As a Registered Dietitian, one of the major topics of conversation with my patients is sweeteners. Which to choose, which to avoid, where they are hiding and how much is too much. Because this can be a generally confusing topic, I’m going to break down the differences of natural and artificial sweeteners today in the hopes that it helps you make a better choice. First, let’s talk about Sugar.

Where does sugar come from?

Sugars are naturally occurring in most plants but are highest in sugar cane and sugar beets. These crops are richest in sucrose, what we know as pure table sugar. These sugary plants are processed to produce a syrup, which we know as molasses. The liquid from the molasses gets evaporated and further purified to make table sugar.

That doesn’t sound too bad . . .

While it is a natural source of sweetness, it is very high in calories and raises blood sugar levels which are contributing to a growing global obesity and diabetes epidemic.

What if I don’t eat that much sugar?

Unfortunately, almost all of us consume too much added sugar because it is hidden in so many foods, even unobvious healthy ones like oatmeal, Greek yogurt, and tomato sauce. It is important to read labels carefully and when it’s an option, to choose the plain variety or make your own.

What if I don’t see sugar or sucrose in my ingredient list?

Sugar is the master disguiser – there are over 50 ways food companies hide sugar in ingredient lists. Even if you don’t see sugar or sucrose in your ingredient list, the food product can still contain a lot of added sugars. Anything that ends with – ose means that it is a sugar, so you also have to look out for maltose, dextrose, glucose, galactose, and certainly fructose.

You also need to look out for tricky phrases like malt, syrup, and evaporated cane juice.

So how are people supposed to still enjoy sweet foods without gaining weight or getting diabetes?

Food manufacturers and policymakers were excited to introduce artificial sweeteners as a way for us to eat and enjoy sweet foods without consuming too many calories or spiking our blood sugar. It seemed like a good solution until we started to see that all of these artificial sweeteners just made everything worse!

What are artificial sweeteners?

Artificial Sweeteners are synthetic, overly processed sugar substitutes created by manipulating different chemicals. Their official names are Aspartame, Ace-K, Saccharin, and Sucralose, but you probably know them by their brand names, Equal, Sweet ‘N Low and Splenda.

How did artificial sweeteners make things worse?

Since the introduction of these artificial sweeteners, our obesity and diabetes epidemic has worsened significantly! The American Cancer Society and the San Antonio Heart Study both showed significant correlations of consuming artificial sweeteners and gaining weight and being more likely to be obese.

Normally, when you consume sugary foods and drinks, your blood sugar spikes, leading your pancreas to produce insulin to bring the blood sugar down. Excess intakes of sugar, like by drinking a sugary soda, instantly spikes your blood sugar way too high and your pancreas has to produce excessive insulin to bring it down. Unfortunately, insulin is also a fat-storing hormone.

So not only does this sugary roller coaster cause diabetes over time but it also significantly leads to weight gain and obesity.

Even though these artificial sweeteners claim to not have sugar, researchers are finding that they are so sweet that they are almost tricking the brain and body to produce insulin unnecessarily that causes increases to body weight and fat.

Researchers have proven the harmful effects of consuming artificial sweeteners time and time again, showing them to cause a series of unhealthy events like increasing appetite, calories consumed later in the day, neurologic effects, an inability to respond to insulin, and disrupting the healthy bacteria in your gut.

And most studies that the FDA is using to back up their support for these artificial sweeteners, is comparing artificial sweeteners to pure sugar. But countless studies that compare using artificial sweeteners to not using them at all, clearly show their faults.

Tell me more about Aspartame?

Aspartame, also known as Equal or NutraSweet, is 220 times sweeter than sucrose and made artificially in a lab by synthesizing methanol with the amino acids, aspartic acid, and phenylalanine. This makes it toxic to somebody with phenylketonuria (PKU).

When was it introduced, what happened?

