Artificial Sweeteners
Article by: Consultant Dietitian from Beacon Premier Wellness
Artificial sweeteners are food additives that offer sweetness while adding minimal to zero calories. They serve as alternatives to sugar, reducing extra calories for weight loss and lowering added carbohydrates, such as added sugar, for blood sugar control in diabetes. Additionally, they function as sweetening agents in numerous beverages and foods. [1] Artificial sweeteners taste sweeter than sugar, requiring only a minimal amount to achieve sweetness. However, the intensity of sweetness varies among different types of artificial sweeteners. Commonly referred to as non-nutritive sweeteners, they find frequent use in sugar-free beverages, candies, gums, and certain baked goods. [1,2]
Difference between Artificial Sweeteners (Non-Nutritive Sweeteners) and Nutritive Sweeteners
Artificial sweeteners differ from sugar, a nutritive sweetener, due to their distinct composition. Sugar exists in various carbohydrate forms, including maltose, sucrose, lactose, fructose, galactose, and glucose, naturally occurring in fruits, milk, honey, molasses, syrup, agave nectar, sweetened beverages, granulated sugar, and others. Sugar possesses properties that induce effects such as crystallization, browning, yeast fermentation, and prevention of microbial growth through moisture absorption. [1] However, this is not the same for artificial sweeteners as do not have similar effects other than adding sweetness. Therefore, they may not produce a similar volume or texture especially when used in baked goods. [2]
Types and uses of Artificial Sweeteners
The types of artificial sweeteners approved by Food and Drug Administration (FDA) are Acesulfame-K, Aspartame, Neotame, Saccharin, Sucralose, Stevia, Luo han guo fruit extract and Advantame. [1-3]
1. Acesulfame-K
Acesulfame-K also known as acesulfame potassium, is around 200 times sweeter than sucrose. [3,4] A common sweetener in beverages, candies, and frozen desserts, and its heat stability makes it suitable for baking at high temperatures. Additionally, it serves as a flavor enhancer in certain foods. The body excretes around 95% of Acesulfame-K through urine, thus not contributing to potassium intake.[1,3] The examples of brand names are Sunett® and Sweet One®.
2. Aspartame
Containing only a few calories (4kcal/g), aspartame boasts a sweetness level 160-220 times greater than sucrose. Consequently, only a small quantity of aspartame is necessary to achieve a sweet flavor. It is a common ingredient in tabletop sweeteners and in carbonated beverages, puddings, fillings, and sugar-free chewing gum production. Nonetheless, it is unsuitable for baking, as the sweetener cannot withstand high temperatures. Companies sell it under the brand names of Nutrasweet®, Equal, and Sugar Twin®. Aspartame can break down into phenylalanine in the body, making it unsuitable for people with phenylketonuria, as they cannot metabolize the amino acid phenylalanine. [1-3]
3. Neotame
Neotame boasts a sweetness level of 7000 to 13,000 times more than regular table sugar. Moreover, it is a common sweetener used to enhance flavor in foods excluding poultry and meats. Additionally, due to its ability to withstand heat without losing its flavor, it is suitable for use at high temperatures such as baking. It is marketed under the name Newtame®. Neotame, a derivative of phenylalanine and aspartic acid, is only partially absorbed in the intestine after ingestion, with the remainder eliminated through urine and feces, rendering its presence in the body insignificant. [1,3,4]
4. Saccharin
Saccharin boasts zero calories and is 300 times sweeter than sugar. Moreover, it finds utility as a tabletop sweetener, in fruit juices, beverages, gums, and high-heat cooking due to its heat stability. Nonetheless, this sweetener has a metallic bitter aftertaste, the intensity of which increases with the amount used. It is commonly sold under the brand names Sweet and Low®, Sweet Twin®, Sweet’N Low®, and Necta Sweet®. [1-3]
5. Sucralose
Its brand name, Splenda®, commonly identifies sucralose. Sucralose is 600 times sweeter than sugar and is commonly found as a general sweetener in various groups such as beverages, gelatin, chewing gum, and frozen dairy desserts. [3] Sucralose can also substitute for sugar in baked products. The body primarily does not absorb sucralose, and it eliminates it through feces. Any absorbed sucralose will eventually be excreted through urine. [1-3]
6. Stevia
Stevia is an artificial sweetener that comes from a natural plant from South America called Stevia rebaudiana Bertoni. [1-3] It only provides very minimal calories, 2kcal/g, most of which the body excretes in the urine after metabolism in the gut and liver. Therefore, it is generally considered a zero-calorie sweetener. [5] The extraction and purification process from Stevia leaves produce stevia glycosides, the sweet component responsible for a sweetness intensity 200-400 times greater than sugar. It’s a common choice for sweetening beverages like teas, cereals, energy bars, desserts, and as a tabletop sweetener. [3,5]
Some common brand names are Truvia®, PureVia® and Enliten®.
