Sugar Substitutes

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EALTHHINTS Texas Cooperative Extension The Texas A&M University System

Editors: Janet M. Pollard, MPH; Mary K. Bielamowicz, PhD, RD, LD, CFCS; Carol A. Rice, PhD, RN Vol.10 No. 3

April 2006

Sugar Substitutes

What are Sugar Substitutes?

Are they safe?

Substances for low-calorie sweetness

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ugar substitutes, also called artificial sweeteners, are substances that are used instead of sucrose (table sugar) to sweeten foods and beverages.1 Sugar substitutes are many times sweeter than table sugar, and therefore, smaller amounts are needed to create the same level of sweetness.1

he rise in obesity in America contributes to disease, disability, and the loss of quality of life. As we strive to promote health and wellness, there are ever-increasing questions about how to lose weight – the best type of exercise and the best diet.

One question that has come to the forefront is about sugar substitutes. Can they really help with “According to a survey conducted in 2004 by the Calorie Control Council, a trade organization, 180 weight loss, and are they safe? million adult Americans use these products. Consumers often select these foods because they This issue of HealthHints will look at sugar want the taste of sweetness without added calosubstitutes and sugar alcohols (polyols) – how they sweeten our foods, their benefits and draw- ries or because they want to reduce the risk of tooth decay. The dietary options that such prodbacks, and, of course, their safety. ucts provide may be especially helpful in the management of obesity and diabetes mellitus.”2 Note: The information in this issue of HealthHints is directed to the general population and does not directly address the needs of people with diabetes. For information on using sugar substitutes in a diabetic meal plan, please see Special Food Needs: A Reference Guide for County Agents at http://fcsagents.tamu.edu/ food_and_nutrition/pdf/SFN2002.pdf.

Did you know? Table sugar, also known as sucrose, is a combination of glucose and fructose (i.e., a disaccharide – composed of 2 simple sugars) derived from sugar cane and sugar beets that have undergone a rigorous refining process to form the crystalline white granules we use today in cooking and at the table.3 All sugars are carbohydrates. Once these carbohydrates are broken down in the body, the sugars are absorbed in the bloodstream and go to the liver where they can be stored as glycogen or used immediately as glucose for energy by the body and brain.3

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E A L T H

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I N T S

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Safety & regulation .............................................. 2 Sweetness & stability ........................................... 3 Sugar alcohols (polyols) ...................................... 5 Weight control ...................................................... 6 Sugars are “carbs” ................................................ 7 Making healthy choices ...................................... 7 References .............................................................. 8

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The only U.S.-approved sugar substitute that requires a label for safety is aspartame. Products that contain aspartame must be labeled with a statement indicating that they contain the amino acid phenylalanine. This statement is to protect individuals with a rare, hereditary, metabolic condition called phenylketonuria, or PKU (pronounced fennel-keet-a-NOOR-ia). Individuals with this condition cannot metabolize phenylalanine and must completely restrict this amino acid from their diets. “Unless the disorder is detected in early infancy and treated with a phenylalanine-restricted diet, it results in mental retardation and other severe, permanent effects. Thus, apparently normal individuals cannot have the disease without knowing it.”2 Newborns have been screened for phenylketonuria in the U.S. and other industrialized countries for the past 50 years.2 Therefore, there is no need for undue concern in regards to the safety labeling on aspartamecontaining products. If you or a loved one has phenylketonuria, you would know it.

Safety & Regulation How do I know if sugar substitutes are safe?

