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October 17, 2013 at 8:40 PMComments: 0 Faves: 1

Sugar Substitute Primer: The Good and the Bad

By Jeffrey VanWingen M.D. More Blogs by This Author

This Saturday is Sweetest Day - a "Hallmark Holiday" that serves to honor loved ones with sweets. Most people feel that the holiday was concocted by the candy industry, but corporately concocted or not, this holiday illustrates well the relationship Americans have with sweets. We like them, but we simultaneously hate the calories attached. Enter artificial sweeteners, no- or low-calorie alternatives to sugar.  They've been around for awhile now, but they continued to be wrapped in controversy.

Besides sugar, there are four different classes of sweeteners:

  1. Artificial Sweeteners: Aspartame, Sucralose, Saccharin 
  2. Sugar Alcohols: Xylitol, Sorbitol, Mannitol
  3. Natural Sweeteners: Honey and Agave
  4. Dietary Supplements: Stevia, Lo Han, Truvia

Artificial Sweeteners

The web is full of negative literature about artificial sweeteners. It's difficult to sort out the true science from the conspiracy theories, so suffice it to say that artificial sweeteners are not harmless or benign.

Artificial sweeteners pass through the body undigested and have no caloric value. Most have a sweet taste similar to table sugar, but not exactly.  It has long been known that saccharin has the ability to cause cancer, and speculation exists about other artificial sweeteners as well. Granted, it would take several gallons of saccharine sweetened soda consumption each day for years to amount to the quantity found to cause cancer, but you wouldn't buy a loaf of bread with "Low in poison!" written on the label opting for the non-poison bread either.

Additional fuel on the anti-artificial sweetener fire include the numerous reports on side effects ranging from headaches to muscle pain to chronic fatigue. Studies have also shown that these no-cal sweeteners aren't nearly as successful as we like to think in regards to weight loss and diabetes prevention. In fact, many studies show that regular consumption of artificial sweeteners pushes things the other way, promoting weight gain and diabetes.

Sugar Alcohols

Sugar alcohols aren't calorie free, but they do have fewer calories than sugar. As sweetness goes, they're not as sweet as sugar, leaving the potential for increased ingestion in order to attain the desired sweetness, which, in turn, increases the caloric figure closer to that of sugar.

Too much sugar alcohol can lead to gas and diarrhea. The glycemic indices (blood sugar raising tendency) are different among the different sugar alcohols, but Xylitol appears to be the best in avoiding sugar spikes. It's also been shown to be less carcinogenic and having less potential to cause tooth decay. However, it is toxic to dogs and needs to be kept safely away from your pooch.

Natural Sweeteners

Honey and agave are both sweet and naturally produced. However, they're quite high in fructose (as much as the infamously unhealthy high-fructose corn syrup). If you're going to use these products, read the label closely, as many of these products being sold as "natural" are actually low-grade, highly-processed products. Honey should not be given to children under the age of one, due to the potential for botulism.

Dietary Supplements

Stevia, Lo Han, and Truvia are derived from plants. Due to their extremely high potency, they are considered calorie-free, and in general, these products are recognized as safe. They've been used in Japan and China for centuries, but Stevia's initial petition to the FDA was rejected in the 1990s amid concerns that it caused infertility and mutations in rat studies. More updated studies in other animals and humans have demonstrated that these products are safe. Remember, although they're plant-based, natural products, they still undergo a refining process similar to sugar.

The Real Problem?

Tricking the body by giving your taste buds and brain something sweet without providing any carbs is not a seamless process. The unintended result is that the body has been primed for a calorie load that isn't actually coming, which intensifies cravings for more sweet foods. In this way, consuming calorie-free or low-calorie sweeteners actually drives hunger and carbohydrate cravings, which could lead to obesity and even diabetes.

Maybe we shouldn't fear table sugar the way we do, provided we keep it in moderation. High fructose syrup, however, should be avoided when possible. Also, sweet foods, whether calorie-rich or calorie-free, should be balanced with nutritional substance like protein or perhaps even some fat. They should be consumed more in the morning than at night, giving the body a better chance to metabolize what has been eaten and prevent it from going into storage in the form of body fat. Basically, it's less about tricking the body into getting something for nothing and more about eating smarter and more restrained.

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