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Artificial sweeteners, which are also called sugar substitutes, alternative sweeteners, or non-sugar sweeteners, are substances used to replace sugar in foods and beverages. They can be divided into two large groups: nutritive sweeteners, which add some energy value (calories) to food; and nonnutritive sweeteners, which are also called high-intensity sweeteners because they are used in very small quantities as well as adding no energy value to food. Nutritive sweeteners include the natural sugars—sucrose (table sugar; a compound of glucose and fructose), fructose (found in fruit as well as table sugar), and galactose (milk sugar)—as well as the polyols, which are a group of carbohydrate compounds that are not sugars but provide about half the calories of the natural sugars. The polyols are sometimes called sugar replacers,
(Illustration by GGS Information Services/Thomson Gale.)
sugar-free sweeteners, sugar alcohols, or novel sugars. Polyols occur naturally in plants but can also be produced commercially. They include such compounds as sorbitol, mannitol, xylitol, and hydrogenated starch hydrolysates.
Nonnutritive sweeteners are synthetic compounds that range between 160 and 13,000 times as sweet as sucrose, which is the standard for the measurement of sweetness. There are five nonnutritive sweeteners approved by the Food and Drug Administration (FDA) for use in the United States as of 2007. They are saccharin, aspartame, acesulfame potassium (or acesulfame-K), sucralose, and neotame. There are other nonnutritive sweeteners that have been approved for use elsewhere in the world by the Scientific Committee on Food (SCF) of the European Commission, the Joint Expert Committee of Food Additions (JECFA) of the United Nations Food and Agricultural Organization, and the World Health Organization (WHO) but have not been approved by the FDA. These substances are alitame, cyclamate, neohesperidine dihydrochalcone, stevia, and thaumatin. All of these will be described in further detail below.
The FDA uses two categories to classify both nutritive and nonnutritive sweeteners for regulatory purposes. Some are classified as food additives, which is a term that was introduced by the Federal Food, Drug, and Cosmetic (FD&C) Act of 1938. This legislation was passed by Congress in response to a mass poisoning tragedy that took the lives of over a hundred people in 1937. A company in Tennessee that manufactured an antibacterial drug known as sulfanilamide, which had been used safely in powdered or pill form to treat childhood infections, dissolved the sulfanilamide in diethylene glycol—related to the active ingredient in automobile antifreeze—in order to market it as a liquid medicine. Diethylene glycol is highly
toxic to human beings and household pets, causing painful death from kidney failure. In 1937 there was no requirement for medications to be tested for toxicity before being placed on the market. The FD&C Act of 1938 thus included a legal definition of a food additive “any substance, the intended use of which results directly or indirectly, in its becoming a component or otherwise affecting the characteristics of food”
The FDA asks the following questions in evaluating a proposed new sweetener as a food additive:
Other sweeteners are classified as generally regarded as safe or GRAS, and are not defined for legal purposes as food additives. The GRAS category was created in 1958 when the FD&C Act was modified by the passage of the Food Additives Amendment. A sweetener, whether nutritive or nonnutritive, can be given GRAS status on the basis of “experience based on common use in food” or a scientific consensus represented by published studies. Sorbitol and a few other polyols have GRAS status along with the natural sugars. Most artificial sweeteners, however, are considered food additives by the FDA.
Artificial sweeteners are used in food products for several reasons: to lower the calorie content of soda pop and other sweet treats as part of weight reduction and weight maintenance diets; to assist patients with diabetes in controlling blood sugar levels more effectively; and to lower the risk of tooth decay. They are also added as excipients (inert substances used to make drugs easier to take in tablet or liquid form) to some prescription medications to disguise unpleasant tastes because they do not react with the active drug ingredients as natural sugars sometimes do. Sorbitol and mannitol are commonly added to toothpaste, mouthwash, breath mints, cough drops, cough syrups, sugarless gum, over-the-counter liquid antacids, and similar personal oral care products to add bulk to the product’s texture as well as minimize the risk of tooth decay.
In addition to adding a sweet flavor, artificial sweeteners are also used in the manufacture of baked goods, beverages, syrups, and other food products to improve texture, add bulk, retard spoilage, or as part of a fermentation process. The polyols in particular are used to retard spoilage because they do not support the growth of mold or bacteria to the same extent as natural sugars.
Nonnutritive sweeteners approved by the FDA
There are five nonnutritive sweeteners approved by the FDA for use in the United States as of 2007:
Nonnutritive sweeteners not approvedfor use in the United States
Artificial sweeteners are generally regarded as safe when used appropriately. The official position of the American Dietetic Association is that nutritive and nonnutritive sweeteners are safe as long as one’s diet follows the current federation recommendations for nutrition.
Some specific artificial sweeteners must be used cautiously by certain groups of people:
There are no known interactions with prescription drugs caused by the use of nutritive or nonnutritive sweeteners. As was noted above, some nonnutritive sweeteners are considered useful excipients for medications precisely because they are chemically inert.
There have been concerns expressed about the use of artificial sweeteners by children because children consume more sweeteners, both nutritive and nonnutritive, per pound of body weight on a daily basis than adults. The use of fruit juice and other sweet beverages by children has greatly increased since the 1980s; however, studies indicate that even children who drink large amounts of diet soda and other beverages usually remain well below the ADI levels for aspartame and other nonnutritive sweeteners. The chief risk to children’s digestive health is fructose, which is found in such popular children’s drinks as apple juice. Fructose is incompletely digested by children below the age of 18 months and may cause diarrhea in older children. Children diagnosed with nonspecific diarrhea maybenefit from being given smaller amounts of fruit juice to drink.
