by Linda Illingworth, RDN
As the inflammatory nature of sugar has become more apparent, food manufacturers have created sugar substitutes to address our insatiable desire for sugar. The FDA has approved six non-nutritive sweeteners: saccharin, aspartame, acesulfame potassium (acesulfame-K, or Ace-K), sucralose, neotame, and advantame. In addition, a category of sweeteners known as polyols was approved for the GRAS or Generally Regarded As Safe list. Sugar substitutes range from plant-derived substances to chemically manufactured molecules that mimic the taste of sugar. But not all sugar substitutes are safe. The early sugar substitute, cyclamate, was banned due to an association with cancer. In 2021, a National Institute of Health (NIH) review of aspartame research found evidence that aspartame can cause mood disorders and mental stress, is correlated with autism from absorption during pregnancy, and long-term use of aspartame can cause neurodegeneration, affecting the hippocampus, learning, and memory.
More recently, another team at the NIH has found that using the sugar alcohol erythritol can increase platelet activity, making the blood more prone to clotting. They discovered that physiological levels created by routine use of erythritol significantly increase the risk of major adverse cardiovascular events (MACE), including death or nonfatal myocardial infarction or stroke. Erythritol is one of the polyols or sugar alcohols initially thought to pass through the gut undigested. We now know that sugar alcohols interface with our gut bacteria and result in changes in our microbiome.
My recommendation is to avoid all chemical sweeteners, including all sugar alcohols. There is limited research on most food additives, and the FDA’s frequent answer to new additives is to place them on the GRAS list until they are proven to cause harm. It’s an industry-friendly approach that creates little impetus for food manufacturers further to investigate the safety of these so-called GRAS ingredients. Instead, it requires independent researchers to find funding and complete safety studies. The EU, which has stricter laws regarding food safety, has banned many GRAS ingredients due to various health concerns.
The best approach is to reduce your use of all sweeteners, but realistically, there will be times you want to sweeten something. Here are several options:
Use refined cane sugar but limit all sources of it to less than 30 grams per day.
Use plant-based Stevia or fruit-based monk fruit (lo han gou), which contains no sugar.