What role does sugar play in our diet?

There are few people who can resist the taste of sweet foods. We are born with a preference for sweets, and it remains with us throughout our lives. However, too much of a good thing can lead to problems such as dental cavities, obesity and the health complications related to being overweight and obese (for example, type 2 diabetes, hypertension, hypertriglyceridemia, and heart disease). Problems such as osteoporosis and vitamin and mineral deficiencies can also occur when high-sugar foods replace more nutritionally balanced foods. The solution for being able to satisfy our sweet tooth, without the disadvantages of sugar, was the invention of nonnutritive sweeteners. But is it really possible to have your cake and eat it too?

For many years, numerous fad diets have claimed that sugar is to blame for the obesity epidemic in our country. While our intake of sugar has gone up, weight gain will occur with the consumption of extra calories from any food, not just sugar. The Dietary Guidelines state that we are to choose beverages and foods to moderate our intake of sugars. In the United States, the number-one source of added sugars is non-diet soft drinks (soda or pop). Other major sources are sweets and candies, cakes and cookies, and fruit drinks and fruit aides. Limiting your intake of these foods and avoiding foods with high amounts of added sugars is the best way to control your intake. A food is likely to be high in sugar if any one of these names appears first or second in the ingredients list on your food label:

Brown sugar Corn sweetener Corn syrup Dextrose Fructose Fruit-juice concentrate Glucose High-fructose corn syrup (HFCS) Honey Invert sugar Lactose Malt syrup Maltose Molasses Raw sugar Sucrose Syrup

Definition

Artificial sweeteners, which are also called sugar substitutes, alternative sweeteners, or non-sugar sweeteners, are substances used to replace sugar in foods and beverages. They can be divided into two large groups: nutritive sweeteners, which add some energy value (calories) to food; and nonnutritive sweeteners, which are also called high-intensity sweeteners because they are used in very small quantities as well as adding no energy value to food. Nutritive sweeteners include the natural sugars—sucrose (table sugar; a compound of glucose and fructose), fructose (found in fruit as well as table sugar), and galactose (milk sugar)—as well as the polyols, which are a group of carbohydrate compounds that are not sugars but provide about half the calories of the natural sugars.The polyols are sometimes called sugar replacers,

Artificial sweeteners

Sweetener Times sweeter than sugar

Calories

Brand name(s)

aspartame 200 4 kcal/g Nutrasweet and Equalsaccharin 200–700 0 Sweet’N Low, Twin,and

Necta Sweetacesulfame-K (potassium)

200 0 Sunett and Sweet One

neotame 7,000–13,000 0 Neotamesucralose 600 0 Splenda

SOURCE: Food and Drug Administration, U.S. Department of Health and Human Services.

sugar-free sweeteners, sugar alcohols, or novel sugars. Polyols occur naturally in plants but can also be produced commercially. They include such compounds as sorbitol, mannitol, xylitol, and hydrogenated starch hydrolysates.

Nonnutritive sweeteners are synthetic compounds that range between 160 and 13,000 times as sweet as sucrose, which is the standard for the measurement of sweetness. There are five nonnutritive sweeteners approved by the Food and Drug Administration (FDA) for use in the United States as of 2007. They are saccharin, aspartame, acesulfame potassium (or acesulfame-K), sucralose, and neotame. There are other nonnutritive sweeteners that have been approved for use elsewhere in the world by the Scientific Committee on Food (SCF) of the European Commission, the Joint Expert Committee of Food Additions (JECFA) of the United Nations Food and Agricultural Organization, and the World Health Organization (WHO) but have not been approved by the FDA. These substances are alitame, cyclamate, neohesperidine dihydrochalcone, stevia, and thaumatin. All of these will be described in further detail below.

