Making a sweet decision

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Sugar substitutes are anything that can be used in place of regular sugar, whether they’re calorie-free or not. You can find information criticizing or praising anything that makes food or beverages sweet, so knowing the facts can help you make the right choices for your health.

Artificial sweeteners

Artificial sweeteners are manufactured, synthetic products. Some are derived from substances that occur in nature—sucralose, for instance, comes from sugar. Others are simply combinations of chemical compounds. Most, if not all of them, are many times sweeter than table sugar (sucrose).

These types of sweeteners are popular primarily because they are very low in calories (or essentially calorie-free in some cases), so many people use them as a weight-loss aid. Some studies have found that the use of artificial sweeteners is associated with weight gain, although researchers don’t know why.

The good and the bad

For the most part, people with diabetes can safely use artificial sweeteners in place of sugar to enhance flavor. And unlike sugar, artificial sweeteners do not promote tooth decay.

Artificial sweeteners have been closely scrutinized and studied for years, mainly because of studies in the 1970s that revealed an association between the use of saccharin and bladder cancer in laboratory rats. After that, products containing saccharin had to carry a warning label. Later research proved that the cancer fears were unfounded, and the warning labels were removed.

Aspartame has been reported to cause headaches, seizures, Alzheimer’s disease, lupus, cancer, and many other health problems. According to the National Cancer Institute, however, there is no sound scientific evidence to support any of those claims.

That’s not to say you should go overboard with the use of any type of artificial sweetener. “Most of them haven’t been around long enough for us to know anything about the effects of long-term use,” says David Tuuk, M.D., medical director at Wind Crest, an Erickson Living community in Highlands Ranch, Colo.

The FDA considers artificial sweeteners food additives and regulates them as such. An acceptable daily intake (ADI) has been determined for most of them, which is the maximum amount you should consume each day over the course of your lifetime. These ADIs are about 100 times less than the smallest amount that might cause a health problem. “Keeping track of exactly how much sweetener you use is hard to do—I just tell patients to take it easy and be sensible about it,” Tuuk says.

Sugar alcohols and novel sweeteners

Sugar alcohols are carbohydrates that occur naturally in some vegetables and fruits. Unlike artificial sweeteners, they are not typically sweeter than sugar. They do, however, have fewer calories than table sugar and that’s why they are often used in sugar-free candy and other products. Sugar alcohols have been in use for a long time and are considered safe, but they can have a laxative effect if too much is ingested.

Novel sweeteners are made from carbohydrate sources and are relatively new on the market. Many are touted as superior to artificial sweeteners because they are natural. But a “natural” claim can mean practically anything. Stevia is an example. “Even though one stevia extract may be 100% stevia, another stevia product may have maltodrextrin and other preservatives,” says Amanda Gilley, R.D., nutrition counseling team leader for the LifeBridge Health and Fitness Nutrition Counseling Program in Pikesville, Md.

Stevia preparations have essentially no calories, but other novel sweeteners such as tagatose still have some calories from carbohydrates.

Sugar and natural sweeteners

“Despite what some people think, we do not need sugar to live,” Gilley says. “Researchers have been finding out more about its addictive effects and the consequences for health.”

According to the American Heart Association, men should ingest no more than nine teaspoons (or 45 grams) daily and women should ingest no more than six teaspoons of sugar each day—about 30 grams. “This can be a challenge,” Gilley says. “Some form of sweetener is added to the majority of prepackaged and processed foods. Even something that seems healthful such as yogurt can have up to 30 grams of sugar per serving.

“If you want to avoid refined sugar, use natural sweeteners such as fruit juices, agave nectar, coconut sugar, honey, maple syrup, dates, or fruit puree,” Gilley suggests. “You can even use spices like cinnamon and ground fenugreek to add a complex sweet taste. Extracts like pure vanilla or almond are also a great option.”

Indulging once in a while, however, is rarely harmful. “You need to be realistic and practice mindful eating,” Gilley says. “Being too strict may mean you are setting yourself up to fail.”


Common sugar substitutes

Artificial sweeteners: acesulfame potassium (Sweet One, Sunnet); aspartame (Equal, NutraSweet); saccharin (Sweet’N Low, Sugar Twin); sucralose (Splenda).

Sugar alcohols: mannitol, sorbitol, xylitol.

Novel sweeteners: stevia extracts (Truvia, Pure Via); tagatose (Naturlose).

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