When aspartame was introduced around 1981, only about 17% of America was obese; now 35% of Americans are obese. Obesity has doubled since aspartame’s introduction to the mainstream market! I am of course not saying that Equal is the sole cause of our obesity epidemic, but what we’ve found is that ironically the more people consume these “no calorie” artificial sweeteners, the more calories people end up consuming throughout the day.

Aside from potentially causing weight and stimulating sugar cravings, why else should I not consume aspartame?

Need a couple more reasons to avoid Aspartame? It has been found to lead to migraine headaches which I have found personally and with many of my clients. A recent study of over 125,000 people, published in the American Journal of Clinical Nutrition, found a link between consumption of aspartame-sweetened soda and the risk of leukemia, lymphoma, and multiple myeloma in men.

What about Splenda, how is it made?

Splenda, also called sucralose, is essentially made by taking sugar or sucrose and adding chlorine to it. Yes, chlorine, like the kind you have in a swimming pool. Because our body can’t digest the chemical of chlorine, your body is less successful at digesting the sugar. You are probably thinking, “Wait, if our body can’t digest chlorine, it is probably not something I should be consuming all day long, that can’t be good for my insides…” And you’d be right!

The company boasts that only 15% of that Splenda packet gets absorbed which makes it so that your body doesn’t get all of the calories from the sugar, but that’s still 85% of chemicals that get filtered through your gut, disturbing your healthy bacteria and microbiota which contributes to your immunity and overall health.

How sweet is Splenda?

One of the scariest parts about Splenda is that it is by far the sweetest sweetener in the market and is a whopping 600 times sweeter than sugar! Talk about stimulating that sugar addiction! All other sweeteners are closer to 200-300 times sweeter than sugar which is why I notice that when my clients are Splenda users, they have a horrible sweet tooth and sugar addiction.

What about the Splenda itself, can it raise blood sugar levels?

Even though it appears calorie-free and the chlorine molecule added to the sugar is supposed to prevent sugar absorption, researchers from the Washington University School of Medicine in St. Louis found that when non-diabetic, obese people drank sucralose, their blood sugar spiked and insulin levels increased by nearly 20%. The researchers concluded that drinking sucralose or Splenda-filled foods overtime can possibly lead to diabetes for this reason.

What about Sweet ‘N Low or saccharin?

Saccharin or Sweet ‘N Low was the first commercial artificial sweetener. It is made by the oxidation of o-toluene sulfonamide, as well as from phthalic anhydride. Have you ever heard the saying, if you can’t pronounce it, you probably shouldn’t be eating it? It would apply well here.

Saccharin isn’t as popular as aspartame and Splenda because people say it has a metallic aftertaste and can’t be used for cooking or baking, and is still worth avoiding. The American Medical Association warns pregnant women to stay away from it for its slow fetal clearance which doesn’t seem like a good sign for everyone else.

And what is the deal with Acesulfame Potassium?

Acesulfame Potassium or Ace K might not be something you are aware of but you are probably consuming it daily! It is used in combination with aspartame and sucralose to help reduce their aftertastes and is prominent in carbonated diet sodas.

Is Ace-K dangerous?

Acesulfame Potassium or Ace K contains methylene chloride, which has been linked to cancer in some studies. Long-term exposure to methylene chloride can also cause headaches, depression, nausea, mental confusion, liver effects, kidney effects and visual disturbances in humans.

Am I consuming artificial sweeteners but don’t know it?

Chances are you are consuming artificial sweeteners and don’t even know it. Food companies are reducing calories and sugar by loading our foods, beverages and even toiletries with these sweeteners. From gum to salad dressing, to bread, to toothpaste, it’s crucial that you know the names of each sweetener and read the ingredient lists to know what you are really consuming.

So what should we be using if we want something sweet?

Luckily, some smart companies have been taking the initiative to find healthier alternatives to artificial sweeteners and sugar.

What about natural sweeteners like honey, maple syrup, coconut nectar, and agave?

