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A new study found that between 2002 and 2018, purchases of packaged food products containing sucralose (Splenda) jumped from 39% to 71%. Purchases of products containing a newer type of sweetener -- rebaudioside A (Stevia, Truvia) -- rose from 0.1% in 2002 to 26% in 2018.
Not all sugar substitutes saw increased use, however. In 2002, 60% of households chose products containing Aspartame (Equal) compared to 49% by 2018. Use of the sweetener saccharin (Sweet'N Low) also declined.
"Some of the messaging from public health folks, doctors and other health care professionals about the need to limit the consumption of sugar and the deleterious effects of sugar may be getting through," said study co-author Shu Wen Ng. She's an associate professor of nutrition at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.
But the science isn't clear on whether sugar substitutes are a healthful choice. There are a number of different choices, and Ng noted each one causes different impacts in the body.
"The message needs to evolve from reducing sugar to reducing sweetness exposure," she said. "Sugar and other foods that may be sweet may be reinforcing a sweetness preference, especially when you're young and still developing your sweetness preferences."
Nutritionist Samantha Heller, from NYU Langone Health in New York City, explained that when people get used to eating sweet, processed foods, natural ones -- like a ripe summer peach -- might not taste sweet enough anymore.
"Studies haven't provided concrete answers yet about the safety of sugar substitutes, or whether they help with weight loss or increase food and sweet cravings," she said. "Since there are so many questions still, and we haven't yet been able to find the answers, I generally tell patients to avoid them, although there are some instances where they can be helpful."
The Calorie Control Council, an industry group, issued a statement in response to the findings.
It said low- and no-calorie sweeteners "are safe and among the most studied ingredients in the world." Those in the marketplace today are considered safe by the U.S. Food and Drug Administration and other regulatory authorities around the world, the statement said.
The group's medical advisor, Dr. Keri Peterson, added that reducing added sugars is an important message to relay to patients.
"Low-calorie sweeteners can serve an important role in diabetes management," Peterson said. "Substituting sugars with low-calorie sweeteners gives diabetics more flexibility in their diets, allowing them to enjoy sweet foods without affecting blood sugar."
The new study reviewed annual survey data on household food purchases. The 2002 survey included data from almost 40,000 U.S. households; the 2018 data included more than 61,000.
The study found a slight decline in the number of households purchasing products with a caloric sweetener (like sugar, corn syrup or honey). The biggest reduction was in purchase of sweetened beverages.
Compared to Hispanic and Black people, white people bought almost twice the number of products containing sugar substitutes. Black people purchased 42% more beverages with caloric sweeteners or sugar substitutes between 2002 and 2018, the study found.
Both Ng and Heller said it isn't always obvious that products contain sugar substitutes.
"People trying to reduce their sugar intake may be drawn to products labeled as 'sugar-free, low calorie or natural,' not realizing that these products contain non-nutritive sweeteners," Ng said.
She recommended that people strive to be aware of what they're eating or drinking, and aim to reduce sweetness overall -- both from sugar and sugar substitutes. Ng also suggested consumers push manufacturers for clearer labeling.
"Consumers should be informed and aware," Ng said. "Products should say on the front whether they contain a non-nutritive sweetener or an actual sweetener."
The findings were published online July 29 in the Journal of the Academy of Nutrition and Dietetics.
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