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Sweeteners - sugar substitutes

High-intensity sweeteners; Non-nutritive sweeteners - (NNS); Nutritive sweeteners; Noncaloric sweeteners; Sugar alternatives

Sugar substitutes are substances that are used in place of sweeteners with sugar (sucrose) or sugar alcohols. They may also be called artificial sweeteners, non-nutritive sweeteners (NNS), and noncaloric sweeteners.

Function

Sugar substitutes may be helpful for people trying to lose weight. They provide sweetness to foods and drinks without adding a lot of extra calories. Most of these contain almost no calories.

Using sugar substitutes in place of sugar can help prevent dental decay. They also may help with blood sugar control in people with diabetes.

Food Sources

Sugar substitutes can be added to food when you eat. Most can also be used during cooking and baking. Most "sugar-free" or low-calorie food products you buy at the store are made using sugar substitutes.

Commonly used sugar substitutes include:

Aspartame (Equal and NutraSweet)

• Nutritive sweetener -- has calories, but is very sweet, so little is needed.
• A combination of two amino acids -- phenylalanine and aspartic acid.
• 200 times sweeter than sucrose.
• Loses its sweetness when exposed to heat. It is best used in beverages rather than baking.
• Hasn't shown any serious side effects.
• FDA approved.
• The FDA requires that foods containing aspartame must have information on the label for people with PKU (phenylketonuria, a rare genetic disorder) alerting them about the presence of phenylalanine.

Many studies have been done on aspartame, and none have found that it is linked to cancer. However, one expert group has classified it as "possibly carcinogenic (cancer causing) in humans." The FDA disagrees with this and states that aspartame is safe to use within recommended use levels. The FDA recommends consuming no more than 40 milligrams of aspartame per kilogram of body weight per day. This is equal to 10 or more 12-ounce cans of diet soft drink per day for a person weighing 150 pounds.

Sucralose (Splenda)

• Non-nutritive sweetener -- no or very low calories
• 600 times sweeter than sucrose
• Used in many foods and drinks, chewing gum, frozen dairy desserts, baked goods, and gelatin
• Can be added to food at the table or used in baked goods
• FDA approved

Saccharin (Sweet 'N Low, Sweet Twin, NectaSweet)

• Non-nutritive sweetener
• 200 to 700 times sweeter than sucrose
• Used in many diet foods and drinks
• May have a bitter or metallic aftertaste in some liquids
• Not used in cooking and baking
• FDA approved

Stevia (Truvia, Pure Via, Sun Crystals)

• Non-nutritive sweetener.
• Made from the plant Stevia rebaudiana, which is grown for its sweet leaves.
• Rebaudiana extract is approved as a food additive. It is considered a dietary supplement.
• Generally recognized as safe (GRAS) by the FDA.

Acesulfame K (Sunett and Sweet One)

• Non-nutritive sweetener
• 200 times sweeter than sugar
• Heat-stable, can be used in cooking and baking
• Can be added to food at the table
• Used together with other sweeteners, such as saccharin, in carbonated low-calorie beverages and other products
• Most similar to table sugar in taste and texture
• FDA approved

Neotame (Newtame)

• Non-nutritive sweetener
• 7,000 to 13,000 times sweeter than sugar
• Used in many diet foods and drinks
• Can be used for baking
• Used as a tabletop sweetener
• FDA approved

Monk Fruit (Luo Han Guo)

• Non-nutritive sweetener
• Plant-based extract of monk fruit, a round green melon that grows in southern China
• 100 to 250 times sweeter than sucrose
• Heat stable and can be used in baking and cooking and is more concentrated than sugar (¼ teaspoon or 0.5 grams equals the sweetness of 1 teaspoon or 4 grams sugar)
• Generally recognized as safe (GRAS) by the FDA

Advantame

• Non-nutritive sweetener
• 20, 000 times sweeter than sugar
• Used as general sweetener and is heat stable, so may be used in baking
• Not commonly used
• FDA approved

Side Effects

People often have questions about the safety and health effects of sugar substitutes. Many studies have been done on FDA-approved sugar substitutes, and they have been shown to be safe. Based on these studies, the FDA states they are safe for use for the general population.

Aspartame is not recommended for people with PKU. Their body is not able to break down one of the amino acids used to make aspartame.

In July 2023, the WHO's International Agency for Research on Cancer classified aspartame as "possibly carcinogenic (cancer causing) in humans". The FDA disagrees with this assessment. The WHO's Joint FAO/WHO Expert Committee on Food Additives (JECFA) has not recommended any change in the acceptable amount of aspartame that can be safely consumed.

There is little evidence to support the use of or avoidance of sugar substitutes during pregnancy. FDA-approved sweeteners are fine to use in moderation. However, the American Medical Association suggests avoiding saccharin during pregnancy due to possible slow fetal clearance.

Recommendations

The FDA regulates all sugar substitutes that are sold or used in prepared foods in the United States. The FDA has set an acceptable daily intake (ADI). This is the amount a person can safely eat each day over a lifetime. Most people eat far less than the ADI.

In 2012, the American Heart Association and the American Diabetes Association published a report that concluded that sensible use of sugar substitutes could help lower caloric and carbohydrate intake. There is also not enough evidence at this time to determine if sugar substitute use leads to weight loss or lower heart disease risk. Some research suggests that they may lead to an increase in weight. Further research is still needed.

References

Aronson JK. Artificial sweeteners. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:713-716.

Azad MB, Abou-Setta AM, Chauhan BF, et al. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. CMAJ. 2017;189(28). PMID: 28716847 pubmed.ncbi.nlm.nih.gov/28716847/.

Gardner C, Wylie-Rosett J, Gidding SS, et al; American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Disease in the Young, and the American Diabetes Association. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2012;126(4):509-519. PMID: 22777177 pubmed.ncbi.nlm.nih.gov/22777177/.

National Cancer Institute website. Artificial sweeteners and cancer. www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet. Updated August 29, 2023. January August 19, 2024.

US Department of Agriculture and US Department of Health and Human Services. Dietary guidelines for Americans, 2020-2025. 9th edition. www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf. Updated December 2020. Accessed August 18, 2023.

US Food and Drug Administration website. High-intensity sweeteners. www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners. Updated December 19, 2017. Accessed August 18, 2023.

US Food and Drug Administration website. Additional information about high-intensity sweeteners permitted for use in food in the United States. www.fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states. Updated July 14, 2023. Accessed August 18, 2023.

US Food and Drug Administration website. Aspartame and other sweeteners in food. www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food. Updated July 14, 2023. Accessed August 29, 2023.

World Health Organization statement website. Aspartame hazard and risk assessment results released. www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released. Updated July 14, 2023. Accessed August 29, 2023.

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Review Date: 8/21/2023  

Reviewed By: Stefania Manetti, RD/N, CDCES, RYT200, My Vita Sana LLC - Nourish and heal through food, San Jose, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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