7. Luo han guo fruit extract
The scientific name of Luo han guo fruit extract is called Siraitia grosvenorri or Swingle fruit. Furthermore, it produces sweet components known as mogrosides. Additionally, the sweetener does not contain any calories, and the fruit is native to China, commonly known as Luo han guo or monk fruit extract. Moreover, with the sweetness intensity of 100 – 250 times more than sugar, it is used as a tabletop sweetener, food ingredient, and a component of sweetener blends. The common brand names of this sweetener include Nectresse®, Monk Fruit in the Raw®, and PureLo®. [1-3]
8. Advantame
The FDA approved Advantame for use in 2014. It boasts a sweetness intensity 20,000 times greater than table sugar. Furthermore, it finds applications as a sweetener in beverages, desserts, candies, jellies, and processed fruits, excluding meat and poultry. Moreover, it remains heat stable and can be utilized in baked goods. [3]
Is it safe to consume?
According to FDA regulatory standards, artificial sweeteners such as Acesulfame-K, Aspartame, Neotame, Saccharin, Sucralose, and Advantame have approval as food additives, whereas Stevia and Luo Han Guo fruit extract are categorized as Generally Recognized as Safe (GRAS). [3] For an item to receive approval from the FDA, whether as a food additive or as GRAS, competent scientists must confirm evidence proving that the item does not cause harm under the conditions of its intended use.[6] The regulations listed by the FDA state that the safety of consuming a substance is based on relevant criteria, including dietary exposure and the population that will consume the substance. [6]
Each artificial sweetener has their own Acceptable Daily Intake (ADI). ADI is the measure of the amount of specific substance or food additive that can be ingested on a daily basis over a lifetime without an appreciable risk to health. [7] The ADI for each artificial sweetener is determined using milligrams/kilogram body weight per day as shown in the table below.
| Sweeteners | Acceptable Daily Intake (ADI) milligrams per kilogram body weight per day (mg/kg bw/d) |
|---|---|
| Acesulfame-K | 15 |
| Aspartame | 50 |
| Neotame | 0.3 |
| Saccharin | 15 |
| Sucralose | 5 |
| Advantame | 32.8 |
| Stevia | 4 |
| Luo han guo fruit extract | Not determined |
Effects on Health
Appetite & Food Intake (Short-Term)
In recent years, researchers conducted a review comprising multiple studies to investigate the consumption of artificial sweeteners and their relation to appetite. Specifically, this review mainly focused on the intake of artificially sweetened beverages and foods affecting food intake. Moreover, the findings revealed that the majority of people did not experience an increased appetite, with only a small number reporting changes in appetite leading to increased hunger or satiety. [8] It is strongly concluded in the Academy or Nutrition and Dietetics Position Paper on the Use of Nutritive and Non-nutritive Sweeteners from the Evidence Analysis Library (EAL) that appetite and food intake is not affected especially by aspartame, saccharin and sucralose. [1]
Energy Intake & Body Weight
Artificial sweeteners, except for aspartame, contain zero calories. Consequently, substituting sugar with artificial sweeteners decreases the intake of sugary drinks or foods, resulting in reduced calorie intake. Moreover, a review also indicates that overweight or obese individuals lower their energy intake by using artificial sweeteners compared to nutritive sweeteners.[9] During their weight loss journey, individuals did not compensate for food intake. Additionally, some also noticed weight changes when using artificial sweeteners. However, it’s crucial to consider other factors that may contribute to effective weight loss.[8] That being said, it is concluded that the usage of artificial sweeteners can be beneficial as part of a weight loss or weight maintenance programme. [1]
Diabetes
In individuals with diabetes, a meta-analysis have demonstrated that there was no strong improvement in glucose and insulin levels. [8,9] There is a limited number of studies which show significant improvement in glycaemic response and HbA1c levels as concluded in the EAL. [1] The use of artificial sweeteners to satisfy desires of the sweet taste without adding carbohydrates and calories may be a part of a practical way to help manage diabetes. Nevertheless, it is important to understand that products that contain artificial sweeteners may also have carbohydrate and energy content; therefore, the nutrition content of these products should be taken into consideration, especially for people with diabetes. [10]
Cancer
Several studies in a 2016 systematic review gathered data on the consumption of artificial sweeteners, particularly aspartame, and assessed the risk of cancers. Moreover, the researchers found that consuming aspartame had no association with the risk of hematopoietic cancer, brain cancer, and kidney tumor in adults. [11]
