As I mentioned in part I, many of my patients have asked me about the many types of alternative sweeteners that are available to them and which are the best for their health. We looked at some natural source sweeteners that are commonly available at most grocery and health food stores, and their benefits and possible drawbacks. Here in Part II, let’s look at the artificial sweeteners that are commonly available in grocery stores and their benefits and drawbacks.

From Sugar Blues to Artificial Sweetener Woes

Back in 1975 a book called Sugar Blues by William Dufty fueled the health revolution against America’s seemingly addiction to white sugar and all its health problems. In response, many artificial sweeteners were born starting with saccharin (Sweet N’ Low), progressing to aspartame (Equal), then to acesulfame-K (Sunette, et al) and sucralose (Splenda).

Today, numerous foods and beverages are sweetened with a few of these sweeteners, namely acesulfame, aspartame and sucralose. Saccharin is still available as an add-in sweetener in packets, powder, or liquid and in a few dietetic foods, toothpastes and cosmetics.

As time went by, however, health issues started to arise from the use of these various sweeteners and their popularity started to wane. More natural source sweeteners (see Part I) started to gain popularity though many of my patients still make use of artificial sweeteners as well. The following is a list of the 4 most common artificial, man-made sweeteners, their pros and cons, as well as my opinion of them, so that you can make your own decision whether to use them.

Acesulfame-K: Discovered in 1967, the “K” stands for potassium, and is often seen as acesulfame potassium on labels, marketed under brand name Sunette. 200 times sweeter than sucrose, is not metabolized by the body and passes through unchanged. Used in thousands of products from foods to pharmaceuticals.

• Pros: Studies have deemed it very safe for human consumption up to levels of 15mg/per lb of body weight. If you weigh 150 lbs, this is 2,250 mg of acesulfame-K per day which is far more than any human likely would use. It has no bitter aftertaste and can be used successfully in baked goods.
• Cons: No real side effects for humans have been reported for this sweetener. Animal studies, done in female rats, have suggested there may be a cancer-causing effect such as breast tumors. Also, leukemia and lung disorders were found in less than maximal doses. May raise insulin levels, however, and may not be suitable for diabetics or metabolic resistant patients.
• My take: Compared to the other available artificial sweeteners, acesulfame-K has the least known human side effects. However, I think there needs to be more human studies done on this sweetener particularly on the possible cancer risk. For low dose consumption I feel it could be used safely on a once in a while basis.

Aspartame: Aspartame is quite a controversial subject. It has a checkered past to be sure.  According to some sources, reportedly, aspartame was once listed on a Pentagon list as a neurotoxin chemical warfare agent.  The patent was later taken over by the G.D. Searle Corporation (and later Monsanto who bought Searle) where it was initially processed as an ulcer treatment and because of its sweet taste, became a calorie-free commercial sweetener (Nutra-Sweet, Equal) for public consumption.

• Pros: Doesn’t spike insulin, is calorie free and has a decently sweet taste with little-to-no aftertaste. It has passed regulatory commissions on human safety and reportedly is metabolized by the body as a protein.
• Cons: Even though aspartame has passed human safety studies, there are many user-reported adverse health effects that have arisen from aspartame users. These include numbness, tingling, headaches, ringing in ears, depression, and neurologic damage to unborn fetus, to name only a few. Pregnant women should not use aspartame nor should people with phenylalanine conditions (PKU).
• My take: I feel aspartame and its more modern update, Neotame, is just too fraught with controversy in its health effects to even consider using it. At best, more human studies are needed to adequately clinically investigate the user complaints of aspartame. I would just say no.

Saccharin: Saccharin has been in use commercially for at least the last 50 years. It is 200-700 times sweeter than sucrose. Banned once back in the late 70’s due to research that showed bladder tumors in rats, it was later re-released for public use stating these studies did not correlate to humans.

• Pros: Does not raise blood sugar levels. Acceptable daily intake (ADI) has been established at 5mg/kg of body weight per day. If you weighed 80 kg, you would limit yourself to 400 mg of saccharin a day. Heat stable and can be used in baking.
• Cons: Has a chemical aftertaste. Has many user-reported allergic-type reactions such as headache, rash, breathing difficulty.  People who are allergic to sulfa may be cross-allergic to saccharin.  Despite being re-released for public use and no longer carries a warning label, may still be carcinogenic to humans and further studies need to be done.
• My take: If you must use an artificial sweetener, this is not the best choice.

Sucralose: Marketed as Splenda, this sweetener has gained a lot of popularity with its marketing ploy stating it’s made from sugar so it tastes like sugar. Part of that statement is true. Splenda does have 1 remaining molecule of sugar while the other 3 have been replaced with chlorine.  It is 600 times sweeter than sucrose and is currently in over 4,500 food products.

• Pros: It does taste like sugar with no aftertaste. FDA reviewed studies have shown that sucralose has no carcinogenic, neurologic or reproductive health risk to humans. It has an acceptable daily intake rating of 15 mg/kg of body weight. If you weigh 80kg, this would be 1200 mg a day.
• Cons: Discovered while trying to create an insecticide it has a high chlorine content, which may predispose users to cancer as chlorine is considered a carcinogen. However, there are no long-term human studies on this aspect of sucralose. Other drawbacks include gastrointestinal issues like bloating, gas, diarrhea, nausea; allergic symptoms like hives, swelling, itchy eyes, other itching, wheezing, cough; neurologic problems like anxiety, anger, mood swings, depression.
• My take: Too high chlorine content for me to safely recommend it for more than occasional use.

Although very occasional use of some artificial sweeteners will not likely harm you, I think you’ll agree with me that most artificial sweeteners have more drawbacks than possible benefits.  In fact, they have as much, if not more, drawbacks as real sugar, just different ones.

I feel that your best bet in using alternative sweeteners in your diet will come from the natural source sweeteners. As I mentioned in Part I, my #1 pick for a sweetener that I recommend to my patients is Stevia and a close second would be Lo Han Guo, though this is a little more expensive and may be more difficult to find.

Whatever sweetener you choose, I would hope you exercise common sense and moderation. Try to cut down your use of sweeteners of all types.  Drinking plenty of water will help flush these substances out of your body. In addition, taking some anti-inflammatory supplements like turmeric, bromelain, ginger, and Vitamin E can help counteract any possible inflammatory response they may cause.

Stay Well,
Mark Rosenberg, M.D.

Acesulfame-K, http://www.caloriecontrol.org/sweeteners-and-lite/sugar-substitutes/acesulfame-k

Acesulfame-K, http://www.buzzle.com/articles/acesulfame-potassium-dangers.html

Aspartame, http://en.wikipedia.org/wiki/Aspartame_controversy

Artificial Sweeteners, http://www.medicinenet.com/artificial_sweeteners/page9.htm