The FDA uses two categories to classify both nutritive and nonnutritive sweeteners for regulatory purposes. Some are classified as food additives, which is a term that was introduced by the Federal Food, Drug, and Cosmetic (FD&C) Act of 1938. This legislation was passed by Congress in response to a mass poisoning tragedy that took the lives of over a hundred people in 1937. A company in Tennessee that manufactured an antibacterial drug known as sulfanilamide, which had been used safely in powdered or pill form to treat childhood infections, dissolved the sulfanilamide in diethylene glycol—related to the active ingredient in automobile antifreeze—in order to market it as a liquid medicine. Diethylene glycol is highly toxic to human beings and household pets, causing painful death from kidney failure. In 1937 there was no requirement for medications to be tested for toxicity before being placed on the market. The FD&C Act of 1938 thus included a legal definition of a food additive “any substance, the intended use of which results directly or indirectly, in its becoming a component or otherwise affecting the characteristics of food”

The FDA asks the following questions in evaluating a proposed new sweetener as a food additive:

How is the sweetener made? What are its properties when it is added to foods or beverages? How much of the sweetener will be digested or otherwise absorbed by the body? Are certain groups of people likely to be more susceptible than others to the additive? Does the sweetener have any known toxic effects, including hereditary disorders or

cancer?

Other sweeteners are classified as generally regarded as safe or GRAS, and are not defined for legal purposes as food additives. The GRAS category was created in 1958 when the FD&C Act was modified by the passage of the Food Additives Amendment. A sweetener, whether nutritive or nonnutritive, can be given GRAS status on the basis of “experience based on common use in food” or a scientific consensus represented by published studies. Sorbitol and a few other polyols have GRAS status along with the natural sugars. Most artificial sweeteners, however, are considered food additives by the FDA.

Purpose

Artificial sweeteners are used in food products for several reasons: to lower the calorie content of soda pop and other sweet treats as part of weight reduction and weight maintenance diets; to assist patients with diabetes in controlling blood sugar levels more effectively; and to lower the risk of tooth decay. They are also added as excipients (inert substances used to make drugs easier to take in tablet or liquid form) to some prescription medications to disguise unpleasant tastes because they do not react with the active drug ingredients as natural sugars sometimes do. Sorbitol and mannitol are commonly added to toothpaste, mouthwash, breath mints, cough drops, cough syrups, sugarless gum, over-the-counter liquid antacids, and similar personal oral care products to add bulk to the product’s texture as well as minimize the risk of tooth decay.

In addition to adding a sweet flavor, artificial sweeteners are also used in the manufacture of baked goods, beverages, syrups, and other food products to improve texture, add bulk, retard spoilage, or as part of a fermentation process. The polyols in particular are used to retard spoilage because they do not support the growth of mold or bacteria to the same extent as natural sugars.

Description

Nutritive sweeteners

Natural sugars. Natural sugars, which are also called primary sweeteners, include sucrose, a compound of glucose and fructose commonly used in crystalline form as table sugar; and fructose, which is a simple sugar found in sucrose and fruit, and is added to foods and beverages in combination with sucrose as high-fructose corn syrup or HFCS. These sweeteners provide about 4 calories per gram. Fructose is sweeter than sucrose; thus smaller amounts of it can be used to sweeten foods and drinks, which allows for some reduction in calories.

Polyols . Polyols provide between 1.6 calories per gram (mannitol) and 3 calories per gram (hydrogenated starch hydrolysates). They are absorbed very slowly and incompletely during digestion, which is why they can be beneficial to patients with diabetes who want to avoid sudden or sharp increases in blood sugar levels.

Nonnutritive sweeteners approved by the FDA

There are five nonnutritive sweeteners approved by the FDA for use in the United States as of 2007:

Acesulfame potassium (acesulfame-K). Acesulfame potassium is a high-intensity nonnutritive sweetener that is about 200 times sweeter than sucrose; 95% of it is excreted from the body unchanged. It was discovered by a German company, Hoechst AG, in 1967. It was first approved by the FDA for use in nonalcoholic beverages in 1998 and for general use in 2003. In addition to its usefulness in reducing the calorie content of foods, in diabetic diets, and in not promoting tooth decay, acesulfame potassium remains stable at the high temperatures used for cooking and baking, has a long shelf life, does not leave any bitter aftertaste, and combines well with other sweeteners. It is sold under the brand names ACK, Sunett, Sweet & Safe, and Sweet One.

