Artificial Sweeteners: Good or Bad?

Artificial sweeteners, also called sugar substitutes, are just about everywhere:  inside packets sold at grocery stores or freely available on restaurant tables and in a multitude of diet drinks, baked goods, frozen desserts and even chewing gum.

Promoted primarily as an option for weight management, these compounds provide the sweetness of sugar without the calories. Sugar-free foods were originally manufactured for diabetics since they result in a reduced spike in glucose levels, compared to their sugar-rich counterparts. Sugar substitutes are anywhere from 200 to 700 times sweeter than actual sugar.

But many studies have raised questions as to the health risks of artificial sweeteners. So consumers are left asking: “Am I better off with regular sugar?”

A recent study found that diets high in saccharin, an artificial sweetener, causes changes in mice and people that could lead to obesity or type 2 diabetes. The sweetener altered microbes in the gut, thereby impairing the body’s ability to process glucose, or blood sugar, researchers say. Other sweeteners could cause similar glucose-intolerance problems that can lead to diabetes, studies have reported.

But no study has established a cause-and-effect relationship between artificial sweeteners and diabetes or “prediabetes.” About one-third of Americans have prediabetes, also known as “impaired glucose tolerance,” which carries an increased risk for developing type 2 diabetes. The National Cancer Institute and other health agencies have not found sound scientific evidence linking artificial sweeteners approved for use in the U.S. to serious health problems.

Sugar-Free Drinks and Your Taste Buds
While some “sugar-free” beverages contain artificial sweeteners and produce zero calories, they still tell your taste buds that you prefer a sweeter taste, says registered dietitian Natalie Castro, chief wellness dietitian for Baptist Health.

“Help your taste buds adapt to needing less sweetness,” Castro says. “Train yourself to want less-sweetened options.”

When it comes to these products, dietitians caution that it’s always best to reduce regular sugar intake and not rely too much on the fake stuff.

“Even though sugar substitutes are considered safe, you’re better off with simply less of the real stuff (sugar) than a lot of the fake stuff,” says Cathy Clark-Reyes, R.D., a dietitian with Baptist Health Primary Care. “Cut back on sugary drinks by choosing infused water, for example, with slices of lemon or oranges in the water bottle. There are healthy alternatives that don’t involve fake sugar.”

Some individuals don’t react well to drinking too many sodas with artificial sweeteners, Clark-Reyes says. Because these sugar substitutes are often combined with “sugar alcohols,” there can be gastrointestinal side effects, such as bloating or diarrhea. Sugar alcohols are carbohydrates that occur naturally in certain fruits and vegetables, but they also can be manufactured. They are also approved by the FDA.

Diabetics Warned About ‘Sugar-Free’ Labels
The American Diabetes Association (ADA) says that artificial sweeteners can help diabetics control their cravings for something sweet—but only to a degree. These sugar substitutes should be carefully integrated into well-balanced diets, the ADA says.

The ADA’s biggest cautionary note about sugar substitutes is to warn diabetes that even foods labeled “sugar-free” will derive other calories and carbohydrates from other ingredients. Diabetics are advised to control overall carbohydrate intake.

“That means foods that carry claims like ‘sugar-free,’ ‘reduced sugar’ or ‘no sugar added’ are not necessarily carbohydrate-free or lower in carbohydrate than the original version of the food,” the ADA says. “Always check the nutrition facts panel, even for foods that carry these claims.”

Eating these foods made with artificial sweeteners on a regular basis is not recommended, Castro said. “Instead, practice eating a healthy nutritiously balanced diet that focuses on portion control and consuming less sweetened foods, snacks, desserts and beverages,” she said.

Despite studies questioning the effects of sugar substitutes on glucose-tolerance, the U.S. Food and Drug Administration has tested and approved the most commonly used artificial sweeteners, including: aspartame (Nutrasweet, Equal); saccharin (Sweet ‘N Low); sucralose (Splenda) and Stevia/Rebaudioside A (Truvia).

Diabetics have to be very cautious when it comes to so-called “sugar-free” foods, says Ms. Clark-Reyes.

“You’ve got to be educated about these supposed diabetic-friendly foods,” says Ms. Clark-Reyes. “You can consume a lot of these foods, but they still contain carbs. And they may not be that filling, so some people can tend to overeat and derail weight-loss goals or healthy sugar levels.”

Impact on Weight Management
Dietitians advice those on weight-management plans to limit artificial-sweetened foods and drinks partly because they can have a psychological component. If you drink a diet soda, for example, you may be more likely to consider eating something sweet or fattening later on.

Some studies have shown that shifting from sugar-sweetened beverages to zero-calorie artificially sweetened drinks may prevent weight gain, or help in weight loss. But other studies have suggested the reverse. A recent study from Johns Hopkins University found that overweight and obese adults who drank diet soda ate the same amount of calories as heavy adults who consumed sugar-sweetened beverages.

“Sugar-free products may still have calories that can result in eating extra calories,” says Castro. “An excess caloric intake can lead to weight gain which can lead to increase risks for developing diabetes, obesity, chronic diseases and even cancer.”

Here are basic facts about the most commonly available, FDA-approved artificial sweeteners, according to the National Institutes of Health (NIH).

Aspartame (Equal and NutraSweet):

  • A combination of two amino acids — phenylalanine and aspartic acid.
  • 220 times sweeter than sugar.
  • Can be added to food at the table.
  • Sucralose (Splenda):

  • 600 times sweeter than sugar.
  • Used in many diet foods and drinks, chewing gum, frozen dairy desserts, fruit juices, and gelatin.
  • Can be added to food at the table.
  • Can be used in cooking and baking.  Splenda Sugar Blend options are available for better baking results.
  • Saccharin (Sweet ‘N Low, Sweet Twin, NectaSweet):

  • 200 to 700 times sweeter than sugar.
  • Used in many diet foods and drinks.
  • Not used in cooking and baking.
  • Stevia (Truvia, Pure Via, Sun Crystals):

  • Non-caloric plant-based sweetener.
  •  Made from the plant Stevia rebaudiana, which is grown for its sweet leaves.
  •  Common names include sweetleaf, sweet leaf, sugarleaf, or simply stevia.
  •  Rebaudiana extract is approved as a food additive. It is considered a dietary supplement.
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