Besides that, a scoping review in 2017 included many studies involving any type of artificial sweeteners or particularly saccharin or aspartame. Moreover, there were several studies which identified that there was an association with the intake of artificial sweeteners and bladder and urinary tract cancer, whereas some reported no association with cancer.[8] Results also showed fewer incidence with risk of other cancers including brain cancer, colorectal, pancreatic, breast, biliary tract and haematological malignancies. [8]
According to the National Cancer Institute (NCI), there is no clear evidence in research studies examining carcinogenicity of a substance which specifies that artificial sweeteners have a direct link to cause cancer in humans. Additionally, artificial sweeteners are regulated by the FDA and deemed as safe to consume according to its Acceptable Daily Intake (ADI) without an appreciable risk to health as mentioned above. [6,7,12]
Pregnancy
It is considered safe by the FDA for pregnant women including lactating mothers to use or consume products with FDA approved artificial sweeteners. [1] Extensive research has examined the safety of artificial sweeteners according to established guidelines before the FDA approved them as safe food additives. Furthermore, according to the Academy of Nutrition and Dietetics, a 2010 research study reported an association between daily intake of one or more artificially sweetened beverages and pre-term births. However, researchers concluded that no other supportive findings existed, and the increased risk of pre-term births was likely due to other factors such as medically induced birth.[1]
Conclusion
Using artificial sweeteners as a sugar substitute offers benefits, particularly in terms of reducing calorie and sugar intake from beverages and certain foods. Despite these benefits, individuals managing diabetes and the general healthy population should adopt healthy eating habits. This involves selecting nutrient-dense foods such as complex carbohydrates, lean protein, healthy fats, and fiber from fruits and vegetables. Furthermore, this entails reducing the consumption of added sugars, processed foods, and energy-rich foods. While consuming artificial sweeteners can help reduce added sugar intake in the diet, it should be done in moderation within the Acceptable Daily Intake (ADI) for health safety. Additionally, it’s important to avoid becoming overly reliant on sweet-tasting beverages and foods.[1-3, 10]
References:
- Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners [Internet]. J Acad Nutr Diet; 2012 [cited 12 April 2022]. Available from: https://www.andeal.org/vault/2440/web/JADA_NNS.pdf
- Nutritive and Nonnutritive Sweetener Resources [Internet]. U.S. Department of Agrculture. [cited 12 April 2022]. Available from: https://www.nal.usda.gov/legacy/fnic/nutritive-and-nonnutritive-sweetener-resources#:~:text=Nutritive%20sweeteners%20provide%20the%20body,added%20to%20food%20and%20beverages
- Additional Information about High-Intensity Sweeteners Permitted for Use in Food in the United States [Internet]. U.S. Food and Drug Administration. [cited 12 April 2022]. Available from: https://www.fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states
- Chattophadyay S, Raychaudhuri U, Chatkraborty R. Artificial Sweeteners – A Review. J Food Sci Tech [Internet]. 2011 [cited 12 April 2022];51(4). Available from: https://europepmc.org/article/pmc/3982014
- Ashwell M. Stevia, Nature’s Zero-Calorie Sustainable Sweetener. Nutr Today [Internet]. 2015 [cited 12 April 2022];50(3):129-134. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890837/
- Ingredients, Additives, GRAS & Packaging Guidance & Regulatory Info [Internet]. U.S. Food and Drug Administration. [cited 12 April 2022]. Available from: https://www.fda.gov/food/guidance-documents-regulatory-information-topic-food-and-dietary-supplements/ingredients-additives-gras-packaging-guidance-documents-regulatory-information
- What Is an Acceptable Daily Intake (ADI)? [Internet]. Eufic.org. 2021 [cited 12 April 2022]. Available from: https://www.eufic.org/en/understanding-science/article/qas-on-acceptable-daily-intakes-adis
- Lohner S, Toews I, Meerpohl J. Health Outcomes of Non-Nutritive Sweeteners: Analysis of the Research Landscape. Nutrition Journal [Internet]. 2017 [cited 12 April 2022];16(1). Available from: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0278-x#Sec21
- Pang M, Goossens G, Blaak E. The Impact of Artificial Sweeteners on Body Weight Control and Glucose Homeostasis. Front Nutr [Internet]. 2021 [cited 12 April 2022];. Available from: https://www.frontiersin.org/articles/10.3389/fnut.2020.598340/full#h6
- Chee W, Binti Mohd Yusof B, Lee L. Medical Nutrition Therapy Guidelines for Type 2 Diabetes Mellitus. 2nd ed. Malaysian Dietitians’ Association; 2013.
- Bernardo W, Simoes R, Buzzini R. Adverse Effects of the Consumption of Artificial Sweeteners – Systematic Review. Rev Assoc Med Bras [Internet]. 2016 [cited 12 April 2022];62(2). Available from: https://www.scielo.br/j/ramb/a/DL6rf3bY8kYDk7wNsjJCGNx/?lang=en
- Artificial Sweeteners and Cancer [Internet]. National Cancer Institute. 2016 [cited 12 April 2022]. Available from: https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet
