Do Low-Calorie Sweeteners Belong in a Heart-Healthy Diet?

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The 2015-2020 Dietary Guidelines for Americans recommend reducing your intake of added sugars to less than 10 percent of total daily calories. If you consume a 2,000 calorie diet, this is equal to less than 12.5 teaspoons of added sugar. The average American consumes 19.5 teaspoons of daily.

Using low-calorie sweeteners as an alternative is supported by those who have successfully maintained weight loss. In a survey of 434 National Weight Control Registry members, who lost at least equal to or greater than 13.6 kilograms (29.2 pounds) and maintained the loss for more than over one year, they had:

  • regularly consumed low-calorie sweetened beverages (53 percent)
  • found diet beverages helped them control total calories (78 percent)

Before a low-calorie sweetener can be identified as safe for the general population, it must undergo a wide range of tests to determine adverse effects at any dose during different stages of the life cycle. The level connected to an adverse effect must be identified, so that an amount without effect can be defined.

Whether a sweetener is approved for use in food products and beverages, it must be proven safe for pregnant women and children.

Concerns about artificial sweeteners and cancer arose when early studies showed that cyclamate in combination with saccharin caused bladder cancer in laboratory animals. Cyclamate was taken off the market, and subsequent studies of saccharine have not shown clear evidence of an association with cancer in humans. Likewise with aspartame: The National Cancer Institute says it is “one of the most exhaustively studied substances in the human food supply, with more than 100 studies supporting its safety.”

The Food and Drug Administration has approved the following low-calorie sweeteners as safe, either as the result of intensive laboratory testing, or because they’ve been “generally accepted as safe.”

Another reason low-calorie sweeteners have been controversial is a commonly held concern is that using sweet yet non-caloric additives might confuse the body, thus provoking increased appetite for sweet foods, reducing overall diet quality and contributing to weight gain.

Much of this controversy has been spurred by associations in observational studies being misinterpreted, inappropriate data extrapolations from research, and/or experimental protocol not being physiologically relevant.

This concern was addressed in a 2014 study of more than 22,000 adults. The study compared overall diet quality between those who used low-calorie sweeteners and those who did not. Those using low-calorie sweeteners were shown to have BETTER diets and were more likely to to try to manage their weight.

The conclusion: Low-calorie sweeteners do have a place within a healthy diet.

Aspartame

Approved by the FDA in 1983, aspartame is a molecule consisting of two amino acids — phenylalanine and aspartic acid. Foods containing aspartame carry a warning label for people with phenylketonuria (PKU) who cannot metabolize phenylalanine. Providing four calories per gram, aspartame is not heat stable; therefore, it should not be used in cooking or baking. Aspartame is 200 times sweeter than table sugar. Its brand names include NutraSweet and Equal.

Saccharin

Approved prior to 1958, saccharin is not metabolized by the body, contributing zero calories to the diet. This low-calorie sweetener is up to 700 times sweeter than table sugar, is heat stable, and can be used for cooking and baking. Saccharin brand names include Sweet ‘N Low, Sweet Twin, and Sugar Twin.

Sucralose

Approved in 1998, sucralose is produced through a process of replacing hydrogen-oxygen groups on sugar molecules with chlorine atoms. The body does not recognize sucralose as a carbohydrate, so it is poorly absorbed and eliminated from the body contributing no calories to the diet. Sucralose is a very stable product and can be used in cooking and baking. Sucralose brand names include Splenda.

Acesulfame potassium (Ace-K)

Approved in 2003 as a general purpose sweetener in food other than meat and poultry, it is about 200 times sweeter than sugar and is often combined with other sweeteners. It is heat stable, and typically found in frozen desserts, candies, beverages, and baked goods.

Neotame

Approved in 2002 for use under certain conditions as a general purpose sweetener and flavor enhancer in foods (except in meat and poultry), it is approximately 7,000 to 13,000 times sweeter than table sugar. It is heat stable, so it stays sweet even during baking. Neotame is sold under the brand name Newtame.

Advantame

Approved in 2014 for use under certain conditions as a general purpose sweetener and flavor enhancer in foods (except in meat and poultry), it is far more intense than the others, approximately 20,000 times sweeter than table sugar, and is heat stable.

Stevia

Approved in 2008, Stevia is sold in a highly purified form of steviol glycosides, which make up the sweetest part of the stevia plant native to South America. Stevia is considered a natural sweetener containing zero calories. U.S. imports of raw stevia leaf are not allowed, but the highly purified form is being marketed after being submitted to the FDA as “generally accepted as safe” and therefore bypassing the extensive testing needed for other sweeteners. Stevia brand names include Truvia, PureVia, and Sun Crystals.

‘Monk’ fruit extracts

Also known as Luo Han Guo fruit or Swingle fruit, the extract of Siraitia grosvenorii is reported to be 100 to 250 times sweeter than sugar. The plant is native to Southern China, and like Stevia, is being marketed after being submitted to the FDA as “generally accepted as safe.” Coffee drinkers can currently sweeten their Starbucks brew with packets that combine Stevia and Monkfruit.

How to incorporate these additives into your diet

If you struggle to avoid drinking soda every day, replacing regular soda with diet soda is a safe option for reducing caloric intake. If you struggle to drink enough water every day, consuming flavored waters containing low-calorie sweeteners is a safe option to boost water intake without increasing caloric intake.

You can also cut calories to promote weight gain by replacing added sugar with low-calorie sweeteners. An example would be the sugar you add to breakfast cereal, coffee, or tea.

Low-calorie sweeteners are most beneficial to health when combined with a healthy diet and active lifestyle. Changing habits doesn’t happen overnight. To ensure you are successful, access How to Make Heart Healthy Changes into Lifelong Habits here.


Lisa Nelson is a registered dietitian since 1999. She provides clients step-by-step guidance to lower cholesterol and lower blood pressure so they can live life and enjoy their family for years to come. Because her own health is the foundation of her expertise, you can trust that Lisa will make it possible for you to see dramatic changes in your health, without unrealistic fads or impossibly difficult techniques. She can be found on Twitter @lisanelsonrd and on Facebook at hearthealthmadeeasy.