carbohydrate-free or lower in carbohydrates.) Sugar substitutes also have the advantage of not contributing to tooth decay.
THE SWEET SCOOP: Heres a look at the most common sugar substitutes, including one newly approved by the FDA, advantame:
Acesulfame potassium (acesulfame-K, ace-K): Sold as Sunett and Sweet One, ace-K is a combination of an organic acid and potassium, discovered in 1967. Ace-K is not broken down by the body and is eliminated unchanged by the kidneys. Heat stable, it can be used for cooking and baking.
Sweetness: 200 times sweeter than sugar.
Regulatory status: First approved by the FDA in 1988; approved as general-purpose sweetener in 2003.
Safety: More than 90 studies support the safety of ace-K in foods and beverages. It has been used extensively for more than 15 years, with no documented health problems in humans. Several long-term animal studies using doses far higher than any person could consume found no association with increased risk of cancer.
Advantame: This new sweetener is a derivative of aspartame and vanillin. Advantame has zero calories and can be used for cooking and baking.
Sweetness: 20,000 times sweeter than sugar.
Regulatory status: Approved by the FDA in 2014. Because advantame is so sweet that it is used in tiny quantities, no PKU warning is required (see aspartame).
Safety: The FDA reviewed 37 scientific animal and human studies before ruling advantame safe.
Aspartame: Sold as Equal and Nutrasweet, aspartame was discovered in 1965. It consists of two amino acids, phenylalanine and aspartic acid. Although aspartame contains four calories per gram, its intense sweetness means it is used in such small amounts that it contributes virtually zero calories to the diet. The body breaks down aspartame into its component amino acids, plus a small amount of methanol, which do not accumulate in the body and are less than amounts from other food sources. Some loss of sweetness (though no safety concerns) may occur in recipes requiring lengthy heating or baking.
Sweetness: 180 times sweeter than sugar.
Regulatory status: First approved by the FDA for use in foods in 1981; approved as a general-purpose sweetener in 1996. People who have a very rare hereditary condition called phenylketonuria (PKU) cant metabolize phenylalanine, and products containing phenylalanine-including aspartame-must carry a warning label.
Safety: Aspartame is one of the most widely studied food ingredients of any type. A 2007 review of the scientific evidence in more than 500 studies and reports over a 25-year span concluded that aspartame does not cause cancer, seizures or adverse effects on cognition or behavior. Although two Italian studies reported a link between aspartame and cancer in rats, the FDA found significant shortcomings in both and stated it would not change its position that aspartame is safe. The European Food Safety Authority reconfirmed aspartames safety in 2013.
Neotame: Similar to aspartame, neotame is a derivative of phenylalanine and aspartic acid. Although neotame is partially absorbed by the body, it is rapidly metabolized and excreted. It can be used in both cooking and baking.
Sweetness: 7,000-13,000 times sweeter than sugar.
Regulatory status: Approved by the FDA in July 2002 as a general-purpose sweetener. Because so little is used, neotame does not require a warning for people with PKU.
Safety: More than 100 studies of neotame have found no negative health effects.
Saccharin: Sold as Sweet N Low, Sweet Twin and Sugar Twin, saccharin is the oldest artificial sweetener, discovered by accident in 1878 during research on coal-tar derivatives. It is not broken down by the body, eliminated without providing any calories. It is heat stable and suitable for cooking and baking.
Sweetness: 300-700 times sweeter than sugar.
Regulatory status: A 1977 study linking high doses of saccharin (the equivalent of hundreds of cans of diet soda daily in humans) to bladder cancer in rats led to a ban in Canada and a proposed ban in the US. But the resulting health-warning label on saccharin was removed in 2000, based on a review by the National Toxicology Program, and the FDA today considers it safe.
Safety: Saccharin has been deemed safe by the American Cancer Society, the American Medical Association and the Academy of Nutrition and Dietetics.
Stevia (Rebaudioside A, Reb-A, rebiana): Sold as A Sweet Leaf, PureVia, Sun Crystals, Steviva and Truvia, stevia-based sweeteners contain highly purified steviol glycosides, derived from the sweetest part of a plant native to South America. Although metabolized, the components do not accumulate in the body. Stevia sweeteners are heat-stable to almost 400 degrees.
Sweetness: 200-300 times sweeter than sugar.
Regulatory status: Until 2008, stevia was permitted in the US only as a dietary supplement. Since then, the FDA has allowed steviol glycosides as general-purpose sweeteners, but is reviewing petitions for other sweeteners derived from the stevia plant.
Safety: The Joint FAO/WHO Expert Committee on Food Additives concluded that steviol glycosides are safe for use in food and beverages.
Sucralose: Sold as Splenda, sucralose is made by substituting three chlorine atoms for hydrogen-oxygen groups in regular sugar. The body does not recognize sucralose as a carbohydrate, so it provides no calories and is excreted unchanged. Heat-stable, sucralose can be used in cooking and baking.
Sweetness: 600 times sweeter than sugar.
Regulatory status: The FDA approved a broad range of uses for sucralose in 1998 and extended approval to all food and beverages in 1999.
Safety: More than 100 scientific studies over a 20-year span have found no adverse effects of sucralose in humans.
Other Options
– Extracts of monk fruit (lo han guo, marketed as Purefruit) have also been approved by the FDA as a general-purpose sweetener; it contains no calories and is 200 times sweeter than sugar.
– Cyclamate, banned in the US in 1970, is still approved for use in 55 countries. It was banned primarily because of a single study linking high doses to bladder tumors in rats. Subsequently, 75 studies have demonstrated its safety and the National Academy of Sciences concluded cyclamate is not carcinogenic. A petition for reapproval is under review by the FDA.
– Sugar alcohols are sweet carbohydrates with fewer calories than sugar, found in many processed foods, candies and toothpaste and mouthwash. They include sorbitol and xylitol.
– Natural sweeteners used as sugar alternatives, including agave nectar, date sugar, honey and maple syrup, all contain roughly as many calories as regular sugar and affect the body similarly. Tufts Susan Roberts adds, Honey is actually higher in glycemic index than table sugar, so for all we know it may be worse for weight regulation.