Artificial Sweeteners: Are They Better or Worse Than the Real Thing?

Controversy about artificial sweeteners has been going on for decades, with claims against them covering a wide spectrum of health problems from headaches to cancer.
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It seems like every day there's a new artificial sweetener on the market that's made from sugar, or acts like sugar when you use it in a recipe, or is "natural" like sugar, except that it's not. Given the American love affair with sugar, not to mention the staggering statistics on obesity as well as disorders like diabetes, many people are turning to artificial sweeteners, so their safety is a big issue. But before we look at artificial sweeteners, let's look at the real thing.

The Real Stuff: Regular Sugar

Regular sugar (sucrose) is a carbohydrate found naturally in fruits and vegetables, and occurs as a result of photosynthesis, which for those who were texting during biology class, is the same process by which plants transform the sun's energy into food. Carbohydrates are the body's main energy source, and are converted into glucose for fuel.

Even though regular sugar only has 16 calories per teaspoon, it's a very concentrated source of carbohydrate that quickly adds up to a lot of calories. It's low in nutrition, and is generally in foods that are high in fat and usually very tasty, so it's easy to eat too much or too many of them. The American Heart Association (AHA) is reporting that Americans are eating about 22 teaspoons of sugar (or 350 calories) every day from the "added sugar" in processed foods and beverages. And, not incidental to the development of artificial sweeteners, it's expensive. In fact, artificial sweeteners were originally developed in the 1950s as a cost cutter, and only became a weight- and cavity-reducing commodity afterward.

The ABC's of "ols," "ils" and "ates"

Sugar is sugar, but once you get into artificial sweeteners, things aren't so simple. You hear terms like sugar alcohols, sugar substitutes, "natural" sugar substitutes, artificial sweeteners, nutritive sweeteners and nonnutritive sweeteners. What's the difference?

Consider a sugar substitute as a generic for anything that replaces real sugar (sucrose). A nutritive sweetener has some calories (less than sugar, though); a nonnutritive sweetener offers no calories. "Natural" sweeteners like honey, maple sugar, molasses and agave nectar, although assumed to be "healthy" alternatives, are often just as processed or refined as regular sugar. Natural sugars can have the same calories as sugar, and are nutritionally similar in that the body processes them into glucose and fructose. So if you're trying to lose weight by cutting calories, or you're a diabetic concerned about blood sugar, then natural sugar substitutes might not be the answer.

Sugar alcohols (also called polyols) are carbohydrates whose chemical structure is like sugar and also like alcohol, but aren't either one. So no wonder everyone's confused. They have calories, but at levels lower than regular sugar (an average of 2 kcal/gram vs. sugar at 4 kcal/gram). Sugar alcohols aren't for use at home like natural sweeteners; they're a manufacturing ingredient for processed foods that add sweetness, bulk and texture. The Food and Drug Administration (FDA) regulates the use of sugar alcohols, which include names you're used to seeing on the packages of frozen desserts, baked goods, fruit spreads, chewing gum and even toothpaste -- sorbitol, mannitol, xylitol, erythritol, isomalt, lactitol, hydrogenated starch, hydrolysates (HSH) and malitol are all sugar alcohols.

Some sugar alcohols occur naturally in plants (sorbitol comes from corn syrup), but most are manufactured from sugars and starches. On the pro side -- in addition to fewer calories, they don't promote tooth decay and they don't get completely absorbed by the body so the conversion to glucose is slower, requiring little or no insulin to be metabolized. For diabetics, this lower blood sugar impact is very important. The downside of incomplete absorption is that - and here's the alcohol part - sugar alcohols can ferment in the intestines and cause bloating, gas or diarrhea if you ingest more than 50 grams, but is possible in as little as 10 grams.

But, most important to remember is that sugar alcohols have fewer calories, not zero calories. Foods with sugar alcohols can get a sugar-free designation because they replace full-calorie sugar sweeteners, but again, they are not calorie-free. Eating too much or too many "sugar-free" foods can be comparable to eating sugared foods. So, check back with my blog post on label reading because a sugar-free designation can be very misleading.

Artificial Sweeteners: The Big Five

Artificial sweeteners are nonnutritive (calorie-free) synthetic sugar substitutes, although they can be manufactured from natural substances like herbs or, in the case of how Splenda describes itself, from real sugar. The only FDA-approved artificial sweeteners that qualify to be on the GRAS list (Generally Recognized as Safe) are the following five products: saccharin (Sweet 'N Low, Sweet and Low, Sweet Twin, Nectra Sweet); aspartame (Nutrasweet, Equal, Sugar Twin); sucralose (Splenda); acesulfame, also known as acesulfame potassium (Sunett, Sweet One); and neotame (chemically most like aspartame, and much sweeter than sucrose).

Controversy about artificial sweeteners has been going on for decades, with claims against them covering a wide spectrum of health problems from headaches to cancer.

A condition coined as "aspartame disease" claims that aspartame causes symptoms like headache, dizziness, vomiting, diarrhea and anxiety attacks. The FDA has reviewed all of the data on this topic and has concluded that the research doesn't support these claims. Additional concerns about aspartame being associated with the development of lymphoma, leukemia and brain cancer were also examined by the National Cancer Institute (NCI), which found no evidence to support the concerns. The FDA also reviewed more than 100 safety studies on each sweetener, finding no evidence of cancer risk or any other health threat.

The most influential studies on an artificial sweetener were in the 1970s, which linked saccharin to bladder cancer in laboratory rats. After the study, the FDA called for saccharin products to carry a warning label much like the ones on cigarettes. However, when later studies refuted the original research, the warning was removed, and now artificial sweeteners are generally considered safe, but recommend in limited quantities. The FDA has established Acceptable Daily Intake (ADIs) rates for each artificial sweetener.

Even though the FDA has determined that the concerns about cancer are unsupported, artificial sweeteners, sugar alcohols and even natural sweeteners can cause intestinal discomfort and can also add up to as many calories as eating regular sugar. For every sweetener upside there's also a downside. My prescription is to eat sensibly and keep the intake of artificial sweeteners to the established ADI levels.

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