Alternative natural sweeteners like honey, maple syrup, coconut nectar, and agave have some of the same problems as sugar, in that they are all 15 calories or more per teaspoon. This adds up quickly, especially when the average American consumes 20 teaspoons a day. That can be an extra 300 calories from sugar daily. The American Diabetes Association lists these as sweeteners to limit.

If not sugar, artificial sweeteners or natural sugar alternatives what do you recommend?

The sweetener I recommend to my patients time and time again is Stevia.

What is Stevia?

Stevia is a plant-based sweetener, originally from the rain forests of Brazil and Paraguay. It is now also grown in the Southeast and even right here in California. The Stevia plant is in the sunflower family and looks a little like a mint leaf.

So Stevia might even be good for me?

Stevia has actually been used for hundreds of years in South America to treat burns and alleviate stomach pains. Studies are also being conducted to measure stevia for its potential benefit as an anti-inflammatory and anti-tumor ability.

And unbelievably, just last year (2015), a study published in the European Journal of Microbiology and Immunity found that whole leaf Stevia significantly reduced the bacteria that causes Lyme Disease.

Is it being used anywhere else?

Stevia is regularly consumed by countries in the world that have some of the lowest obesity and diabetes rates like Brazil. It also accounts for nearly 40% of the sweetener market in Japan and is commonly used in various parts of South America.

Where can I find Stevia?

Stevia is already widely available as a tabletop sweetener, in packets, in large quantities for baking and integrated into products in many grocery aisles.

So Stevia isn’t bad for me?

Not only is Stevia not bad for you because it doesn’t contain calories or increase your blood sugar or insulin levels the way the other sweeteners do and it has the potential of long term health benefits!

See below for more resources and information!

Resources:

1. Pepino, M. Y., Tiemann, C. D., Patterson, B. W., Wice, B. M., & Klein, S. (2013). Sucralose Affects Glycemic and Hormonal Responses to an Oral Glucose Load. Diabetes Care, 36(9), 2530-2535. doi:10.2337/dc12-2221

2. Rogers, P. J., Hogenkamp, P. S., Graaf, C. D., Higgs, S., Lluch, A., Ness, A. R., . . . Mela, D. J. (2015). Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes Relat Metab Disord International Journal of Obesity, 40(3), 381-394. doi:10.1038/ijo.2015.177

3. What Is Stevia? (n.d.). Retrieved May 13, 2016, from http://www.livescience.com/39601-stevia- facts-safety.html#sthash.19hgM9ol.dpuf

4. Schernhammer ES, Bertrand KA, Birmann BM, Sampson L, Willett WC, Feskanich D. Consumption of artificial sweetener- and sugar-containing soda and risk of lymphoma and leukemia in men and women. Am J Clin Nutr. 2012 Dec;96(6):1419-28. Epub 2012 Oct 24. Erratum in: Am J Clin Nutr. 2013 Aug;98(2):512.

5. Cong W, Wang R, Cai H, et al. Long-Term Artificial Sweetener Acesulfame Potassium Treatment Alters Neurometabolic Functions in C57BL/6J Mice. Matsunami H, ed. PLoS ONE. 2013;8(8):e70257. doi:10.1371/journal.pone.0070257.

6. Yang Q. Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience 2010. The Yale Journal of Biology and Medicine. 2010;83(2):101-108.

7. Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr. 2009;89:1–14.

8. Brown RJ, de Banate MA, Rother KI. Artificial Sweeteners: A systematic review of metabolic effects in youth. [Epub 18 Jan 2010];Int J Pediatr Obes.

Additional Resources:

What is Stevia
SweetLeaf
Aspartame
Sweeteners: Facts and Fallacies 
Artificial Sweeteners
Ling Yeouruenn, A New Compendium of Materia Medica, 1995 Science Press, Beijing
Diabetes: What Can I Eat
Eat Any Sugar Alcohol Lately
Glycemic Index for 60 + Foods
Sweeteners – Sugar Substitutes

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