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ugar substitutes are regulated by the U.S. Food and Drug Administration (FDA). The FDA is an agency of the Department of Health and Human Services, which regulates food, drugs, medical devices, cosmetics, biologics, and radiation-emitting products. A law established in 1958 requires the FDA to approve food additives, including sugar substitutes, before they can be available for sale in the United States; however, this legislation does not apply to products that are “generally recognized as safe (GRAS).” Such products do not require FDA approval before being marketed. 1

There are currently five low-calorie (nonnutritive) sweeteners approved for use in the U.S. Extensive scientific research has demonstrated the safety of these five sugar substitutes:

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Claims of adverse behavioral, neurological, carcinogenic, allergic, and other adverse effects have been made against sugar substitutes, particularly aspartame. These claims are often highly circulated through e-mail and Internet sites, but they have not been supported by scientific research. In fact, numerous studies have been conducted that have found aspartame to be safe and these claims to be unfounded. “A controversial animal cancer study of aspartame conducted using unusual methodology is currently being reviewed by regulatory authorities in several countries.”2 To date, this is the only outstanding controversy. No other issues about the safety of acesulfamate, aspartame, neotame, saccharin, or sucralose remain unresolved at the present time.2

acesulfame-K (common brand names: SweetOne, Sunette, Sweet & Safe, Ace-K), aspartame (common brand names: NutraSweet, Equal, others), neotame (common brand names: not yet available), saccharin (common brand names: Sweet ’N Low, Sweet ’N Low Brown, Sugar Twin, Necta Sweet, Hermesatas, others), and sucralose (common brand name: Splenda).

There are three other low-calorie sweeteners used in other countries but not approved as food ingredients in the U.S.:

• • •

alitame, cyclamate, and steviol glycosides.

Eating sweeteners is safe as long as you do not eat too much of them. The Acceptable Daily Intake (ADI) is the amount of a food additive that can be safely consumed on a daily basis over a person’s lifetime without any adverse effects.4 The ADI is usually set at 1/100 of the maximum level at which no adverse effect was observed in

Steviol glycosides may be sold as a dietary supplement in the U.S., but marketing this product as a food ingredient in the U.S. is illegal.2 Both alitame and cyclamate are currently under study by the FDA for potential safety approval in the U.S. 2

animal experiments. These levels are set to ensure that actual daily intakes do not exceed the ADI. Recent worldwide evaluation indicates that intakes of low-calorie sweeteners are below the ADIs for these substances.2 We’ll take a look at these numbers in the next section.

The acceptable daily intake for acesulfame-K is 15 mg/kg/d.2 Aspartame Aspartame (Equal or NutraSweet) is about 200 times sweeter than table sugar. Unlike other artificial sweeteners, aspartame is made from protein; it leaves no bitter chemical or metallic aftertaste. Although each gram of aspartame contains about 4 calories, the amount needed to sweeten foods is so tiny that the amount of calories you get is of no consequence.5, 6

Sweetness & Stability Factors contributing to food usages

Aspartame, however, is not heat stable, so you cannot use it in cooking. Additionally, if you store drinks that contain aspartame in heat, they will eventually lose their sweetness. Note: When heat causes aspartame to breakdown, the only result is that the beverage loses its sweetness.

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ow sweet each sugar substitute is, as well as whether or not it stays stable when heated, both contribute to what types of foods and/or beverages the sweetener can be used in and whether or not it can be used in cooking. Sometimes combinations of sweeteners will be used to provide just the right amount of sweetness, bulk/texture, or both. In most cases, the goal is to keep calories low while giving the taste closest to sucrose (table sugar) or to the expectation of the consumer.

Aspartame-containing products that might be used in recipes carry a label stating that the product should not be used in cooking or baking. This is not a health warning; its purpose is simply to inform people that aspartame does not maintain its sweetness in heated conditions.2

The following information shows how sweet each sugar substitute is compared to sucrose, how stable it is in heat, and the “acceptable daily intake” – the estimated amount (usually expressed in milligrams per kilogram of body weight per day - mg/ kg/d) that a person can safely consume on an average day over a lifetime without risk.

As noted earlier, some people say that aspartame causes a wide variety of symptoms. Research has been unable to prove this sensitivity or describe how these symptoms could be triggered in the body. The one true concern about aspartame is for people with PKU, a genetic disorder. People with this disorder cannot metabolize the amino acid phenylalanine, which is in aspartame. To help these people avoid it, the FDA requires that warnings be included on products that contain aspartame.6 For more information on the safety of aspartame (and other sweeteners), see Sugar Substitutes: Americans Opt for Sweetness at: http://www.fda.gov/fdac/features/1999/ 699_sugar.html.