Aspartame. Aspartame, which is also about 200 times sweeter than sugar, was discovered in 1965 by a researcher at Searle Laboratories working on antiulcer medications. It is unusual among nonnutritive sweeteners in that it is completely broken down during digestion into its basic components—the amino acids aspartic acid and phenylalanine plus a small amount of methanol. Aspartame was approved by the FDA for tabletop use in 1981 and for use in carbonated beverages in 1983. As of the early 2000s, the United States uses 75% of the aspartame produced in the world, 70% of this amount consumed in diet beverages. Aspartame is the nonnutritive sweetener that has received the greatest amount of negative attention in the mass media because of a rumor that it caused Gulf War syndrome (GWS) in veterans of the Persian Gulf conflict of 1991, and because of a study done in Europe in 2005 that linked aspartame to two types of cancer (leukemia and lymphomas) in female laboratory rats. In response to the 2005 European study, the National Cancer Institute (NCI) conducted a study of half a million people in the United States in 2006 and found no connection between cancer rates and aspartame consumption. The details of this study can be found in a fact sheet available on the NCI website. Another study conducted by the National Toxicology Program (NTP) of the National Institute of Environmental Health Sciences (NIEHS) of aspartame as a possible carcinogen found no evidence that the sweetener causes cancer in humans. Aspartame is sold under the brand names NutraSweet, Equal, and Sugar Twin (blue box).

Saccharin. Saccharin is the oldest nonnutritive sweetener, having been discovered in 1879 by a chemist working at Johns Hopkins University. It is about 200 to 700 times as sweet as sugar. It was used extensively during World Wars I and II, when sugar was rationed in the United States as well as in Europe. It is still the least expensive high-intensity sweetener used around the world—about 65 million pounds per year in the late 1990s. Saccharin passes through the body essentially unchanged. It was so widely used in the United States that it was considered a GRAS substance when the Food Additives Amendment was passed in 1958, but it lost that status when studies performed on laboratory rats in the 1970s indicated that it might cause bladder cancer. At that point Congress mandated that all foods containing saccharin must carry a warning label that they might be hazardous to health. Later studies indicated that the bladder tumors in rats are caused by a mechanism that does not operate in humans, and that there is no evidence that saccharin is unsafe for humans. In 2000 the NTP took saccharin off its list of carcinogens and the saccharin-warning label was removed from food. Details of the controversy over saccharin and cancer can be found on the NCI website. Saccharin is presently sold under the trade names of Sweet ’N Low, Sweet Twin, and Necta Sweet.

Sucralose Sucralose is unusual in that it is the only nonnutritive sweetener made from sugar, but it is about 600 times as sweet as table sugar. Sucralose is manufactured from sugar by substituting three chlorine atoms for three hydroxyl groups in the sugar molecule. Only about 11 % of sucralose is absorbed during digestion; the remainder is excreted unchanged. The FDA approved sucralose in 1998 as a tabletop sweetener and in 1999 as a general-purpose sweetener. The acceptable daily intake (ADI) for sucralose is 5 mg per kilogram of body weight per day. Like acesulfame potassium, sucralose is highly heat-stable and works well in foods that must be baked or cooked. Sucralose is sold under the trade name Splenda for table use.

Nonnutritive sweeteners not approved for use in the United States

Alitame . Alitame is a compound of aspartic acid, D-alanine, and an amide; it is 2000 times sweeter than sugar. In 1986 it was reviewed by the FDA, which found the application to be deficient. As of 2007, alitame is approved for use only in Australia, New Zealand, Mexico, Colombia, and China.

Cyclamate . Cyclamate, which is about 30 times sweeter than sugar, was used as a nonnutritive sweetener in the United States until 1969, when it was shown to cause cancer in laboratory rats when combined with saccharin. Although cyclamate by itself was found by the National Academy of Sciences not to be a carcinogen in 1985 and is approved for use in over 50 countries, it has not been reinstated by the FDA for use in the United States as of 2007.

