Sugar Substitutes

Andrew Siegel, M.D.  Blog #123

For many of us who have a “sweet tooth,” sweet tastes are delightful and we actively seek them out in accordance with our evolutionary drives. The first bite of that sugary Cinnabon is pure bliss. The brain’s reward pathway squirts out the neurotransmitter dopamine and we get a jolt of near ecstasy—the mind-body connection in action. Hopefully, within a matter of minutes, leptin—our satiety hormone that regulates appetite—will counteract the dopamine, making subsequent bites less rewarding and stopping us from gorging.

Sugar is ubiquitous in our diets, not just in the places you expect it, but also “stealth” sugar in breads, crackers, pretzels, chips, salad dressings, sauces, etc.  If you read food labels you might be shocked about the presence of sugar in many unexpected destinations. Sugar (sucrose) is clearly unhealthy and processing and refinement “advances” have permitted its consumption in unreasonable, immoderate and unwarranted amounts, contributing to America’s expanding waistlines and derrières.  So what’s the skinny on sugar substitutes?  Are they helpful in terms of losing weight? Are they better for our dental health than sugar? Are they helpful for diabetics?  Do they have risks?

Sugar substitutes duplicate the sweetness of sugar, but without the caloric (energy) load. Natural sugar substitutes originate from nature and include the following: agave nectar; date sugar; fruit sugar concentrate; honey; maple syrup; and molasses. Synthetic substitutes are concocted by chemists in a lab and are known as artificial sweeteners.   There are 6 “super-sweet” high-intensity substitutes approved for use by the FDA. The super-sweet sugar substitutes are the following: stevia (Truvia); aspartame (NutraSweet; Equal); sucralose; neotame (manufactured by the NutraSweet company); acesulfame (Nutrinova); and saccharin (Sweet’N Low).  Aspartame is the most popular artificial sweetener in United States and sucralose is not far behind.

Sugar substitutes are widely prevalent in our food supply—in processed foods, baked goods, dietary foods, dietary soft drink beverages, powdered drink mixes, canned foods, jams and jellies, dairy products, toothpastes, chewing gums, sugar-free desserts such as ice cream, yogurts, and puddings, and in vitamins and medicines including cough drops.

In terms of weight loss, sugar substitutes can be an effective and attractive means of consuming less calories since the substitutes are non-nutritive and have virtually no calories, while retaining the sweet taste of food substances.    This is in contrast to sucrose that has 4 calories per gram.  Additionally, sugar substitutes are dental friendly, as they—unlike sucrose—are not fermented by the bacterial flora that lives on the teeth and thus do not produce acidy waste products that cause tooth decay.   Sugar substitutes can be effective for diabetics who have trouble regulating blood glucose levels since sugar substitutes do not elevate blood sugar levels the way sucrose does.

Sugar substitutes, while providing a sweeter taste than sugar, contain few or no calories, which is why using them has been thought to aid weight management. Our food-reward system plays a critical role in regulating eating behavior and controlling the number of calories consumed. When the tongue perceives sweetness, the brain expects a glucose infusion, which increases levels of dopamine and stimulates reward centers in the brain.  Without the energy kick provided by actual sucrose, sugar substitutes cannot fool our brains into feeling satisfied. Sugar imposters yield no such reward and cravings can persist and cause more rebound consumption than eating sugar in the first place.

The Food and Drug Administration (FDA) is the governmental body responsible for the regulation of sugar substitutes. Over the years, health concerns have been raised with respect to the use of substitutes and they have been the subjects of intense scrutiny. The general consensus is that there is no sound evidence that any of the substitutes approved for use in the United States cause serious health problems and that they are generally safe in limited quantities. However, there is ongoing and unsettled controversy regarding whether substitute usage is problematic in terms of health risks. We remain muddled in a debate about the health implications of substitutes and whether they might be linked to obesity, cancer, Alzheimer’s disease, ADD, autism, etc.  Search on the Internet and you will learn about the “conspiracy theories” concerning artificial sweeteners.

Saccharin (Sweet’N Low) was the first artificial sweetener, originally synthesized in 1879.  It is 400 times as sweet as sugar.  Although saccharin was previously considered hazardous when it was discovered to cause cancer in rats and carried a warning label, the warning label was subsequently repealed and saccharin has been removed from the hazardous list.  Cancer in laboratory rats has not been found to necessarily correlate with cancer in humans.

Aspartame (Equal; NutraSweet) was discovered serendipitously in 1965 when a scientist at Searle was working on a drug for peptic ulcer disease and spilled some of the chemical on his hand. He accidentally noted its sweet taste, and the rest is history.  It is 200 times as sweet as sugar and derives from 2 amino acids, aspartic acid and phenylalanine.  It is undesirable as a baking sweetener because, when heated, it breaks back down into its constituent amino acids.  It has sometimes been linked to headaches.

Stevia is a natural sweetener that is derived from the stevia plant; its leaves have been used as a sweetener in South America for centuries. It is 300 times as sweet as sucrose.  It was discovered by botanist Petrus Jacobus Stevus, which is why it was named Stevia.

Sucralose (Splenda) is a chemically modified form of sugar that was discovered in 1976 and is about 600 times as sweet as sucrose. It is stable when heated, so is appropriate for use in cooked foods.   Most of consumed sucralose passes out of the body unchanged, with only a small amount getting absorbed.

Neotame (from NutraSweet) is chemically similar to aspartame, but is significantly sweeter, being the sweetest of the group.  It is the only artificial sweetener deemed safe by the Center for Science in the Public Interest (CSPI).

Acesulfame is calorie-free and 200 times as sweet as sucrose; it is formed by adding potassium to aceto-acetic acid.  It is not metabolized by the body, but is excreted unchanged.  Because it is heat stable, it can be used in cooking and baking.

Sugar alcohols are carbohydrates that occur naturally in certain fruits and vegetables, but can also be synthesized.   They do contain calories but they are lower in calories than sucrose. They are used in many processed foods and household items including chocolate, candy, frozen desserts, chewing gum, toothpaste, mouthwash, baked goods and fruit spreads.

Bottom Line: The take-away message is “everything in moderation.” Whether you indulge in items sweetened with sugar derived from sugar beet or sugar cane, sugar alcohols, or any of the natural or artificial sweeteners, consumption should always be kept in check.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health, in press. Will be available in e-book and paperback formats in later 2013.

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