Health & nutrition insights.
Non-Nutritive Sweeteners: The Sugar of the Future?
Listen to our podcast episode about this topic here: https://podcasters.spotify.com/pod/show/achievingyourbest/episodes/Tick-Bite-Induced-Meat-Allergy-Alpha-Gal-Syndrome-e28gu5i
Non-caloric sweeteners (also called low-calorie sweeteners, artificial sweeteners, and sugar substitutes) have been around for over 100 years. They became extremely popular during the 1950s-1980s by ultra-processed food and beverage companies as a “healthier alternative” for those with diabetes and/or weight management goals. They were also touted as more environmentally friendly due to the fact that they don’t need land for growing (like sugar cane) or any smoke-producing refineries. Most of them pass through the body without being metabolized which makes them low-to-no-calorie. Seems like the perfect sugar of the future! If only…
These synthetic sweeteners have long been suspected of adverse health effects such as cancer and weight gain. Last week the World Health Organization made a statement about using caution with their intake:
“WHO suggests that non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases.”
So today we are going to talk about the history of these sweeteners, how they are regulated by the government, how they are metabolized by the body, possible adverse health effects, and the recommendations for intake.
History of Non-Nutritive Sweeteners: It All Began with Coal Tar and Accidents
- 1897: Saccharin, named for the Latin word for sugar, was discovered accidentally by a Johns Hopkins University researcher who was looking for new uses for coal tar derivatives. He forgot to wash his hands before lunch and tasted something sweet on his fingers. After tasting everything in his lab to determine the source, he figured out it was benzoic sulfimide, a coal tar derivative that is 300 times sweeter than sugar.
- 1901: Fun fact: Monsanto got its start selling saccharin
- 1907: Saccharin is widely used in sodas and canned goods. Americans had no idea what was in their foods. Series of food and drug information reforms leads to a recommended ban of saccharin by the USDA. President Theodore Roosevelt vetoed the ban due to a personal weight-loss regimen using daily doses of saccharin prescribed by his doctor.
- 1912: Saccharin is banned.
- 1914: WWI begins. Saccharin ban is reversed due to sugar rations. People continue to consume it.
- 1937: Cyclamate (the original substance in Sweet’N Low) is discovered by a University of Illinois grad student working on a fever-reducing drug, during a smoke break when he tasted something sweet on his fingers. It is 30-50 times sweeter than sugar and 1/10th the price of sugar cane.
- 1950s-1960s: Diet soda boom. Cyclamate is used to sweeten Tab and Diet Pepsi. Americans consume more than 17 million pounds of the stuff each year.
- 1968: Cyclamate is banned for good. Proven to cause bladder cancer. Sweet’N Low becomes a saccharin-based product.
- 1965: Aspartame is discovered. James Schlatter, a research chemist for G.D. Searle and Company, licked his fingers while developing a new ulcer drug in 1965 and, yes, tasted something sweet. That was aspartame, an amino acid compound (a mixture of aspartic acid and phenylalanine) that is 200 times sweeter than sugar.
- 1976: Sucralose (Splenda) is discovered when scientists find a way to molecularly bond sucrose molecules with chlorine (yes, chlorine). It is 600 times sweeter than sugar. It was released to shelves 2 years later.
- 1981: Aspartame hits shelves as “Nutrasweet” and the sweet component in the new soda Diet Coke. It replaced more than 1 billion pounds in the American diet during the 1980s.
- Today: Splenda reigns as the most popular sweetener on the market today. The search for the next big artificial sweetener is already on, including a compound called neotame (6,000-10,000 times sweeter than sugar).
Regulation of Sugar Substitutes:
In the United States, the Food and Drug Administration (FDA) allows the following sugar substitutes to be used:
- Acesulfame potassium (Sweet One, Sunett)
- Aspartame (NutraSweet, Equal)
- Neotame (Newtame)
- Saccharin (Sweet’N Low)
- Sucralose (Splenda)
- Luo han guo (Monk Fruit in the Raw)
- Purified stevia leaf extracts (Truvia, PureVia, others)
The sweeteners fall mainly into three categories:
- High-intensity sweeteners that have no calories, such as stevia and monk fruit, as well as acesulfame K (Ace-K), aspartame, saccharin, and sucralose (be aware that since such small amounts of high-intensity sweeteners are needed, these are often combined with other, bulkier, sweeteners)
- Low-calorie sweeteners such as erythritol and xylitol as well as allulose, glycine, inulin, kabocha extract, lucuma, polydextrose, sorbitol, and tagatose
- Sugar alternatives such as agave syrup, coconut sugar, date syrup, glycerol, honey, maple syrup, trehalose, and yacon syrup.
The FDA also suggests how much of a sugar substitute you can safely have each day. This amount is called the acceptable daily intake (ADI). It varies by a person’s weight and the type of sugar substitute used. For example, the ADI for aspartame is 50mg per 1 kg of body weight. (So a person who weighs 45 kg (or 100 lbs) can consume up to 2,250mg per day, which is about 11 cans of Diet Coke.
