Sugar Substitutes, what’s the deal?

Lately I’ve been getting a lot of questions from my patients, family, and friends about artificial sweeteners and sugar substitutes. Many wonder if they’re good for you, if they’re bad for you, and what the risks and benefits are of consuming sweeteners other than sugar. To be perfectly honest with you, when a patient asks if artificial sweeteners are safe to consume, I really DON’T know the answer. I myself am a regular consumer of artificial sweeteners; I always end my coffee order with “Skim and two Splendas,” and this makes me feel as though I don’t really have a right to tell my patients to avoid them if I eat them every day, right? There is an assumption that artificial sweeteners like aspartame are carcinogenic, but then how are could they be so prevalent in the food supply? My intention with this blog post is not to sway your opinion on artificial sweeteners in any direction, only to present the information I found and what I would recommend if someone were to ask me my opinion in the future. I found this thorough overview article from The Mayo Clinic that breaks down the different types of sweeteners  out there, along with their risks and benefits. Here’s what they had to say.

Sugar substitute is a term that can cover any sweetener that can be used in place of sugar, such as:

  • Artificial sweeteners like Sweet n’ Low, Splenda, or Equal
  • Sugar alcohols like xylitol, mannitol, and xorbitol
  • Novel sweeteners like stevia extracts (Truvia)
  • Natural sweeteners like maple syrup, agave nectar, honey, and molasses.

Artificial sweeteners may be completely synthetic or can be derived from natural substances, however most of them have a much higher degree of sweetness than actual sugar. They are zero calories, because technically they’re not actually carbohydrates, and are widely used throughout the food supply, more specifically in diet products, like diet sodas and desserts.

  • The Good: Artificial sweeteners do not cause tooth decay and leave a sweet taste without the calories. Artificial sweeteners are also beneficial for people with diabetes, because they do not elevate blood sugar.
  • The Bad: Even though they’re zero calories, they may increase your cravings for more sweet things (the mechanism behind this is still unknown). Additionally, some artificial sweeteners leave a horrible aftertaste.
  • The Controversial: Some believe that artificial sweeteners, like saccharin and aspartame, are linked to cancer. But based on large amounts of both human and animal studies, artificial sweeteners are deemed Generally Recognized as Safe, or GRAS, by the FDA. In a study conducted by the National Cancer Institute, those who drank artificially sweetened beverages were not at an increased risk to develop blood cancers such as lymphomas, leukemia, or brain tumors when compared to those who abstained from artificially sweetened beverages. The FDA recommends that artificial sweeteners are safe when consumed in moderation, and have acceptable daily intakes for each type of sweetener:

Acceptable Daily Intake (ADIs) for Popular Artificial Sweeteners: are determined based on body weight. The following amount of tabletop sweetener packets that you would find in a coffee house is based on a 60kg, or 132 pound, person:

Aspartame (Equal or Nutrasweet): 75 packets/day

Saccharin (Sweet N’ Low): 45 packets/day

Steviol glycosides from Stevia plants (Truvia, Enliten): Conditionally safe (see the “Novel Sweeteners” section below), but generally 9 packets/day

Sucralose (Splenda): 23 packets/day

Sugar Alcohols are just as sweet, if not less so, than natural sugar, and are found in nature or can be manufactured in a lab. They are often utilized not only in processed foods, but in general household items like gum, toothpaste, and mouthwash.

  • The Good: Sugar alcohols are less processed by the body when compared to regular sugar, which can keep blood sugar levels low for diabetics.
  • The Bad: Sugar alcohols are real carbohydrates, so they contain calories and therefore may not be as effective for weight loss. However, they only contain only 2 calories/gram as opposed to the 4 calories/gram found in sugar. Also, when consumed in high amounts (anywhere between 10g and 50g), sugar alcohols can have an osmotic effect and pull water into the gut, causing diarrhea, bloating, and gas.

Novel Sweeteners: The FDA has approved the use of highly refined stevia (found in products like Coke Zero and in Truvia), however not whole leaf or crude stevia extracts, as the consumption of these forms of stevia plant may lead to kidney problems, and have yet to be deemed GRAS by the FDA.

Natural Sweeteners are often found in the home and are added to all different types of foods to enhance the sweetness.

  • The Good: natural sweeteners are chemically very similar to regular sugar, and they are both broken down to fructose and glucose in the body. If you’re not into chemicals and man-made foods products, then natural sweeteners are obviously a good choice for you.
  • The Bad: There’s really no health advantage to consuming a natural sweetener over regular sugar. People generally pick natural sweeteners because of taste. Since they’re nutritionally similar to real sugar, they contribute to tooth decay, elevated blood sugar, weight gain, and high blood cholesterol. It should also be noted that even some “natural” sweeteners aren’t completely natural, and may go through some sort of processing before hitting the shelves.

