Sugar Substitutes: Are They Safer Than Sugar?

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We’re all familiar with the dangers of excess sugar, especially for those managing diabetes or trying to shed a few pounds. It seems sugar is being added to all our food products these days. While that may thrill our tastebuds, it’s not doing much for our waistlines or the diabetes epidemic. But what about sugar alternatives? Are they safer? Let’s look at the pros, the cons, and the concerns of sugar alternatives.

Science has given us a variety of artificial or non-nutritive sweeteners that offer sweetness without the blood sugar spike or the calorie overload. But are these sugar substitutes any better for us? The FDA has approved 6 non-nutritive sweeteners for use in our food supply. These include (in order of their FDA approval date): aspartame (1974), saccharin (1977), acesulfame potassium (1988), sucralose (1998), Neotame (2002), and Advantame (2014). (¹)

Aspartame

Aspartame, commonly found in those iconic blue packets under the brand name Equal, is about 200 times sweeter than sugar. It is a go-to choice for many because of its taste similarity to sugar. The FDA approved aspartame as a sweetener in 1974. Whether you’re sweetening your morning coffee or mixing up a refreshing beverage, aspartame is a versatile companion in the quest for sweetness without the calories.

Aspartame has been one of the most extensively studied food additives. After decades of research, there seems to be a consensus from regulatory agencies from major countries as well as professional organizations such as the Academy of Nutrition and Dietetics, the American Diabetes Association, the American Heart Association, and the American Cancer Society regarding the relative safety of aspartame.(2,3,5)

However, people who have difficulty metabolizing phenylalanine because of a rare genetic disorder called phenylketonuria (PKU) should avoid or restrict aspartame. And I will add, those prone to seizures or headaches, especially migraine, may want to minimize exposure to aspartame as well. It’s also advised to avoid aspartame during pregnancy.

The Acceptable Daily Intake (ADI) for aspartame is 50 mg/kg bodyweight per day according to the FDA. That translates to about 92 packets of Equal per day OR about 18 cans of diet soda (depending on amount of aspartame in each can) for a 150-lb person. Both the European Food Safety Authority (EFSA) and the joint committee formed by the Food and Agriculture Organization of the United Nations and the World Health Organization (WHO) recommend a slightly lower ADI for aspartame, at 40 mg/kg/day. Either way, that’s a lot of blue packets and diet soda!

While aspartame appears safe to use in reasonable amounts, there are still possible health effects that are unknown to us. Just apply the same caution you would for sugar. Enjoy a little but not too much and make sure your overall diet includes all the right foods for sufficient nutrients.

Saccharin

Saccharin is a pioneer in the world of artificial sweeteners. It has been around for over a century. This organic compound with a sweet taste was discovered by chemists Remsen and Fahlberg in a lab at Johns Hopkins University in 1879. Saccharin became the first commercially available non-nutritive sweetener – coming out prior to the FDA approval process. During WWI, saccharin became popular due to the sugar shortage. In the 1960s it gained favor to help with weight loss. You probably know it best in its pink packet labeled with the brand name Sweet N’ Low.^TM

Since saccharin is 200 to 700 times sweeter than granulated sugar, you only need a tiny amount to satisfy that sweet tooth. And although sweeter than sugar, it does have a slightly bitter and metallic aftertaste. Saccharin is relatively heat stable making it suitable for use in baked goods. It provides no calories and does not promote tooth decay. It is not metabolized by the body, so it’s excreted unchanged.

Saccharin has had its fair share of controversy, however. In the 1970s, researchers found rats given high doses of saccharin had a greater incidence of developing bladder cancer. When the FDA approved saccharin in 1977, Congress required packaging of saccharin to display a cancer warning label. However, in 2000, after epidemiological studies had made no connection to saccharin use and bladder cancer in humans and scientists had discovered that humans metabolize saccharin differently than rats, the warning label requirement was rescinded.

More recent research has looked at the effect non-nutritive sweeteners may have on the gut microbiome and the potential impact on health. Research into the gut microbiome has become a hot topic in recent years. In a study published in 2022 in the journal Nutrients, titled “Potential Effects of Sucralose and Saccharin on Gut Microbiota: A Review”, researchers concluded, “Indeed, the mechanisms by which low-calorie and non-calorie sweeteners may alter the gut microbiota remain unclear, and it is not possible to conclude at present whether their effect is direct on the microbiota or mediated by the metabolic situation of the host, for which there are still no conclusive studies.”

The difficulties with determining the effect of these non-nutritive sweeteners on human gut microbiota is complicated by the fact that individuals’ gut microbiota varies. How one gut bacteria may interact with saccharin does not mean all gut bacteria will interact the same way. There are too many variables. Therefore, the results are inconclusive.

Another research paper entitled, “Long-Term Saccharin Consumption and Increased Risk of Obesity, Diabetes, Hepatic Dysfunction, and Renal Impairment in Rats” proposes another conclusion. It says, “The administration of saccharin throughout the treatment period was correlated with impaired kidney and liver function. Both hyperglycemic and obesity-inducing side effects were observed. There was an increased oxidative status of the liver,… Therefore, it is suggested that saccharin is unsafe to be included in the diet.”

This study used a control group and three experimental groups of rats which were treated with different doses of saccharin at 2.5, 5, and 10 mg/kg bodyweight, respectively. Each experimental group received sodium saccharin once per day for 120 days while the control group was treated with distilled water only. But do rat studies translate to humans?

