Artificial Sweeteners

Definition

Artificial sweeteners, which are also called sugar substitutes, alternative sweeteners, or non-sugar sweeteners, are substances used to replace sugar in foods and beverages. They can be divided into two large groups: nutritive sweeteners, which add some energy value (calories) to food; and nonnutritive sweeteners, which are also called high-intensity sweeteners because they are used in very small quantities and add no energy value to food. Nutritive sweeteners include the natural sugars—sucrose (table sugar; a compound of glucose and fructose), fructose (found in fruit as well as table sugar), and galactose (milk sugar)—as well as the polyols, which area group of carbohydrate compounds that are not sugars but provide about half the calories of the natural sugars. The polyols are sometimes called sugar replacers, sugar-free sweeteners, sugar alcohols, or novel sugars. Polyols occur naturally in plants but can also be produced commercially. They include such compounds as sorbitol, mannitol, xylitol, and hydrogenated starch hydrolysates.

FDA-approved artificial sweeteners

Sweetener

Times sweeter than sugar

Calories

Brand name(s)

aspartame

200

4 kcal/g

Nutrasweet and Equal

saccharin

200-700

0

Sweet'N Low, Twin, and Necta Sweet

acesulfame-K (potassium)

200

0

Sunett and Sweet

One

neotame

7,000-13,000

0

Neotame

sucralose

600

0

Splenda

Advantame

20,000

0

Advantame (Has no brand name)

SOURCE: Food and Drug Administration. “Additional Information about High-Intensity Sweeteners Permitted for Use in Food in the United States.” U.S. Department of Health and Human Services. https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm (accessed April 2, 2018).

Nonnutritive sweeteners are synthetic compounds that range between 160 and 13,000 times as sweet as sucrose, which is the standard for the measurement of sweetness. There are five nonnutritive sweeteners approved by the Food and Drug Administration (FDA) for use in the United States. They are saccharin, aspartame, acesulfame potassium (or acesulfame-K), sucralose, and neotame. There are other nonnutritive sweeteners that have been approved for use elsewhere in the world by the Scientific Committee on Food (SCF) of the European Commission, the Joint Expert Committee of Food Additions (JECFA) of the United Nations Food and Agricultural Organization, and the World Health Organization (WHO) but have not been approved by the FDA. These substances are alitame, cyclamate, neohesperidine dihydrochalcone, stevia, and thaumatin.

KEY TERMS
Acceptable daily intake level (ADI)—
The level of a substance that a person can consume every day over a lifetime without risk. The ADIs for artificial sweeteners are very conservative measurements.
Carcinogen—
A substance or other agent that causes cancer. Some artificial sweeteners have been banned in the United States and elsewhere on the grounds that they may be carcinogens.
Excipient—
An inert substance, such as certain gums or starches, used to make drugs easier to take by allowing them to be formulated into tablets or liquids. Some artificial sweeteners are used as excipients.
Food additive—
Defined by the Federal Food, Drug, and Cosmetic Act (FD&C) of 1938 as “any substance, the intended use of which results directly or indirectly, in its becoming a component or otherwise affecting the characteristics of food.”
Fructose—
A simple sugar that occurs naturally in sucrose and fruit. It can be added in combination with sucrose in the form of high-fructose corn syrup (HFCS) to sweeten foods because it is sweeter than sucrose. Large amounts of fructose can cause diarrhea in infants and young children.
Generally recognized as safe (GRAS)—
A phrase used by the federal government to refer to exceptions to the FD&C Act of 1938 as modified by the Food Additives Amendment of 1958. Sweeteners that have a scientific consensus on their safety, based on either their use prior to 1958 or to well-known scientific information, may be given GRAS status.
Gulf war syndrome (GWS)—
A disorder characterized by a wide range of symptoms, including skin rashes, migraine headaches, chronic fatigue, arthritis, and muscle cramps, possibly related to military service in the Persian Gulf war of 1991. GWS was briefly attributed to the troops' high consumption of beverages containing aspartame, but this explanation has been discredited.
High-intensity sweetener—
Another term for nonnutritive sweetener, used because these substances add sweetness to food with very little volume.
Nonnutritive sweetener—
Any sweetener that offers little or no energy value when added to food.
Nutritive sweetener—
Any sweetener that adds some energy value to food.
Phenylketonuria (PKU)—
A rare inherited metabolic disorder resulting in accumulation of phenylalanine, an amino acid, in the body. It can lead to intellectual disability and seizures. People with PKU should not use products containing the artificial sweetener aspartame because it is broken down into phenylalanine (and other products) during digestion.
Sucrose—
The natural sweetener commonly used as table sugar; sucrose is a compound of two simple sugars, glucose and fructose. It is used as the standard for measuring the sweetening power of high-intensity artificial sweeteners.

