In the last decade, sugar has become the #1 enemy of all dieters. No matter if you are on ketogenic, paleo, vegan, vegetarian, low carbohydrate, low fat, low calories,etc., all these diets have one thing in common: Sugar is bad for you. This movement has create space in the food industry for a new product: artificial sweeteners! In this article we will dive deep on popular sugar alternatives and find out if they are better for your health.
What are artificial sweeteners?
Let's start with a definition. Artificial sweeteners (we will refer to as AS during this article) are also known as sugar alternative, sugar substitute, low calorie sweetener, no calorie sweetener, non-nutritive sweetener or high intensity sweeteners. They are considered food additives that provide sweet taste with no (or very low) calories. They also have no impact on blood sugar levels and can either be partially digestible or not digestible.
Are they regulated?
Yes! Because they are considered a food additive, they need to be regulated by Health Canada (Food and Drugs Act and Regulation). Health Canada has the responsibility to protect consumers and therefore assess the safety and dosage of the different food additives.
Health Canada will come up with an acceptable daily intake (ADI) which is based on animal studies. Studies will determine the dose at which a food additive causes any health issues and then divide it by 100 to get the ADI. This ensure that if you follow the ADI, you should not have any undesired health consequences.
Dose at which rats get any health issues / 100 = ADI
In Canada, there are many approved artificial sweeteners, such as:
Let's go through the most popular AS.
Aspartame is the most used AS worldwide with approximately 16 000 tons used every year world wide . Some brand names you may recognize are NutraSweet® or Equal®. Aspartame is about 200 times sweeter than sucrose, therefore you require a very small quantity to have the same sweet taste. Aspartame is mostly used in diet soft drinks. This AS is metabolized in the small intestine, and provides 4 calories/g. Aspartame is not heat stable, and not a good cooking ingredient.
Aspartame is constituted of 2 amino acids (aspartic acid and phenylalanine) and a methanol. It was thought in the past that aspartame could be toxic it contains methanol (which can be toxic in high amounts). However, the amount of methanol in aspartame is lower than in many natural foods such as fruit juice and is very unlikely going to lead to methanol toxicity. (Actually only one case of methanol toxicity was reported and the man in question consumed 12 LITERS of juice in a day..... a little excessive!)
In Canada, the ADI for aspartame is 40mg/kg/day. So for example someone who weights 75 kg (165lbs) the ADI would be 3000mg/day which would be equivalent to 24 cans of diet coke... so as you can tell, the acceptable daily intake is pretty high and hard to achieve (unless you go through 24 cans of diet soft drink!!)
Acesulfame-K also known as Ace-K, is an artificial sweetener that is 200 times sweeter than sugar (same as aspartame). Some brand names you may recognize are Sunnett® and Sweet One®. This AS is not metabolized by the body (therefore offers no calories). Ace-K is heat stable and can be used for food preparation and baking.
The ADI for Ace-K is 15mg/kg/day. This may seem low however Ace-K is rarely used on it's own, and usually paired with sucralose.
This AS used in over 100 countries worldwide. In 1970, saccharin was de-listed as a safe food additive in Canada on the basis that it could be a carcinogenic in lab rats. It wasn't until 2016 that saccharin was re-listed as a safe food additive as studies revealed that the carcinogenic effects in lab rats was not relevant to humans. (I thought this was important to mention, as sometimes we fear foods and tend to associate cancer with everything (#ThanksSocialMedia).. In this case, Health Canada did their due diligence, assessed studies and decided to remove a product from market until further studies came out. To me this creates a sense of trust and knowing that Health Canada has our back!)
Saccharin, also known as Sweet'N Low® is 300 times sweeter than sugar. It is heat stable (good for cooking). Saccharin is not metabolized by our body, so again there not provide any calories. The ADI is 5mg/kg/day, which again is lower however as it has a higher sweetening taste, you require less to have the desired taste.
Sugar alcohols are a family of AS that include, but not limited to : Lactitol, Xylitol, Maltitol, and Sorbitol. To recognize them look for names finishing in "ol". Despite the name "sugar alcohols", these AS will not get you tipsy! The name is based on the chemical compound -OH in every molecule.
They are partially adsorbed in small intestine (therefore provide some calories). These are mostly found in gum, sugar free candies and treats. Sugar alcohols should be limited to 10g/day as too much can lead to urgent visits to the washroom (i.e. diarrhea). Xylitol has been shown to increase saliva excretion and can be beneficial for individual with dry mouths (such as cancer patients).
Sucralose is an AS that is 600 times as sweet as sugar (the most sweet of all AS). Sucralose most known brand name is Splenda®. It is partially metabolized in the small intestine and provide some calories. Sucralose is also heat stable which makes it good for cooking. The ADI is 9 mg/kg/day.
