October 31, 2014
Packets of sugar and sugar substitutes, generic

Are Sugar Substitutes Safe?

by Berkeley Wellness  |  

Americans trying to cut down on sugar and calories are increasingly turning to sugar substitutes. But many worry about the safety of these products and thus are attracted to those now promoted as “natural,” as opposed to the older “artificial” sweeteners. Many fears are based on unfounded Internet rumors and anecdotal reports.

Some things are certain: Most sugar substitutes are hundreds of times sweeter than table sugar (sucrose), so you need only tiny amounts (the powders are mostly filler). Most are calorie-free; the rest contain fewer calories than sugar. And they don’t affect blood sugar or promote tooth decay.

Do sugar substitutes really help you stay slim?

This has been surprisingly hard to prove. As sugar substitutes have grown in popularity, Americans have only grown fatter. That doesn’t mean that sugar substitutes are the culprit, of course. Observational studies comparing weight or changes in weight in people who drink diet beverages and those who do not have yielded conflicting results, probably because so many other factors come into play. For instance, people who consume diet drinks are often overweight to begin with. And when they lose weight, it could be because they take other weight-control steps as well. On the other hand, people who drink such beverages may not lose weight because they may compensate for the “saved” calories by eating more of other foods.

Clinical trials have generally found that diet beverages can help people lose a few pounds, but the trials have been short and small. Research has been inconsistent as to whether sugar substitutes decrease, increase, or have no effect on appetite and satiety. In 2012, a Scientific Statement from the American Heart Association and American Diabetes Association concluded that it’s plausible that sugar substitutes could promote modest weight loss, but that longer, well-designed clinical trials are lacking.

Are these sweeteners risky or not?

In some studies, animals given huge amounts of certain sugar substitutes (usually saccharin) had higher rates of various cancers. But the great majority of human (observational) studies have failed to find a link to cancer.

In the last few years, some observational studies have linked sugar substitutes or diet soft drinks to strokes, heart attacks, diabetes and premature births, among other things. But just because there’s an association doesn’t mean that the sweeteners cause these problems. There may be things about people who consume sugar substitutes that put them at risk. They may have more health problems, have poor diets or be heavier or more sedentary. While researchers adjust the data for such “confounding factors,” residual ones undoubtedly remain. These studies are not very convincing, but more research is needed.

Bottom line: It’s likely that sugar substitutes will always be controversial, especially since the rumors about them, even debunked ones, keep circulating on the Internet. The available evidence suggests they’re safe, with a few caveats. Still, moderation is a good idea, since there’s no truly long-term research on safety. Moreover, a high intake of sugar substitutes is often a marker for a lousy diet. Sugar substitutes are not a simple fix for obesity, but when combined with other small yet sustainable calorie-cutting steps and consumed in the context of a healthy diet, they can help some people control their weight. A better alternative is to simply cut down on sweets (however they’re sweetened) and opt for water or seltzer.

Sugar Substitutes: All are Not Equal

There are a host of different sugar substitutes currently on the market. Which, if any, should you consider using?