Reality check on Low / No Cal Sweeteners

Celebrations or festivities are just incomplete without sweets. Diabetics, those who are obese, or weight watchers often feel guilty whenever they indulge in sweets. A solution for this guilt: low-calorie and no-calorie sweeteners. But are they healthy?

A sweet preparation is a must at times of merry-making. Sugar and its products serve as the most widely used sweeteners for these preparations, but they are high in calories and have other side effects. To combat this negative effect, low- or no-calorie sweeteners are gaining popularity because they can help us cut down on calories, control weight, and manage chronic conditions like diabetes.

FDA-Approved Artificial Sweeteners

To date, the Food and Drug Administration (FDA) has approved six high-intensity artificial sweeteners: aspartame, saccharin, acesulfame-K (Ace-K), neotame, sucralose, and advantame. Additionally, stevia extract (steviol glycosides) has GRAS (Generally Recognised as Safe) status.

Common Artificial Sweeteners

Aspartame (marketed as Sugar-Free Gold®, Equal®): Aspartame is 200 times sweeter than sugar, with calories the same as sugar, i.e. 4 kcal/gram. However, since the amount of aspartame used is pretty low, people consider it free of calories. In July 2023, the WHO's International Agency for Research on Cancer (IARC) classified aspartame as "possibly carcinogenic to humans" (Group 2B) based on limited evidence, though the FDA and other regulatory agencies maintain it is safe at current consumption levels. People suffering from phenylketonuria (a rare genetic condition) should avoid aspartame completely. Acceptable Daily Intake (ADI): 50 mg/kg body weight (FDA) or 40 mg/kg (WHO).

Saccharin (Sweet'N'Low®, SugarTwin®): It does not contain any calories, does not raise blood sugar levels, and its sweetness is 200-700 times sweeter than sugar. ADI: 5 mg/kg body weight.

Acesulfame-K (Sunnet®, Sweet One®): Acesulfame-K is 200 times sweeter than sugar, with no calories. The body does not break it down; the kidneys eliminate it unchanged. Therefore, diabetic patients may safely use the product without it affecting their blood glucose levels. ADI: 15 mg/kg body weight.

Neotame: One of the newer low-calorie sweeteners, neotame is approximately 7,000-13,000 times sweeter than sugar. ADI: 0.3 mg/kg body weight.

Advantame: Approved by the FDA in 2014, advantame is approximately 20,000 times sweeter than sugar and is stable at high temperatures. ADI: 32.8 mg/kg body weight.

Sucralose (Splenda®, Sugar-Free Natura®): Sucralose is the only non-calorie sweetener that manufacturers create from real sugar. To produce sucralose, manufacturers alter the sugar molecule, making it 600 times sweeter than sugar. The body does not digest, absorb, or metabolise sucralose for energy. As a result, it does not affect blood glucose levels, making it safe for diabetics. ADI: 5 mg/kg body weight (FDA) or 15 mg/kg (WHO).

Stevia (Sugar-Free Herbvia®, Uber Natural sweetness®): A natural alternative sweetener, stevia is a herb extract that is much sweeter than sugar (200-400 times) and calorie-free. The FDA has approved certain purified steviol glycosides as GRAS. ADI: 4 mg/kg body weight.

Tagatose: Tagatose has GRAS status in the US. It is derived from lactose, a carbohydrate present in dairy products. It provides 1.5 kcal/g in the US (2.4 kcal/g in the EU) and is about 90% as sweet as sugar. Unlike sugar, the body does not fully absorb tagatose, so it has a reduced caloric impact and does not significantly affect blood glucose levels.

Comparison Table

Important Facts about Sugar Substitutes

• Cancer Risk: Most regulatory agencies, including the FDA and European Food Safety Authority, have concluded that approved sweeteners are safe at current consumption levels. However, in 2023, the WHO's IARC classified aspartame as "possibly carcinogenic" based on limited evidence, while simultaneously reaffirming its safety at current intake levels. The scientific community continues to monitor research in this area.

• Other Health Effects: Sugar substitutes do not increase the risk of other diseases. In contrast, they can be a potentially useful tool in the management of calorie and carbohydrate intake, promoting overall health management.

• Pregnancy and Nursing: All approved sweeteners are considered safe for pregnant and nursing mothers at normal consumption levels. However, physicians or dietitians recommend seeking their advice for personalised guidance.

• Individual ADI Levels: Each sweetener has its own specific Acceptable Daily Intake (ADI) level set by regulatory agencies. These levels represent the amount that can be safely consumed daily over a lifetime without adverse effects. The ADI varies significantly between sweeteners.

Unapproved Sweeteners

Sugar substitutes not yet approved by the FDA include Alitame (Aclamate) and Cyclamate (currently banned by the FDA in the United States but approved in many other countries).

Author's take on Sugar Substitutes: No artificial sweetener should play a major role in a healthy diet. Each sweetener has a specific maximum acceptable daily intake based on body weight. For example, for aspartame (ADI: 50 mg/kg), a 50 kg person could safely consume up to 2.5 grams per day, while for saccharin (ADI: 5 mg/kg), the same person should limit intake to 250 mg per day.

All the above-mentioned sweeteners are considered safe today based on current scientific evidence, but ongoing research continues to evaluate their long-term effects. Like sugar, sugar substitutes also contribute little or nothing in the form of nutrients and may replace more nutritious foods in the diet. People should use them judiciously and avoid making them a part of everyday life. A balanced diet rich in whole foods remains the best approach to health.

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