Nonnutritive Sweeteners

During the discussion that I have with patients about the protein-sparing modified fast, many are surprised to hear me endorse the use of “sugar-substitutes (AKA: nonnutritive sweeteners).” There has been a lot of negative information in the lay press about this and I thought my patients would like to hear what the facts are and what is the position of national authoritative groups such as the American Dietetic Association and the Food and Drug Administration.

As humans we are born liking the sensation of sweetness...this research dates back to 1977. “Consumers who want the taste of sweetness without added energy may select nonnutritive sweeteners to assist in the management of weight, diabetes, and other chronic diseases.” Nutritive sweeteners (sugar, fructose, honey, etc) contain 4 calories per gram. Nonnutritive sweeteners off no energy and no calories.

There are five nonnutritive sweeteners that have FDA approval: acesulfame-K, aspartame, neotame, saccharin, and sucralose. As these sweeteners have been hows to promote diet healthfulness and by themselves do not increase the risk of obesity nor cause behavior disorders and lower the risk of dental caries (tooth decay), “it is the position of The American Dietetic Association that consumers can safely enjoy a range of nutritive and nonnutritive sweeteners when consumed in a diet that is guided by current federal nutrition recommendations.”

Acesulfame potassium or acesulfame K is about 200 times sweeter than sugar and is highly stable so can be used in foods, beverages and baked goods. It is not broken down by the body and is often used in combination with other nonnutritive sweeteners.

Aspartame is about 200 times sweeter than sugar. Aspartame is unstable in hot liquids and should not be used in cooking. It is made by joining two amino acids together. The body breaks this down back to the two amino acids and this is why there are warning labels on foods containing aspartame. Phenylalanine (one of the two amino acids from which aspartame is made) can accumulate and cause harm in people with a rare genetic disease known as phenylketonuria (PKU). People with PKU should limit their intake of aspartame and aspartame-containing foods. There are many concerns about aspartame's safety on the internet. The National Institute of Health has released study results stating that aspartame does not increase the risk of leukemia, lymphoma or brain cancer.

Saccharin is about 400 times sweeter than sugar and is noted to be stable with heating making it useful in baking and cooking. The internet is replete with reports linking saccharin intake with bladder cancer. Follow-up studies with animals and humans have shown no association between consumption of saccharin and cancer incidence. The federal government has removed saccharin from the list of potential cancer-causing agents. This history still has many people concerned about consumption of saccharin.

Sucralose is about 600 times sweeter than sugar. It has been shown to be stable at high temperatures and is frequently used in cooking and baking. It is excreted unchanged in the stool as very minimal amounts are absorbed. The FDA reviewed over 110 studies in humans and animals regarding safety and sucralose as found to pose no carcinogenic, reproductive or neurologic risk in humans. It is the bulking agent for sucralose that actually gives it calories but makes it equal volume for cooking (ie cup for cup).

Neotame is about 7000-13000 times sweeter than sucrose. It is partially absorbed in the small intestine and rapidly metabolized and excreted. It is approved for use all over the world. It is marketed as a sweetener without bitter, metallic or off flavors and it can be used to enhance the other flavors in a food.

What I advise people is: If you are uncomfortable with intake of saccharin, please avoid its use. But note that, “taken as a whole nutritive and FDA-approved nonnutritive sweeteners are safe for children and pregnant women.” Nonnutritive sweeteners have the potential to save a consumer up to 16 kcal/tsp of sweetening translating into loss of a pound of weight in 9-10 days.

Sources:
American Dietetic Association Report. Position of the American Dietetic Association: Use of nutritive and nonnutritive sweeteners. Journal of the American Dietetic Association. 2004;104:255-275.

International Food Information Council Foundation. Low Calorie Sweeteners: Their role in healthful eating. Oct 2000.

Aspartame: review of safety issues. JAMA. 1985;254 (3):400-402.

Aspartame:review of recent research. Comments Toxicology. 1989;3 (4): 253-278.