That’s Not Sugar: Artificial Sweeteners and Your Health

Sugar may not be good for you, but at least its effects are known, unlike some sugar substitutes.

Two Johns Hopkins University researchers accidentally discovered saccharin in 1879, and it became the first artificial sweetener on the market, available at a lower cost than sugar. The market for high-intensity sweeteners is growing and is expected to reach nearly $3 billion globally by 2022, despite a lack of widespread understanding of their health effects.

Added sugars include all sugars used in processed foods: sweetened drinks, grain-based desserts, fruit drinks, dairy desserts, candy and ready-to-eat cereals, according to research published by the Journal of American Medical Association (JAMA). They do not include naturally occurring sugar, such as in fruits and fruit juices. Sugary drinks are the main sources of sugar in the American diet, making up more than 33 percent of the country’s sugar intake.

Since sugar substitutes continue to gain popularity, it is important to have up-to-date information. Nursing@Simmons compared sugar’s nutritional value to those of the most widely used sweetener substitutes to identify their health value and potential risks.


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Although high amounts of sucrose, or table sugar, add empty calories to a diet and contribute to obesity, diabetes and related chronic conditions, the American Heart Association says that its use in small doses to make nutritional food more appetizing can be beneficial. However, over the last three decades, Americans have steadily increased their consumption of added sugars, a factor in the obesity epidemic.


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Saccharin, also known as Sweet’N Low, has been extensively used as a noncaloric sweetener in foods and beverages. In the 1970s, rat studies found a link between saccharin consumption and bladder cancer, which resulted in a 1981 congressional mandate for warning labels on all foods containing the substance. Later studies failed to find a carcinogenic effect in humans, and it was removed from the U.S. National Toxicology Program’s Report on Carcinogens in 2000. Although Congress removed the warning label, the Center for Science in the Public Interest placed saccharin on its “avoid” list.


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Also known as Equal or NutraSweet, aspartame is a low-calorie sweetener with a sugar-like taste that can be found in diet drinks, gum, yogurt and cough drops. Although there have been extensive studies and controversy regarding the safety of aspartame consumption, the Advisory Forum of the European Food Safety Authority noted that as of 2009, there was no new evidence proving that aspartame was unsafe. In addition to the EFSA, the World Health Organization, the Academy of Nutrition and Dietetics and the U.S. Food and Drug Administration all say that aspartame consumption in moderation poses no health threats. However, when reviewing food additives, the CSPI gave it their lowest ranking due to a potentially increased risk of cancer.


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Also known as Splenda, sucralose is a product made of chlorinated sugar. Although one study indicated a negative impact on the immune system, further studies did not support the finding, and it is deemed safe by the FDA and Center for Science in the Public Interest. Its sweet taste and chemical stability allow it to be used in more than 4,000 food products as a replacement for sugar, as well as in beverages, frozen desserts, chewing gum, baked goods and other foods.


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Also known as Truvia or Pure Via, stevia is derived from Stevia rebaudiana, a South American plant. It has been used for decades to sweeten beverages and make tea in the plant’s native Paraguay. In the early 1990s, the FDA rejected stevia for use as a food ingredient, but in 1995, the agency said it could be used as a dietary supplement. Although the use of crude stevia extracts did not gain FDA approval, refined stevia products were given a “Generally Regarded As Safe” approval status from the agency in 2008. Today, it is used widely to sweeten foods and beverages, and as an additive to diet drinks and yogurt.


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Although most agave comes from a natural source, the blue agave plant, it is not distributed in its raw state. By the time it gets to the store shelf, it is highly processed and actually contains more calories than table sugar. However, since agave is sweeter than sugar, less may be needed.


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Honey is a natural sweetener produced by bees from the nectar of flowers. Enzymes in bee saliva create a chemical reaction that turns nectar into honey, which is then deposited into the walls of the hive. A versatile sweetener, honey can be used in baking, sauces and hot drinks and as an additive in any type of food. It is made up of fructose, glucose, water and minerals, and has antioxidant properties. Since honey has a lower glycemic index than sugar, it does not raise blood sugar levels as rapidly. However, it also has more calories than sugar, so it should be used in moderation


You do not have to be overweight to be at risk of heart disease from a diet high in sugar. About one in 10 Americans get 25 percent or more of their daily calories from added sugar, compared to the average person, who gets about 10 percent. The JAMA study also found that those in the former group were more than twice as likely to die from heart disease as the average American.

Individuals who have chronic conditions influenced by diet can consult their primary care providers, such as Family Nurse Practitioner, to learn more about using sweeteners as part of a healthy lifestyle. The American Heart Association also offers recommended dietary intake of sugar for healthy consumption.

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