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Artificial Sweetener : Our Friend or Foe?

Image: Tetra Images/Getty Images

What is Artificial Sweetener?

Artificial sweeteners are also known as non-nutritive sweetener which provides no or a few calories per gram, with intense sweetness as compared to sugar. They are increasingly popular as an alternative to sugar as they are calorie-free, have less impact on blood sugar levels, and do not promote tooth decay. The common food sources of artificial sweeteners are chewing gum, diet soda and in “sugar-free” and “no sugar added” products.

In general, they are considered safe for consumption because they are not metabolized in the body. The United States Food and Drug Administration (US-FDA) authority has approved six artificial sweeteners, including saccharine, aspartame, sucralose, neotame, acesulfame-K, and stevia for use in humans and has classified them under generally recognized as safe (GRAS) category.

#1 Is Artificial Sweetener a Healthy Option in Weight Management and Blood Sugar Control?

Dietitian: When consumed within daily acceptable limit, artificial sweetener may be a helpful tool in managing weight and blood glucose level by limiting carbohydrate and energy intake. However, the evidence for health effects due to the use of artificial sweeteners is conflicting. Potential harms from the consumption of artificial sweeteners could not be excluded.

#2 Is Artificial Sweetener Suitable for Diabetic Patients?

Dietitian: Diabetic patients may consider artificial sweeter as sugar replacement in short term period for blood glucose control and they are advised to consume artificial sweeteners in minimal amount. They should not rely on artificial sweetener in the long-run. Research has found that long-term use might pose harmful effects among diabetic patients. They are encouraged to reduce sugar intake gradually as our taste buds can get adjusted and adapted for less sweetness as time goes. Besides, diabetic patients are recommended to include 2 exchanges of fruits in your daily intake as it provides natural sweetness, and dietary fibre which helps in blood sugar control.

#3 Who Should Not Take Artificial Sweeteners?

Dietitian: Aspartame breaks down into phenylalanine on digestion. Therefore, people with phenylketonuria (PKU) cannot take aspartame because their body cannot break down the amino acid phenylalanine, and eventually the accumulation of phenylalanine causes toxicity to brain tissue.

Table 1: A Summary Report from the Center of Science in the Public Interest on the Levels of Safety of Different Artificial Sweeteners

Sweetener

Brand / Type that available in Malaysia

Comments

Aspartame

Equal, Pal Sweet

Caloric Value: 4 kcal/g
Status: Probably Safe.

-The Acceptable Daily Intake (ADI) for diabetics who want to take the aspartame is 50mg/kg.

- Some user reported of headaches after consuming. People with PKU (phenylketonuria) should avoid aspartame. It is used in many food items, especially beverages and snacks

Stevia

EverSweet

Caloric Value: 0 kcal/g

Status: Inadequately tested.

FDA granted stevia a GRAS status in December 2008. However it is not approved in Canada.

The problem with stevia is there is not enough studies to conclude whether taking it in a large amount from food would be safe or not. Here’s what troubles the toxicologists:

Reproductive problems.

Stevioside “seems to affect the male reproductive organ system,” European scientists concluded last year. When male rats were fed high doses of stevioside for 22 months, sperm production was reduced, the weight of seminal vesicles (which produce seminal fluid) declined, and there was an increase in cell proliferation in their testicles, which could cause infertility or other problems.1 And when female hamsters were fed large amounts of a derivative of stevioside called steviol, they had fewer and smaller offspring.2 Would small amounts of stevia also cause reproductive problems? This has yet to be determined.

Cancer.

In the laboratory, steviol can be converted into a mutagenic compound, which may promote cancer by causing mutations in the cells’ genetic material (DNA). “We don’t know if the conversion of stevioside to steviol to a mutagen happens in humans,” says Huxtable. “It’s probably a minor issue, but it clearly needs to be resolved.”

Energy metabolism.

Very large amounts of stevioside can interfere with the absorption of carbohydrates in animals and disrupt the conversion of food into energy within cells. “This may be of particular concern for children,” says Huxtable.

The bottom line: If you use stevia sparingly (once or twice a day in a cup of tea, for example), it isn’t a great threat to you. But if stevia were marketed widely and used in diet sodas, it would be consumed by millions of people. And that might pose a public health threat.

Sucralose

Splenda

Caloric Value: 0 kcal/g

Status: Safe

The Acceptable Daily Intake (ADI) is 9mg/kg body weight per day

Sucralose has undergone many scientific studies and been deemed safe for use in lots of different food items. You can find sucralose in snacks, baked goods, ice cream, and even in pharmaceutical products.

Source: Malaysian Dietitian’s Association. (2013). Medical Nutrition Therapy Guidelines for Type 2 Diabetes Mellitus (2nd ed). Malaysia: Malaysian Dietitian’s Association.

 

Take Home Message

In general, artificial sweeteners are safe to consume within the acceptable daily intake levels. However, large scale of clinical studies is warranted due to their invalidated benefits. Consumers especially those with diseases are encourage to consult dietitians or nutritionists before taking artificial sweeteners in order to assess the overall individual benefits and risks. Last but not least, it is important to read the food labels when buying a product. Do remember that sugar free doesn’t mean calorie or carbohydrate free, and it still may be high in fat, saturated fat, or salt.

 

References:

Artificial Sweeteners [Image](n.d.). Retrieved June 16, 2020, from https://www.theguardian.com/society/2017/sep/14/artificial-sweeteners-raise-risk-of-type-2-diabetes-study-suggests#img-1

Diekman, C. (2012, September). Sweeteners: Facts and Fallacies — Learn the Truth About the Different Types of Sweeteners to Better Counsel Patients. Today’s Dietitian, 14(9), 42. Retrieved June 16, 2020, from https://www.todaysdietitian.com/newarchives/090112p42.shtml

Ingrid,T., Szimonetta, L., de Gaudry Daniela, K., Harriet, S., & Joerg J, M. (2019). Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ, 364 :k4718. doi: https://doi.org/10.1136/bmj.k4718

Mahan, L.K., Escott-Stump, S., & Raymond, J.L. (2012). Krause’s Food and the Nutrition Care Process (13th Edtiion), Philedelphia: W.B. Sounders Company.

Malaysian Dietitian’s Association. (2013). Medical Nutrition Therapy Guidelines for Type 2 Diabetes Mellitus (2nd ed). Malaysia: Malaysian Dietitian’s Association.

Malaysian Dietitian’s Association. (n.d). Artificial Sweeteners: Friend or Foe? Retrieved June 16, 2020, from http://www.dietitians.org.my/health-info/artificial-sweeteners-friend-or-foe

Schaeffer, J. (n.d) E-News Exclusive: Artificial Sweeteners. Retrieved June 16, 2020, from https://www.todaysdietitian.com/enewsletter/enews_0713_01.shtml

Sharma, A., Amarnath, S., Thulasimani, M., & Ramaswamy, S. (2016). Artificial sweeteners as a sugar substitute: Are they really safe? Indian Journal of Pharmacology, 48(3), 237–240. doi: 10.4103/0253-7613.182888