The Truth About Sugar and Artificial Sweeteners

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Sugar-what would we do without it? It is the lifeline for every pancake ever tossed; the key to a perfect cake; the reason coffee is palatable first thing in the morning; and the only hope rhubarb ever had of becoming a noteworthy pie. So simple. So valuable, wars have been fought over it. So when Robert Lustig, M.D., a professor of pediatric endocrinology at the University of California, San Francisco, launched an attack on the white stuff that went viral on YouTube and subsequently reached an even wider audience with Gary Taubes' alarmingly titled "Is Sugar Toxic?" last April in The New York Times Magazine, dessert and sugary drink lovers everywhere took note.

Could sugar single-handedly be to blame for a host of illnesses, including cancer, diabetes, heart disease, and obesity? Say it ain't so. "It's a question of how much" says Christine Gerbstadt, M.D., R.D., a physician and dietitian in Sarasota, Florida. "If you are physically active and eating sugar in moderation, it's not going to destroy your health. On the other hand, it's not going to improve it, either."

Many dietitians are on the fence about the latest attack on sugar. "It's an interesting debate, but it leaves the average person with more questions than answers," says Melissa Joy Dobbins, R.D., a spokesperson for the Academy of Nutrition and Dietetics in Chicago. "To show a cause-and-effect relationship, you need proper studies. It reminds me of a cartoon I read years ago, where everyone had died-and the common denominator was that they'd all eaten carrots."

But while the big guns (American Heart Association, American Cancer Association, FDA, and so on) are still noncommittal on the health risks associated with sugar, plenty of people are looking to other options to satisfy their sweet tooth, especially as those lists of New Year's resolutions get compiled.

The alternatives are plentiful: saccharin, stevia, aspartame, acesulfame-K, sucralose, and Neotame have all been FDA-approved as low-cal sweeteners. But these, too, have come under fire. Everyone remembers the saccharin cancer scare back in the '70s, when scientists found it caused cancer in lab rats. The FDA has since cleared saccharin's reputation, but the damage has been done, and to this day, sugar substitutes have to fight for a clean bill of health in public perception.

Then there's the matter of a study that made a big splash in 2005, when researchers at the University of Texas Health Science Center in San Antonio determined that people who drank diet sodas were actually more likely to gain weight than those sipping the regular stuff. Advantage: sugar advocates. But not so fast: "It's less clear cut," says researcher Christina Shay, Ph.D., a professor in the department of biostatistics and epidemiology at the University of Oklahoma Health Sciences Center in Oklahoma City. In a November 2011 study, Shay found that women who consumed two or more sugary beverages a day had higher rates of triglycerides in their body (a risk factor for heart disease) and impaired fasting glucose levels (a precursor to diabetes) than those who drank one sugary beverage or less daily. When it comes to the diet soda study, says Shay, "it could be a matter of reverse causation-those who are already overweight use diet sweeteners in an effort to lose pounds, not the other way around."

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What's more, the weight gain associated with diet sweeteners could very well be attributed to another American phenomenon: "I call them the Diet Coke and Big Mac crowd," says Barry Popkin, Ph.D., a professor of nutrition at the University of North Carolina at Chapel Hill, and author of The World Is Fat, alluding to a cultural tendency to sacrifice a little in order to splurge a lot. It's Popkin's opinion that if we didn't know the soda was diet (or the cake was low-cal or the ice cream was sugar-free), we'd all eat it, be happy, and lose weight. "There is far too much evidence that shows we do not consume based on calories anymore," he says. "We eat so much that the issue of hunger and physiological need is lost. Hence we eat the box in front of us, and if the box has less calories, some research suggests [that our calorie intake will drop.]"

The bottom line: If you're looking to take a break from sugar (and given that the average American downs 22 spoonfuls a day of the stuff, maybe that's not such a bad idea), your options have never been better. The current generation of low-cal artificial sweeteners is doing a decent job masquerading as the real thing, but you'll still probably never mistake that sugar-free yogurt for the regular one. Technically known as "synthetic sugar substitutes," the products are created by chemists in a lab, isolating molecules that allow them to greatly enhance the sweetness properties of the substance while forming structures that pass through the body virtually unabsorbed (hence lower in calories).

Here's what you need to know about your sugar alternatives.

Name: Saccharin
Sold as: Sweet'N Low
Backstory: The original sugar substitute, it was created in the late 1800s in a Johns Hopkins lab by a scientist researching an alternative to coal tar.
How sweet? 200 to 700 times sweeter than table sugar
Need to know: "You'd need to drink 160 diet soft drinks a day, every day, to approach the levels considered unsafe by the FDA," says Dr. Gerbstadt.

Name: Aspartame
Sold as: Equal, Nutrasweet
Backstory: A product of two amino acids (building blocks for proteins), this sweetener was discovered in 1965 and has been taking hostile fire ever since for claims of toxicity. (The FDA maintains it is safe for consumer use.) It is nevertheless one of the original and therefore best-known alternatives, making it a popular pick for sweetener packets.
How sweet? 200 times sweeter than sugar
Need to know: Aspartame has been added to more than 6,000 foods, personal care products, and pharmaceuticals, but soft drinks account for more than 70.

Name: Sucralose
Sold as: Splenda
Backstory: "Sucralose is an isomer of sugar," says Dr. Gerbstadt. "It's nearly identical on the molecular level." Because of this, sucralose manufacturers like to claim it's "made from sugar," which it's not.
How sweet? 600 times sweeter than sugar
Need to know: Sucralose will not break down at high temperatures, so you can bake with it. Choose the version specially formulated for baking-it has low-calorie fillers to replace the bulk of sugar.

Name: Acesulfame potassium (also called acesulfame-K)
Sold as: Sunett, Sweet One
Backstory: Approved by the FDA in 1998, "acesulfame-K is a good option for baking because it will withstand the heat," says Dobbins.
How sweet? 200 times sweeter than sugar
Need to know: According to the American Dietetic Association, 95 percent of acesulfame-K passes through the body and is eliminated through urine, so the body does not absorb any energy from the product-hence, no calories.

Name: Neotame
Sold as: Not available for individual consumer consumption
Backstory: Neotame is widely used in the coatings of OTC tablets and throat lozenges, as well as for adding sweetness or enhanced flavor to liquid or chewable medications, vitamins, and other pharmaceutical products, so if you take one of these products you likely consume it almost every day without realizing it.
How sweet? At least 7,000 times sweeter than sugar
Need to know: Approved by the FDA only in 2002, Neotame is a relative newbie to the non-nutritive sweetener category. Like sucralose, it does not break down under heat, so it is frequently used in commercial baking of sugar-free snacks. The absence of any metallic aftertaste (often a complaint with artificial sweeteners) has made it a popular choice for enhancing the sweetness and flavor of sugar-free gum.

Name: Stevia
Sold as: Truvia
Backstory: Truvia is derived from the Stevia Rebaudiana Bertoni bush, native to Central and South America, lending it popularity as a "natural" sugar alternative. In truth, the plant extracts have been so highly refined to make the sweetener, there is little natural about it.
How sweet? 200 to 300 times sweeter than sugar
Need to know: A study in the Journal of Agricultural and Food Chemistry found stevia to have anti-inflammatory properties, potentially helpful in moderating various health conditions. Promising, but as Shay points out, "there are holes in the evidence, both pro and con, for these sweeteners. They are relatively new, and it takes years of collecting data and doing studies to know their real effect."


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