Artificial Sweeteners in Your Diet

Podcast Transcript

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Natalie Salvatore, RN:

Welcome to Love Your Heart. My name is Natalie Salvatore. I'm a registered nurse at the Heart Vascular and Thoracic Institute at Cleveland Clinic. I'm excited to be joined today by Julia Zumpano, a registered dietician in our Department of Preventive Cardiology. Today we're going to talk a little bit about artificial sweeteners, specifically erythritol. Two of our doctors recently published an article on erythritol and cardiovascular risk. So, I wanted to talk to you today a little bit about artificial sweeteners and specifically erythritol. Let's start with general, what are artificial sweeteners?

Julia Zumpano, RD:

So artificial sweeteners are a group of food additives that were designed to serve as sugar substitutes in foods, therefore, they would not have calories. So artificial sweeteners don't have calories and they provide minimal or no effect on your blood sugar. So, they're intended to be used for food products that would be safe for people who have diabetes or elevated blood sugars or are trying to lose weight, so trying to cut calories.

Natalie Salvatore, RN:

Great. Are there different types?

Julia Zumpano, RD:

Yes, there are. There are artificial sweeteners and then sugar alcohols. There are several of each category. They all maintain very similar properties. They are chemical sweeteners that are much sweeter than sugar, anywhere from 300 times to thousands of times sweeter than sugar when you compare the equal volume and those are the sugar substitutes. The sugar alcohols on the other hand are not as sweet as sugar. They're less sweet. Our body does produce sugar alcohols on its own, although not to the extent or the quantity that we are utilizing in products. So, they do tend to be in high concentrated amounts in products.

Natalie Salvatore, RN:

That's so interesting to hear the different alternatives that are being used in the foods that we consume every day. Are all of the artificial sweeteners the same?

Julia Zumpano, RD:

They're structurally a little bit different. Again, like I mentioned, some are sweeter than others and some are less sweet than others. So, they all have various different properties. Some people are more sensitive to some versus others. For instance, sugar alcohols have always been shown to have some gastrointestinal effects so some gas bloating even can cause some looser stools. So, some people just tend to avoid or limit those because of the negative effects of them. But they all do follow very similar properties, but they're chemically a little bit different in structure.

Natalie Salvatore, RN:

I know you mentioned that they would be used in some of our food to replace some of that sugar. So how can we tell if our foods have these in them?

Julia Zumpano, RD:

That's a great question. So that's where it gets a little tricky. Sometimes they could not even be listed on the label. So, sugar alcohols are generally recognized as safe or considered GRAS by the food drug administration. So, they may not even be listed on the label. The artificial sweeteners on the other hand are typically listed in the ingredient list, but you can certainly have some hidden sources of sugar alcohols in your foods without even knowing it.

The foods that would contain these sugar alcohols and artificial sweeteners would be labeled as being keto friendly or diabetic friendly or no sugar added or sugar-free. Zero calorie. If they're sweetened beverages that don't have any calories, it could state that. They could also indicate they're naturally sweetened or made with sweeteners with natural compounds. So that's where you have to be very aware of what the label is saying and even the front of the package. So not only the ingredient list, but also what they're using to market the product to you.

Natalie Salvatore, RN:

So, it sounds like we need to be pretty cautious and diligent readers of these labels. Now GRAS, as you mentioned, stands for generally recognized as safe by the Food and Drug Administration, the FDA. So, when it comes to the labeling on these packages, as long as it's one of these considered safe substances, there's pretty loose requirements for labeling.

Julia Zumpano, RD:

That's correct. Exactly.

Natalie Salvatore, RN:

Now, specifically to erythritol, you highlighted some of the key similarities and differences between artificial sweeteners and sugar alcohols, but how, specifically to this erythritol, is it compared to regular sugar?

Julia Zumpano, RD:

So erythritol is only about 70 percent as sweet as sugar, so it's less sweet than sugar. But oftentimes erythritol can be mixed with other artificial sweeteners to just carry the flavor. The taste and texture of erythritol is very favorable and it's very similar to sugar. So they'll commonly mix erythritol with maybe another artificial sweetener in a product or even in a packet, like some of those packets you might see at a restaurant, the different colored packets, they may put erythritol in it or sugar alcohol combined with that to just enhance the mouth feel and the taste and the texture and just gives it a better end product.

Natalie Salvatore, RN:

Sounds like you can find it pretty much in anything. What would be your biggest piece of advice or tips for our listeners as they head into the grocery store?

Julia Zumpano, RD:

Well, you really want to focus on whole foods because we know whole foods doesn't have any artificial sweeteners or sugar alcohols. So really getting your sweetness from things like vegetables and fruits, things like sweet potatoes, grains. We want to choose whole foods as much as possible. If you are trying to have something sweet, it's best to use something like honey or maple syrup versus using an artificial sweetener.

Store bought desserts are going to be where you really don't know what's being used, especially if it's a sugar-free product. Regular sugar in some cases is a little more safe, but not necessarily healthier. So, we want to just be sure that we are not starting to consume large amounts of sugar because we're avoiding sugar alcohols or artificial sweeteners. We really want to focus on eating more whole foods, reading labels, being aware of what's in the food and when possible, making your sweet treats at home, so you know what's inside them.

So maybe looking up some heart healthy dessert recipes using honey, maple syrup, applesauce, prunes, or dates using any kind of fruit really to sweeten it. Cocoa powder, of course, there's a lot of ways that you can add more flavor to desserts without necessarily having to use artificial sweeteners, sugar alcohols, or even large amounts of sugar.

Natalie Salvatore, RN:

I think that's an important point that you mentioned to take into consideration regular sugar versus an alternative sugar, an artificial sugar, a sugar alcohol, that whichever way you're going to go, neither one is necessarily the best. The best would be shopping the produce section and using those whole foods like you mentioned. So that's something that's great. I know I've heard patients and even family members say, oh, it's sugar-free, it's healthy. But really taking into consideration that moderation and less processed foods are better.

Julia Zumpano, RD:

Yes, absolutely. And if you are going to bake at home with natural sugar, that's something you can do is purchase more of a sugar alcohol or artificial sweetener that does not contain erythritol or does not has had that additive in it. Something like I use liquid stevia a lot, so the liquid stevia has no other additives, and it can be controlled very easily because it's in a liquid dropper. So, I may cut the sugar in the recipe in half and just add a couple drops of the liquid stevia just to add a little boost. So, there's little tips and tactics like that you can use, but those really would be used at home when in your own kitchen when you're making things from scratch, and you know what's going in them. That's really the best-case scenario, just coming up with really simple sweets and treats that you can have.

One I often suggest that actually has no artificial sweetener, but it's a recipe that we have on our website called energy balls. So, they're different varieties of them, but they're made with oats and flax seeds, peanut butter, honey, and then chocolate chips or dried fruit. You can even throw a little bit of applesauce there, but you really do try to limit the sugar in the recipe, but they're very satisfying and filling and can provide other nutrients.

That's really our goal is trying to focus on whole foods where we're going to gain other nutrients, not just sugar. Where you have these packaged foods, whether dessert foods or drinks, that have all these artificial ingredients and they really have no nutritional value. So, it's okay to use a little bit of the natural sweetness that is grown on the earth like honey or maple syrup to give us a small touch of sweetness. But we really want to focus on having that in a whole food, like maybe adding a little bit to a bowl of steel cut oats or plain Greek yogurt with berries. So really looking at maximizing our intake of whole foods.

Natalie Salvatore, RN:

Great. Thank you so much. It was a pleasure to chat with you about these artificial sweeteners and ways that we can incorporate healthy sweets into our diet.

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