According to the Food and Drug Administration (FDA), there are two types of sweeteners: non-nutritive and nutritive. Non-nutritive sweeteners are often referred to as sugar substitutes, or artificial sweeteners. This article focuses on non-nutritive sweeteners and whether the evidence or research supports their purported benefits.
What are non-nutritive sweeteners?
Non-nutritive sweeteners are food additives that are used instead of sugar to sweeten foods, beverages and other products such as oral care products and certain medications.
Non-nutritive sweeteners contain few or no calories or nutrients. They may be derived from plants, herbs or from sugar itself. They have a greater intensity of sweetness compared with sugar, so smaller quantities are needed for flavoring foods and beverages.
There are eight non-nutritive sweeteners that have been approved by the FDA. They include aspartame (Equal or NutraSweet), acesulfame potassium (Sunette or Sweet One), neotame, saccharin (Sweet’N Low, Sweet Twin and Sugar Twin), sucralose (Splenda or Equal Sucralose), stevia (Truvia, Stevia in the Raw, SweetLeaf, Sweet Drops, Sun Crystals and PureVia), luo han guo or monk fruit extract (Monk Fruit in the Raw) and advantame.
Carbonated drinks are the top source of artificial sweeteners in the American diet.
Sugar alcohols are considered a nutritive sweetener because they contain some calories and provide energy when consumed. Sugar alcohols may be extracted from fruits and vegetables; however, most are manufactured. They are often used in products labeled as “sugar free” or "reduced-sugar.”
Sugar alcohols end in an “ol” with the exception of hydrolysates. Examples of sugar alcohols include erythritol, isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol and hydrogenated starch hydrolysates. High doses of some sugar alcohols, particularly mannitol and sorbitol, may cause gas, stomach pain and diarrhea as they pass through the digestive tract essentially unchanged.
What are the proposed benefits of non-nutritive sweeteners?
Weight control: Non-nutritive sweeteners may be useful for people who are trying to lose or maintain their current weight as they have few or no calories.
Diabetes management: Persons with diabetes may choose to consume foods and beverages containing non-nutritive sweeteners due to their minimal, if any, impact on blood glucose.
Are there safety concerns? What does the research say?
Research suggests that stevia and monk fruit, the natural sugar substitutes, are safe for human consumption, though it’s not clear that they lead to weight loss. There has been conflicting information about the safety of artificial sweeteners. Some studies suggest that artificial sweeteners could increase the risk of type 2 diabetes, heart and kidney disease and cancer, and may negatively impact our mental health and gut health.
It seems doubtful that artificial sweeteners help people cut back on calories and sugar to improve their health or lose weight. A review conducted for the World Health Organization examined 56 studies into the effects of sugar substitutes on health. It found there is no evidence artificial sweeteners provide any benefit and that they may have some risks.
In reference to the proposed benefit of managing blood sugars, in 2018, the American Heart Association science advisory, supported by the American Diabetes Association, concluded “there is not enough evidence to determine whether sugar substitute use definitively leads to long-term reduction in body weight or cardiometabolic risk factors, including glycemia or glucose control.” As a way to cut back on sugar sweetened beverages, they encouraged the use of water (plain, carbonated and unsweetened flavored) as the best option.
I am not a proponent of artificial sweeteners in general, but they may help some individuals. If my patients want to use them, I advise limiting their use to one item a day. In addition, for my patients with diabetes, I advise them to use an 80/20 rule: 80% of the time consume foods in their natural form without added sweeteners or non-nutritive sweeteners, and 20% of the time use a non-nutritive sweetener to enhance the sweetness of foods you feel you can’t live without.
Always consult your healthcare provider before making any major changes to your diet or lifestyle, especially if you have a chronic disease.
Stacy Trogdon, RDN, CDE, is a registered dietitian nutritionist with Overlake's Outpatient Nutrition clinic.