Myths and Facts About Sugar Substitutes

By Dr. Sanjay Gupta

Calorie-free sweeteners probably aren't dangerous, but they may not help you lose

weight either.

Research suggests people are cutting back on their

sugar intake, but it’s still having a serious health

impact worldwide. According to the American Heart

Association, tens of thousands of global deaths each year from heart disease, cancer, and type 2

diabetes may be linked to sugary drinks.

For many people, artificial sweeteners offer a

calorie-free way to satisfy sweet-tooth cravings.

But do these sugar substitutes pose health risks,

and how do they affect the way we taste and

consume food?

“We still don’t fully understand the long-term

effects of artificial sweeteners,” said Alexandra

Kaplan Corwin, a registered dietician in the division

of pediatric endocrinology and diabetes at The Children’s Hospital at Montefiore Medical Center in

New York City. “Though the [U.S. Food and Drug

Administration] has said they’re safe and the

National Cancer Institute says they don’t cause

cancer, we still don’t really know if there are long-

term health consequences.”

In the 1970s, studies linked the sugar-substitute

saccharine to urinary bladder cancer in lab rats. In

response, Congress required that foods containing

saccharine have a warning label. Follow-up studies

found no cancer-risk in humans, and the National

Institutes of Health removed saccharin from a list

of suspected carcinogens in 2000.

The safety of another sugar substitute came into

question after a study suggested an increase in

brain tumors in the U.S. might be related to the

use of aspartame. But the National Cancer

Institute traced the increased tumor rates back to

the 1970s, years before the substitute was on the

market. Subsequent research found no connection

between aspartame and cancer in humans.

This month, the European Food Safety Authority

concluded that aspartame is safe at levels

contained in diet soda.

“None of these studies have been replicated in

humans with the same results,” said Kristi King, a

clinical dietician at Texas Children’s Hospital in

Houston. “It seems like the amount of sweeteners

you’d have to consume on a daily basis over your

lifetime would have to be enormous to have any

kind of detrimental side effect.”

While there’s no evidence these sugar substitutes

are dangerous, a recent study suggests they don’t

guarantee weight loss. Researchers from the Yale

University School of Medicine found that eating

foods with artificial sweeteners when we’re hungry

or tired increases the likelihood of choosing higher-

calorie foods later on.

Brain scans of mice found that the brain signal that

regulates levels of dopamine, a neurotransmitter

associated with the brain’s reward center, is only

triggered when regular sugar is broken down.

“The results suggest that a ‘happy medium’ could

be a solution; combining sweeteners with minimal

amounts of sugar so that energy metabolism

doesn't drop, while caloric intake is kept to a

minimum,” according to Yale professor and study

lead Ivan de Araujo.

“Artificial sweeteners aren’t necessarily a magic

bullet for weight loss,” said Corwin. “They don’t

contain calories, but you have to make sure you’re

not letting yourself think you can eat more

because you had a diet soda instead of a regular

one.”

Sugar substitutes are much sweeter than sugar,

which can have an adverse effect on how we

choose what foods to eat. “If you’re having a lot of

artificial sweeteners, they can increase your

preference for them and make more nutritious

foods less tasty and appealing,” said Corwin.

Here’s how five FDA-approved artificial sweeteners

measure up on the “sweetness scale,” according to

the Sugar Association:

Acesulfame K, or ace K, is 200 times sweeter

than sugar.

Aspartame (marketed as Equal and

NutraSweet) is 200 times sweeter than sugar.

Neotame is about 40 times sweeter than

aspartame, or 8,000 times sweeter than

sugar.

Saccharine (commonly sold as Sweet ’N Low)

can be between 200 and 700 times sweeter

than sugar.

Sucralose (sold as Splenda) is 600 times

sweeter than sugar.

For people trying to lose weight or manage

conditions like heart disease and diabetes, the

American Heart Association and the American

Diabetes Association support the moderate use of

artificial sweeteners. Reducing sugar in your diet is

important, but “sugar free” isn’t the same as

healthy.

Here are some healthy tips on consuming sugar

and sugar substitutes:

If you’re looking to avoid both sugary and

artificially sweetened drinks, try water or

seltzer flavored with fruit slices or mint leaves.

Among sugar substitutes, Corwin prefers the

natural sweetener stevia, which is derived

from a plant. Refined stevia extract is

“generally regarded as safe,” but the FDA

hasn’t approved it in whole-leaf or crude form

because of concerns about possible side

effects.

When buying juice drinks for your kids, look

for the phrase “100 percent juice.” Those

juices will contain the vitamins and minerals

found in the fruit, said King. Avoid products that are “fruit flavored.”

The AHA recommends fresh fruit or canned

fruits packed in water or natural juice over

fruit canned in syrup. Instead of adding sugar

to oatmeal or cereal, use fresh or dried fruit.

Avoid nutrient-poor, processed foods and

beverages with added sugar, said King.

Naturally occurring sugars found in fruit and

milk, in moderation, can still be part of a

healthy diet.

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