Diabetes: Sugar Substitutes & Nonnutritive Sweeteners
What are nonnutritive sweeteners?
Nonnutritive sweeteners are substances that are 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.
Nonnutritive sweeteners (also called sugar substitutes or artificial sweeteners) contain few or no calories or nutrients. Artificial sweeteners 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 seven 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 and sucralose.
- 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.
- 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. It is a derivative of the amino acids phenylalanine and aspartic acid.
- 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.
- Sucralose (Splenda® and Equal “yellow packet”) is a chemical derivative of sucrose (table sugar). It 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.
- Stevia (Truvia®, A Sweet Leaf®, 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 nonnutritive sweetener to reduce bitterness.
- Lo han guo (Monk fruit extract) (Nectresse®) is a natural sweetener made from crushed monk fruit. It is the newest nonnutritive sweetener on the market. It has been used as a sweetener in China for almost 1000 years. It contains no calories and is about 150 times sweeter than sugar.It is often blended with other nonnutritive sweeteners.
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% 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 are found in many fruits and vegetables. They are often used in products labeled as “sugar-free” or “reduced-sugar.” Examples of polyols include erythritol, isomalt, lactitol, maltitol, mannitol, sorbitol and xylitol. Moderate doses of up to 10 to 15 grams/day are generally tolerated. At higher dosages, consuming some sugar alcohols (sorbitol, lactitol, isomalt, and xylitol) may cause gas, stomach pain and diarrhea.
What are the pros and cons of sugar substitutes?
Benefits of nonnutritive sweeteners include:
Weight control: Nonnutritive sweeteners may be useful for people who are trying to lose weight or maintain their current weight. Nonnutritive 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 nonnutritive sweeteners vs. those with added sugars as these sweeteners will affect blood sugars to a much smaller extent.
Prevention of tooth decay: Nonnutritive 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 in sugar-free gum helps to prevent dental cavities.
Pleasant taste: These products sweeteners provide a sweet taste while attempting to decrease added sugars in diet which 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 nonnutritive 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?
All nonnutritive sweeteners approved for use in the United States are determined to be safe.
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 rare genetic 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 phenylketonuria should avoid foods and beverages that contain aspartame.