Are Artificial Sweeteners Good Alternatives?
By Debra Nessel, RD, CDE, Torrance Memorial Medical Center
Artificial sweeteners are chemical or natural compounds which offer the
sweetness of sugar with negligible calories and zero carbohydrates. When
added to food products or marketed as a food, artificial sweeteners have
undergone rigorous safety testing to gain approval by the Food and Drug
Administration (FDA). The FDA also establishes safe consumption levels,
or Acceptable Daily Intakes (ADI), for sweeteners. Common artificial sweeteners include:
Saccharin is the oldest, hitting the market in 1977. It is still in use today under
the brand name SWEET’N LOW®and the diet soft drink TaB®.
While the FDA does not limit its use in pregnancy and considers it safe,
your Torrance Memorial diabetes educators discourage the use of this product
during pregnancy and breastfeeding because saccharin can cross the placenta
and can enter breastmilk.
Aspartame has been on the market since 1981. It is found in Equal® and NutraSweet®.
Aspartame breaks down into two amino acids in the body–phenylalanine
and aspartic acid. We get these amino acids from other foods such as milk.
People with a rare genetic disorder called phenylketonuria (PKU) should
not consume any food containing Aspartame because phenylalanine must be
limited in PKU. Aspartame is commonly used in diet soft drinks and some
foods such as light yogurts.
Acesulfame potassium (often called acesulfame K) was approved for use by the FDA in 1988. It
has a slightly bitter taste and is often blended with other artificial
sweeteners in beverages and foods. It is sold under the names Sunett®
and Sweet One®. Acesulfame K crosses the placenta during pregnancy.
Sucralose entered the marketplace in 1998 under the brand Splenda. It is stable under
heat and therefore can be used in baking. Only about 25 percent of the
Splenda enters the blood stream and most stays in the intestinal tract
and is excreted in feces.
Stevia is the only sweetener that is not synthetically produced. It is derived
from the leaves of an herb found in Brazil and Paraguay that is related
to the daisy plant. Stevia was recognized as safe by the FDA in 2008.
It is found in products such as Sprite®, Truvia®, Pure Via™,
OnlySweet™ and Stevia Extract in the Raw®. Some studies have
shown a positive effect of Stevia on blood glucose while other research
Stevia is also sold as a dietary supplement, which is not FDA approved.
At high doses, stevia can cause interactions with insulin and blood pressure
medications and cause headaches, dizziness and diarrhea. Your Torrance
Memorial diabetes educators do not advise the use of stevia as a dietary
supplement at this time. It may be used in moderation as a sweetener.
Currently there is not enough evidence to make recommendations about the
use of stevia during pregnancy.
Whether non-nutritive sweeteners are safe depends on your definition of
safe. Studies leading to FDA approval have ruled out cancer risk, for
the most part. However, those studies were done using far smaller amounts
of diet soda than the 24 ounces a day consumed by many people who drink
diet soda. We really don’t know what effect large amounts of these
chemicals will have over many years.
While it is commonly accepted that people with diabetes can use artificial
sweeteners without them raising blood glucose levels, often people wonder
whether the sweeteners are completely harmless. At Torrance Memorial,
our diabetes educators encourage our clients to use moderation with the
sweeteners (1-2 servings/day or less) and to try to select foods as close
to nature’s source as possible. It would also be best for diabetic
and pre-diabetic patients to avoid honey, agave nectar, and high fructose
corn syrup. The primary goal for these patients is to maintain glucose
control, so these sugars and the food items they are added to may cause