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Family Health Magazine - NUTRITION

We all Like it Sweet
Understanding the choices

Many products on the market are geared to weight loss and blood glucose control. When deciding what type of sweetener to use, consider:

• calories
• source (natural or artificial)
• safety (acceptable daily intake)
• possible side effects.

What are natural sweeteners?

Natural sweeteners, also called sugars, occur naturally in food. (See Table 1 for list.) These natural sweeteners are added to food during processing. Food manufacturers know that these added sugars enhance flavour, add texture and aid in the browning of foods.

It is important to read food labels to find added sugars. You may not think a food has much sugar in it, but you might be surprised when you read the nutrition facts. Sometimes these added sugars are called hidden sugars. (Added sugars are not the sugars that are in food naturally, such as lactose in milk and fructose in fruit and vegetables.)

Health Canada recommends eating no more than 40 grams (10 teaspoons or 50 mL) of added sugar a day. In one teaspoon (5 mL) or four grams of sugar, there are 14 calories.

What are sugar alcohols?

Sugar alcohols (see Table 1) are considered ‘reduced calorie sweeteners.’ They raise blood glucose levels, but have half the calories of regular white sugar. Sugar alcohols are found naturally in fruits and vegetables. They also are manufactured in large amounts to be added to foods. Sugar alcohols are often found in foods like sugar-free gum, candy, jam, frozen desserts and ice cream products. Since they are not absorbed completely by the body, consuming large quantities (more than 10 grams per day) can cause side effects like diarrhea, gas and bloating.

What are artificial sweeteners (sugar substitutes)?

Artificial sweeteners are also known as sugar substitutes. They have few or no calories, and do not raise blood glucose levels. Most artificial sweeteners are synthetic. One substitute for sugar, called stevia, occurs naturally.

Artificial sweeteners are high-intensity, and usually far exceed the sweetness of sugar. A little goes a long way in creating a sweetened taste. They come in tablet, liquid, individual packets and granulated form.

How safe are artificial sweeteners?

Health Canada must approve all the artificial sweeteners that are sold in Canada. Once a sweetener is approved, Health Canada sets strict guidelines for how it can be used. Artificial sweeteners approved for use as food additives are aspartame, sucralose, acesulfame-potassium and neotame. Others can be used only as tabletop sweeteners for people to add to their own food, but are not approved for use in pre-packaged foods. These include cyclamate, saccharin and stevia.

Health Canada assigns a safety limit, called the acceptable daily intake (ADI), for each sweetener. The ADI is the estimated amount of sweetener, based on body weight, that a person can safely consume every day over a lifetime, without risk. Health Canada also determines which sugar substitutes are safe for pregnancy. Safe amounts according to the ADI are listed in Table 2.

The ADI is a conservative amount. It is generally one per cent of the highest dose at which studies have demonstrated no harmful effects. For instance, the ADI for aspartame is 40 mg/kg of body weight. This means that someone weighing 60 kilograms (132 pounds) could safely have 2400 mg of aspartame every day for their lifetime. That amounts to ten cans of diet pop or about 100 packets of Equal (blue packet) every day. On the other hand, the upper safe limit for the yellow-packet SugarTwin (which contains cyclamate in Canada) is about two to three packets per day.

Artificial sweeteners not recommended in pregnancy are cyclamate (SugarTwin – yellow packet, Sweet‘N Low, and Sucaryl), and saccharin (Hermesetas). Stevia is also not recommended in pregnancy (an acceptable limit has not been established in Canada). Health Canada also recommends that children and adults with phenylketonuria (PKU) should avoid aspartame.

Entire websites are devoted to the dangers of artificial sweeteners. The majority of research suggests they are safe to consume in moderation. Artificial sweeteners have only been around for 25 years or so. Since they are new, the long-term risk of consuming them is unknown and a concern. Using them in small amounts makes the most sense.

Do artificially sweetened foods really help you lose weight?