In general, artificial sweeteners are safe in limited amounts for healthy people, including pregnant people.
The FDA suggests to limit or cut out sugar substitutes:
- If you’re living with a rare genetic disease called phenylketonuria. Foods and drinks with aspartame can lead to serious health problems.
- If you have a bowel disease. Using sugar substitutes might make your symptoms flare up.
- Adults shouldn’t give sugar substitutes to children under 2 years old.
How do Non-Nutritive Sweeteners Affect Blood Sugar & Insulin?
- We have tightly controlled mechanisms to keep our blood sugar levels stable
- Blood sugar levels increase when we eat foods containing carbohydrates.
- When digested, carbohydrates are broken down into sugar and absorbed into the bloodstream, leading to an increase in blood sugar levels.
- When our blood sugar levels rise, our body releases insulin.
- Insulin is a hormone that acts like a key. It allows blood sugar to leave the blood and enter our cells, where it can be used for energy or stored as fat.
- But small amounts of insulin are also released before any sugar enters the bloodstream. This response is known as cephalic phase insulin release. It is triggered by the sight, smell, and taste of food, as well as chewing and swallowing.
- If blood sugar levels drop too low, our livers release stored sugar to stabilize it. This happens when we fast for prolonged periods, like overnight.
- There are theories on how artificial sweeteners may interfere with this process:
- The sweet taste of artificial sweeteners triggers cephalic phase insulin release, causing a small rise in insulin levels.
- Regular use changes the balance of our gut bacteria. This could make our cells resistant to the insulin we produce, leading to both increased blood sugar and insulin levels.
- More research is needed to determine the long-term effects.
How do Non-Nutritive Sweeteners Affect Sugar Cravings?
- Two theories have been proposed for this. More research is needed.
- 1. After consuming the sweetener, the slight rise in insulin levels “unlocks” the cells so they can accept carbohydrates. But no carbs enter the cells because there is none (or not enough) present. The brain is signaled to crave more sugar in order to satisfy the carb-hungry cells.
- 2. Non-nutritive sweeteners are far more potent than table sugar and high-fructose corn syrup. A miniscule amount produces a sweet taste comparable to that of sugar, without comparable calories. Overstimulation of sugar receptors from frequent use of these hyper-intense sweeteners may limit tolerance for more complex tastes. That means people who routinely use artificial sweeteners may start to find less intensely sweet foods, such as fruit, less appealing and unsweet foods, such as vegetables, downright unpalatable.
How Can Non-Nutritive Sweeteners Affect Weight Control?
- One concern is that people who use artificial sweeteners may replace the lost calories through other sources, possibly offsetting weight loss or health benefits. This can happen because we like to fool ourselves: “I’m drinking diet soda, so it’s okay to have cake.” The AHA and ADA also added this caveat to their recommendation.
- Research suggests that they may prevent us from associating sweetness with caloric intake. As a result, we may crave more sweets, tend to choose sweet food over nutritious food, and gain weight. Participants in the San Antonio Heart Study who drank more than 21 diet drinks per week were twice as likely to become overweight or obese as people who didn’t drink diet soda.
- In prospective observational studies, with up to 10 years of follow-up, was as follows. Higher intakes of the sweeteners were associated with higher BMI and increased risk of incident obesity, but not other measures of body fatness.
What About Other Health Effects?
Higher intakes of NSS were associated with increased risk of type 2 diabetes, CVDs and CVD mortality, and all-cause mortality in long-term prospective observational studies with average follow-up of 13 years (very low to low certainty evidence), but were not associated with differences in overall cancer incidence or mortality (very low certainty evidence).
Use of NSS (predominantly saccharin) was associated with increased risk of bladder cancer as assessed in case–control studies (very low certainty evidence).
Follow this link to view an article about the pros and cons of each type of artificial sweetener: https://www.consumerlab.com/answers/what-are-the-health-benefits-of-stevia-is-it-safe/stevia-benefits-safety/?search=sweeteners
The Bottom Line:
- WHO suggests that non-sugar sweeteners should not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases.
- Long-term studies have suggested that frequent consumption of the sweeteners, and in larger than recommended amounts, is associated with obesity, Type 2 Diabetes, and cardiovascular disease.
- In small and infrequent amounts, in healthy people, non-caloric sweeteners are generally regarded as safe.
- World Health Organization. Use of non-sugar sweeteners: WHO guideline. August 2023. ISBN 978-92-4-007362-3
- Steffen B, et al. Long-term aspartame and saccharin intakes are related to greater volumes of visceral, intermuscular, and subcutaneous adipose tissue: the CARDIA study. International Journal of Obesity. 2023. https://doi.org/10.1038/s41366-023-01336-y