Sugar Substitutes & Non-Nutritive Sweeteners

What are non-nutritive sweeteners?

Nonnutritive sweeteners are substances used instead of sugars (i.e., sucrose, corn syrup, honey, agave nectar) to sweeten foods, beverages and other products, such as oral care products and certain medications.

Non-nutritive sweeteners (also called sugar substitutes or artificial sweeteners) contain few or no calories or nutrients. They may be derived from plants or herbs, or even sugar itself. They have a greater intensity of sweetness compared with sugar, so smaller quantities are needed for flavoring foods and beverages. Some artificial sweeteners are not metabolized, meaning that they pass through the digestive tract essentially unchanged.

The eight nonnutritive sweeteners that have been approved by the U.S. Food and Drug Administration (FDA) are aspartame, acesulfame potassium, luo han guo (monk) fruit extract, neotame, saccharin, stevia, sucralose and advantame.

• Aspartame (Equal® or NutraSweet®) is about 200 times sweeter than table sugar. Aspartame is used as a tabletop sweetener found in a wide variety of foods and beverages, including cereals, yogurt, frozen and gelatin desserts, candy, sugar-free gum, juices, diet sodas, and many other products. It is also used in drugs such as vitamin supplements and laxatives. It is often found in a blue packet. This sweetener MUST be avoided by those who have phenylketonuria (PKU), a rare genetic disorder.
• Acesulfame potassium (Sunett® and Sweet One®) is generally used in combination with other non-nutritive sweeteners and is frequently found in sugar-free sodas.
• Neotame is also used in low-calorie foods and beverages, but to a lesser extent than other sweeteners. It is about 7,000 to 13,000 times sweeter than sugar.
• Saccharin (Sweet ‘N Low®, Sweet Twin® and Sugar Twin®) is the oldest artificial sweetener on the market. It was discovered in the late 1800s. Saccharin is 200 to 700 times sweeter than table sugar. It is often found in a pink packet.
• Sucralose (Splenda® and Equal Sucralose) is 600 times sweeter than sugar. Sucralose is very versatile. It can be used as a replacement for sugar in cooking and baking, or used with sugar in recipes. It is found in many low-calorie foods and beverages, such as baked goods and other desserts, canned fruits, dairy products and syrups. Sucralose may also be used as a tabletop sweetener. It is often found in a yellow packet.
• Stevia (Truvia®, Stevia in the Raw®, SweetLeaf® Sweet Drops™, Sun Crystals® and PureVia®) is extracted from the leaves of the stevia plant, which is native to South America. Stevia is 200 to 300 sweeter than sugar. Stevia is used in a wide range of foods and beverages, including teas and juices, and as a tabletop sweetener. It is often blended with another non-nutritive sweetener to reduce bitterness. It is often found in green packets.
• Luo han guo (Monk fruit extract) (Monk Fruit in the Raw ®) is a natural sweetener made from crushed monk fruit. It is the newest non-nutritive sweetener on the market. It has been used as a sweetener in China for almost 1,000 years. It contains no calories and is about 10-250 times sweeter than sugar. It is often blended with other non-nutritive sweeteners.
• Advantame is the newest non-nutritive sweetener approved by the FDA. It is 20,000 time sweeter than sugar. It is not commonly used at this time.

Sugar alcohols (polyols)

Sugar alcohols are carbohydrates and are considered to be nutritive sweeteners because they contain some calories and provide energy when consumed. However, on average they only have about 50 percent as many calories as sugar per gram. While sugar contains 4 calories per gram, sugar alcohols provide an average of about 2 calories per gram. (The calorie content varies depending on the specific sugar alcohol.) Although sugar alcohols possess a chemical structure that is similar to that of alcohol and sugar, they do not affect the body like alcohol.

