The Skinny on Sweeteners
by Sonia Ahuja

    Two-thirds of adults in the United States are overweight or obese (according to the Centers for Disease Control and Prevention). Being overweight or obese increases the likelihood of developing heart disease, diabetes and some cancers. So it’s no surprise that the market for artificial sweeteners is booming.
    One teaspoon of table sugar (sucrose) weighs 4.2 grams and contains 4 calories per gram, or about 16 calories per teaspoon. Many people prefer to use artificial sweeteners in order to dodge the sugar calories, but with some health concerns surrounding artificial sweeteners, why do so many people continue to use them? Some studies of these sweeteners indicate varying and controversial degrees of dietary safety. The Food and Drug Administration has approved these for use as general-purpose sweetening agents. Since many people still prefer artificial sweeteners over table sugar, let’s take a look at the different sweeteners on the market and the health concerns associated with them.

Artificial Sweeteners

Acesulfame potassium (Acesulfame-K)
    Marketed as Sunette® or Sweet One®, it is found in many sugar-free products, including some chewing gums and diet drinks. It is 200 times sweeter than an equal amount of table sugar. It should not be used by anyone on a potassium-limited diet or anyone with allergies related to potassium-bearing products. 

Aspartame
    Sold as Equal® and Nutra-Sweet® and 200 times sweeter than table sugar, the sweetener has been around since 1965, but because of conflicting studies regarding health concerns (especially for people with migraines), it wasn’t approved by the FDA for public use until 1981. According to studies, a component of aspartame converts to formaldehyde at temperatures above 90 degrees. Also, aspartame can be harmful to anyone with phenylketonuria (PKU), a rare hereditary disease. Although aspartame is a nutritive sweetener, the slight amounts of additives such as dextrose and maltodextrin has an inconsequential effect on blood sugar.

Cyclamates
    Known to be the “baddie” in the U.S., though it’s still sold in Canada as Sugar Twin®. It was marketed as Sucaryl and is 30 to 50 times as sweet as sugar. It was first discovered in 1937 and banned in the U.S. in 1969 when studies linked it to increased cancer risk. The FDA has never lifted the ban in the U.S. despite its being petitioned for at least once this decade for re-approval.

Neotame
    Made by NutraSweet®, this product is between 7,000 and 13,000 times sweeter than table sugar. It is extremely potent and is moderately heat stable. Neotame is rapidly metabolized, completely eliminated, and does not accumulate in the body. Food manufacturers are attracted to this sweetener as its use greatly lowers the cost of production compared to using sugar or high fructose corn syrup because of the lower quantities needed to achieve the same sweet flavor. It is chemically similar to aspartame, but is used at lower levels and is more stable.

Saccharine
    Primarily marketed in pink packets known as Sweet ’N Low®, saccharineis 300 to 500 times sweeter than table sugar. Since 1957, the contents of these miniscule packages have been consumed by Americans as if it poses no health concern whatsoever. Despite studies linking it to bladder cancer in rats, the FDA has allowed saccharine to remain on the market because no apparent problems arose in humans. However, a little warning label is printed on the package. It is considered a non-nutritive sweetener since it cannot be absorbed by the body.

Sucralose
    First marketed in Canada in 1991 and approved by the FDA in 1998, sucralose is the sweetening ingredient in Splenda®. Sucralose is made from sugar and is approximately 600 times sweeter than table sugar. Its chemistry does not change when heated or baked, making it a great sugar substitute for cooks. It can be used in products requiring freezing. Because it is so sweet, it’s mixed with other fibers to bring its volume up to something more or less equal to sugar.  It’s considered a non-nutritive sweetener because it contains molecules too large for absorption into the body.

Other Alternatives to Table Sugar

Fructose
    Though a natural fruit sugar, it has a glycemic index of only 22, about one-third of table sugar. Because it causes a lower elevation in blood sugar and a lower requirement for insulin than an equivalent amount of table sugar, some consider it a good substitute for table sugar. 

Stevia
    An herb native to South America, stevia has been used as a sweetener for centuries in some countries. Though used widely in Brazil and Japan, the U.S. banned it in the early 1990s, allowing it to be sold only as a supplement.  Because stevia has a negligible effect on blood glucose, it has become an attractive alternative to sugar and artificial sweeteners.