Neohesperidine dihydrochalcone . Neohesperidine dihydrochalcone is a compound that is about 1500 times sweeter than sugar and adds a slight licorice flavor to foods and beverages. The FDA considers neohesperidone GRAS as a flavoring but not as a sweetener.

Stevia. Stevia is a sweetener derived from a shrub native to South America. The FDA has not received sufficient scientific evidence to indicate that stevia is safe for use as a food additive.

Thaumatin . Thaumatin is an intensely sweet mixture of proteins that also acts as a flavor enhancer. The FDA has given thaumatin GRAS status as a flavor adjunct but has not approved it as a sweetener as of 2007.

Acesulfame K: What is the positive side?

Acesulfame K has been an approved sweetener since 1988, and yet most people are not even aware that this is a nonnutritive sweetener being used in their food and beverages. It is listed in the ingredients on the food label as acesulfame K, acesulfame potassium, Ace-K, or Sunett. It is 200 times sweeter than sucrose (table sugar) and is often used as a flavor-enhancer or to preserve the sweetness of sweet foods. The FDA has set an Acceptable Daily Intake (ADI) of up to 15 mg/kg of body weight/day.

Acesulfame K: What is the negative side?

The problems surrounding acesulfame K are based on the improper testing and lack of long-term studies. Acesulfame K does contain the carcinogen methylene chloride. Long-term exposure to methylene chloride can cause headaches, depression, nausea, mental confusion, liver effects, kidney effects, visual disturbances, and cancer in humans. There has been a great deal of opposition to the use of acesulfame K without further testing, but at this time, the FDA has not required that these tests be done.

Neotame: What is the positive side?

In 2002, the FDA approved a new version of aspartame called Neotame. Neotame is chemically related to aspartame without the phenylalanine dangers for individuals with PKU. It is much sweeter than aspartame with a potency of approximately 7,000 to 13,000 times sweeter than sucrose (table sugar). The FDA has set an Acceptable Daily Intake (ADI) at 18 mg/kg of body weight/day.

Neotame: What is the negative side?

Neotame entered the market much more discreetly than the other nonnutritive sweeteners. While the Web site for neotame claims that there are over 100 scientific studies to support its safety, they are not readily available to the public. Opponents of neotame claim that the studies that have been done do not address the long-term health implications of using this sweetener. Without scientifically sound studies, done by independent labs, the opponents of neotame will continue to refute its use.

Aspartame: What is the positive side?

Aspartame was discovered in 1965 and approved by the FDA in 1981 for dry uses in tabletop sweeteners, chewing gum, cold breakfast cereals, gelatins, and puddings. It was able to be included in carbonated beverages in 1983. In 1996, the FDA approved its use as a "general purpose sweetener," and it can now be found in more than 6,000 foods.

Aspartame is also known as Nutrasweet, Equal, and Sugar Twin. It does provide calories, but because it is 160 to 220 times sweeter than sucrose, very small amounts are needed for sweetening so the caloric intake is negligible. The FDA has set the Acceptable Daily Intake (ADI) for aspartame at 50 mg/kg of body weight. To determine your ADI, divide your weight in pounds by 2.2 and then multiply it by 50. For example, if you weighed 200 lbs., your weight in kg would be 91 (200 divided by 2.2) and your ADI for aspartame would be 4550 mg (50 x 91). The amount of aspartame in some common foods is:

12 oz. diet soda—up to 225 mg of aspartame 8 oz. drink from powder—100 mg of aspartame 8 oz. yogurt—80 mg of aspartame 4 oz. gelatin dessert—80 mg of aspartame ¾ cup of sweetened cereal—32 mg of aspartame 1 packet of Equal—22 mg of aspartame 1 tablet of Equal—19 mg of aspartame

