Artificial sweeteners and other sugar substitutes

Whether your goal is cutting calories or eating healthier, sugar substitutes abound. Understand the pros and cons to make an informed choice.

If you're trying to reduce the sugar and calories in your diet, you may be turning to artificial sweeteners or other sugar substitutes. You aren't alone.

Today artificial sweeteners and other sugar substitutes are found in a variety of food and beverages marketed as "sugar-free" or "diet," including soft drinks, chewing gum, jellies, baked goods, candy, fruit juice, and ice cream and yogurt.

Just what are all these sweeteners? And what's their role in your diet?

Understanding artificial sweeteners and other sugar substitutes

Sugar substitutes are loosely considered any sweetener that you use instead of regular table sugar (sucrose). Artificial sweeteners are just one type of sugar substitute. The chart lists some popular sugar substitutes and how they're commonly categorized.

Artificial sweeteners	Sugar alcohols	Novel sweeteners	Natural sweeteners
Acesulfame potassium (Sunett, Sweet One)	Erythritol	Stevia extracts (Pure Via, Truvia)	Agave nectar
Aspartame (Equal, NutraSweet)	Hydrogenated starch hydrolysate	Tagatose (Naturlose)	Date sugar
Neotame	Isomalt	Trehalose	Fruit juice concentrate
Saccharin (SugarTwin, Sweet'N Low)	Lactitol		Honey
Sucralose (Splenda)	Maltitol		Maple syrup
	Mannitol		Molasses
	Sorbitol
	Xylitol

The topic of sugar substitutes can be confusing. One problem is that the terminology is often open to interpretation. For instance, some manufacturers call their sweeteners "natural" even though they're processed or refined, as is the case with stevia preparations. And some artificial sweeteners are derived from naturally occurring substances — sucralose comes from sugar, for example.

Regardless of how they're classified, sugar substitutes aren't magic bullets for weight loss. Take a closer look.

Artificial sweeteners

Artificial sweeteners are synthetic sugar substitutes but may be derived from naturally occurring substances, including herbs or sugar itself. Artificial sweeteners are also known as intense sweeteners because they are many times sweeter than regular sugar.

Uses for artificial sweeteners

Artificial sweeteners are attractive alternatives to sugar because they add virtually no calories to your diet. In addition, you need only a fraction compared with the amount of sugar you would normally use for sweetness.

Artificial sweeteners are widely used in processed foods, including baked goods, soft drinks, powdered drink mixes, candy, puddings, canned foods, jams and jellies, dairy products, and scores of other foods and beverages.

Artificial sweeteners are also popular for home use. Some can even be used in baking or cooking. Certain recipes may need modification, though, because artificial sweeteners provide no bulk or volume, as does sugar. Check the labels on artificial sweeteners for appropriate home use.

Some artificial sweeteners may leave an aftertaste. You may need to experiment with artificial sweeteners to find one or a combination that you enjoy most.

Possible health benefits of artificial sweeteners

One benefit of artificial sweeteners is that they don't contribute to tooth decay and cavities. They may also help with the following:

·         Weight control. One of the most appealing aspects of artificial sweeteners is that they are non-nutritive — they have virtually no calories. In contrast, each gram of regular table sugar contains 4 calories. A teaspoon of sugar is about 4 grams. For perspective, consider that one 12-ounce can of a sweetened cola contains 8 teaspoons of added sugar, or about 130 calories. If you're trying to lose weight or prevent weight gain, products sweetened with artificial sweeteners rather than with higher calorie table sugar may be an attractive option. On the other hand, some research has suggested that consuming artificial sweeteners may be associated with increased weight, but the cause is not yet known.

·         Diabetes. Artificial sweeteners may be a good alternative to sugar if you have diabetes. Unlike sugar, artificial sweeteners generally don't raise blood sugar levels because they are not carbohydrates. But because of concerns about how sugar substitutes are labeled and categorized, always check with your doctor or dietitian about using any sugar substitutes if you have diabetes.

