Are sugar substitutes safe?

A national survey found that more than 144 million American adults consume sugar-free products regularly. Supporters of no-calorie sugar substitutes, like aspartame and saccharin believe the sweeteners are safe in moderation, but critics question their safety. Is there really cause for concern? Here is a summary of the less-than-sweet controversies surrounding approved sugar substitutes:

• Acesulfame-K (Sunett)

The sweetener was approved by the Food and Drug Administration (FDA) in 1988 for use in soft drinks. It is about 200 times sweeter than sugar and calorie free. It often is combined with other sweeteners. More than 90 studies verify the sweetener's safety. One expert, Emmanual Farber, M.D., Ph.D., says, "Acesulfame-K has not been shown to be carcinogenic and is reasonably safe."

• Aspartame (NutraSweet, Equal and NatraTaste)

Aspartame is one of the most thoroughly tested and studied food additives the FDA has approved. Major health groups and agencies in more than 90 countries, including the World Health Organization (WHO) and American Medical Association (AMA) have said it's safe. Scientific studies have not been able to prove a connection to the sweetener for causing brain tumors, headaches, allergic reactions, seizures and behavioral changes, but the Centers for Disease Control and Prevention does leave open the possibility that small groups of people are sensitive to aspartame.

• Saccharin (Sweet'N Low and Sugar Twin)

The safety of this sweetener is loaded with controversy. In the 1970s, high doses of saccharin were shown to cause bladder cancer in male rats. This prompted an effort to ban the sweetener. Some experts argue that the doses of saccharin used in the studies were unrealistically high. Opponents argue that population studies show an association between heavy users of artificial sweeteners (mostly saccharin) and bladder cancer, and should not be ignored.

• Sucralose (Splenda)

Sucralose is the only no-calorie sweetener made from real sugar. It is about 600 times sweeter than sugar. It does not promote tooth decay nor affect blood sugar levels, making it an option for diabetics. The FDA has concluded sucralose does not cause cancer, reproductive or neurologic risk to humans. Splenda also can be used by pregnant women and nursing mothers.

Even if the artificial sweeteners featured in this article were given the green light for safety, they still would fall short in providing good nutrition. In a healthy diet, people should limit their consumption of these types of sweeteners. Although sucralose seems to have the fewest safety concerns and aspartame appears safe in moderation, it's best to limit yourself to a couple of servings a day. Acesulfame-K is still an unknown, but it may be safest when combined with another sweetener and occasional packet or two of Sweet'N Low isn't likely to be harmful either.

Consider these points when deciding on whether or not to use sugar substitutes:

• Read labels - sugar substitutes now are found in hundreds of products.

• Vary your choices or use products containing more than one sweetener. Since some sweeteners enhance each other's sweetness, blends often use less of each. This reduces your exposure to any one sweetener.

• Don't rely on no-calorie sweeteners to make pounds disappear. If you use sugar substitutes to help manage your weight, make them part of a sensible plan that includes healthful eating, exercise and lifestyle changes.

Alvina Begay, R.D., is a registered dietitian at Flagstaff Medical Center.

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