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Most people associate sweetness with happiness, good times and good food. In fact, the average American goes so far as to consume an estimated 20 teaspoons of sugar each day.
However, sweet foods can quickly add up to excess calories, which, if not expended by the body, are stored in the muscle or liver as fat.
For many people with diabetes, artificial sweeteners open up an exciting array of choices and options involving foods that may otherwise be considered too difficult to work into a healthy meal plan. Artificial sweeteners can significantly lower the carbohydrate content of foods, sweeten calorie-free beverages and provide a replacement for sugar in many recipes.
A Low-Calorie Option
In trying to avoid too many calories or carbohydrates, we turn to artificial sweeteners as an excellent calorie- and sucrose-free way to add sweetness back to foods—especially desserts. According to a 1998 survey by the Calorie Control Council, 144 million Americans regularly consume artificially sweetened products in various forms every day.
Numerous alternative and artificial sweeteners are currently available. Despite their number and widespread use, however, controversy about their safety seems to be a recurring question.
The U.S. Food and Drug Administration (FDA) has currently approved five artificial sweeteners—saccharin, aspartame, acesulfame K, sucralose and neotame (approved in July 2002)—for use in a variety of foods. At least two other sweeteners are under review.
Back to the Beginning
Saccharin—which is 300 times sweeter than sugar and is sold under the trade names Sweet 'n Low and Sugar Twin—was the first artificial sweetener.
Discovered in 1879 at Johns Hopkins University by chemistry research assistant Constantine Fahlberg, it derives its name from the Latin "saccharum" (meaning "sugar"). Saccharin was used only sporadically as a sweetener until World War I, when sugar rationing helped to dramatically increase its popularity. Saccharin use continued its upward trend during World War II and afterward.
In 1960, however, a study suggested that saccharin caused bladder cancer in rats. The FDA reacted by limiting the product's use. An immediate public uproar ensued because saccharin was the only artificial sweetener on the market at the time.
The FDA even considered banning saccharin in 1977, although Congress eventually placed a moratorium on the ban to allow more research. For a long time, however, products containing saccharin carried a label stating that saccharin caused cancer in laboratory animals.
Numerous studies conducted since 1977 have demonstrated that saccharin does not cause cancer in humans in doses that people normally consume. On December 15, 2000, Congress passed legislation to remove the label that had been required on saccharin-sweetened foods since 1977. The National Toxicity Program has also removed saccharin from its list of cancer-causing substances.
Aspartame Enters the Market
Aspartame—which is 180 to 200 times sweeter than sugar and is sold under the trade names Equal and Nutra-Sweet—was discovered by James Schlatter in 1965 when he noticed the sweet taste of a compound he had created while working on new drugs to treat ulcers.
In 1981, the FDA approved aspartame for use as a tabletop sweetener and in powdered mixes. In 1996, it was approved for use in all foods and beverages.
Of all the artificial sweeteners, aspartame has come under the most scrutiny. To date, the FDA has received thousands of complaints involving multiple symptoms—from headaches, dizziness and nausea to seizures and memory loss—allegedly related to the use of aspartame. Hard-liners who oppose aspartame insist that it is causing a rise in multiple sclerosis, brain tumors, systemic lupus erythematosus, migraine headaches and Alzheimer's disease as a result of its overuse in multiple product lines.
Marion Franz, MS, RD, CDE, wrote in Diabetes Health("Is Aspartame Dangerous?" August 2002, p. 72) that many organizations, including the Multiple Sclerosis Foundation, the Fibromyalgia Wellness Letter and the American Diabetes Association, have made public statements refuting these claims. She adds that "in 2001, the journal Regulatory Toxicology and Pharmacology published an evaluation of aspartame's use and safety since its approval...This evaluation, which cited extensive scientific research investigating various allegations, reported that no causal relationship between aspartame and adverse effects had been found."
The American Diabetes Association stated its position on February 9, 1999: "The American Diabetes Association considers aspartame—as well as the other FDA-approved nonnutritive sweeteners saccharin, acesulfame K, and sucralose—acceptable sugar substitutes and a safe part of a diabetic meal plan."
Other organizations, such as the American Medical Association and the American Dietetic Association, agree and endorse the use of these products for people on weight loss diets and those diagnosed with diabetes.
All agree, however, that there is a small segment of the population who should avoid aspartame: those who have a rare inherited disease called phenylketonuria (PKU). People with PKU lack the enzyme that converts the phenylalanine in foods to tyrosine. The body's inability to break down and metabolize this by-product of aspartame—or any other food containing phenylalanine—causes developmental disabilities. An estimated one in 16,000 people is sensitive to phenylalanine. People with this condition are aware that they have it; routine screening to detect the condition is done at birth in the United States.
Two other approved sweeteners, acesulfame potassium (K) and sucralose, receive less attention than some of the other products.