Acesulfame-K Acesulfame-K (SweetOne, Sunette, Sweet & Safe, Ace-K) is about 200 times sweeter than table sugar and does not leave an aftertaste. The “K” is the chemical symbol for potassium. Acesulfame-K (pronounced a-seh-SUHL-faym K) is not used by the body and remains unchanged in body waste. Thus, it is a noncaloric sweetener, meaning it contains zero calories per gram. It can also be used in diabetes meal plans, and it does not contribute to tooth decay. Heating acesulfame-K does not change its sweetening power; rather, it remains stable under heat. Manufacturers use acesulfame-K in packet sweeteners, chewing gum, pudding, gelatins and other foods.5

The acceptable daily intake for aspartame is 50 mg/kg/d. 2

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Neotame The FDA has approved the NutraSweet Company to start marketing neotame as a nonnutritive, general-purpose sweetener in foods. This product is the most recent addition to the nonnutritive (noncaloric) sweeteners approved in the U.S. in 2002.

Saccharin remains stable in heat. It is approved in the U.S. for use as a tabletop sweetener and sweetener for beverages. It can also be used in medicines, such as cough syrups. Its stability for some food purposes, however, is limited because its sweet taste is accompanied by bitterness, which some people detect more than others.2

Neotame is a soluble, crystalline white powder that is about 8,000 times sweeter than table sugar. Neotame is also heat-stable, unlike NutraSweet’s other sweetener, aspartame.

Saccharin is the oldest of the approved nonnutritive sweeteners. Like aspartame, saccharin has been surrounded with controversy over its safety since its discovery in 1878.2 Questions have lingered about whether saccharin may cause cancer in humans since studies in rats verify increases in bladder cancer. Controversy over high dosages of saccharin given to rats in these studies, as well as varying physiologic differences between animals (rats) and humans continue, even today.

Neotame can be used as a tabletop sweetener and in baked goods, nonalcoholic beverages such as soft drinks, chewing gum, confections and frostings, frozen desserts, gelatins and puddings, jams and jellies, processed fruits and fruit juices, toppings and syrups. In fact, it is approved for use in all foods and beverages. Although researchers have looked at possible links to cancer, birth defects, and nerve damage, they have found no concerns about nerve toxins or behavioral effects in people from eating neotame.7, 8, 9 The acceptable daily intake for neotame is 18 mg/p/d (that is, 18 milligrams per person per day).2

However, after hundreds of studies and reviews by the FDA, saccharin has been approved as safe for human consumption in the U.S. The American Cancer Society, American Medical Association, and American Dietetic Association agree that saccharin is acceptable.10 In the year 2000, saccharin was delisted from the Report on Carcinogens, stating: “Saccharine will be delisted from the report on carcinogens, because the rodent cancer data are not sufficient to meet the current criteria to list this chemical as reasonably anticipated to be a human carcinogen. This is based on the perception that the observed bladder tumors in rats arise by mechanism not relevant to humans, and the lack of data in humans suggesting a carcinogenic hazard.”11 For a handout and more information on the safety of saccharin (and other sweeteners), see the following publication from The University of Arizona Cooperative Extension: Sugar Substitutes – Are They Safe? at http://ag.arizona.edu/pubs/ health/az1229.pdf.

Saccharin Saccharin (Sweet ’N Low, Sweet ’N Low Brown, Sugar Twin, Necta Sweet, or Hermesatas) is about 300 times sweeter than table sugar. Saccharin does not convert to glucose. It is readily absorbed and is excreted unchanged by the kidneys. Therefore, saccharin contains zero calories per gram. This is an alternative sweetener to consider for people with diabetes.

Saccharin has become a popular sugar substitute for people suffering from diabetes, obesity, or gout. Saccharin may also help to maintain good dental health since it does not contribute to the development of cavities. Note: “Sodium saccharin” – the most common form of saccharin used to sweeten foods – may increase the sodium content in the diet. Be sure 4 to read food labels carefully.