Recent research shows that cravings for sweet things may increase when artificially sweetened foods and drinks are consumed. This finding is based on studies of rats that were given diet pop. Although sweeteners may not help you lose weight, they help you limit calories from carbohydrates, and so may help you reduce weight. The impact of artificial sweeteners on weight control is still unknown for humans. Moderate use is the current recommendation. As well, the impact of artificial sweeteners on human cravings continues to be studied.

Are artificial sweeteners allowed for children?

Health Canada has indicated that most sweeteners are considered safe for children. However, as a general rule most children should obtain food from natural sources. Your children could be consuming more artificial sweetener than you think if they have diet drinks, puddings, fruit leathers, and other sugar-free products.

Natural sugar contains 14 calories per teaspoon. Unless blood glucose control is needed, the recommendation would be to choose a natural sweetener over an artificial one. Artificial sweeteners can be given to children in moderation if there is concern about excess sugar or calories.

Understanding more about sweeteners and how they may affect your health can help in making wise choices.

Table 2. Other sweeteners approved for use in Canada
Sweeteners & Brand Names	Sources, Uses and Relative Sweetness	Safety
* ADI = Acceptable Daily Intake
Aspartame Equal (blue packet) NutraSweet SugarTwin (blue packet) Sweet‘N Low	Available as a packet or tablet Permitted to be added to packaged beverages and foods Not recommended in baking Made from combining two amino acids chemically 200 times the sweetness of sugar	Considered safe during pregnancy ADI: 40 mg/kg body weight per day; for example, a 60 kg person can have 2400 mg per day maximum One packet of Equal (blue packet) has 22 mg aspartame; one can of diet pop has 225 mg aspartame People with phenylketonuria (PKU) should avoid aspartame
Sucralose Splenda	Available in packets Permitted to be added to packaged beverages and foods Heat stable - can be used in cooking Manufactured from sugar 600 times sweeter than sugar	Considered safe during pregnancy ADI: 9 mg/kg body weight per day; for example, a 60 kg person can have 540 mg per day maximum One packet of Splenda has 12 mg sucralose
Acesulfame Potassium (Ace-K) Sunett Sweet-n-Safe Sweet One	Added to packaged beverages and foods Not permitted to be sold in individual packets in Canada Manufactured using acetoacetic acid 200 times sweeter than sugar	Considered safe during pregnancy ADI: 15 mg/kg body weight per day; for example, a 60 kg person can have 900 mg per day maximum A sweetened drink might contain about 45 mg of Ace-K
Neotame Lakanto	Added to packaged foods like beverages, tabletop sweeteners, chewing gums, baked goods, frozen desserts Similar to aspartame 7000 to 13,000 times sweeter than sugar	Considered safe during pregnancy Similar to aspartame but safe for people with phenylketonuria ADI: 18 mg/kg of body weight per day
Stevia * Truvia and Purevia are other sweeteners derived from the stevia.	Natural product from stevia, also called sweet leaf, from the sunflower family In Canada, stevia leaf can be sold without health claims Sold for individual use only as a sweetener, and in some natural health foods - not allowed for widespread use in foods Stevia leaf is about 30 to 45 times the sweetness of sugar, and stevia extract is about 250 times sweeter	Not recommended for children or during pregnancy ADI: does not exist for stevia in Canada About one calorie per gram of stevia extract
Cyclamate SugarTwin (yellow in Canada) Sweet‘N Low in Canada Sucaryl	Available as a packet, liquid or tablet Not permitted for use in packaged beverages and foods Made from two sugar molecules but is not absorbed like sugar 30 to 50 times sweeter than sugar	Not recommended during pregnancy ADI: 11 mg/kg body weight per day; for example, a 60 kg person can have 660 mg per day maximum One packet of SugarTwin (yellow) has 260 mg cyclamate
Saccharin Hermesetas	Only available as tablet Hermesetas from a pharmacy In Canada, not permitted for use in packaged beverages or foods Bitter taste when heated Made from a combination of chemicals like ammonia, toluene 300 times the sweetness of sugar	ADI: 5 mg/kg body weight per day; for example, a 60 kg person can have 300 mg of saccharin per day One tablet of Hermesetas contains 12 mg of saccharin

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While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specifid medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physican promptly. Copyright 2012, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1  [NU_FHa13]