Natural sources don’t give us options to satisfy our sweet cravings without increasing our calorie load. White sugar, brown sugar, honey, jaggery all have similar calorie content. Sugar substitutes help in reducing calorie intake, since many of them have close to zero calories. A 500 ml can of a cola has approximately 12 spoons of added sugar- almost 220 calories. A can of diet cola has zero calories! Theoretically, therefore, sugar substitutes are a very attractive proposition. However, they are not without controversy.
There are two common types of sugar substitutes- artificial sweeteners and sugar alcohols. Artificial sweeteners are synthetic substitutes and include saccharin, cyclamate, aspartame, sucralose, acesulfame and neotame.
The other variety of sugar substitutes are plant derived sugar alcohols (like erythritol, mannitol and sorbitol. In addition to sweetness, they add some texture to food. The sweetness of sugar alcohols varies from 25-100% as compared to sugar. Eating high quantities of sugar alcohols can cause bloating, loose stools or diarrhoea, although tolerance usually develops over a period of time.
Stevia and monk fruit sugar are described as a ‘natural’ sweeteners since they are derived from plant sources.
Sugar substitutes are widely used in processed foods, including soft drinks, cookies, chocolates, and jams. Some, like sucralose, can be used in baking or cooking. A ‘sugar free’ label on a product can lead us to believe that the product is “zero calorie”, leading to overconsumption. For example, a bar of sugar free chocolate contains about 60% of the calories of a regular slab, due to its fat content.
It remains unclear if replacement of dietary sugar with artificially sweetened products can reverse the health consequences (like obesity, diabetes, and heart disease) of sugar overconsumption. In some studies artificial sweeteners have been shown to increase the risk of diabetes and obesity, although others have not found such evidence.
A WHO 2022 report on the health effects of artificial sweeteners observed modest associations between consumption of beverages with artificial sweeteners to cholesterol abnormalities and high blood pressure. It has also been suggested that use of these sweeteners may alter our gut flora, potentially leading to a greater risk of weight gain and diabetes. A 2022 French study showed an association of artificial sweetener intake with increased risk of heart disease, stroke and cancer. Saccharine was once linked to cancer in rats, and aspartame to brain tumours, without solid evidence. Concerns like adverse impact on kidneys, memory loss, dementia and stroke have been reported but remain unproven. The mixing of alcohol with artificially sweetened beverages increases blood alcohol levels and increases chances of intoxication. Sweeteners may alter how our brains respond to signals, making less sweet substances like fruits unappealing to our senses and leading us to crave more sweets!
Those who consume large amounts of sweet beverages and are trying to kick the habit can use artificially sweetened beverages temporarily and gradually try to taper the consumption, replacing it with water. Those with bowel disorders and who have bariatric procedures should also avoid them completely.
What then should those of us trying to lose weight or control diabetes do? Try and give up sugar completely. If your sweet cravings are persistent, it is safe to consume sweeteners in small amounts. Use of small amounts of sweeteners – say 1-2 servings a day is generally considered safe, although solid data is lacking. It is possible that plant derived sweeteners like monk fruit sugar or stevia may be the safer, but this too remains unproven.
Dr. Ambrish Mithal, Chairman & Head - Endocrinology & Diabetes, Max Hospital, Saket
