Artificial sweeteners are often touted as the healthier alternative to sugar as they are calorie-free, but experts warn the evidence is unclear. — HENDRIK SCHMIDT/dpa
CONSUMING too much sugar is harmful to health, doctors keep telling us. But most of us literally love la dolce vita. Can artificial sweeteners be a healthier alternative?
First, let’s take a closer look. Many artificial sweeteners, also known as sugar substitutes, are much sweeter than sugar.
”Chemically, they’re a wide range of substances that are differently structured and work differently,” says Dr Stefan Kabisch from the Department of Endocrinology and Metabolic Medicine at Charité University Hospital in Berlin. Some are absorbed in the intestines, others aren’t. Some even have a bitter aftertaste.
”Compared with sugar, (intense) artificial sweeteners have the advantage of causing no tooth decay and being calorie-free,” says Katrin Böttner, a food and nutrition specialist at the consumer advice centre in the German state of North Rhine-Westphalia.
Twelve are currently approved for use in the European Union, including acesulfame K (E950), aspartame (E951), cyclamate (E952), saccharin (E954) and stevia glycosides from Stevia (E960a), the last of which is a natural, plant-based sweetener.
Sugar alcohols are another type of sugar substitute. “They’re all structured similarly,” says Kabisch. Eight are currently approved for use in the EU, including erythritol (E968), sorbitol (E420) and xylitol (E967).
They’re about as sweet as sugar or less so. And they have calories, but fewer than sugar – except erythritol, which has none.
”It’s not broken down by bacteria in the intestines, but completely resorbed and excreted via urine,” Kabisch says. “Erythritol can be used, for example, for baking, just like sugar.” Dr Stefan Kabisch and Katrin Böttner
Tummy problems
Consumed in large amounts, however, sugar alcohols can cause gastrointestinal problems such as flatulence and diarrhoea.
”Individual tolerance varies,” notes Böttner. “You should know this, as you may not attribute these symptoms to them.”
But back to the original question: Are artificial sweeteners a healthier alternative to sugar?
To answer this, it’s important to realise that your sugar intake doesn’t consist only of refined sugar added to foods. Natural sugars are found, for instance, in fruits as well as in honey and agave nectar – “liquid sugar that health-wise hardly differs from refined sugar,” Kabisch says.
While sugar is an energy-rich nutrient, we can survive without it for decades. Our body is evolutionarily programmed to love eating sugar and to utilise lots of it though.
”At the time this programme took hold, we went long periods without food,” explains Kabisch. “So it made sense to lay in fat reserves.”
This isn’t the case today, but sugar intake still activates the brain’s reward system.
It’s difficult to quantify a “healthy” intake of sugar. According to the World Health Organisation (WHO), calories in the form of sugar shouldn’t exceed 10% of a person’s daily calorie intake. So if your daily calorie requirement is, say, 2,000, you shouldn’t consume more than about 50g of sugar.
This applies only to free sugars, however – that is, to sugars added to foods or drinks, or that are naturally present in honey, syrup and fruit juices. It doesn’t include the sugars found in fruit, vegetables and milk.
”Sugar is definitely problematic from a health standpoint – sugar substitutes less so,” says Kabisch, adding that there’s insufficient research on which of the sugar substitutes – intense artificial sweeteners or sugar alcohols – is the healthier alternative.
Wean it off
He and Böttner agree that the evidence is unclear, the data spotty, and many studies flawed.
”At the end of the day, you’ve got to consider and decide for yourself,” Böttner says. “Although the majority of studies haven’t shown sugar substitutes to be harmful to health, much more research needs to be done.”
Kabisch points out that observational studies have shown that a disproportionate number of people who excessively consume artificial sweeteners are overweight and diabetics.
”Reverse causality is probably at work here though,” he says. In other words, the sweeteners aren’t to blame for their condition, but rather they consume them to help control their diabetes.
”Less research has been done on sugar alcohols, but it’s already clear that they alter intestinal flora,” he says. So people with a bowel condition, such as Crohn’s disease or irritable bowel syndrome, should be careful.
Both Kabisch and Böttner recommend a long-term reduction in sugar intake, arguing that the healthiest course of action isn’t to satisfy your craving for sweets by switching to artificial sweeteners, but by curbing the craving.
This takes self-discipline and staying power – it’s not enough to avoid sugary foods for a few days now and then. “You’ve got to lastingly wean yourself off the urge to eat sweets,” Kabisch says.
”It’s harder for some people than others, but can be done.”
Checking the lists of ingredients when you go grocery shopping is a good idea too.
”Artificial sweeteners are in more processed foods than you may think,” says Böttner – not only in sugary drinks, but also where you wouldn’t expect them. On ingredients lists, they must be identified as “sweeteners” or marked with an E number. – dpa/Bernadette Winter