Stevia is a natural sugar from the plant Stevia Rebaudiana Bertoni. The sweetening agent from the plant is compound known as steviol glycosides. Stevia is 200-300 times sweeter than sugar. Stevia is metabolized in the intestine and therefore provides calories. Stevia can be used for cooking however it has a distinct taste and can alter taste of baked goods.
Stevia leaf is not considered to be a food additive but a food ingredient and therefore there is no set limitation by Health Canada. However, purified stevia extract is regulated as a food additive. The ADI for stevia is 4 mg/kg/day.
Monk Fruit Extract
Monk fruit also know as Swigle fruit is native from China. Monk fruit sweeteners come from the juice from the fruit which can be in liquid from (extract) or be dehydrated to have powder form. Monk fruit sweetener provides zero calories and is 150-200 times sweeter than sugar. This AS is also heat stable and can be used for cooking. Just like stevia, monk fruit sweeteners have a particular taste and can alter taste of baked good.
In Canada, Monk fruit sweeteners have been approved for table top sweeteners (so you can buy as an ingredient) but not yet approved to be used in food industry as sweetener (which means you will not find it prepared foods such as diet drinks, candies, pastries, etc.), As of now, there is no ADI established for monk fruit sweeteners as no health issues have been demonstrated in animal studies (even in high doses).
What are the side effects of using artificial sweeteners?
Studies are controversial on this subject. Some studies report increase food intake following consumption of AS consumption while other studies show no effect. One review also report that aspartame may have lowering effect on appetite.
Takeaway: AS impacts different people differently. Listen to your body. If you consume AS, notice your hunger for the rest of the day. Are you more hungry? Less hungry? Same as always?
Increased Risk of Cancer?
Studies are controversial. For urinary track and bladder cancer, 11 case-control studies found association with AS however 20 other studies did not. Another study on breast cancer survivors demonstrated that most survivors vs non survivors consumed less AS.
Take away: Based on current evidence, we cannot link cancer to AS consumption
Chronic Kidney Disease
Most studies are based on lab rats. In these studies, a correlation was found between aspartame and kidney dysfunction. Also, in these studies, the amount of aspartame given is not representative a normal consumption. However, human studies have not been able to reproduce these results. A 2014 litterature review concluded that consuming AS does not increase risk of chronic kidney disease.
Take away: Based on current evidence, we cannot link chronic kidney disease to AS consumption
AS have been correlated with less cavities. Sugar alcohol in particular compared to sugar increase pH in mouth which can lead to less cavities.
Take away: AS consumption compared to sugar leads to less cavities
Another tip, brush your teeth after eating sugar!!
Increased Risk of Type 2 Diabetes
Studies reported increased risk of type 2 diabetes when consuming AS. In animal and human studies, saccharin was correlated with glucose intolerance. Another 2016
Take away: Evidence support increased risk of type 2 diabetes with consumption of AS.
In adult studies, results are controversial (some participant lost weight, others gained). In pediatric studies, consumption of AS did not lead to weight gain.
So the question is: Should you use AS or just regular sugar?
This is a question I get often when talking about artificial sweeteners. And the answer is: (drrrrrum rolllll) it depends. AS can be a good tool if you are trying to reduce sugar consumption. Most North Americans tend to over consume sugar so sugar alternatives are a great way to reduce consumption while enjoying sweets. If you are a diabetic trying to control blood sugar- AS can also be a great tool. If you are in good health and have a balanced diet with limited added sugar there is no need to use sugar substitute. However, sugar alternative IS NOT an alternative to a healthy diet. Also- BE THE EXPERT OF YOUR BODY. Meaning, if you have AS and you have adverse effects- don't have it. If you have some once in a while and enjoy it, have it!
Children under the age of 2 years old should not consume AS.
Children (over 2 years old) are at higher risk of consuming too much AS. This is due to their smaller size (easier to reach ADI) and their food choices.
Women who are pregnant should limit or restrict AS during pregnancy- Stevia and Monkfruit have not shown any adverse effect in pregnancy.
With the decline in reputation of sugar, many of us turn to artificial sweeteners to get that sweet taste we crave. As we read in this article, there are many different AS available for us to choose from. Although more studies are needed to clarify long term effects on our health and eating behaviours, as of now evidence supports the safe use of these AS (as long as you respect ADI). AS can be a tool to help manage blood sugar and decrease sugar consumption but does not remplace a healthy balanced diet.
Questions? Comments? Don't hesitate to reach out!
Marie-Pier Pitre-D'Iorio, RD, B.Sc.Psychology
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