During the early 1990s, some researchers identified a possible connection between high levels of aspartame consumption and attention-deficit hyperactivity disorder (ADHD) in children. Two studies published in 1994 in Pediatrics and the New England Journal of Medicine respectively, however, found no connection between aspartame and ADHD, even when the children were given 10 times the normal daily amount of aspartame. Aspartame and other nonnutritive sweeteners, however, may have an additive effect on nerve cell development when they are combined with food colorings. This possibility was suggested by a 2006 study of laboratory mice in the United Kingdom, but the implications for humans are far from clear.
High intake of sweeteners added to food is of greatest concern during adolescence. As people age, they generally lower their intake of calories from added sugars. Fewer than 10% of adults over age 50 derive more than 25% of their daily calories from sugars, which is the maximal intake value established by the IOM. Nearly a third of adolescent females exceed this level, however, with almost a third of the extra sugar intake coming from carbonated beverages sweetened with high-fructose corn syrup. Although the rise in obesity in children and adolescents is a complex problem that cannot be attributed to a single factor, preliminary studies suggest that nonnutritive sweeteners may be useful in reducing adolescents’ consumption of drinks sweetened with HFCS.
Nabors, Lyn O’Brien, ed. Alternative Sweeteners, 3rd ed. New York: M. Dekker, 2001.
“Artificial Sweeteners: No Calories ... Sweet!” FDA Consumer 40 (July-August 2006). Available online at http://www.fda.gov/fdac/features/2006/406_sweeteners.html (accessed March 22, 2007).
Henkel, John. “Sugar Substitutes: Americans Opt for Sweetness and Lite.” FDA Consumer, February 2006. Available online at http://www.cfsan.fda.gov/—dms/fdsugar.html (accessed March 22, 2007).
Lau, K., W. G. McLean, D. P. Williams, and C. V. Howard. “Synergistic Interactions between Commonly Used Food Additives in a Developmental Neurotoxicity Test.” Toxicological Sciences 90 (March 2006): 178–187.
Shaywitz, B. A., C. M. Sullivan, G. M. Anderson, et al. “Aspartame, Behavior, and Cognitive Function in Children with Attention Deficit Disorder. Pediatrics 93 (January 1994): 70–75.
Wax, Paul M. “Elixirs, Diluents, and the Passage of the 1938 Federal Food, Drug, and Cosmetic Act.” Annals of Internal Medicine 122 (March 15, 1995): 456–461. Available online at http://www.annals.org/cgi/content/full/122/6/456 (accessed March 23, 2007).
Wolraich, M. L., S. D. Lindgren, P. J. Stumbo, et al. “Effects of Diets High in Sucrose or Aspartame on the Behavior and Cognitive Performance of Children.” New England Journal of Medicine 330 (February 3, 1994): 301–307.
American Dietetic Association (ADA). Position Statement on the Use of Nutritive and Nonnutritive Sweeteners Available online at http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_3794_ENU_HTML.htm. This position paper was adopted by the ADA’s House of Delegates on October 18,1992; reaffirmed on September 6, 1996; and reaffirmed again on June 22, 2000. It will remain in effect until December 31, 2009.
National Cancer Institute (NCI) Fact Sheet. Artificial Sweeteners and Cancer: Questions and Answers Bethesda, MD: NCI, 2006. Available online at http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners.
National Cancer Institute (NCI) Fact Sheet. Aspartame and Cancer: Questions and Answers Bethesda, MD: NCI, 2006. Available online at http://www.cancer.gov/cancertopics/factsheet/AspartameQandA.
Office of Food Additive Safety. Guidance for Industry: Frequently Asked Questions about GRAS College Park, MD: Office of Food Additive Safety, 2004. Available online at http://www.cfsan.fda.gov/-dms/grasguid.html.
American Dietetic Association (ADA). 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Telephone: (800): 877-1600. Website: http://www.eatright.org.
Dietitians of Canada/Les die´te´tistes du Canada (DC). 480 University Avenue, Suite 604, Toronto, Ontario, Canada M5G 1V2. Telephone: (416) 596-0857. Website: http://www.dietitians.ca.
Institute of Medicine (IOM). 500 Fifth Street NW, Washington, DC 20001. Telephone: (202) 334-2352. Website: http://www.iom.edu.
National Cancer Institute (NCI). NCI Public Inquiries Office, 6116 Executive Boulevard, Room 3036A, Bethesda, MD 20892-8322. Telephone: (800) 4-CANCER. Website: http://www.cancer.gov/.
National Toxicology Program (NTP). Report on Carcinogens. P.O. Box 12233, MD EC-14, Research Triangle Park, NC 27709. Telephone: (919) 541-4096. Website: http://ntp.niehs.nih.gov/ntpweb/index.cfm?objectid=7182FF48-BDB7-CEBA-F8980E5DD01A1E2D.
Office of Food Additive Safety, HFS-200, Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5100 Paint Branch Parkway, College Park, MD 20740. Telephone: (301) 436-1200. Website: http://www.cfsan.fda.gov/list.html.
U. S. Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. Telephone: (888) INFO-FDA. Website: http://www.fda.gov/default.htm.
Rebecca J. Frey, Ph.D.