Possible health concerns with artificial sweeteners

Artificial sweeteners have been the subject of intense scrutiny for decades. Critics of artificial sweeteners say that they cause a variety of health problems, including cancer. That's largely because of studies dating to the 1970s that linked saccharin to bladder cancer in laboratory rats. Because of those studies, saccharin once carried a warning label that it may be hazardous to your health.

But 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 U.S. cause cancer or other serious health problems. And numerous research studies confirm that artificial sweeteners are generally safe in limited quantities, even for pregnant women. As a result of the newer studies, the warning label for saccharin was dropped.

Artificial sweeteners are regulated by the Food and Drug Administration (FDA) as food additives. They must be reviewed and approved by the FDA before being made available for sale. In some cases, the FDA declares a substance "generally recognized as safe" (GRAS). These GRAS substances, including highly refined stevia preparations, are deemed by qualified professionals based on scientific data as being safe for their intended use, or they have such a lengthy history of common use in food that they're considered generally safe and don't require FDA approval before sale.

The FDA has also established an acceptable daily intake (ADI) for each artificial sweetener. This is the maximum amount considered safe to consume each day over the course of your lifetime. ADIs are intended to be about 100 times less than the smallest amount that might cause health concerns.

Sugar alcohols and novel sweeteners

Sugar alcohols (polyols) are carbohydrates that occur naturally in certain fruits and vegetables, but they also can be manufactured. They're not considered intense sweeteners, because they aren't sweeter than sugar. In fact, some are less sweet than sugar. As with artificial sweeteners, the FDA regulates the use of sugar alcohols.

Sugar alcohols aren't considered noncaloric or non-nutritive sweeteners because they contain calories. But they're lower in calories than is regular sugar, making them an attractive alternative. Despite their name, sugar alcohols aren't alcoholic. They don't contain ethanol, which is found in alcoholic beverages.

Novel sweeteners are combinations of various types of sweeteners. Novel sweeteners, such as stevia, are hard to fit into one particular category because of what they're made from and how they're made. Note that although the FDA has approved highly refined stevia preparations as a novel sweetener, it has not approved whole-leaf stevia or crude stevia extracts for this use.

Tagatose and trehalose are considered novel sweeteners because of their chemical structure. They're categorized by the FDA as GRAS substances. Tagatose is a low-carbohydrate sweetener similar to fructose that occurs naturally but is also manufactured from lactose in dairy products. Foods containing tagatose can't be labeled as "sugar-free." Trehalose is found naturally in mushrooms.

Uses for sugar alcohols

Sugar alcohols generally aren't used when you prepare food at home. Rather, they are found in many processed foods and other products, including chocolate, candy, frozen desserts, chewing gum, toothpaste, mouthwash, baked goods and fruit spreads, usually replacing sugar on an equal basis.

When added to foods, sugar alcohols add sweetness, bulk and texture. They also help food stay moist, prevent browning when heated and add a cooling sensation to products.

Sugar alcohols are often combined with artificial sweeteners to enhance sweetness. Check the food label to help see if a product contains sugar alcohols. Food labels may list the specific name, such as xylitol, or simply use the general term "sugar alcohol."

Possible health benefits of sugar alcohols

One benefit of sugar alcohols is that they don't contribute to tooth decay and cavities. They may also help with the following:

·         Weight control. Sugar alcohols are considered nutritive sweeteners because they contribute calories to your diet. Still, sugar alcohols have fewer calories than does regular sugar — about 2 calories per gram on average. This means that sugar alcohols can be considered lower calorie sweeteners, and they may aid weight-control efforts.

·         Diabetes. Unlike artificial sweeteners, sugar alcohols can raise blood sugar levels because they're carbohydrates. But because your body doesn't completely absorb sugar alcohols, their effect on blood sugar is less than that of other sugars. Different sugar alcohols can affect blood sugar differently. You can consume sugar alcohols if you have diabetes, but you still must pay attention to the total amount of carbohydrates in your meals and snacks. Talk to your doctor or dietitian for guidance.