The first, acesulfame K—sold under the trade names Sunett, Sweet One and DiabetiSweet—was approved in 1998 as a tabletop sweetener but is now widely used in baked goods, frozen desserts, candy and beverages.
Many studies have been conducted to verify the safety of acesulfame K. It is about 200 times sweeter than sugar, is calorie-free and is now contained in an estimated 4,000 products. This sweetener has an excellent shelf life and does not break down when heated. It has been approved for use in 90 countries and has been found to be safe for all segments of the population. Products that contain it are not required to carry warning labels.
Sucralose—also known as Splenda—appears to be the most intense sweetener currently on the market, more than 600 times sweeter than sugar.
Sucralose was discovered in 1976 and was approved for use in 1998 as a tabletop sweetener and in baked goods, nonalcoholic beverages, gum and various other products. The manufacturer of sucralose claims that it tastes more like sugar because it originates from regular table sugar. Because sucralose is so sweet, it is bulked up with the starchy powder maltodextrin, so that it can be measured like sugar. Because sucralose cannot be digested, it adds no calories to food, nor does it affect blood-glucose levels, which allows people with diabetes to use it safely.
Products containing sucralose are not required to carry any warning labels.
The newest sweetener, neotame, was approved by the FDA in July 2002 for use in a variety of products, including baked goods, soft drinks, jams and jellies, and frozen products. It is estimated to be 7,000 to 13,000 times sweeter than sugar, depending on how it is used in food.
Moderation Is Key
Although sugar substitutes have a long history of controversy, the Calorie Control Council observes that Americans are continually searching for good-tasting, low-calorie products as a part of a healthy lifestyle. Sugar substitutes can be a part of a beneficial overall diet plan.
However, as with any other diet plan or regimen, moderation appears to be key. Artificial sweeteners are not magic foods that will melt pounds away or instantly lower blood glucose, but they can be used in combination with other health guidelines and a meal plan that lowers weight and blood-glucose levels.
How Much Should We Consume? Acceptable Daily Intakes
Amid the flurry of questions and accusations concerning artificial sweeteners, you might wonder how much of these products you can eat and still be safe.
The FDA has set what is called an Acceptable Daily Intake (ADI) level for all sweeteners it considers safe. ADI is defined as the amount of a food additive that can be safely consumed on a daily basis over a person's lifetime without any adverse effects. This determination, made by the FDA, includes a 100-fold safety factor. The ADI is the equivalent of 81 packets of Equal or 15 cans of diet soda (180 fluid ounces).
A breakdown of the ADI for each sweetener follows. The ADI applies to everyone, with or without diabetes. To convert kilograms (kg) to pounds, take your weight in pounds and divide by 2.2.
Do Sugar Alcohols Count?
Although technically not artificial sweeteners, sugar alcohols get a quick mention because they do not typically cause a quick rise in blood-glucose levels.
These types of lower-calorie options include sorbitol, xylitol, lactitol, mannitol and maltitol. They can be found in candy, cookies and chewing gums.
Clinical adviser's note: Sugar alcohols may cause diarrhea—especially in children. In addition, although the sugar alcohols are lower in calories than the sugars fructose, sucrose or glucose, consuming products that contain sugar alcohols rarely results in lower daily calorie intake or improvement in long-term blood-glucose levels, according to the 2000 Evidence-Based Nutrition Principles and Recommendations position statement of the American Diabetes Association.
Still Wanting In - Two Sweeteners Trying to Make Their Case With the FDA
Two artificial sweeteners currently under review by the FDA are alimate and cyclamate.
Alimate, whose manufacturer submitted a petition for approval in 1986, is considered 2,000 times sweeter than sugar and could potentially be used in baked goods, beverages and confections. Research has not found it to be a carcinogenic agent or the cause of any reproductive problems. A green light is expected soon from the FDA.
Cyclamate, discovered in 1937 at the University of Illinois, encountered the same problems as saccharin when it was blamed for bladder cancer in rats. Although cyclamate was banned in the United States in 1969, the FDA is currently reconsidering its position because the product has produced no ill effects in humans after multiple studies. In 1982, the Cancer Assessment Committee of the FDA reviewed scientific evidence and determined that cyclamate is not carcinogenic. The National Academy of Sciences reaffirmed this in 1985.
Another sweetener, stevia, has become widely used as an alternative to the approved sweeteners on the market. Stevia is derived from a shrub and can impart a sweet taste to foods. The FDA considers stevia an unapproved sweetener, and it cannot be sold labeled as a sweetener.
"The safety of stevia has been questioned by published studies," says Martha Peiperl, a consumer safety officer in the FDA's Office of Premarket Approval. "And no one has ever provided the FDA with adequate evidence that the substance is safe."
Under provisions of 1994 legislation, stevia can be sold as a "dietary supplement," though it cannot be promoted as a sweetener.
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