In other countries, the ADI for saccharin is set between 2.5–5.0 mg/kg/d. No ADI is currently set by the FDA in the United States. Saccharin is permitted by the FDA under an interim regulation that specifies the amount of saccharin permitted in beverages, processed foods, and tabletop sweeteners.2

Sugar Alcohols (Polyols) Another sweet alternative Sugar alcohols, also called polyols, are another category of sugar-free sweeteners. Sugar alcohols are carbohydrates, but they are not sugars, nor are they alcohols. Since “polyol” is not a very consumer-friendly word, scientists call them sugar alcohols because their chemical structure partly resembles sugar and partly resembles alcohol.12

Sucralose Sucralose (Splenda) is about 600 times sweeter than sugar or sucrose and is the only nonnutritive sweetener made from sugar, so it tastes like sugar. Better yet, your body doesn’t metabolize it as sugar. This means that sucralose gives you the sweet taste of sugar without carbohydrates or calories.

Unlike the low-calorie sugar substitutes (mentioned in the previous section), which are used only in tiny amounts to sweeten foods, sugar alcohols provide the “bulk” of sugar without as many calories.13 They are used cup-for-cup (volume-for-volume) in the same amount as sugar is used.12 Sugar alcohols deliver the taste and texture of sugar with about half the calories. They vary in sweetness from about half as sweet as sugar to equally as sweet, and they are sometimes combined with low-calorie sweeteners to create the desired level of sweetness.14

More than 100 scientific studies conducted over 20 years have shown that sucralose is safe, and the FDA has authorized the use of it in foods. Research has also shown that sucralose does not raise blood sugar in people with diabetes. Sucralose is heat stable. You can use sucralosecontaining products, such as Splenda, just as you would sugar when you cook and bake. Splenda stays sweet regardless of how long the cooking time or how high the cooking temperature. You can use Splenda the same way you would use sugar. Substitute 1 cup of Splenda for 1 cup of sugar.5

The most familiar sugar alcohols used in the U.S. are:

• • •

Note: “Splenda Sugar Blend” is a mix of pure sugar (sucrose) and the Splenda brand sweetener (sucralose). It is used in half the amount, substituting 1/2 cup Splenda Sugar Blend for 1 cup sugar.

sorbitol, manitol, and xylitol.

Other sugar alcohols permitted for use in food in the U.S. are:

• • • • •

The acceptable daily intake for sucralose is 5 mg/ kg/d. 2

isomalt, erythritol, lactito, maltitol, and hydrogenated starch hydrolysates (HSH) (aka: polyglycitol, polyglucitol).2, 14

Sugar alcohols have been used in foods around the world for many years.12 In fact, some sugar alcohols, such as sorbitol and xylitol, occur naturally in certain fruits and other foods.2 The World Health Organization has carefully reviewed them and concluded that they are safe for human consumption. The FDA classifies some sugar alcohols as GRAS (generally recog5

nized as safe), while others are approved food additives.12

Weight Control

Sugar alcohols have three potential benefits over sugar as a food ingredient:

Can alternative sweeteners help?

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Sugar alcohols do not promote the development of tooth decay. “The bacteria in dental plaque, which produces substantial amounts of decay-promoting acid from sugars and starches, produces little or no acid from these substances [sugar alcohols].”2

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Sugar alcohols produce a lower glycemic response than most sugars do. “Thus, these use may be advantageous for people with diabetes.”2

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Humans naturally have an appetite for sweet things. Unfortunately, sugary foods consumed in large quantities can add up to a surplus of calories, which can contribute to weight gain.10

Most sugar alcohols have fewer calories than sugar. Sugar has 4 calories per gram (16 calories per teaspoon). Most commonly used sugar alcohols have fewer calories, as can be seen below: sorbitol mannitol xylitol erythritol isomalt lactitol maltitol HSH

