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brown & white sugar crystals

Listen to Dr. Neal address artificial sweeteners on Episode 70 of the podcast Optimal Health Daily.

When I was a health educator for a weight loss program, we would always tell our patients if they wanted to satisfy their sweet craving, diet soda and other foods with so-called alternative sweeteners were a good option. This was especially true for those with diabetes. Why would we recommend the consumption of artificial sweeteners? It was because these foods typically had no (or very few) calories and no real sugar. This means that they could consume as many sodas and sugar-free hard candies as they would like, still satisfy their sweet craving, but without worrying about getting off track with their weight loss or blood sugar goals. But was this really the best advice?

Artificial Sweeteners and Sugar Options

There are so many artificial sweeteners available at your local market now, it’s hard to keep track. While some of them have been sold commercially for decades, others are rookies and newer to the game. What we’re learning is, not all of these sugar substitutes are created “equal.” Get it? Because Equal® is one type of sugar substitute? Ok, I’ll stop.

For some of the newer substitutes on the market, there’s not much scientific data on their health effects so I may not be able to speak to all of them. But I will mention the following:

  • Equal (aka aspartame, NutraSweet or AminoSweet)
  • Sweet ‘N’ Low (saccharin)
  • Splenda (sucralose)
  • Stevia
  • Sugar alcohols (like sorbitol and mannitol)
  • Yacon syrup

Stevia

First up on this artificial sweeteners list is Stevia®. Stevia is sometimes, but not often, called “Rebiana.” This sweetener comes in different forms like Truvia, PureVia, and SweetLeaf. Each is a little different in their chemical compositions. Stevia itself comes from the leaves of the yerba dulce plant. For now, it is generally recognized as safe. This means that, at this time, there’s not enough scientific evidence to show that Stevia consumption may harm us. But I should mention that there are some studies that have shown Stevia may lead to genetic mutations, but these studies were performed in a lab and not with actual living humans.

Sugar Alcohols

Next, sugar alcohols. These actually are made up of real sugar, but less of it. You usually find sugar alcohols in sugar-free gums and candies. They are called sugar alcohols because they do in fact contain some real sugar, but they also consist of a little bit of alcohol as well. From a taste standpoint, these aren’t as sweet as real sugar but the advantage is that they are absorbed into the bloodstream much more slowly. For those struggling to manage their blood sugar, this is a good thing. Sugar alcohols are generally recognized as safe, but I always warn folks to watch how much of these they consume. When you start approaching 50 grams of sugar alcohols per day, they may have a laxative effect.

Aspartame

What about Equal or NutraSweet? Both of these artificial sweeteners are made of aspartame. You’ll find Equal or NutraSweet in diet sodas. The Harvard School of Public Health found an association between diet soda consumption and cancer in men. Meaning, as men consumed more diet soda with Equal or NutraSweet, their risk of cancer also went up. They believe this is due to the fact that our bodies convert aspartame to formaldehyde. Formaldehyde may sound familiar—this is what coroners use to preserve human bodies after they have passed on.

Turns out, formaldehyde is also a known carcinogen (or cancer-causing agent). So, at this time, it’s probably best to limit your consumption of Equal and NutraSweet.

In my experience, many people confuse Equal and NutraSweet with Sweet ‘N’ Low®, so I feel like I should mention this one as well. Sweet ‘N’ Low is also known as saccharin… and this is one we probably also want to avoid.

Sweet'N Low

Moving on to Sweet'N Low (saccharin)… this one we likely also want to avoid. People like to use this substitute because it is 350 times sweeter than sugar, so a little goes a long way. Different scientific sources have found that there’s an increased risk for cancer with consumption.

Splenda (sucralose), relatively new to the market, should be consumed with caution. Splenda is made by reacting sucrose (a type of sugar) with chlorine.

There are some concerns that sucralose alter our microbiome (or the health and variety of the good bacteria in our gut). Once the microbiome is involved, the effects could range from regulation of body weight, to incidence of inflammatory bowel disease, and the absorption and metabolism of foods and nutrients by the body.

It’s advised that folks shouldn’t get more than 5 milligrams of Splenda per kilogram of body weight. So, a 150 lb. (68 kg) person shouldn’t consume more than 340 mg of Splenda per day. Consider: each individual packet of Splenda is about 4,000 mg.

Yacon Syrup

Finally, yacon syrup. A rookie when it comes to the sugar substitute game, this product became a household name after Dr. Oz promoted this as a potential weight loss tool. After his TV producers conducted a study of over 700 women, results found that yacon syrup may have helped with their weight loss. But, the study had huge design flaws. So it’s hard to know whether the syrup helped the women lose the weight or whether it was due to something else entirely. At this time, I would say save your money until we have more research to know whether it’s truly safe to consume in the longer term and whether it actually helps with weight loss.

And going back to my story at the beginning, given this information: telling my patients to substitute diet soda for regular soda in any quantities they wished, may have been a bit shortsighted. Now, I should mention something about the natural sugars found in foods. Natural sugars found in foods, likely don’t pose the same health risks. But consuming minimally-processed foods are the key. Think about fruit, for example. Fruits can be high in sugar, but they also contain fiber which has 2 effects on the body:

  1. it slows down the body’s absorption of those sugars, and
  2. the fiber acts as a prebiotic in that it can help our gut grow more helpful bacteria and help promote a healthy microbiome.

Bottom line is: the only sugar substitutes that would be considered safe to use on a regular basis at this point are sugar alcohols (sorbitol and mannitol) and possibly Stevia. While the others don’t need to be avoided completely, it would be wise to limit your consumption.

Listen to Dr. Neal address this topic on Episode 70 of the podcast Optimal Health Daily.

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Neal Malik

Dr. Neal Malik ("Dr. Neal") is currently a professor at California State University, San Bernardino. Before this, he served as Department Chair at Bastyr University California. Dr. Neal has also published peer-reviewed scientific research and presented at national conferences. Send in your health related question and Dr. Neal will answer it on the Optimal Health Daily show!
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