The bottom line: as dietitians say with most other foods, everything is good in moderation. Having a packet or two of an artificial sweetener in your coffee every morning will likely not increase your risk of developing cancer, diabetes, or hyperlipidemia. However, relying too heavily on “diet foods,” that contain other highly processed and unnatural ingredients may not be so good either. Additionally, you could be toeing the line between “enough” and “too much” without even realizing it, as artificial sweeteners can be found in a plethora of unexpected places like protein powders, yogurts, frozen yogurts, chewing gum, snack foods, salad dressings, etc. Focus on eating a generally balanced, healthy diet that consists of natural, whole foods, and you should be fine using a little bit of whatever type of sweetener you so desire. After all, what is life without a little sweetness?

Source: The Mayo Clinic

Source: FDA: Food Additives & Ingredient

Coffee Coffee Coffee

So recently, I finished binge watching Gilmore Girls on Netflix. It brought me back to my days after middle school when I would come home, turn on ABC Family, and just watch for hours. I feel like rewatching it now has given me a much better appreciation of Lorelai and Rory, their fast-paced banter, their over-involved references to pop culture, and their strong mother-daughter bond. (Although *SPOILER ALERT,* I’ll admit I had to stop watching before Lorelai and Luke broke up and she went off to Europe and married Christopher. Ugh.).

Other than a newfound appreciation for the amazing writing (before the plot lines got a little too ridiculous, true fans you’ll know what I’m talking about), I also had a new appreciation for the Gilmore Girls’ love of coffee. I can now definitely relate as I start off almost every morning by brewing three cups of coffee in my mini Mr. Coffee coffeemaker. I feel like I’m sleepwalking without it, and I think it actually helps my productivity and focus at work. But watching Gilmore Girls in its (almost) entirety has made me question the risks and benefits of regular, coffee drinking. Are Lorelai and Rory, and myself for that matter, headed for a lifetime of heart problems and doom? The answers may actually surprise you.

The Good:

  • Coffee contains nutrients such as magnesium, potassium, niacin, choline, and vitamin E, that work as antioxidants and help your body carry out many energy-producing functions.
  • Consistent coffee intake increases insulin sensitivity, or reduces your risk for high blood sugar and type 2 diabetes.
  • Coffee helps protect against the development of Alzheimer’s Dementia and Parkinson’s disease.
  • Consumption decreases the risks of colorectal cancer and liver cancer.
  • A study by the National Institute of Health (NIH) found a lower incidence of depression in those who drank at least four cups of coffee compared to those who do not drink any coffee.
  • The caffeine in coffee can provide fuel that can be used in sports that require long-term energy, such as in cycling or running races.

The Bad:

  • More than five cups/day can lead to an increased risk of a heart attack or coronary heart disease.
  • More than five cups/day can also lead to an increase of cardiac arrhythmias or atrial fibrillation, both of which can lead to strokes.
  • Caffeine is a stimulant and can cause increased blood pressure after consumption.
  • Unfiltered coffee, like espresso or boiled coffee, is associated with an increased consumption of oily compounds, which can increase your LDL, or “bad,” cholesterol, and further contribute to heart disease. These effects were not found in filtered coffee consumption.
  • Excessive coffee intake may interfere with calcium, iron, and zinc absorption.

Interesting Facts:

  • Some people have an allergy to caffeine that causes them to experience nervousness, irritability, GI distress, anxiety, or tremors.
  • Coffee intake of greater than 3 cups/day while pregnant may increase the risk of miscarriage. If you’re pregnant and still need your morning fix, talk to your doctor about what’s safe to consume.
  • If ethics are important to you, look for coffee that states it’s “fair trade” on the label (same with chocolate). You can find out more about that here.
  • The world’s largest producer of the coffee bean is Brazil.
  • The largest coffee chain in the world is Starbucks, with over 20,000 stores worldwide.

My Conclusions:

  • If you’re already hooked on coffee, there’s no need to stop drinking it now! It has shown to have plenty of health benefits when consumed in moderation (3-4 cups/day). However, if you find that you consistently drink greater than 5 cups/day (about 40 oz), you may be at an increased risk for heart disease, high blood pressure, or high cholesterol. Also be mindful and try not to go overboard; avoid ordering coffee drinks with a lot of flavored syrups and whipped cream (like Frappucinos or Coolatas). These drinks contain a lot of calories from sugar and fat and therefore may cancel out all of the wonderful health benefits.

Hopefully Richard and Emily can refer the Gilmore Girls to a good cardiologist.

Don’t worry Rory, I’m only kidding.

And also you’re a fictional character.

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