Weight Loss

Sugar Substitutes- Do They Cause Health Concerns?

In an effort to appeal to the health-conscious consumer, food companies often use artificial sugars or sugar substitutes to sweeten their products. Many of the sweeteners provide flavor with hardly any (if any at all) caloric addition to the food, making them a great way to cut calories. But, critics of sugar substitutes say that they cause a variety of health problems. Today we’ll explore the different sugar substitutes and how they may impact your health.

Types of sugar substitutes

There are a variety of sugar substitutes widely used in products today. They range from natural sweeteners to those that are artificial (although may be derived from natural components). Keep in mind that while sugar substitutes may provide a way to enjoy sweet items with fewer calories, some people do experience negative side-effects from consuming the ingredients. Symptoms can range from headaches, digestive issues, mood changes, and even dizziness. It all depends on your sensitivity to such ingredients; if you find yourself feeling a little “off” after consuming something with sugar substitutes, reduce your intake and work with your provider to better understand what may be the underlying cause of the symptoms. For some, the sensitivity can be more serious (as with those that have certain metabolic disorders), and specific artificial sweeteners must be avoided altogether.

When companies add a sugar alternative to a product, it can be any of several types. The most common are:

Natural sweeteners

These include honey, molasses, maple syrup, coconut sugar, agave nectar, date sugar, among other possibilities. Natural sugar substitutes may seem healthier than sugar, but their vitamin and mineral content isn’t significantly different. For example, honey and sugar are nutritionally similar, and your body processes both into glucose and fructose. When it comes to using a natural sweetener, there isn’t much of a benefit other than flavor preference.

Sugar alcohols

Naturally found in fruits and vegetables, sugar alcohols can also be manufactured. Some variations include mannitol (similar in taste/flavor to sugar), sorbitol (commonly found in sugar-free foods and drinks), xylitol (often found in chewing gums), erythritol, lactitol, isomalt, maltitol and hydrogenated starch hydrolysates (HSH). Sugar alcohols are not commonly used in home food preparation, but are found in many processed foods. Sugar alcohols do contain calories, but fewer than regular sugar.

For people with metabolic syndrome, prediabetes or diabetes, sugar alcohols, except perhaps maltitol, can be considered excellent alternatives to sugar because of their low glycemic index meaning they raise blood sugar levels minimally.

The downside? Some people may experience digestive sensitivity with gas, bloating, and diarrhea resulting from consuming sugar alcohols. If you have irritable bowel syndrome (IBS) or a sensitivity to FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides And Polyols- short chain carbohydrates that are poorly absorbed in the small intestine), you may want to consider avoiding sugar alcohols completely.

Novel sweeteners

Novel sweeteners are hard to fit into a category because of what they’re made from and how they’re made. Stevia is an example. The FDA has approved highly refined stevia preparations as novel sweeteners but hasn’t approved whole-leaf stevia or crude stevia extracts for this use.

Tagatose is also considered a novel sweetener because of its chemical structure. Tagatose is a low-carbohydrate sweetener similar to fructose that occurs naturally but is manufactured from the lactose in dairy products. The FDA categorizes tagatose as a GRAS (generally recognized as safe) substance.

Artificial sweeteners

Artificial sweeteners are synthetic sugar substitutes. But they may be derived from naturally occurring substances, such as herbs or sugar itself. Artificial sweeteners are also known as intense sweeteners because they are many times sweeter than sugar. Artificial sugars add almost no calories to foods and you only need a small amount of the sweetener to gain the same impact as sugar.

The list of FDA-approved artificial sweeteners includes:

  • Acesulfame potassium (Ace-K)
  • Advantame
  • Aspartame
  • Neotame
  • Saccharin
  • Luo Han Guo fruit extracts
  • High-purity steviol glycosides (Stevia rebaudiana)
  • Sucralose

Are artificial sweeteners safe?

You may be surprised to see saccharin on the list of FDA approved artificial sweeteners. Discovered in 1879, saccharin — which is 300 times sweeter than sugar — was used during World War I and World War II to make up for sugar shortages and rationing. In the 1970s, the FDA was going to ban saccharin based on the reports of a Canadian study that showed that saccharin was causing bladder cancer in rats. A public outcry kept saccharin on the shelves (there were no other sugar substitutes at that time), but with a warning label that read, “Use of this product may be hazardous to your health. This product contains saccharin which has been determined to cause cancer in laboratory animals.”

That warning label is no longer needed, says Ruth Kava, PhD, RD, director of nutrition for the American Council on Science and Health. Further research has shown that male rats have a particular pH factor that predisposes them to bladder cancer. What may be true for male rats does not necessarily hold true for humans (or even for female rats); hence, no more warning labels for saccharin. “A lot of things that cause harm in animals don’t always cause harm in humans,” she says.

According to the National Cancer Institute and other health agencies, there’s no sound scientific evidence that any of the artificial sweeteners approved for use in the United States cause cancer or other serious health problems. Numerous studies confirm that artificial sweeteners are generally safe in limited quantities, even for pregnant women. As a result, the warning label for saccharin was dropped.

It’s not all good news

The American Heart Association (AHA) and American Diabetes Association (ADA) have given a cautious nod to the use of sugar substitutes in place of sugar to combat obesity, metabolic syndrome, and diabetes, all risk factors for heart disease.

Sugar substitutes are typically far more potent than table sugar and high-fructose corn syrup. A small amount produces a sweet taste comparable to that of sugar, without the calories. But, over stimulation of sugar receptors from frequent use of these sweeteners may limit tolerance for more complex tastes, researchers say. That means people who routinely use substitutes may start to find less intensely sweet foods, such as fruit, unappealing and less sweet foods, such as vegetables won’t seem appealing at all.

This is less than ideal if you’re turning away from healthy foods that provide nutritional value you need. Fruits and veggies are high in nutrients, low in glycemic load, and high in fiber, while also providing a bit of natural sugar. All those factors benefit our health. Artificial sugars increase blood glucose levels, cause inflammation and free radicals, and can increase the risk for serious health concerns like diabetes and cardiovascular disease.

Sugar substitutes may also prevent us from associating sweetness with caloric intake, leading us to crave more sweets and potentially gain weight. Participants in the San Antonio Heart Study who drank more than 21 diet drinks per week were twice as likely to become overweight or obese as people who didn’t drink diet soda.

To top it all off, it has also been discovered that sweeteners alter your gut microbiota, sometimes leading to glucose intolerance, and an increased risk for diabetes. Healthy bacteria within the gut is targeted as “food” for unhealthy bacteria, leading to an imbalance of bacteria due to some sweeteners not being absorbed. This can wreak havoc on your body- as you’ll read here, where we discuss the importance of gut health.

Take into account that not all this information is gloom and doom when it comes to sugar substitutes. The FDA regulates the safety of sugar substitutes with a goal of making sure that the amounts typically consumed are not harmful for the general population, taking into account daily intake over an individual’s lifetime. Monitor your body’s reaction when consuming sugar substitutes and make adjustments as needed (speak to your provider about any concerns).

Whether a sugar substitute or “regular” sugar, please keep in mind that sugar intake should be limited. Daily intake should not exceed 9 teaspoons for men, 6 teaspoons for women, and less than 6 teaspoons for kids. Higher levels can impact general wellness, including a higher risk of diabetes, higher blood pressure, inflammation, weight gain, increased pain, and fatty liver disease. All these factors are linked to an increased risk for heart attack and stroke. In moderation (and with provider guidance), sugar and sugar substitutes may be enjoyed without risk to your health.










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