    Although more than 60 percent of Americans consume artificial sweeteners, there is controversy over health issues associated with their use.  Many well-known doctors and authors of health books recommend that people steer clear of artificial sweeteners because research does not back up the safety of these products. And some studies have suggested that using artificial sweeteners does not necessarily lead to weight loss.
    A study by the University of Texas Health Science Center at San Antonio in 2005 concluded that weight gain and obesity were associated with increased use of diet soda. However, the study, reviewed by Charlotte Grayson Mathis, M.D., in a WebMD Medical News 2005 article, “Drink More Diet Soda, Gain More Weight? Overweight Risk Soars 41 Percent with Each Daily Can of Diet Soda Soft Drink,” did not establish whether increased weight leads to increased consumption of diet drinks or whether consumption of diet drinks could have an effect on weight gain.
    Another study — this time conducted by two psychologists, Susan Swithers, Ph.D., and Terry Davidson, Ph.D., at Purdue University — also suggests that using artificial sweeteners could make people put on weight. Experiments on lab rats indicated those eating food sweetened with artificial sweeteners consumed more calories than their counterparts whose food was sweetened with natural sugar (“A Role for Sweet Taste: Calorie Predictive Relations in Energy Regulation by Rats,” Behavioral Neuroscience, Feb. 2008.)
    But Marilyn Tanner-Blasiar, a registered dietician at Washington University School of Medicine, says people shouldn’t conclude that artificial sweeteners are not good for consumption based on studies such as the one conducted by Purdue, because the subjects were animals, not people.
    “A lot more research is needed before we can say that artificial sweeteners are not safe to use,” she said. Tanner-Blasiar, who advises many families with overweight children and adolescents, says using both artificial sweeteners and natural sugars (white, brown, maple syrup, honey) are fine, as long as they are used in moderation.
    “I think it’s okay to use artificial sweeteners as long as you use them within reasonable limits,” Tanner-Blasiar explained. “People should watch how it affects them.”
    Also, she said, despite some of the many studies indicating that artificial sweeteners many not help subjects lose weight, or may even cause them to gain weight, it doesn’t prove that artificial sweeteners shouldn’t be consumed by those watching their waistline and their blood sugar levels.
    “We don’t know what other variables may have been involved in these studies. There could be other reasons why the subjects gained weight,” said Tanner-Blasiar.
    But some medical doctors do not recommend using artificial sweeteners for several reasons. Andrew Weil, M.D., director of the Program in Integrative Medicine at the University of Arizona, believes that just because the Purdue investigators suggested that sweeteners changed the way a rodent’s body regulates food intake, it does not mean that sweeteners have the same effect on humans. But Weil says we should steer clear of artificial sweeteners because there is some circumstantial evidence that artificial sweeteners are implicated in the obesity epidemic. “The number of Americans consuming artificially sweetened food and drink rose from 70 million in 1987 to 160 million in 2000. During that same period, obesity rates rose dramatically,”  he wrote on his web site,  www.drweil.com.
    The position of the American Dietetic Association (ADA) on the use of artificial sweeteners is that it’s okay to use them as long as they are consumed in a diet guided by current federal nutrition recommendations, as well as individual health goals. The ADA said, “There is little direct clinical evidence showing negative long-term effects of these sweeteners on overall health,” in a 2004 article published in the Journal of the American Dietetic Association.

High Fructose Corn Syrup vs. Sugar

    High fructose corn syrup is derived from a group of corn syrups and preservatives. It’s made by converting glucose in cornstarch into fructose, another form of sugar, and then mixing it with pure corn syrup, which is 100 percent glucose. The end product is a combination of fructose and glucose. HFCS is a popular ingredient in many sodas, fruit-flavored drinks and other processed foods because it extends the shelf life of processed foods and is cheaper than sugar.
    Concern about HFCS has grown in recent years. The FDA has gone back and forth as to whether or not it can be considered “natural.” And there have been numerous reports about it containing mercury. Whether or not it is safe to consume is up in the air.
    According to an October 2008 article by Laura Dolson, a health and food writer featured on About.com., most of the carbohydrates people eat are made up of chains of glucose. When glucose enters the bloodstream, the body releases insulin to help regulate it. But fructose is processed in the liver, and when too much fructose enters the liver, the liver can’t process it all fast enough for the body to use as sugar.
    “Instead, it starts making fats from the fructose and sends them off into the bloodstream as triglycerides” she wrote.  According to Dolson, HFCS is considered to be bad for our health because: high blood triglycerides are a risk factor for heart disease; fructose ends up circumventing the normal appetite signaling system, so appetite-regulating hormones aren’t triggered, causing some people to eat more. And there is growing evidence that excess fructose consumption may facilitate insulin resistance (pre-diabetes) and eventually Type-2 Diabetes. However, she wrote, some of this effect may be from chemicals in soda that react with the HFCS.
    In light of the controversy and because of the growing trend toward eating healthier, it seems that by eliminating HFCS from our diets we not only eliminate the possible health hazard, but we just might discover that “natural foods” (the kind we cook at home from raw ingredients) are more satisfying as well as perhaps easier on our wallets. But just to be fair, both HFCS and sugar have their pitfalls. Sugar, now thought to be a better choice than HFCS, is not to be considered healthful just because it’s “natural.”
    According to an article by Shannon Clark and reported by Fox News in April, 2007, fructose is better than foods that contain pure glucose. Fructose goes to the liver after consumption and has a nominal impact on insulin and blood sugar levels.
    “This makes it a better option if you want to avoid the highs and lows typically associated with foods that contain pure glucose. Sugar, while composed of partial fructose, will still send the glucose straight to the blood, causing insulin levels to increase while you experience a quick burst of energy.” These bursts of energy are often followed by a drop, which often makes people feel hungry and crave more sugary foods. So a person may end up consuming more calories and gaining weight.