Are Artificial Sweeteners Safe?

Last Editorial Review: 3/30/2005

WebMD gets the low down on artificial sweeteners on the shelves and in the pipeline

By Denise Mann
WebMD Weight Loss Clinic - Feature

Reviewed By Brunilda Nazario, MD

March 23, 2005 -- The way artificial sweeteners were discovered could have been a scene out of the classic comedy The Nutty Professor.

In 1879, Ira Remsen, a researcher from Johns Hopkins University in Baltimore, Md., noticed that a derivative of coal tar he accidentally spilled on his hand tasted sweet. While he did not morph into the slim, but obnoxious Buddy Love as the characters played by Eddie Murphy and Jerry Lewis did in their film versions of the comedy, his spill set the stage for the development of saccharin -- an artificial sweetener known today to many seasoned dieters as Sweet-n-Low. This is now the most recognized name brand of the saccharin-based sugar substitutes.

Now more than 125 years later, saccharin is joined by a growing list of artificial sweeteners with varying chemical structures and uses including acesulfame potassium (Sunett); aspartame (NutraSweet or Equal); sacralose (SPLENDA), and D-Tagatose (Sugaree). And there's a whole host of new ones on the horizon.

These products substitute for sugar. For example, they can replace corn syrup, used in many sodas and sweetened drinks, and table sugars. However, the sweet remains in anything and everything from chocolate and ketchup to gum, ice cream, and soft drinks. But are artificial sweeteners safe? Can they help people shed extra weight? What role should they play in person's diet -- if any?

Here's what WebMD found out:

Artificial sweeteners, also called sugar substitutes, are compounds that offer the sweetness of sugar without the same calories. They are anywhere from 30 to 8,000 times sweeter than sugar and as a result, they have much fewer calories than foods made with table sugar (sucrose). Each gram of refined table sugar contains 4 calories. Many sugar substitutes have zero calories per gram.

"Artificial sweeteners can serve a definite purpose in weight loss and diabetes control," says New York City-based nutritionist Phyllis Roxland. "It enables people that are either carb-, sugar-, or calorie-conscious to take in a wider range of foods that they would either not be allowed to eat or could only eat in such teeny amounts that they were not satisfying." Roxland routinely counsels patients in the offices of Howard Shapiro, MD, a weight loss specialist and author of Picture Perfect Prescription.

In other words, artificial sweeteners allow people to stick to a good diet for a longer period of time, she says. In a diet, artificial sweeteners are considered "free foods." The sugar substitutes don't count as a carbohydrate, a fat, or any other exchange.

"These products can be useful when used appropriately for people like diabetics who need to control their sugar intake and in overweight people," agrees Ruth Kava, PhD, RD, director of nutrition for the American Council on Science and Health (ACSH) in New York City.

Artificial sweeteners do not affect blood sugar levels, but some foods containing artificial sweeteners can still affect blood sugar because of other carbohydrates or proteins in these foods. In other words, while foods that contain artificial sweeteners may be sugar-free, they may not be carbohydrate-free.

Just because a food contains artificial sweeteners instead of sugar is not carte blanche for grazing, Kava points out.

"The real key to weight loss is calories," Kava points out. "If you substitute a diet soda for a sugar soda, you save 100 calories, but if you eat 15 sugar-free cookies [which have calories] instead of two regular cookies, you may not be helping yourself at all," she says.

"If somebody is trying to lose weight and cut back on calories, artificial sweeteners can add flavor to unsweetened beverages or other products," says Michael F. Jacobson, PhD, executive director of the Center for Science in the Public Interest (CSPI) in Washington. That said, "somebody who consumes a lot of artificially sweetened foods should think twice about their diet and ought to be eating real food," he tells WebMD.

"I don't think [artificial sweeteners] are needed at all," he says. "I fear that in some cases people have a diet soda for lunch and then have a couple of tablespoons of ice cream -- giving up the saved calories," he says.

Using sugar substitutes instead of sugar can lower your risk of tooth decay, but "the acid in diet soda still could contribute to dental erosion," Jacobson points out.

Safety, particularly as it relates to cancer risk, is on many people's mind as a result of the saccharine saga, which began in the 1970s. In 1977, the U.S. Food and Drug Administration tried to ban this sweetener as animal studies showed that it caused cancer of the bladder, uterus, ovaries, skin, and other organs. But the food industry intervened, urging Congress to keep it on the market with a warning label that (until recently) read: "Use of this product may be hazardous to your health. This product contains saccharin, which has been determined to cause cancer in laboratory animals."