The FDA asks the following questions in evaluating a proposed new sweetener as a food additive:

Purpose

Artificial sweeteners are used in food products for several reasons: to lower the calorie content of soda pop and other sweetened drinks and foods as part of weight reduction and weight maintenance diets; to assist patients with diabetes in controlling blood sugar levels more effectively; and to lower the risk of tooth decay (e.g., in chewing gum). They are also added as excipients (inert substances used to make drugs easier to take in tablet or liquid form) to some prescription medications to disguise unpleasant tastes because they do not react with the active drug ingredients as natural sugars sometimes do. Sorbitol and mannitol are commonly added to toothpaste, mouthwash, breath mints, cough drops, cough syrups, sugarless gum, over-the-counter liquid antacids, and similar personal oral care products to add bulk to the product's texture as well as minimize the risk of tooth decay.

In addition to adding a sweet flavor, artificial sweeteners are also used in the manufacture of baked goods, beverages, syrups, and other food products to improve texture, add bulk, retard spoilage, or as part of a fermentation process. The polyols in particular are used to retard spoilage because they do not support the growth of mold or bacteria to the same extent as natural sugars.

Description

Nonnutritive sweeteners approved by the FDA

There are seven nonnutritive sweeteners approved by the FDA for use in the United States:

Nonnutritive sweeteners not approved for use in the United States

Precautions

Artificial sweeteners are generally regarded as safe when used appropriately. The official position of the Academy of Nutrition and Dietetics is that nutritive and nonnutritive sweeteners are safe as long as they are consumed in moderation and a person's overall diet follows the current federation recommendations for nutrition.

The Institute of Medicine (IOM) maintains measurements of acceptable daily intake (ADI) levels for artificial sweeteners approved for use in the United States. The ADI is a regulatory definition that is often misunderstood. It is a very conservative estimate of the amount of a sweetener that can be safely consumed on a daily basis over the course of a person's lifetime. The ADI is not intended to be used as a specific point at which safe use ends and health risks begin, as occasional use of an artificial sweetener over the ADI is not of concern. To use aspartame as an example, its ADI is 50 mg per kilogram of body weight per day. An adult weighing 150 lb. (68 kg) would have to drink 20 12-oz. (.35-L) containers of diet soft drink containing aspartame, eat 42 servings of gelatin, or use 97 packets of tabletop sweetener to reach the ADI.

Some specific artificial sweeteners must be used cautiously by certain groups of people:

Interactions

There are no known interactions with prescription drugs caused by the use of nutritive or nonnutritive sweeteners. As was noted above, some nonnutritive sweeteners are considered useful excipients for medications precisely because they are chemically inert.

Parental concerns

There have been concerns expressed about the use of artificial sweeteners by children because children consume more sweeteners, both nutritive and nonnutritive, per 1 lb. (.45 kg) of body weight on a daily basis than adults. The use of fruit juice and other sweet beverages by children has greatly increased since the 1980s; however, studies indicate that even children who drink large amounts of diet soda and other beverages usually remain well below the ADI levels for aspartame and other nonnutritive sweeteners. The chief risk to children's digestive health is fructose, which is found in such popular children's drinks as apple juice. Fructose is incompletely digested by children below the age of 18 months and may cause diarrhea in older children. Children diagnosed with nonspecific diarrhea may benefit from being given smaller amounts of fruit juice to drink.

During the early 1990s, some researchers identified a possible connection between high levels of aspartame consumption and attention-deficit hyperactivity disorder (ADHD) in children. Two studies published in 1994 in Pediatrics and the New England Journal of Medicine respectively, however, found no connection between aspartame and ADHD, even when the children were given 10 times the normal daily amount of aspartame. Aspartame and other nonnutritive sweeteners, however, may have an additive effect on nerve cell development when they are combined with food colorings. This possibility was suggested by a 2006 study of laboratory mice in the United Kingdom, but the implications for humans are far from clear.