While the FDA has approved saccharin for human consumption, they do include an Acceptable Daily Intake (ADI) at 15 mg/kg bodyweight daily. This would equal about 45 packets of Sweet N’ Low per day for a person weighing 132 lbs. Just notice this ADI is higher than the dose used in rats.

Acesulfame Potassium

Acesulfame potassium, or Ace-K for short, joins the party with a taste 200 times sweeter than sugar. This sugar alternative holds up well under heat, making it another great option for baking. This trait makes it appear in lots of food products. It’s a staple for your low-calorie, sugar-free desserts. And you’ll find it in the ingredients list of many food products.

Even though the International Agency for Research on Cancer (IARC) and Joint (FAO/WHO) Expert Committee on Food Additives (JECFA) issued a report in July 2023 concluding aspartame should be labeled as “possibly carcinogenic to humans”, the FDA argues the point that being “possibly carcinogenic” does not mean that aspartame is actually linked to cancer.

The FDA has concluded, “FDA scientists do not have safety concerns when aspartame is used under the approved conditions.” Aspartame has also received the green light for use from other regulatory authorities such as Health Canada and the European Food Safety Authority. Both consider it safe at current permitted use levels. The ADI for acesulfame potassium is 15 mg/kg bodyweight per day. That’s equivalent to 23 packets of Sweet One or Sunett (brand names of Ace-K) for a 132-lb. person.

Sucralose

No discussion about sugar substitutes would be complete without mentioning sucralose, also known by its brand name Splenda. This popular powder in the yellow packet was discovered and introduced in the late 1970s. It was approved for use in Canada in 1991 and FDA approved in the US in 1998. It’s 600 times sweeter than sugar. With a molecular formula of C₁₂H₁₉Cl₃O₈, it’s not to be confused with sucrose with a molecular formula of C₁₂H₂₂O₁₁. Superficially, sucrose and sucralose molecules look similar. Sucralose is actually made from sucrose by replacing 3 of the oxygen-hydrogen groups with chlorine. By adding chlorine molecules, sucralose is not metabolized by the body and contributes no calories. But unlike most artificial sweeteners, sucralose doesn’t have a bitter aftertaste. It’s also heat stable making it suitable for baking. But if cooked long enough or at a high enough temperature, it can release potentially harmful compounds called chlorophenols.

Studies have not shown any links between sucralose and cancer or developmental defects. It’s considered safe for children, pregnant and nursing women, as well as for people with diabetes. Interestingly, however, sucralose has been shown to raise blood sugar in certain people. Also, sucralose may increase insulin and blood glucose levels and decrease insulin sensitivity, all effects that people with diabetes are trying to avoid.

One study titled, “The hidden hazardous effects of stevia and sucralose consumption in male and female albino mice in comparison to sucrose”, stated “In conclusion, non-caloric sweeteners either artificial (sucralose) or natural (stevia) hide several risks to their consumers. They are responsible for: 1- increasing glycaemia in spite of their lack of calories, 2- increasing liver enzymes due to the intestinal flora reshaping, 3- elevation of urea and creatinine levels, 4- reduction of the anti-inflammatory cytokines and elevation of the pro-inflammatory cytokines secretion. On the other hand, sucrose is a caloric sweetener with some risks of course; but it is safer than sucralose or stevia. So we recommend not using sucralose or stevia and decreasing the used daily dose of sucrose instead.” With that said, what’s the ADI of sucralose? The FDA says 5 mg/kg bodyweight per day is considered safe. That’s equal to 23 packets of Splenda for a 132 lb. person per day.

Neotame

Now, let’s talk about neotame, the newcomer to the scene. Neotame introduced in 2002, is incredibly potent, clocking in at a whopping 7,000 to 13,000 times sweeter than sugar. Yes! You read that right. Due to its intense sweetness, only a minuscule amount is needed to achieve the desired level of sweetness in your culinary creations.

The ADI for neotame, also known as brand name Newtame, is 0.3mg/kg bodyweight per day or about 23 packets of neotame. Fortunately, at that level of sweetness, it doesn’t take much.

Advantame

The most recent and lesser-known non-nutritive sweetener is Advantame. This newcomer was FDA approved as a food additive in 2014 and has the most intense sweet taste at 20,000 times sweeter than sucrose. It’s also heat stable so it may be used in baked goods. The ADI is 32.8 mg/kg bodyweight per day or about 4,290 packets of Advantame for a 132 lb. person. There is such a thing as too sweet – don’t you think?

WHO Recommendations

Even with current research showing their safety, newer research continues to emerge questioning the benefits and safety of using these non-nutritive sweeteners. The World Health Organization released an article in May 2023 advising people to avoid using non-nutritive sweeteners for weight control. The recommendation is based on a systematic review of the available evidence which suggests that use of non-sugar sweeteners does not confer any long-term benefit in reducing body fat in adults or children. Results of the review also suggest that there may be potential undesirable effects from long-term use of sugar-substitutes, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults. They recommend finding ways to decrease overall sugar intake instead and focus on natural sugars from whole fruits.

Final Thoughts

The debate continues and more research is needed to investigate long-term safety of using artificial sweeteners. As with most things in life, time will tell. In the meantime, if you choose any of these artificial sweeteners, using a reasonable amount of the sweet stuff in your diet may be fine. Remember: in large amounts, sugar is not good for your health either. Moderation is still your best and safest bet.

And there you have it, a sweet journey through the world of non-nutritive sweeteners. Remember, whether you’re managing diabetes, watching your weight, or simply looking for a healthier alternative to sugar, limiting your amount is the best solution.