I am devoting the articles for this month to the unhealthy items we are exposed to in our food and environment. My intent is to create awareness so that you can create a healthier environment for your children.
Artificial sweeteners have been around for a long time as an inexpensive sugar substitute. These sweeteners are far sweeter than natural sugar, ranging from 100 to 1000s times the sweetness of sugar. The long-term safety issues of these additives in children are largely unknown. Current data simply shows that more research is warranted.
Packets of artificial sweeteners, now known as non-nutritive sweeteners
Saccharin was the first artificial sweetener synthesized over a hundred years ago. This sweetener, and others, were approved as food additives in 1958. Artificial sweeteners, now known as non-nutritive sweeteners (from here on I will refer to these as NNS), are found in more than 6,000 food and beverage items, including diet beverages, snack foods, candies, yogurt, chewing gum, vitamins, medicines, salad dressings, and ketchup. The number of food items containing NNS has quadrupled over the last several years. The FDA has approved eight different sugar substitutes, outlined in the table below. Any food or beverage labeled diet, sugar-free, sugarless, low sugar, reduced sugar, reduced calorie, or low-calorie typically contains an NNS.
Non-nutritive sweetener Commercial name Sweetness compared to
Sucrose (table sugar)
Aspartame NutraSweet, Equal, Sugar Twin 200 times
Acesulfame potassium Sunnet, Sweet One 200 times
Advantame No commercial name 20,000 times
Aspartame-acesulfame Twin Sweet 350 times
Neotame Newtame 13,000 times
Saccharin Sweet’N Low, Sweet Twin 700 times
Sucralose Splenda 600 times
Luo han guo Monk fruit in the raw, PureLo Lo 600 times
Stevia Truvia, Pure Via, Enliten 200-400 times
Stevia crystals have 200-400 times the sweetness of sugar so a little packs a lot of sweetness
The FDA approved a number of these sweeteners amidst the obesity epidemic as a way to cut calories in foods and beverages. However, new studies show that these have not made a difference in the obesity epidemic, and may play a role in insulin resistance, the first step to type 2 diabetes. More scientific research has been requested over the past decade as some scientists think the obesity epidemic correlates with the tremendous increase in the use of these items. Many feel that these chemicals have contributed to this epidemic they intended to help fight.
Reducing sugar intake for everyone is worthwhile, but artificial sweeteners may not be a better alternative, especially for children. Dietary Guidelines for Americans and the American Academy of Pediatrics (AAP) state: "sugar substitutes should not be given to children under two". The AAP has called for regulations for food manufacturers to label the amount of NNS contained, not simply list the type in the ingredients. The AAP also recommends that children avoid NNS as much as possible. There has not been enough research on children thus far to warrant their frequent or long-term use. Current estimates show NNS use in 25% of children and 44% of adults. Due to their smaller body size and relatively higher intake, children consume more NNS per pound of body weight per day.
Because NNS are 200 to 20,000 times sweeter than sugar, data suggest they may affect taste preferences for sweet foods, creating a desire for more. Animal studies have shown an increase in insulin response to this sweetness, further increasing food intake and leading to obesity. Studies in humans have given mixed results, but one thing that human studies have revealed is higher rates of metabolic syndrome and type 2 diabetes in those who regularly use NNS, primarily from diet beverages, compared to those who don’t consume these beverages.
The intense sweetness of NNS may lead to cravings for high-sugar foods
One of the reasons for this is that artificial sweeteners can actually change the microbiome of the gut in ways that can lead to glucose intolerance.
(For a refresher on the gut microbiome, see blog post from 11/9/22).
Alterations in the microbiota are associated with a greater risk of developing insulin resistance, glucose intolerance, metabolic syndrome, weight gain, and type 2 diabetes.
Another concern is that NNS use in children may be associated with a greater preference for sweet foods. Children already prefer sweetness, but these sweeteners expose them to abnormally sweet items and may lead to cravings for foods high in sugar and calories.
The increased trend in NNS use coincides with the increase in childhood obesity, as does the increased trend in sugar consumption. Several studies on children and adolescents have reported a correlation between high NNS intake and a higher BMI. Long-term benefits of NNS for weight loss or weight gain prevention have been inconclusive, with only limited benefits seen. Some research indicates that children ages six and older exceed the recommended daily intake of NNS by more than 50%.
Of even further concern is that a very recent study indicated that aspartame might play a role in triggering anxiety. These studies were in mice, but aspartame has already been linked in humans to behavioral and cognitive problems, including headaches, migraines, irritability, insomnia, depression, and seizure.
Aspartame is the most commonly used sweetener on the market. Once metabolized, its by-products are:
Aspartic acid
Phenylalanine
Methanol
Methanol breaks down further into formaldehyde. These components can cross the blood-brain barrier and each is harmful at high doses. Because of the phenylalanine, persons with PKU (phenylketonuria) must avoid aspartame entirely. The breakdown products are believed to be more harmful than aspartame itself, but again in high doses. These metabolites can affect the levels of neurotransmitters in the brain, such as serotonin and dopamine, which help regulate mood, cognition, and sleep.
Some alternatives to NNS include honey, coconut sugar, maple syrup, table sugar, & brown sugar
So how do we satisfy that sweet tooth for ourselves and our children?
Sugar in and of itself is not bad as long as our consumption is limited.
Naturally sweet foods - for example, whole fruit - are nutrient-dense and high in fiber. Fruit can be served fresh, frozen, or canned in juice with no sugar added.
Other common natural sweeteners include:
honey*
dates
sugar
coconut sugar
maple syrup
molasses
agave nectar*
**Infants cannot have honey or agave nectar. Agave nectar is unpasteurized, and honey can cause botulism.
For more healthy sweet treat ideas, see post entitled "Sweet Tooth", 8/10/22.
In conclusion, artificial sweeteners have not been studied adequately in children and adolescents. They should not form a significant part of a child’s diet as recommended by the AAP.