Aspartame has been approved for use in over 100 countries. An editorial in the British Medical Journal states that the "evidence does not support links between aspartame and cancer, hair loss, depression, dementia, behavioral disturbances, or any of the other conditions appearing in Web sites. Agencies such as the Food Standards Agency, European Food Standards Authority, and the Food and Drug Administration have a duty to monitor relations between foodstuffs and health and to commission research when reasonable doubt emerges. Aspartame's safety was convincing to the European Scientific Committee on Food in 1988, but proving negatives is difficult, and it is even harder to persuade vocal sectors of the public whose opinions are fuelled more by anecdote than by evidence. The Food Standards Agency takes public concerns very seriously and thus pressed the European Scientific Committee on Food to conduct a further review, encompassing over 500 reports in 2002. It concluded from biochemical, clinical, and behavioral research that the acceptable daily intake of 40 mg/kg/day of aspartame remained entirely safe—except for people with phenylketonuria

Aspartame: What is the negative side?

Aspartame is one of the most controversial nonnutritive sweeteners. There are numerous Web sites, books, and articles stating various reasons why aspartame should not be consumed. Some site studies to support their theories while others base their claims on industry-related conspiracies. The following is a summary of the opposing views on aspartame:

Industry conspiracies: Conflicts of interest in the studies performed on aspartame and the way in which its approval was obtained is an ongoing controversy. Dr. Robert Walton surveyed the studies of aspartame in the peer-reviewed medical literature. He states that "of the 166 studies felt to have relevance for questions of human safety, 74 had Nutrasweet industry related funding and 92 were independently funded. One hundred percent of the industry-funded research attested to aspartame's safety, whereas 92% of the independently funded research identified a problem." Other reports of federal employees working for the companies responsible for the testing and distribution of aspartame are cited on all of the sites and books opposing the use of aspartame.

Aspartame disease: H.J. Roberts, MD, coined the term "aspartame disease" in a book filled with over 1,000 pages of information about the negative health consequences of ingesting aspartame. Dr. Roberts reports that by 1998, aspartame products were the cause of 80% of complaints to the FDA about food additives. Some of these symptoms include headache, dizziness, change in mood, vomiting or nausea, abdominal pain and cramps, change in vision, diarrhea, seizures/convulsions, memory loss, and fatigue. Along with these symptoms, links to aspartame are made for fibromyalgia symptoms, spasms, shooting pains, numbness in your legs, cramps, tinnitus, joint pain, unexplainable depression, anxiety attacks, slurred speech, blurred vision, multiple sclerosis, systemic lupus, and various cancers. While the FDA has assured us that the research does not show any adverse health complications from aspartame, there has been some evidence to suggest that some of these symptoms can be related to aspartame:

Headaches: One study confirmed that individuals with self-reported headaches after the ingestion of aspartame were in deed susceptible to headaches due to aspartame. Three randomized double-blind, placebo-controlled studies with more than 200 adult migraine sufferers showed that headaches were more frequent and more severe in the aspartame-treated group.

Depression: In a study of the effect of aspartame on 40 patients with depression, the study was cut short due to the severity of reactions within the first 13 patients tested. The outcome showed that individuals with mood disorders were particularly sensitive to aspartame and recommended that it be avoided by them.

Cancer: In an initial study, 12 rats out of 320 developed malignant brain tumors after receiving aspartame in an FDA trial. There have been other studies to both support and contradict this finding. A recent study, conducted by Italian and French researchers indicates there is no association between low-calorie sweeteners and cancer. The researchers evaluated a variety of studies between the years of 1991 and 2004. These studies assessed the relationship between low-calorie sweeteners and many cancers, including oral and pharynx, esophagus, colon, rectum, larynx, breast, ovary, prostate and renal cell carcinomas. The researchers examined the eating habits of more than 7,000 men and women in their middle ages (mainly 55 years and over). Based on the data evaluated, there was no evidence that saccharin or other sweeteners (mainly aspartame) increase the risk of cancer at several common sites in humans. The debate continues while more research is conducted.