Sugar alcohols may be extracted from fruits and vegetables; however, most are manufactured. They are often used in products labeled as “sugar-free” or “reduced-sugar.” Examples of polyols include erythritol, isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol and hydrogenated starch hydrolysates (HSH). Moderate doses of up to 10 to 15 grams/day are generally tolerated. At higher dosages, consuming some sugar alcohols, particularly sorbitol and mannitol, may cause gas, stomach pain and diarrhea.

What are the pros and cons of sugar substitutes?

Benefits of non-nutritive sweeteners include:

Weight control: Non-nutritive sweeteners may be useful for people who are trying to lose weight or maintain their current weight. Non-nutritive sweeteners have few or no calories, compared with about 16 calories in 1 teaspoon (4 grams) of sugar. When used as tabletop sweeteners or in cooking or baking, they can provide the sweetness of sugar without the calories.

Diabetes control: People with type 2 diabetes may choose to consume foods and beverages containing non-nutritive sweeteners vs. those with added sugars as these sweeteners will affect blood sugars to a much smaller extent.

Prevention of tooth decay: Non-nutritive sweeteners do not increase the chances of developing dental cavities. That is why they are used in oral hygiene products, such as mouthwash and toothpaste. Studies have shown that xylitol may help prevent dental cavities.

Pleasant taste: These sweeteners provide a sweet taste for those attempting to decrease dietary added sugars that have been associated (directly or indirectly) with overweight/obesity, pre-diabetes, type 2 diabetes, inflammation, and some cancers.

Drawbacks of sugar substitutes include:

Inadequate calorie intake: Growing children need to consume an adequate number of calories every day for proper nutrition. If they consume a lot of low-calorie foods and beverages every day, they might run the risk of not consuming enough calories to sustain normal growth. Even if they are trying to lose weight, children and adults must consume adequate levels of calories based on their height and weight. Consult a nutritionist or dietitian for help with planning meals that are nutritious and meet dietary guidelines.

Nutrition issues: Beverages with non-nutritive sweeteners may replace nutritious beverages such as low-fat milk.

Stability issues: With a few exceptions, artificial sweeteners undergo chemical changes when exposed to high temperatures, such as those required for cooking and baking. Consumers should read the product label to find out how a non-nutritive sweetener can be used. Even if the sweetener is approved for cooking and baking, the recipe might need to be adjusted to yield the desired results.

How safe are sugar substitutes?

FDA-approved sugar substitutes are considered safe in the amounts that people typically eat or drink.

The FDA has set an acceptable daily intake (ADI) level for each non-nutritive sweetener approved for general use in the U.S. (including pregnant and lactating women). The ADI is the maximum amount of sweetener that can be consumed each day over a lifetime without causing health risks. It is virtually impossible for the average consumer to exceed the ADI based on normal consumption levels for low-calorie foods and beverages.

There is an exception regarding the use of aspartame (NutraSweet). This is for people who have been diagnosed with phenylketonuria (PKU), a disorder in which the body lacks the enzyme that breaks down an amino acid called phenylalanine. Unless the person avoids certain foods that contain phenylalanine, it can accumulate in the body and cause damage to the brain and central nervous system. Because aspartame changes to phenylalanine and aspartic acid when it enters the digestive tract, people with PKU should avoid foods and beverages that contain aspartame.

Despite being considered safe by the FDA, and evidence to support at least a short-term benefit for weight management, there are questionable health disadvantages associated with non-nutritive sweeteners. In general, they offer no nutritional advantage. Dietary recommendations for their consumption are inconsistent across different health organizations and are often inconclusive. Taking a cautious approach may be prudent until there is more research in this area. One cannot go wrong by following the recommendations offered in the 2015 Dietary Guidelines scientific committee to “reduce added sugars in the diet and replace with healthy options, such as substituting water for sugar-sweetened soda, instead of non-nutritive sweeteners.” The American Heart Association, suggests: “For those who consume sugar-sweetened beverages regularly, a low-calorie or non-nutritive-sweetened beverage may serve as a short-term replacement strategy, but overall, people are encouraged to decrease both sweetened and non-nutritive-sweetened beverages and use other alternatives, with an emphasis on water intake.”