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Sunday
Sep202009

Non-Calorie Sweeteners: Pros and Cons

Written by Tom Nikkola - Director of Nutrition & Weight Management

The use of sugar and sugar alternatives is one of the most debated areas of nutrition today. It is also an area of significant confusion. More of the population today understands the negative impact of consuming excess sugar, whether it is in the form of high-fructose corn syrup, sucrose, or other "natural" sugars. One alternative is nonnutritive sweeteners (NNS). In considering the use of nonnutritive sweeteners, people are confronted with very opposing viewpoints. To make this even more complicated, there are several different NNS to choose from. In the first post on this subject, we looked at whether NNS use has been shown to increase appetite. In the second one, we looked at the evidence behind whether NNS support weight loss. Today, we'll take a look at the four most common nonnutritive sweeteners - aspartame, saccharin, acesulfame-K and sucralose. There are many others, such as stevia and various sugar alcohols. Those may be topics for another day.

How much can we use?

The FDA has established acceptable daily intake amounts for NNS. The current ADI equivalents for NNS are as follows:

  • Aspartame: 18-19 cans of diet cola
  • Saccharin: 9-12 packets of sweetener
  • Acesulfame-K: 30-32 cans of diet lemon-lime soda
  • Sucralose: 6 cans of diet soda

Does this mean that consuming more than these amounts in a single day will cause problems? No. It means the above is the average daily amount that can be consumed, according to current research and not result in complications for the average population. On an individual level, some people may not handle one of the above NNS at all. In this case, they should completely avoid that NNS. It would be the same recommendation if someone had a severe peanut allergy. They should stay away from any peanut consumption. But that does not mean the rest of the population needs to refrain from eating peanuts. As we look at some of the concerns around the various NNS below, this is an important point to consider. Every person has a unique metabolism and may be sensitive to any number of ingredients in our food supply, natural or processed/man-made. If someone finds they respond poorly to a NNS, they should avoid it, but it does not mean their friends need to.

Diet soda is not the only place NNS are found, but non-calorie/low-calorie beverages are where the most NNS are consumed by the population. In diet drinks, it is common to find only one of the NNS used. The most commonly used NNS in diet drinks is aspartame. As we'll see below, aspartame also has more question marks surrounding it than the other NNS, which is why diet drinks are so often called into question.

In foods and pre-made mixes, more than one NNS is often used. A combination such as Sucralose and Ace-K provides a more natural-tasting sweetness to a product, and significantly reduces the amount of either one used in a product because of the synergistic effect of the two sweeteners.

Pros and Cons of NNS

Many of the health concerns related to NNS have come from anecdotal reports, which have not yet been proven through research. Some of the perceptions of NNS have been shaped by the food industry as well. As an example, when sucralose (Splenda) came onto the market, the sugar industry was quick to cast doubt on the product, as it had an interest in avoiding the decreased use of sugar. To complicate research conclusions, much of the research on NNS has favored the party funding the research. When research has been done by a NNS company, the research has provided positive results. When research has been done by other parties more interested in showing negative effects of NNS use, the results have more often been negative. Much of the disagreement about NNS stems from the fact that the NNS requires a man-made process to create the product. If NNS were produced by nature, it is not likely there would be such strong opposition.

The most common reported occurrence with the use of some NNS is headaches. Because each NNS is different, if the use of one NNS causes headaches, it should not be concluded that all NNS use causes headaches for an individual. According to anecdotal reports, aspartame seems to have more negative observations associated with it than other NNS. In looking at the messages to the public about the use of NNS, some of the points of view are quite extreme. If more research in the future paints a different, conclusive picture on any of the NNS below, we'll be sure to share that. Below is a brief summary of the four main nonnutritive sweeteners.

Aspartame

Aspartame is commonly sold under the brand name "Nutrasweet." Headaches are the most commonly discussed concern with the use of aspartame. Allergic reactions have also been allegedly observed with the use of aspartame, such as swelling  of the lips, tongue and throat. When studies have been done to review these observations, researchers have had trouble replicating the occurrences with random sampling of the population. When swelling or hives have occurred in research, it occurred in placebo groups like it did in the aspartame groups, so no conclusions could be drawn. Because beverages often contain other ingredients, such as caffeine, it is possible the perceived side-effects could come from something other than aspartame. However, for those who do not respond well to aspartame or a different sweetener, it would be wise to use an alternative, or avoid NNS use.

The largest concern for aspartame use is in those with phenylketonuria, which is a rare inborn error of metabolism where they cannot metabolize phenylalanine. Significant ingestion of aspartame by those with phenylketonuria is thought to be a risk for neurological disorders. Though studies have shown that those with phenylketonuria can tolerate the aspartame amounts found in diet cola, use should be moderated. The phenylalanine content of a 12 oz diet Coke is 90 mg. Phenylalanine is found naturally in foods as well. In fact, milk contains 404 mg in an 8 ounce glass. That is not to say milk should be avoided. It is just to point out that phenylalanine is also found in nature. Those with a history of depression may be more sensitive to aspartame use as well.