Increased hunger: A study done with 14 dieters comparing the effects of aspartame-sweetened and sucrose-sweetened soft drinks on food intake and appetite ratings found that substituting diet drinks for sucrose-sweetened ones did not reduce total calorie intake and may even have resulted in a higher intake on subsequent days. In another study of 42 males given aspartame in diet lemonade versus sucrose-sweetened lemonade, there was no increase in hunger ratings or food intake with the diet group. Weight loss results from consuming fewer calories than your body needs. When you replace a caloric beverage with a noncaloric beverage, you will be saving calories and could lose weight if it is enough calories to put you in a negative balance. For aspartame to increase weight, there would have to be something else going on. There is not enough research to determine if something does exist so the jury is still out on this one.

Saccharin: What is the positive side?

Saccharin has been around for over 100 years and claims to be the best researched sweetener. Saccharin is also known as Sweet and Low, Sweet Twin, Sweet'N Low, and Necta Sweet. It does not contain any calories, does not raise blood sugar levels and is 200 to 700 times sweeter than sucrose (table sugar).

Out of the five FDA approved nonnutritive sweeteners, saccharin is often chosen to be the safest one. The FDA's guidelines on the use of saccharin for beverages are not to exceed 12 mg/fluid ounce, and in processed food, the amount is not to exceed 30 mg per serving. The Acceptable Daily Intake (ADI) for saccharin is 5 mg/kg of body weight. To determine your ADI, divide your weight in pounds by 2.2 and then multiply it by 5. For example, if you weighed 180 lbs., your weight in kg would be 82 (180 divided by 2.2) and your ADI for saccharin would be 410 mg (5 x 82). Saccharin is used in tabletop sweeteners, baked goods, jams, chewing gum, canned fruit, candy, dessert toppings, and salad dressings. It also is useful in cosmetic products, vitamins, and pharmaceuticals.

There was a great deal of controversy surrounding the safety of saccharin back in the '70s. In 1977, research showed bladder tumors in male rats with the ingestion of saccharin. The FDA proposed a ban on saccharin based on the Delaney Clause of the Federal Food, Drug, and Cosmetic Act, enacted in 1958. This clause prohibits the addition to the human food supply of any chemical that had caused cancer in humans or animals. Congress intervened after public opposition to the ban and allowed saccharin to remain in the food supply as long as the label carried this warning: "Use of this product may be hazardous to your health. This product contains saccharin which has been determined to cause cancer in laboratory animals." Further research was required to confirm the tumor findings.

Since then, more than 30 human studies have been completed and found that the results found in rats did not translate to humans, making saccharin safe for human consumption. The original study published in 1977 has since been criticized for the very high dosages, that were hundreds of times higher than "normal" ingestion for humans, that were given to the rats. In 2000, the National Toxicology Program (NTP) of the National Institutes of Health concluded that saccharin should be removed from the list of potential carcinogens. The warning has now been removed from saccharin-containing products

Saccharin: What is the negative side?

The safety concerns of consuming products with saccharin remain even with the removal of the warning. According to a report written in 1997 written by the Center for the Science in Public Interest (CSPI) in response to the National Toxicology Program (NTP) removing saccharin from the list of potential carcinogens: "It would be highly imprudent for the NTP to delist saccharin. Doing so would give the public a false sense of security, remove any incentive for further testing, and result in greater exposure to this probable carcinogen in tens of millions of people, including children (indeed, fetuses). If saccharin is even a weak carcinogen, this unnecessary additive would pose an intolerable risk to the public. Thus, we urge the NTP on the basis of currently available data to conclude that saccharin is "reasonably anticipated to be a human carcinogen," because there is "sufficient" evidence of carcinogenicity in animals (multiple sites in rats and mice) and "limited" or "sufficient" evidence of carcinogenicity in humans (bladder cancer) and not to delist saccharin, at least until a great deal of further research is conducted."

Another claim made against saccharin is the possibility of allergic reactions. The reaction would be in response to it belonging to a class of compounds known as sulfonamides which can cause allergic reactions in individuals who cannot tolerate sulfa drugs. Reactions can include headaches, breathing difficulties, skin eruptions, and diarrhea. It's also believed that the saccharin found in some infant formulas and can cause irritability and muscle dysfunction. For these reasons, many people still believe that the use of saccharin should be limited in infants, children, and pregnant women. Without research to support these claims, the FDA has not imposed any limitations.