QUESTIONS TO ASK YOUR DOCTOR
  • What artificial sweeteners are safest to add to my diet?
  • What are the reactions and allergies associated with artificial sweeteners?
  • How can using artificial sweeteners in my diet help with my diabetes and other health concerns?
  • What are the effects of artificial sweeteners on conditions like glucose intolerance?
  • Are artificial sweeteners addictive?

High intake of sweeteners added to food is of greatest concern during adolescence. As people age, they generally lower their intake of calories from added sugars. Fewer than 10% of adults over age 50 derive more than 25% of their daily calories from sugars, which is the maximal intake value established by the IOM. Nearly one-third of adolescent females exceed this level, however, with almost one-third of the extra sugar intake coming from carbonated beverages sweetened with high-fructose corn syrup. Although the rise in obesity in children and adolescents is a complex problem that cannot be attributed to a single factor, preliminary studies suggest that nonnutritive sweeteners may be useful in reducing adolescents' consumption of drinks sweetened with HFCS.

See also Food additives ; Hyperactivity ; Obesity ; Sugar ; Sugar tax .

Resources

BOOKS

Nabors, Lyn O'Brien, ed. Alternative Sweeteners. 4th ed. Boca Raton, FL: CRC Press, 2012.

Peñ a, Carolyn Thomas de la. Empty Pleasures: The Story of Artificial Sweeteners from Saccharin to Splenda. Chapel Hill: University of North Carolina Press, 2010.

PERIODICALS

Lau, K., et al. “Synergistic Interactions between Commonly Used Food Additives in a Developmental Neurotoxicity Test.” Toxicological Sciences 90, no. 1 (March 2006): 178–87.

Shaywitz, B. A., et al. “Aspartame, Behavior, and Cognitive Function in Children with Attention Deficit Disorder.” Pediatrics 93, no. 1 (January 1994): 70–75.

Wax, Paul M. “Elixirs, Diluents, and the Passage of the 1938 Federal Food, Drug, and Cosmetic Act.” Annals of Internal Medicine 122, no. 6 (March 15, 1995): 456–461. http://www.annals.org/cgi/content/full/122/6/456 (accessed April 24, 2018).

Whitehouse, C. R., J. Boullata, and L. A. McCauley. “The Potential Toxicity of Artificial Sweeteners.” American Association of Occupational Health Nurses Journal 56, no. 6 (2008): 251–59.

Wolraich, Mark L., et al. “Effects of Diets High in Sucrose or Aspartame on the Behavior and Cognitive Performance of Children.” New England Journal of Medicine 330 (February 3, 1994): 301–7.

Yang, Quing. “Gain Weight by ‘Going Diet?’ Artificial Sweeteners and the Neurobiology of Sugar Cravings: Neuroscience 2010.” Yale Journal of Biology and Medicine 83, no. 2 (2010): 101–8.

WEBSITES

Mayo Clinic staff. “Artificial Sweeteners: Understanding These and Other Sugar Substitutes.” https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthyeating/in-depth/artificial-sweeteners/art-20046936 (accessed April 24, 2018).

National Cancer Institute. “Artificial Sweeteners and Cancer.” http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners (accessed April 24, 2018).

U.S. Food and Drug Administration. “Generally Recognized as Safe (GRAS).” https://www.fda.gov/food/ingredientspackaginglabeling/gras/default.htm (accessed April 24, 2018).

ORGANIZATIONS

Academy of Nutrition and Dietetics, 120 South Riverside Plz., Ste. 2000, Chicago, IL, 60606-6995, (312) 899-0040, (800) 877-1600, amacmunn@eatright.org, http://www.eatright.org .

Dietitians of Canada, 480 University Ave., Ste. 604, Toronto, Ontario, Canada, M5G 1V2, (416) 596-0857, Fax: (416) 596-0603, centralinfo@dietitians.ca, http://www.dietitians.ca .

National Cancer Institute, 6116 Executive Blvd., Ste. 300, Bethesda, MD, 20892-8322, (800) 4-CANCER (4226237), http://www.cancer.gov .

U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, 20993-0002, (888) INFO-FDA (463-6332), http://www.fda.gov .

Rebecca J. Frey, PhD

  This information is not a tool for self-diagnosis or a substitute for professional care.