Paging Dr. Frischer: Artificial Sweeteners
Years ago, soft drink companies developed so-called “healthy” alternatives to sugary drinks…by using artificial sweeteners. Since then, a significant number of studies have concluded that artificial sweeteners are no better than sugar, and in many cases much worse. What is the current thinking?
There are three types of artificial sweeteners: synthetic sweeteners, plant-based sweeteners and sugar alcohols. They are very concentrated, up to 600 times more concentrated than table sugar. They have virtually no calories, and don’t directly affect our blood sugar levels. They don’t even enter our bloodstream, but stay in the digestive tract until they exit the bowels. In addition to soft drinks, they are found in frozen desserts, candies, yogurt, baked goods, chewing gum, breakfast cereals, gelatins, puddings, and more. Products may claim to be “sugar-free,” “reduced sugar,” or to have “no added sugar.”
Synthetic sugar substitutes approved by the U.S. Food and Drug Administration (FDA) include:
· Aspartame (Equal, NutraSweet)
· Saccharine (Sweet ’N Low)
· Sucralose (Splenda)
· Neotame (Newtame)
· Acesulfame K (Sunett, Sweet One)
Plant-based sweeteners include Stevia, extracted from the stevia plant and heavily processed. It is 200 to 400 times sweeter than table sugar and has no carbohydrates, calories, or artificial ingredients. It does not directly affect blood sugar levels. However, it does have a negative effect on stomach bacteria, possibly leading to gas and bloating. It may raise the risk of heart attack and stroke, because it is often mixed with erythritol. It might actually stimulate appetite. Monk fruit can be used in dried or liquid form. It is up to 250 times sweeter than sugar. Like stevia, monk fruit has no calories, carbohydrates, or sugar. It is costly and not always easy to locate, and its flavor, texture, and aftertaste are different from that of sugar. Thaumatin is a no calorie protein from the West African katemfe fruit. It has been used in drinks, gums, and cereals. It is valued for heat stability and ability to mask bitterness. It is up to 2,000 times sweeter than sugar.
The FDA also allows the use of sugar alcohols, such as sorbitol, xylitol and mannitol.
What are some of their advantages of artificial sweeteners?
Blood sugar: They don’t raise the level of sugar in the blood because they are not carbohydrates.
Dental health: Artificial sweeteners don’t cause tooth decay and cavities. They have no carbohydrates to ferment, so bacteria in our mouths cannot feed on them, produce acids, and break down our enamel.
Fewer calories: Sugar substitutes often have very few or no calories.
And what are some disadvantages?
Sense of taste: Because they are sweeter than sugar, our taste buds get accustomed to the sweetness. More natural foods such as fresh fruits and sweet vegetables no longer taste as sweet.
Gut flora: The balance of good bacteria in the gut, known as the gut microbiome, can be altered by long-term use, leading to the development of glucose intolerance.
Digestion: Some sugar substitutes, including sugar alcohols, can cause bloating, gas and diarrhea in large quantities.
Do they cause cancer? Aspartame has been labelled as possibly carcinogenic to humans by the International Agency for research on Cancer (IARC), but the FDA disagrees with this, and the official position is that no link has been found between artificial sweeteners and cancer. However, long-term use has been linked to a higher risk of heart disease, type 2 diabetes, and stroke.
Artificial sweeteners certainly can help to cut calories and support weight loss when used in moderation, especially as a substitute for sugar-sweetened drinks. Although research is mixed, sugar remains more strongly linked to weight gain and metabolic issues than do artificial sweeteners.
Still, whole foods and balanced habits are the most reliable approach for long-term health. Please don’t rely on artificial sweeteners. A healthy diet is all about moderation and making informed choices. I urge you to read nutrition labels, monitor overall sugar intake, be mindful of cravings, stay hydrated, and to focus on whole, unprocessed foods.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 10927 Downey Ave., Suite C, Downey, CA 90241.