Sugar substitutes have been controversial in the mainstream media as long as I’ve been a dietitian! The controversy often stems from inaccurate messaging conveyed by celebrities, advocates and media unable to accurately interpret the scientific research.
Recently, the World Health Organization (WHO) disclosed their guidelines recommending adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake with a further reduction to below 5% or roughly 25 grams (6 teaspoons) per day to provide additional health benefits. This has sparked a flood of questions from my clients and friends about sugar substitutes.
Let’s back up for a minute and explore sugar consumption among Canadians. Currently, the Canadian Sugar Institute reports that Canadians’ “added or free” sugar consumption has been on the decline over the past 15 years. They estimate “added or free” sugars make up about 11% (or roughly 12 teaspoons) of Canadian’s energy intake and our consumption is about one-third less than our American friends to the south. Sounds like we are on the right track! Now, are you wondering what added or free sugars are? They include all sugars, corn syrups, honey, nectars and maple syrup added to foods and beverages. It does not include sugars that naturally occur in fruits, vegetables, and dairy products.
So let’s get back to debunking three myths about sugar substitutes, as Canadians try to decrease their sugar intake even more . . .
Myth #1 Aspartame Causes Cancer
Aspartame is a low calorie sweetener that is used in a variety of foods such as soft drinks, breakfast cereals, chewing gum, desserts, yogurts, as well as a table-top sweetener (1, 2). In Canada, the acceptable daily intake (ADI) is 40 mg/kg of body weight per day. To illustrate, in a person weighing 50 kg, they could safely consume 2000 mg of aspartame per day. For perspective, there are up to 200 mg of aspartame in one can of diet pop (2).
According to the American Cancer Society, “There are no health problems that have been consistently linked to aspartame use.” It’s an ingredient helpful for the diabetic population, in particular, as it sweetens foods and beverages and it doesn’t contribute to the overall sugar level in blood.
Individuals with allergies to phenylalanine or those with phenylketonuria (PKU) should limit their intake of aspartame; consequently all products containing aspartame must be clearly labelled.
Myth #2 Sucralose Stimulates Appetite and Insulin Response
Sucralose is available in individual packets or in bulk packaging. Unlike aspartame, which may change flavour when cooked, sucralose is stable enough to be used when cooking and baking. The ADI sits at 9 mg/kg of body weight per day. In this case, an individual weighing 50 kg could consume 450 mg of sucralose per day. Each packet of Splenda contains 12 mg of sucralose (2).
In a study of 128 diabetics conducted over three months, sucralose was given at concentrations of three times the maximum estimated daily intake. Results found that no negative responses were noted on any measure of blood glucose control (3). Other studies have noted that sucralose does not stimulate the release of insulin or delay gastric emptying. Thus, sucralose does not affect appetite and it may even help maintain glucose homeostasis (4,5).
Myth #3 Stevia Increases Blood Pressure
Stevia rebaudiana Bertoni plant contains sweet compounds known as steviol glycosides, which are used in the sweetening product Stevia (1). Stevia may be used as a table-top sweetener or it can be added to foods such as yogurts, cereals, chewing gums, spreads, drinks, and baked goods. The ADI for Stevia is 4 mg/kg of body weight per day. A person weighing 50 kg could consume 200 mg of Stevia per day without adverse effects (2).
Clinical studies have demonstrated that stevia sweeteners do not affect blood pressure or blood glucose response. Therefore, stevia based sweeteners are safe for diabetics (3). In addition, stevia has been shown to reduce postprandial insulin levels, with a more significant effect than aspartame (7).
Understanding the Research
Many times we hear high-level statistics and findings from studies about sugar substitutes being a dietary delinquent and aren’t given full detail on the quality of the study, how the study was conducted or who the study was conducted on.
The takeaway here is simple. Remember these three questions: 1) Are the diets in the study artificially contrived and based on animal models (e.g. not resembling a typical human mixed diet)? 2) Was there over-feeding of one particular sugar substitute or ingredient in the experimental diets? 3) Who were the participants in the study? All of these answers will help us to best interpret the study findings.
The available evidence suggests sugar substitutes are safe. There are many different types of sweeteners available and they can be used for many different reasons. Moderation is always the best approach for all sugars and sweeteners. A high intake of sugar substitutes is not a simple fix for poor lifestyle habits or obesity. However, when combined with other nutrition strategies and consumed in the context of a healthy diet, they can help people with diabetes manage their disease and assist those with obesity in weight loss (3-7). Check in with your Dietitian to help you debunk the myths and understand what is best for you based on your individual needs.
- Health Canada. Sugar Substitutes; 2010 [cited 2015 March 1]. Available from http://www.hc-sc.gc.ca/fn-an/securit/addit/sweeten-edulcor/index-eng.php
- Canadian Diabetes Association. Sugar & Sweeteners; n.d. [cited 2015 March 1]. Available from http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/diet-nutrition/sugar-sweeteners
- Tandel K R. Sugar substitutes: Health controversy over perceived benefits. J Pharmacol Pharmacother. 2011;2:236-243.
- Shankar P, Ahuja S, Sriram K. Non-nutritive sweeteners: Review and update. Nutrition. 2013;29:1293-1299.
- Fitch C, Keim K S. Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners. J Acad Nutr Diet. 2012;112:739-758.
- Gardner C et al. Nonnutritive Sweeteners: Current Use and Health Perspectives: A Scientific Statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2012;35:1798-1808.
- Anton S D, Martin C K, Han H, Coulon S, Cefalu W T, Geiselman P, et al. Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Appetite. 2010;55:37-43.