To satisfy the public’s craving for sweetness and concern about the health effects of sugar, food companies increasingly have turned to sugar substitutes. Natural and artificial sweeteners are added to everything from soda pop to toothpaste, lip balm to snack items.
Now, studies are raising concerns about the health effects of these substitutes.
A recent study linked the zero-calorie sugar substitute erythritol with an increased risk of stroke. Though the research wasn’t definitive, it raised the question of which sugar substitute — if any — might be the healthiest.
Unfortunately, that’s not easy to answer.
All sweeteners that you can buy have met the government’s standard of “generally recognized as safe,” meaning research has shown they aren’t toxic.
But just because something isn’t toxic doesn’t mean it’s healthy — or that it’s helpful for weight management or disease prevention, said Allison Sylvetsky, an associate professor at The Milken Institute School of Public Health at the George Washington University.
“There has been more and more research showing that these low-calorie sweeteners are not inert and they do have health effects,” Sylvetsky said.
Concerns about sugar substitutes
The long-term effects of sugar substitutes are largely unknown. Most of the safety studies that have been done were short-term because it’s difficult and costly to do years-long trials.
Each sugar substitute has a different chemical structure and needs to be considered separately, said Dr. Walter Willett, a nutrition researcher at the Harvard T.H. Chan School of Public Health.
British physiology researcher Havovi Chichger said her studies suggest that chemicals we perceive as sweet can activate receptors not just in the mouth but also in the heart, lungs and lining of the blood vessels.
“They’re doing something very significant, but we don’t fully understand what,” said Chichger, an associate professor in biomedical science at Anglia Ruskin University in England.
Her research has found that aspartame, sucralose and saccharine all activate these sensors and in high doses can cause glucose intolerance, a first step toward diabetes.
For a study published last August in the journal Cell, 120 volunteers were randomly assigned to consume aspartame, saccharin, sucralose or stevia over two weeks at doses below what’s generally considered acceptable. Each substitute changed the participant’s gut microbes but in different ways. Saccharine and sucralose significantly altered their glucose tolerance, suggesting these can contribute longer-term to metabolic diseases including diabetes.
Chichger and others worry that these sweeteners have become so ubiquitous that they’re hard to avoid.
“In smaller quantities, as they were originally meant to be had, I think sweeteners can be a useful weight-loss tool, which is good for people,” she said.
But while “everyone thought they were perfectly fine to have,” Chichger said, “I think we now understand that’s not the case.”
Sugar probably isn’t better
Research done over decades supports the idea that sugar can damage human health. Experts say sugary drinks are the worst.
But replacing these drinks with artificially sweetened ones isn’t the answer.
Too much sugar clearly disrupts the body’s metabolism, potentially leading to diabetes, high blood pressure, cholesterol and an increased risk of heart attack and stroke.
“It is very well validated that sugar is at least as metabolically harmful as any of the sweeteners, so our results and conclusions with sweeteners are by no means any sort of recommendations to revert to sugar,” said Dr. Eran Elinav, head of the systems immunology department at the Weizmann Institute of Science in Israel, who is a leading researcher on artificial sweeteners.
Pop is particularly harmful, he said, because it has calories but no nutrients.
“Our recommendation is to stick with water as much as possible,” Elinav said.
It’s also best to avoid foods with a lot of added sugar, such as most desserts, Willett said, and “not worry about adding a teaspoon or two of natural sugar when desired.”
The current Dietary Guidelines for Americans advise that sugar should account for less than 10% of the total calories we consume. The American Heart Association recommends even less added sugar: no more than 100 calories a day, or about 6 teaspoons, for most children and adult women, and no more than 150 calories a day, or about 9 teaspoons, for most men.
Each teaspoon of sugar has 16 calories, and there are about 10 teaspoons in, for instance, one 12-ounce can of Coke.
Pros, cons of sweeteners
Not surprisingly, the food and beverage industry supports the availability and safety of sugar substitutes.
“Low- and reduced-calorie ingredients including sweeteners and dietary fiber offer consumers healthy alternatives and a greater variety of products from which to choose,” said Robert Rankin, executive director of Calorie Control Council, an industry group. “Evidence shows that low- and no-calorie sweeteners are a safe and effective alternative to added sugars and can be used as part of a balanced diet to help consumers achieve dietary goals, whether it be managing body weight or diabetes, reducing the consumption of added sugars or reducing total caloric intake.”
The International Sweeteners Association, an international nonprofit representing suppliers of low- and no-calorie sweeteners, says “sweeteners are one of the most thoroughly researched ingredients in the world and have been proven safe by global regulatory bodies for decades.”
Studies are underway to finally answer the question of what’s the healthiest way to sweeten foods, Chichger said. This is an area of “massive interest” among researchers, she said, and, “in the next few years, we should be able to answer a lot of the questions.”
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