Another negative for aspartame is that it is not stable in non-acidic fluids or when heated. One of the breakdown products is methanol, or "wood alcohol" which is toxic to the body. A healthy adult can metabolize up to 2000 mg of methanol per day. A 12-ounce diet Coke provides 18 mg of methanol. Again, this is found in nature. In fact, tomato juice provides 71 mg of methanol in 8 ounces. Of course, tomato juice provides a host of other nutrients as well, so you cannot compare the two. Of all of the NNS, aspartame seems to carry the most concerns with it. An occasional diet cola is not likely to cause problems. For many people, diet cola is used to help them get through the day and is used as a major source of caffeine. Using it on more than an occasional basis is probably not a good idea.

Saccharin

In 1977, saccharin, commonly known as "Sweet n' Low" was tied to bladder cancer in studies on rats. The studies used megadoses of saccharin, equivalent to 800 to 1000 cans of diet soda for an average adult. Since that time, it has had the reputation for increasing the risk of cancer. However, studies since that time have not supported the idea that it poses a serious health risk. In the research done on this NNS, it has been shown to be safe in the diet. It is not as popular a NNS because of the bitter aftertaste if leaves in the mouth. It is also not commonly used in cooking or baking.

Acesulfame-K

Ace-K has been approved for use since 1988. It is 200 times sweeter than sucrose, and is usually used in combination with another sweetener. In megadoses, the methylene cholride in Ace-K could cause problems, but it is rarely used by itself, and because it is so sweet, the amounts used are extremely low. It is mainly used to enhance the taste profile of another sweetener, so minimal amounts are used. It has not received much attention as it is used in such small amounts, and has not been associated with health complications. It can be found in some alcoholic beverages, but is generally used as a NNS in foods, sauces and confections.

Sucralose

Marketed under the brand name Splenda, this is one of the newer major sweeteners on the market (the newest is Truvia, which we won't cover today). Sucralose is created by changing the structure of a sugar molecule. Sucralose has the benefit of working well with heat and in baking. When it came to market, its close resemblance and taste to sugar caught the attention of the sugar industry. The sugar industry was quick to point out the fact that sucralose contained chlorine, which created a reputation for sucralose that it could lead to problems from people ingesting chlorine. This was a somewhat misleading way to cast doubt on sucralose, as the chlorine does not break apart from the sucralose. Instead, it passes through the body undigested, which is very different than ingesting pure chlorine. Normal table salt also contains half of its structure as chlorine. In some people, sucralose can cause bloating or gas, but again this could be dose-dependant. Overall, the evidence behind sucralose has been positive.

Summary

Overall, for  the majority of the population, the use of NNS in moderation seems to be okay. Having said that, there is no doubt that someone reading this article has personally experienced a negative effect of one or more of the NNS. Some people do not tolerate one or more of the NNS well. These are also the stories that are most commonly discussed in media and books. Of all of the NNS available, it seems that aspartame would best be moderated. In people consuming large volumes of diet soft drinks, replacing most of those soft drinks with water is an important step toward optimal health.

The biggest challenge in reviewing this group of nonnutritive sweeteners in a single article was to cover as many high-points as possible without taking up so much space that the full article would not be read. If you choose to do your own research on using NNS, choose your sources wisely. The opinions on NNS can be quite extreme and may exaggerate some of the truths. It makes for a great story, and may make someone sound like more of an expert. In reality, as a population, we consume far too much sugar and total calories. Small amounts of diet cola are likely a better choice than regular cola. Water or unsweetened iced tea is a better choice than diet cola. Having said all that, to be on the safe side, we no longer use artificial sweeteners in our nutritional products, and our LifeCafes have eliminated most, if not all products containing such ingredients.

Go to: Non-Calorie Sweeteners: Do they increase appetite?

Go to: Non-Calorie Sweeteners: Do they support weight loss?

References:

Garriga MM, Berkebile C, Metcalfe DD. A combined single-blind, double-blind, placebo-controlled study to determine the reproducibility of hypersensitivity reactions to aspartame. J Allergy Clin Immunol. 1991 Apr;87(4):821-7

Geha R, Buckley CE, Greenberger P, Patterson R, Polmar S, Saxon A, Rohr A, Yang W, Drouin M. Aspartame is no more likely than placebo to cause urticaria/angioedema: results of a multicenter, randomized, double-blind, placebo-controlled, crossover study. J Allergy Clin Immunol. 1993 Oct;92(4):513-20.

Eades, Mary Dan. Sweeter than Sugar? http://www.proteinpower.com/drmd_blog/?p=142 Apr 1, 2007

Kovacs B, Shiel W. Artificial Sweeteners. http://www.medicinenet.com/artificial_sweeteners/article.htm#role. Medicinenet.com

Aragon A. Artificial sweetener use: current controversies. Alan Aragon's Research Review. April 1, 2009

Food & Nutrition Australia. Review of Non-nutritive Sweeteners. Food & Nutrition Australia. June, 2008

Magnuson B. Straight Facts on Aspartame & Health. Article prepared by Magnuson for The Beverage Institute for Health & Wellness

Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr 2009;89:1-14

Aragon A. Artificial sweetener use: current controversies. Alan Aragon Research Review. April 2009

Lutsey P, Steffen L, Stevens J. Dietary Intake and the Development of the Metabolic Syndrome: The Atherosclerosis Risk in Communitites Study. Circulation 2008;117:754-761

Vartanian L, Schwartz M, Brownell K. Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta-Analysis. Am J Public Health. 2007;97:667-675

Nettleton J, Lutsey P, Wang Y, Lima J, Michos E, Jacobs D. Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Mult-Ethnic Study of Atherosclerosis. Diabetes Care. 32:688-694, 2009

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

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