Possible health concerns with sugar alcohols

As with artificial sweeteners, the FDA regulates sugar alcohols as food additives. Sugar alcohols used in U.S. manufactured food generally have GRAS status.

There are few health concerns associated with sugar alcohols. When eaten in large amounts, usually more than 50 grams but sometimes as little as 10 grams, sugar alcohols can have a laxative effect, causing bloating, intestinal gas and diarrhea. Product labels may carry a warning about this potential laxative effect.

Natural sweeteners

Natural sweeteners are sugar substitutes that are often promoted as healthier options than processed table sugar or other sugar substitutes. But even these so-called natural sweeteners often undergo processing and refining, including agave nectar.

Among the natural sweeteners that the FDA recognizes as being generally safe for consumption are fruit juices and nectars, honey, molasses, and maple syrup.

Uses for natural sweeteners

Natural sweeteners have a variety of uses both at home and in processed foods. They are sometimes known as added sugars because they're added to foods during processing. They may be used to sweeten drinks such as tea and cocktails, in desserts, as pancake and waffle toppings, on cereals, and for baking, for example.

Possible health benefits of natural sweeteners

Although natural sugar substitutes may seem healthier than processed table sugar, their vitamin and mineral content isn't significantly different from that of sugar. Honey and sugar, for instance, are nutritionally similar, and both end up in your body as glucose and fructose. Choose a natural sweetener based on how it tastes and its uses, rather than on its health claims.

Possible health concerns with natural sweeteners

So-called natural sweeteners are generally safe. But there's no health advantage to consuming added sugar of any type. And consuming too much added sugar, even natural sweeteners, can lead to health problems such as tooth decay, poor nutrition, weight gain and increased triglycerides. Also, be aware that honey can contain small amounts of bacterial spores that can produce botulism toxin. Because of that, honey shouldn't be given to children less than 1 year old.

Moderation is key with sugar substitutes

When choosing sugar substitutes, it pays to be a savvy consumer. Get informed and look beyond the hype. While artificial sweeteners and sugar substitutes may help with weight management, they aren't a magic bullet and should be used only in moderation.

Just because a food is marketed as sugar-free doesn't mean it's free of calories. If you eat too many sugar-free foods, you can still gain weight if they have other ingredients that contain calories. And remember that processed foods, which often contain sugar substitutes, generally don't offer the same health benefits as do whole foods, such as fruits and vegetables.

Do you know how much sugar is in your diet? See why added sugar is a concern and how you can cut back.

By Mayo Clinic staff

If you're like many people, you may be eating and drinking more sugar than you realize because it's added to so many foods and beverages. That added sugar means added calories.

Some experts also suspect there's a relationship between added sugars and obesity, diabetes and heart disease, but this view is controversial.

Does that mean you can or should avoid added sugar? Not necessarily. Read on to learn more about added sugar, including where it's most commonly found.

A few facts about sugar

All sugar, whether natural or processed, is a type of simple carbohydrate that your body uses for energy. Fruits, vegetables and dairy foods all naturally contain sugar.

"Added sugar" refers to sugars and syrups added to foods during processing. Desserts, sodas, and energy and sports drinks are the top sources of added sugar for most Americans.

Why is sugar added to so many foods?

Sweetness has an almost universal appeal. So adding sugar to processed foods makes them more appetizing. But sugar is also added to foods because it:

·         Boosts flavor

·         Gives baked goods texture and color

·         Helps preserve foods, such as jams and jellies

·         Fuels fermentation, which enables bread to rise

·         Serves as a bulking agent in baked goods and ice cream

·         Balances the acidity of foods containing vinegar and tomatoes

Why is added sugar a problem?

Foods with a lot of added sugar contribute extra calories to your diet but provide little nutritional value. In addition, added sugar is often found in foods that also contain solid fats.