2.6 1.6 2.4 0.2 2.0 2.0 2.1 3.0

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he average American eats the equivalent of 20 teaspoons of sugar a day....”10 About 60 percent of that consumption is from nutritive corn sweeteners in sodas and other sweetened beverages. The other 40 percent is from table sugar and small amounts of other nutritive (calorie containing) sweeteners, such as honey and molasses.10

To lose weight, we must decrease the total calories, especially from foods with lots of calories from sugars and fats, and increase our physical activity to expend the extra calories. Many health-conscious consumers seek out alternative low-calorie sweeteners (like sugar substitutes and sugar alcohols) to help lower their daily calorie count without having to give up their favorite foods.10

cal/g cal/g cal/g cal/g cal/g cal/g cal/g cal/g.2

So, can alternative sweeteners such as sugar substitutes and sugar alcohols help with weight loss? The answer to that question has not come without some controversy. If we use alternative sweeteners correctly – in place of other sugarsweetened foods – we can potentially lower our weight. The problem is, we don’t always use these alternatively sweetened foods correctly.

“Most polyols [sugar alcohols] are incompletely digested and poorly absorbed; this is the primary reason why their caloric values are lower than that of sugar.”2 One disadvantage to sugar alcohols, however, is that this incomplete absorption may cause negative gastrointestinal effects (a laxative effect) in some people, such as gas production, softer stools, and even diarrhea. There are large differences in tolerance among people consuming sugar alcohols. Some individuals who wish to consume these products will need to start with small amounts and build up a tolerance over a few days until their body can adapt to larger amounts.2

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I can remember when I first got a box of reduced-calorie chocolate cookies that used a sugar substitute. They were delicious, and I ate half the box “guilt-free.” I suppose you see the problem here. If I am replacing 2 cookies made with table sugar with half a box of cookies made with a sugar substitute, I may have reduced my sugar intake, but I still got a half-a-box worth of calories from the other ingredients in the cookies. Calories count! We can’t just assume that a box that says sugar-free or fat-free, for that matter, means we aren’t getting any of the calories. We may also be replacing nutritious foods in our diet with foods that provide no nutritional value. It is important to read labels and keep our intake of these products in moderation for health and weight control.

Sugars are “Carbs”: Read Labels Carefully Sugars and sugar alcohols are types of carbohydrates (“carbs”). Sugar alcohols are not completely digested. So, if you eat foods that contain large amounts of sugar alcohols, your blood glucose may rise less than with other carbohydrates, which may help in a diabetic meal plan. Note, however, that the term “low carb food,” “net carbs,” and “low impact carbs” are not approved label claims and are not a good way to choose foods.16 Read food labels. If a food has more than 10 grams of sugar alcohol, half the grams can be subtracted from the “total carbohydrate” value listed on the package. For example:

“’Successful’ weight reduction – losing weight and keeping it off – involves many factors, such as eating habits (including a balanced diet, eaten in moderation), exercise and long-term commitment....The majority of those who use low-calorie sweeteners to lose or maintain weight do not rely solely on these products.”15 “Health professionals agree that the key to losing weight is to burn more calories than are consumed, either by increasing physical activity or consuming fewer calories – preferably both.”15 Lowcalorie sweeteners can be incorporated into this plan, if desired.

If total carbohydrates = 26g Total sugar alcohol = 22g (half this amount = 11g) Thus, 26–11 = 15g carbs to count.16 “Even if a food is ‘low’ in carbohydrates, it may not be low in calories or a healthy food. Use common sense to meet your carbohydrate goals, and do not lose track of the bigger picture. Take steps to build good eating habits and keep active.”16

Making Healthy Choices Want a Guide to Effective Weight Loss for Your Clientele or Yourself?

Keep it moderate – keep it healthy

Here’s a great resource:

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Winning by Losing: A Guide to Effective Weight Control http://caloriecontrol.org/winweigh_print.html

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he choice to use sugar substitutes is a personal one. The FDA has approved five sugar substitutes to choose from. You may choose some of these to try to control weight or as part of a diabetic meal plan. You can also control these factors without sugar substitutes – the choice is yours. Mostly, you want to have a balanced diet – burning more calories than you consume. Use sugar substitutes and all foods that don’t have nutritional value in moderation. If we fill up on foods with little or no nutritional value, we may deprive our bodies of the nutritional elements we need to stay healthy. When using sugar substitutes, use them as part of – not a substitute for – a healthy meal plan and active lifestyle.