Sucralose: What is the positive side?

Sucralose is the newest nonnutritive sweetener on the market. It is most well known for its claim to be made from sugar. It is as sold as Splenda and is 600 times sweeter than sucrose (table sugar). It provides essentially no calories and is not fully absorbed. In 1998, it was approved for limited use, and in 1999, it was given approval for use as a general-purpose sweetener. It is currently found in over 4,500 products, including foods that are cooked or baked.

The FDA reviewed studies in human beings and animals and determined that sucralose did not pose carcinogenic, reproductive, or neurological risk to human beings. The Acceptable Daily Intake (ADI) for sucralose was set at 5 mg/kg of body weight/day. To determine your ADI, divide your weight in pound by 2.2 and then multiply it by 50. For example, if you weighted 200 lbs., your weight in kg would be 91 (200 divided by 2.2) and your ADI for sucralose would be 455 mg (91 x 5).

Sucralose: What is the negative side?

A lot of the controversy surrounding sucralose stems from the fact that it was discovered while trying to create a new insecticide. The claim that it is made from sugar is a misconception about the final product. According to the book Sweet Deception, 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, making it unlike anything found in nature. The Splenda Web site even states that "although sucralose has a structure like sugar and a sugar-like taste, it is not natural." The product Splenda is also not actually calorie-free. Sucralose does have calories, but because it is 600 times sweeter than sugar, very small amounts are needed to achieve the desired sweetness. The first two ingredients in Splenda are dextrose and maltodextrin, which are used to increase bulk and are carbohydrates that are not free of calories. One cup of Splenda contains 96 calories and 32 grams of carbohydrates, which is substantial for people with diabetes but unnoticed due to the label claiming that it's a no calorie sweetener.

The name sucralose is another misleading factor. The suffix -ose is used to name sugars, not additives. Sucralose sounds very close to sucrose, table sugar, and can be confusing for consumers. A more accurate name for the structure of sucralose was purposed. The name would have been trichlorogalactosucrose, but the FDA did not believe that it was necessary to use this so sucralose was allowed.

The presence of chlorine is thought to be the most dangerous component of sucralose. Chlorine is considered a carcinogen and has been used in poisonous gas, disinfectants, pesticides, and plastics. The digestion and absorption of sucralose is not clear due to a lack of long-term studies on humans. The majority of studies were done on animals for short lengths of time. The alleged symptoms associated with sucralose are gastrointestinal problems (bloating, gas, diarrhea, nausea), skin irritations (rash, hives, redness, itching, swelling), wheezing, cough, runny nose, chest pains, palpitations, anxiety, anger, moods swings, depression, and itchy eyes. The only way to be sure of the safety of sucralose is to have long-term studies on humans done.

Precautions

Artificial sweeteners are generally regarded as safe when used appropriately. The official position of the American Dietetic Association is that nutritive and nonnutritive sweeteners are safe as long as one’s diet follows the current federation recommendations for nutrition.

Some specific artificial sweeteners must be used cautiously by certain groups of people:

Polyols : Some polyols—most commonly mannitol and sorbitol—have a laxative effect in some people if they are consumed in large amounts (more than 50 g/day of sorbitol or 20 g/day of mannitol). Persons with diabetes may wish to limit their consumption of products containing polyols or increase their use gradually until they see how their bodies react to these sweeteners.

Aspartame : Because aspartame is broken down in the body to the amino acid phenylalanine, foods or beverages containing aspartame should not be used by persons with phenylketonuria (PKU), a rare inherited disease that causes phenylalanine to accumulate in the body. The FDA requires all products containing aspartame sold in the United States to be labeled with the following warning: “Phenylketonurics: Contains Phenylalanine.” Although the breakdown products of neotame also include phenylalanine, the amount is so small that it does not affect people with PKU.