Eating too many foods with added sugar and solid fats sets the stage for potential health problems, such as:

·         Poor nutrition. If you fill up on foods laden with added sugar, you may skimp on nutritious foods, which means you could miss out on important nutrients, vitamins and minerals. Regular soda plays an especially big role. It's easy to fill up on sweetened soft drinks and skip low-fat milk and even water — giving you lots of extra sugar and calories and no other nutritional value.

·         Weight gain. There's usually no single cause for being overweight or obese. But added sugar may contribute to the problem. Many foods and beverages contain lots of sugar, making them more calorie-dense. When you eat foods that are sugar sweetened, it is easier to consume more calories than if the foods are unsweetened.

·         Increased triglycerides. Triglycerides are a type of fat in the bloodstream and fat tissue. Eating an excessive amount of added sugar can increase triglyceride levels, which may increase your risk of heart disease.

·         Tooth decay. All forms of sugar promote tooth decay by allowing bacteria to proliferate and grow. The more often and longer you snack on foods and beverages with either natural sugar or added sugar, the more likely you are to develop cavities, especially if you don't practice good oral hygiene.

Recommendations regarding added sugar

In the 2010 Dietary Guidelines for Americans, the U.S. Department of Agriculture (USDA) recommends that no more than about 5 to 15 percent of your total daily calories come from added sugar and solid fats.

The American Heart Association has even more-specific guidelines for added sugar — no more than 100 calories a day from added sugar for most women and no more than 150 calories a day for most men. That's about 6 teaspoons of added sugar for women and 9 for men.

Unfortunately, most Americans get more than 22 teaspoons — or 355 calories — of added sugar a day, which far exceeds these recommendations.

Recognizing added sugar

Identifying added sugar can be confusing. Most people look at the Nutrition Facts part of the label for the total number of grams of sugar in a serving of the product. It's important to realize, however, that the amount shown includes natural sugars found in certain ingredients, such as grain, fruit and milk. The only reliable way to identify added sugar is to look at the ingredient list.

Ingredients are listed in descending order by weight. If you see sugar listed among the first few ingredients, the product is likely to be high in added sugar. Know that sugar goes by many different names, though.

Different names for added sugar

Sugar goes by many different names, depending on its source and how it was made. This can also make it hard to identify added sugar, even when you read ingredient lists and food labels.

Check for ingredients ending in "ose" — that's the chemical name for many types of sugar, such as fructose, glucose, maltose and dextrose. Here's a list of other common types of added sugar:

·         Cane juice and cane syrup

·         Corn sweeteners and high-fructose corn syrup

·         Fruit juice concentrate and nectars

·         Honey

·         Malt syrup

·         Molasses

Despite what you may have heard, there's no nutritional advantage for honey, brown sugar, fruit juice concentrate or other types of sugar over white sugar.

How to reduce added sugar in your diet

To reduce the added sugar in your diet, try these tips:

·         Drink water or other calorie-free drinks instead of sugary, nondiet sodas or sports drinks. That goes for blended coffee drinks, too.

·         When you drink fruit juice, make sure it's 100 percent fruit juice — not juice drinks that have added sugar. Better yet, eat the fruit rather than juice.

·         Choose breakfast cereals carefully. Although healthy breakfast cereals can contain added sugar to make them more appealing to children, plan to skip the non-nutritious, sugary and frosted cereals.

·         Opt for reduced-sugar varieties of syrups, jams, jellies and preserves. Use other condiments sparingly. Salad dressings and ketchup have added sugar.

·         Choose fresh fruit for dessert instead of cakes, cookies, pies, ice cream and other sweets.

·         Buy canned fruit packed in water or juice, not syrup.

·         Snack on vegetables, fruits, low-fat cheese, whole-grain crackers and low-fat, low-calorie yogurt instead of candy, pastries and cookies.

The final analysis

By limiting the amount of added sugar in your diet, you can cut calories without compromising on nutrition. In fact, cutting back on foods with added sugar and solid fats may make it easier to get the nutrients you need without exceeding your calorie goal.

Take this easy first step: Next time you're tempted to reach for a soda or other sugary drink, grab a glass of ice-cold water instead.