Sugar Substitutes: Are They As Sweet As They Seem?

What are sugar substitutes?

By: Tayla Carter, MS, LDN, Registered Dietitian (RD) at the Signature Healthcare Outpatient Nutrition Clinic

Sugar substitutes, or non-nutritive sweeteners (NNS), are artificial or naturally occurring substances that are used to sweeten food and beverage products, without adding sugar, and contain little to no calories. These sweeteners are often found in products labeled as “sugar-free,” “diet,” or “keto,” and are popular choices for people who have diabetes or are trying to lose weight to help reduce excess sugar and calories in the diet. Some of these sweeteners are also much sweeter than sugar, which means smaller amounts are required to sweeten a food or beverage item.

https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food#:~:text=Other%20Types%20of%20Sweeteners%20Allowed,mannitol%2C%20erythritol%2C%20and%20maltitol.

There are several sweeteners approved for use in the United States, including artificial sweeteners such as aspartame, acesulfame potassium (Ace-K), and saccharin, sugar alcohols such as sorbitol, xylitol, mannitol, and erythritol, and plant derived NNS including Stevia and Monk fruit extract. All of these sweeteners have been approved for use by the Food and Drug Administration (FDA), or are considered to be Generally Recognized as Safe (GRAS) by the FDA. The FDA also sets an accepted daily intake (ADI) for each sweetener. Sounds sweet, right?

Well, you may have seen recent headlines warning against potentially harmful effects of popular artificial sweeteners such as erythritol and aspartame, but before you panic and start obsessing over labels and ingredients lists of your favorite products, let’s take a closer look at what the research actually says about some of these sweeteners that have made headlines lately.

Erythritol

Erythritol is a type of sugar alcohol. This sweetener is naturally occurring in some fruits and vegetables in very small amounts, produced by the human body during glucose metabolism, and used as an additive in many diet and sugar-free products, in much larger amounts than naturally occurring erythritol. For example, Truvia is a stevia blend sweetener that contains erythritol. A recent NIH-funded study examined the relationship between erythritol and heart attacks and stroke. A study with more than 1,000 participants found that elevated levels of erythritol in the blood were associated with risk for cardiovascular events, as it is suggested by the research the high levels of erythritol increase blood clotting. However, it is important to note that correlation does not equal causation. Erythritol is still approved by the FDA, but more research is needed to better understand the possible link between this sweetener and cardiovascular risk.

Aspartame

Aspartame has been used in the United States since the early 80’s. The sweetener is found in the brand name sweetener, Equal, and many diet sodas, such as Diet Coke. The International Agency for Research on Cancer (IARC), a cancer research agency of the World Health Organization (WHO) recently labeled aspartame as “possibly carcinogenic to humans”. According to cancer.org, the Joint FAO/WHO Expert Committee on Food Additives (JECFA) is a committee tasked with the role of evaluating the safety of food additives. After completing a dietary exposure assessment, JECFA has concluded that “the evidence of an association between aspartame consumption and cancer in humans is not convincing”, and that current estimates of human dietary consumption do not pose a concern for health and disease risk. Substances classified as “possibly carcinogenic to humans” are “generally used either when there is limited, but not convincing, evidence for cancer in humans, or when there is convincing evidence for cancer in lab animals, but not both”.

In conclusion, it seems that there is more research needed about the long-term effects of these sweeteners and their association with disease risk. If you have concerns about possible health risks of these ingredients, feel free to limit or avoid them. However, if there are products you enjoy that contain erythritol, aspartame, or another sugar substitute that are helping you reach your health goals such as reducing sugar intake, maintaining healthy blood sugar levels, or maintaining a healthy weight, then you may choose to continue to consume them in moderation. Lastly, it is best to look past the headlines, which can often be misleading and lead to unnecessary fear. Instead, consider consulting a Registered Dietitian or doctor, who can help you interpret the ever-changing research in the world of nutrition.