"One thing is clear, consumers embrace these sweeteners."

In the late 1990s, the Calorie Control Council stated that the main health concern about saccharin was bladder cancer in male rats -- not people. They stated that further research has shown that male rats have a particular predisposition to bladder cancer and as a result the National Institutes of Health removed saccharin from its hit list of cancer-causing agents.

"Congress said no to the [original call for a] ban due to backlash but stated that there has to be a warning," ACSH's Kava recalls. "More recently, Congress de-listed saccharin as very high doses may cause bladder cancer in male rats -- not in female rats or anyone else," she says. According to the National Cancer Institute, there's no scientific evidence that any of the artificial sweeteners approved for use in the U.S. cause cancer.

"The cancer risks are not something that an individual person should worry about," CSPI's Jacobson says. "It's more a risk for the government as the potential problems occur when millions of people consume the sweeteners for years," he tells WebMD.

But cancer risk may not be the only safety concern with these artificial sweeteners.

"My overlying feeling is that artificial sweeteners are safe," says ACSH's Kava. "The only caveat is asparatame in people with a rare disorder known as phenylketonuria (PKU), who are unable to metabolize phenylalanine. PKU is detected at birth through a mandatory screening program.

Jacobson adds that in the short term, some people develop headaches after consuming foods sweetened with aspartame.

As far as short-term effects, sugar alcohols -- technically not considered artificial -- can cause bloating and diarrhea in some people and the effect may occur with as little as 50 grams of sugar alcohol. These sweeteners include sorbitol. Lactitol and mannitol are lower in calories than sugar, don't promote tooth decay, or cause an increase in blood sugars, according to the FDA.

Some of these "can cause powerful diarrhea and people ought to pay some attention to that," CSPI's Jacobson says.

The key is really to know your body and your limits, Roxland adds. "Sometimes it says right on the package that 'excess consumption may have a laxative effect' but does that mean two Velamints will give you the runs?" she says. "I have known some people who eat two pieces of gum and have the worst diarrhea and others who chew a whole pack and are fine," she says.

Overdosing on Equal?

As far as nonsugar alcohol sweeteners, Roxland does not see a tremendous potential for overdose. "Even if a person binges on low-calorie Fudgesicles or Creamsicles, as long as their diet is otherwise healthy, there is no downside because they would probably be bingeing on something a lot worse," she says.

One thing is clear, consumers embrace these sweeteners. As many as 180 million Americans routinely eat and drink sugar-free products such as desserts and artificially sweetened sodas, according to 2004 statistics compiled by the Calorie Control Council, and with new products in the pipeline and on the shelves, the trend shows no sign of abating.

The newest artificial sweetener on the block is sucralose (SPLENDA). It is not affected by heat and retains its sweetness in hot beverages, baked goods, and processed foods. This has some advantages, Roxland says. "Nutrasweet can't be stored for long periods and you can't cook with it, but Splenda is heat stable so you can use it in cooking."

There are others in the pike including alitame (brand name Aclame?), which is 2,000 times sweeter than sucrose. A petition for its use in a broad range of foods and beverages has been filed in the U.S.

Another sweetener is Cyclamate, which is a 30 times sweeter than sucrose but as such it has the least "sweetening power" of the commercially acceptable intense sweeteners. It was banned in the U.S. in 1970, but currently there is a petition at the FDA for reapproval.

Dihydrochalcones (DHCs) are noncaloric sweeteners derived from bioflavonoids of citrus fruits that are approximately 300 to 2,000 times sweeter than sucrose.

Glycyrrhizin, a noncaloric extract of licorice root, is 50-100 times sweeter than sucrose. It is approved for use in the U.S. as a flavor and flavor enhancer.

Stevioside comes from leaves of a South American plant and is 300 times sweeter than sucrose. It is currently approved for use in 10 countries, including Japan, Paraguay, and Brazil. It can be sold in the U.S. as a dietary supplement only.

Another potential sweetener is Thaumatin (TalinTM), a mixture of proteins from a West African fruit that's approximately 2,000-3,000 times sweeter than sucrose. In the U.S., it's approved as a flavor enhancer for beverages, jams and jellies, condiments, milk products, yogurt, cheese, instant coffee and tea, and chewing gum.

Published March 25, 2005.

SOURCES: Phyllis Roxland Ruth Kava, PhD, RD, nutritionist; and director, nutrition, American Council on Science and Health, New York City. Michael F. Jacobson, PhD, executive director, Center for Science in the Public Interest, Washington.

©1996-2005 WebMD Inc. All rights reserved.

Health Solutions From Our Sponsors