Interactions

There are no known interactions with prescription drugs caused by the use of nutritive or nonnutritive sweeteners. As was noted above, some nonnutritive sweeteners are considered useful excipients for medications precisely because they are chemically inert.

Parental concerns

There have been concerns expressed about the use of artificial sweeteners by children because children consume more sweeteners, both nutritive and nonnutritive, per pound of body weight on a daily basis than adults. The use of fruit juice and other sweet beverages by children has greatly increased since the 1980s; however, studies indicate that even children who drink large amounts of diet soda and other beverages usually remain well below the ADI levels for aspartame and other nonnutritive sweeteners. The chief risk to children’s digestive health is fructose, which is found in such popular children’s drinks as apple juice. Fructose is incompletely digested by children below the age of 18 months and may cause diarrhea in older children. Children diagnosed with nonspecific diarrhea maybenefit from being given smaller amounts of fruit juice to drink.

During the early 1990s, some researchers identified a possible connection between high levels of aspartame consumption and attention-deficit hyperactivity disorder (ADHD) in children. Two studies published in 1994 in Pediatrics and the New England Journal of Medicine respectively, however, found no connection between aspartame and ADHD, even when the children were given 10 times the normal daily amount of aspartame. Aspartame and other nonnutritive sweeteners, however, may have an additive effect on nerve cell development when they are combined with food colorings. This possibility was suggested by a 2006 study of laboratory mice in the United Kingdom, but the implications for humans are far from clear.

High intake of sweeteners added to food is of greatest concern during adolescence. As people age, they generally lower their intake of calories from added sugars. Fewer than 10% of adults over age 50 derive more than 25% of their daily calories from sugars, which is the maximal intake value established by the IOM. Nearly a third of adolescent females exceed this level, however, with almost a third of the extra sugar intake coming from carbonated beverages sweetened with high-fructose corn syrup. Although the rise in obesity in children and adolescents is a complex problem that cannot be attributed to a single factor, preliminary studies suggest that nonnutritive sweeteners may be useful in reducing adolescents’ consumption of drinks sweetened with HFCS.

Is it safe to blend artificial sweeteners?

Many people have a preference for a specific sweetener without realizing that numerous products now contain combinations of nutritive and/or nonnutritive sweeteners. The three key advantages for these sweetener blends are:

Taste: The major limitation to the use of saccharin is its bitter aftertaste. Combining saccharin with other sweeteners helps alleviate this problem.

Cost: Using combinations of nonnutritive sweeteners can result in a sweeter taste with less sweeteners, saving companies money.

Flexibility: The ability to combine nonnutritive and nutritive sweeteners can offer people low-calorie choices, along with the no calorie ones.

The blending of sweeteners is presenting a whole new set of problems. Research has not been done, and is not required to be done, on combinations of sweeteners. There is no way to know what happens to the chemicals once they are combined in the products or how they are processed in our bodies in that combination. This is an unnecessary risk that is being taken. The proper procedure would be to require thorough, credible studies on the safety of these combinations before allowing them into our food and medicine. While it would take time and money to conduct these tests, it's clearly a case where it's better to be safe than sorry.

Can you get something for nothing?

Our innate desire for sweetness may be interfering with our ability to judge right from wrong. There is nothing in our diet that we can consume without a cost. The cost can be excess calories, fat, protein, or carbohydrates. It's even possible to consume excess water. We see calorie- and sugar-free sweeteners and believe that there isn't a cost, but maybe there is. Unfortunately, the research that has been done is failing us. With two sides battling over the safety of these sweeteners, it's imperative that we get the answers from the "gold standard" of research studies: independent, randomized, double-blinded, placebo-controlled studies. It's our responsibility to be aware of what we are consuming and to protect our safety.

Acceptable Daily Intakes have been set for each nonnutritive sweetener for a reason; we can't ingest unlimited quantities of these additives. If you believe that you are experiencing any of the symptoms from the consumption of a nutritive or nonnutritive sweetener, then eliminating them from your diet is the best way to determine if it's so. Sweeteners are not essential nutrients in our diet, so they exist to nurture our sweet tooth, not our bodies.