References 1. National Cancer Institute (2006). Artificial sweeteners and cancer: Questions and answers. Retrieved April 4, 2006. From http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners. 2. Kroger, M; Meister, K; and Kava, R. Low-calorie sweeteners and other sugar substitutes: A review of the safety issues. In Comprehensive Reviews in Food Science and Food Safety 2006; 5:35-47. 3. Greeley, A. (2001). U. S. Food and Drug Administration: Not only sugar is sweet. Retrieved April 4, 2006. From http://www.fda.gov/bbs/topics/CONSUMER/CON00133.html. 4. American Dietetic Association (2006). Use of nutritive and nonnutritive sweeteners. Retrieved March 24, 2006. From http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/ advocacy_adap0598_ENU_HTML.htm. 5. Mayo Clinic (2004). Sugar substitutes: Sweet taste without all the calories. Retrieved April 4, 2006. From http://mayoclinic.com/health/diabetes-diet/NU00592. 6. American Dietetic Association (2003). Straight answers about aspartame. Retrieved April 24, 2006. From http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_1030_ENU_HTML.htm. 7. Sweeteners Holdings, Inc. (2002). Neotame: FAQs. Retrieved April 24, 2006. From http:// www.neotame.com/faq.asp. 8. United States Food and Drug Administration (2002). FDA approves new nonnutritive sweetener neotame. Retrieved April 24, 2006. From http://www.fda.gov/bbs/topics/ANSWERS/2002/ ANS01156.html. 9. United States Food and Drug Administration. FDA approves new sugar substitute. Food Chemical News, July 15, 2002, p.17. Retrieved April 24, 2006. From http://www.foodchemicalnews.com/ ejournals/search/SearchQuery.asp?Idx=applications%5C7&request=July+15%2C+2002&stemming =True&phonic=False&natlang=False&maxfiles=500&sort=DATE&sort_type=0&chkShowAbstract =0&perpage=25&startat=1&onpage=1. 10. Henkel, J (2004). Sugar substitutes: Americans opt for sweetness and lite. In FDA Consumer Magazine, Nov–Dec 1999 (rev. 2004). Retrieved January 9, 2006. From http://www.fda.gov/fdac/ features/1999/699_sugar.html. 11. National Institutes of Health (2000). Report on Carcinogens, 11th ed. Summary actions on the nomination of saccharin for delisting from the report on carcinogens. Retrieved April 4, 2006. From http://ntp.niehs.nih.gov/ntp/roc/eleventh/append/appb.pdf. 12. Calorie Control Council (2003). Polyols in sugar-free and reduced calorie foods and beverages: Questions and answers about polyols or sugar replacers. Retrieved March 24, 2006. From http:// www.caloriecontrol.org/polyol_qa_brochure.pdf. 13. Calorie Control Council (2004). FAQs. Retrieved March 24, 2006. From http://caloriecontrol.org/ faqs.html. 14. American Dietetic Association (2006). Polyols: Sweet benefits. Retrieved March 24, 2006. From http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_1035_ENU_HTML.htm.

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15. Calorie Control Council (2004). Benefits of using low-calorie sweeteners. Retrieved March 24, 2006. From http://caloriecontrol.org/benefit.html. 16. Diabetes Care and Education Dietetic Practice Group (2004). The truth about carbs. Retrieved April 24, 2006. From http://www.dce.org/publications/files/truth_carbs.pdf.

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Texas Cooperative Extension Attn: Janet M. Pollard 2251 TAMU College Station, Texas 77843-2251

Extension programs serve people of all ages regardless of socioeconomic level, race, color, sex, religion, disability, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating A member of The Texas A&M University System and its statewide Agriculture Program

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