Sweet Without Sugar?

Submitted by Amy Sercel MS RD CD

Edited by Marcia Bristow MS RDN CSSD CD

Have you ever had a craving for something sweet but didn’t want the calories from a sugary snack?  Some people manage this by eating foods made with artificial sweeteners.  Artificial sweeteners are ingredients that provide sweetness without adding calories.  Right now, there are five FDA-approved artificial sweeteners: saccharin, acesulfame, aspartame, neotame, and sucralose.¹ They’re usually found in diet soda and sugar-free versions of candy, ice cream, sports drinks, fruit spreads, and juice.²

You might choose a food made with artificial sweeteners to keep your overall calorie intake lower as part of a goal to lose or maintain weight.  Unfortunately, studies have shown that using artificial sweeteners might not really help with weight loss, and could also raise your risk for Type 2 Diabetes and heart disease.^2–4 Eating artificial sweeteners makes it more difficult to regulate the amount of sugar-sweetened foods you eat later because your brain no longer realizes that sugar-sweetened foods actually contain calories.³ It also looks like artificial sweeteners don’t satisfy the “reward center” of your brain the same way regular sugar does, so you’ll still crave sweets after eating an artificial sweetener and may be more likely to overeat and gain weight as a result.² Other studies also suggest that artificial sweeteners change your microbiome, or the bacteria that live inside your intestines.  This change might contribute to Type 2 Diabetes and weight gain.³

Some people react to the controversy around artificial sweeteners by looking to a more natural, calorie-free alternative sweetener: stevia.  Although it seems like stevia first showed up only a few years ago, people have been using it as a sweetener for hundreds of years.⁵ The stevia found in food products is actually the compound Rebaudioside A (Reb A), a highly purified extract from the plant Stevia rebaudiana.  Reb A is the only part of the stevia plant that has been generally recognized as safe by the Food and Drug Administration (FDA).  Stevia leaves, crude stevia extracts, and whole leaf stevia have not been given FDA approval, and can therefore only be sold as supplements.^6,7

Although in the past stevia was thought to be connected with fertility problems and birth defects, in 2008 the FDA determined that Reb A is safe after reviewing studies submitted by the companies that produce stevia. While the FDA reviewed these studies and decided that they show Reb A’s safety, it’s difficult to solely rely upon studies that were conducted by the company that makes a product; research without bias holds more credibility.  When a company who can profit from a product funds a study about the safety of that product, the study may be influenced by research or funding bias in which the results are either consciously or unconsciously influenced to show the product in a more favorable light.^8,9

For this reason, when Reb A received FDA approval in 2008 it was important for companies without ties to stevia production to conduct more studies to truly prove stevia’s safety.⁶ Since then, not many studies have been performed in humans and few of them are long-term.  However, some independent studies suggest that eating Reb A does not result in any significant toxicity.  A systematic review by Massachusetts General Hospital found that stevia should be evaluated farther for potential positive impacts on blood cholesterol levels and insulin sensitivity.¹⁰ Other studies suggest that stevia doesn’t lead to the same sugar cravings that other artificial sweeteners are known to cause.^11–13 Since stevia has only been FDA-approved for 9 years, more research is needed to learn about stevia’s long-term health impacts.

The amount of artificial sweeteners and stevia that the FDA considers safe to eat in one day varies depending on your body weight and the type of sweetener.¹⁴ For example, the FDA recommends eating no more than 4 milligrams of stevia per kilogram of your body weight per day, but states that it’s acceptable to eat up to 50 milligrams of aspartame per kilogram of your body weight per day.¹⁵ Since more research is needed to learn about their long-term health impacts, it is best to use them all in moderation.  Limit the amount of artificial sweeteners and stevia you use by choosing unprocessed foods, drinking water or milk instead of diet soda or juice, and satisfying your cravings for sweet foods with fruit instead of candy, desserts, or baked goods.

References:

1.         Strawbridge H. Artificial sweeteners: sugar-free, but at what cost? Harvard Health Blog. http://www.health.harvard.edu/blog/artificial-sweeteners-sugar-free-but-at-what-cost-201207165030. Published July 16, 2012. Accessed March 15, 2017.

2.         Harvard T.H Chan School of Public Health. Artificial Sweeteners. The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/artificial-sweeteners/. Published September 4, 2013. Accessed March 15, 2017.

3.         Swithers SE. Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends Endocrinol Metab. 2013;24(9):431-441. doi:10.1016/j.tem.2013.05.005.

4.         Nettleton JE, Reimer RA, Shearer J. Reshaping the gut microbiota: Impact of low calorie sweeteners and the link to insulin resistance? Physiol Behav. 2016;164, Part B:488-493. doi:10.1016/j.physbeh.2016.04.029.

5.         Stevia: It’s Not Just About Calories. ResearchGate. https://www.researchgate.net/publication/228831065_Stevia_It’s_Not_Just_About_Calories. Accessed March 21, 2017.

6.         Is Stevia Safe? - EatingWell. http://www.eatingwell.com/nutrition_health/nutrition_news_information/is_stevia_safe. Accessed March 22, 2017.

7.         Nutrition C for FS and A. FDA Basics - What refined Stevia preparations have been evaluated by FDA to be used as a sweetener? https://www.fda.gov/AboutFDA/Transparency/Basics/ucm214865.htm. Accessed March 22, 2017.

8.         Six industry-funded studies. The score for the year: 156/12. Food Polit Marion Nestle. March 2016. http://www.foodpolitics.com/2016/03/six-industry-funded-studies-the-score-for-the-year-15612/. Accessed April 22, 2017.

9.         Who pays for science? http://undsci.berkeley.edu/article/who_pays. Accessed April 22, 2017.

10.       Ulbricht C, Isaac R, Milkin T, et al. An evidence-based systematic review of stevia by the Natural Standard Research Collaboration. Cardiovasc Hematol Agents Med Chem. 2010;8(2):113-127.

11.       Anton SD, Martin CK, Han H, et al. Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Appetite. 2010;55(1):37-43. doi:10.1016/j.appet.2010.03.009.

12.       Abo Elnaga NIE, Massoud MI, Yousef MI, Mohamed HHA. Effect of stevia sweetener consumption as non-caloric sweetening on body weight gain and biochemical’s parameters in overweight female rats. Ann Agric Sci. 2016;61(1):155-163. doi:10.1016/j.aoas.2015.11.008.

13.       Shivanna N, Naika M, Khanum F, Kaul VK. Antioxidant, anti-diabetic and renal protective properties of Stevia rebaudiana. J Diabetes Complications. 2013;27(2):103-113. doi:10.1016/j.jdiacomp.2012.10.001.

14.       Artificial Sweetener Labeling Initiative. The Sugar Association. https://www.sugar.org/nutritional-advocacy/artificial-sweetener-labeling-initiative/. Accessed March 15, 2017.

15.       Nutrition C for FS and A. Food Additives & Ingredients - Additional Information about High-Intensity Sweeteners Permitted for use in Food in the United States. https://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients/ucm397725.htm#Steviol_glycosides. Accessed April 22, 2017.