Sugar and Sugar Substitutes — Moderation is Key

Katie Krebs, Pediatric Registered Dietitian
St. Cloud Hospital Women & Children's Center

Sugar is a hot topic in the media and in the health world. Diets high in sugar (and the calories that come with) have been linked with developing obesity, heart disease, and diabetes. The health community recommends that both children and adults reduce their sugar intake. With the big push to lower sugar intake, some food companies are taking sugar out of their foods. Many more offer low sugar or “no sugar added” products. However, often the sugar is not simply removed or reduced; instead it is replaced with a sugar substitute.

A Breakdown of Sweetener

“Artificial sweeteners”, “sugar substitutes”, or “high-intensity sweeteners” are all words to describe sweet substances other than table sugar (sucrose) that are used to sweeten foods. These sweeteners break down into a few categories.

• Artificial sweeteners are synthetic substances, though some are developed from naturally occurring materials. This category includes aspartame, saccharin, acesulfame potassium, sucralose (Splenda), neotame, and newly added advantame.
• Sugar alcohols are carbohydrates that are naturally found in some foods but are also manufactured. They are added to foods and other sweet tasting products such as gum, toothpaste, or mouthwash. Though called sugar “alcohols”, they do not contain ethanol. These sweeteners usually end in “itol” – xylitol, manitol, sorbitol, etc.
• Novel sweeteners are a combination of two types of sweeteners. For example, Truvia^© is made by combining a sugar alcohol with refined substances from the stevia plant called steviol glycosides.
• Natural sweeteners include honey, molasses, maple syrup, and agave nectar. Keep in mind that “natural” sweeteners still contribute added sugars and calories to foods. Remember, foods marketed natural are not necessarily healthier for you.

Artificial sweeteners, sugar alcohols, and novel sweeteners are extremely sweet, so very little is needed. All artificial sweeteners used in foods are approved for use by the Food and Drug Administration and have been extensively studied for their safety. Acceptable daily intakes (ADIs) have been set for these sweeteners. The ADIs are created to be about 100 times less than the smallest amount that could cause health concerns based on safety studies. Most people never get close to the ADI for artificial sweeteners. For example, a child weighing about 65 lbs would need to drink 8 cans of diet pop or consume 43 table sweetener packets every day to reach the ADI for aspartame. Eating too much of foods or drinks containing sugar alcohols can cause side effects such as diarrhea or increased gas and bloating.

Which is better for you?

I am often asked whether it is better for their children to have foods and beverages sweetened with sugar or a sugar substitute. My response is to consume all sweetened foods in moderation, whether they are sweetened with sugar, agave nectar, sucralose, xylitol, or any other added sweetener. Offer your child mostly water and milk with an occasional sweet beverage. Include a dessert or other treat with meals 1-2 times per week rather than daily. Choose more whole and minimally processed foods that don’t have added sugar or other sweeteners. For example, offer fresh or frozen fruits most days and applesauce or fruit juice only occasionally. Make your own lemonade with water, lemons, and a small amount of the sweetener of your choosing. Finally, when it comes to comparing two products side by side, low/no calorie sweetener versus added sugar, decide what makes the most sense for your child and your family. Foods and beverages sweetened with artificial sweeteners are often lower in calories. These items may be a better option if your child is gaining weight too quickly or is overweight.

Any type of sweetener should be used in moderation. You can reduce your child’s added sweetener intake by watching his or her beverages, offering more whole foods, and making desserts a once in a while kind of treat.

Enjoy all the sweetness in life – just remember to enjoy those sweetened with sugar and sugar substitutes in moderation!