Sugar substitutes

Sugar substitutes are substances used to replace the sweetness of sugar in foods, beverages, and other items taken orally, such as medications. People seek substitutes for sugar, which is also called sucrose, for many reasons. As a result, a variety of sugar substitutes exists. A number of sugar substitutes are chemical in origin. While these substitutes provide a sweet taste, they do not always perform the same way that sugar does in baked goods, and some may leave an aftertaste. Questions about the potential health risks of certain sugar substitutes have been raised.

Background

People first noticed the sweetness of sugar in New Guinea more than ten thousand years ago. They chewed pieces of raw sugarcane to release their sweetness. Over the centuries, sugar was carried from island to island until it finally reached Asia about 1000 BCE. Once sugar reached Muslim countries, armies carried it throughout the region. Europeans were introduced to sugar during the Crusades, and explorers including Henry the Navigator and Christopher Columbus carried sugarcane with them to plant in the lands they visited.

As sugar spread throughout the world, physicians noticed its connection to various conditions. In 1675 Thomas Willis, who helped found the British Medical Society, noticed that the urine of diabetics was very sweet. By the nineteenth century, physicians noticed a correlation between the rise in sugar consumption and the increase in conditions such as high blood pressure, diabetes, and obesity.

A teaspoon of sugar contains sixteen calories, or units of food energy. The body needs calories to function. However, sugar calories provide energy but no other nutritional value. The average twelve-ounce can of cola contains more than ten teaspoons of sugar; an orange-flavored soda can have as many as thirteen teaspoons. Neither contains any other nutrients. In contrast, a banana contains the equivalent of about three teaspoons of sugar but also provides fiber, potassium, and a host of other vitamins the body can use. During the nineteenth century, researchers began looking for sugar substitutes that would provide the sweetness people wanted without the calories that led to weight gain and other negative effects.

The first artificial sweeteners were discovered by accident by researchers attempting to develop medicinal products. However, food manufacturers were quick to see the advantages of an alternative to sugar that could be produced chemically—rather than grown—and that had few or no calories. The use of these sugar substitutes grew during World War II when sugar became scarce. The popularity of sugar substitutes, and the types available, continued to increase throughout the twentieth century and into the twenty-first.

Overview

Saccharin, a zero-calorie artificial sweetener derived from coal tar, was discovered at Johns Hopkins University in 1879. Although its discovery was an accident—the students who found it were trying to create a medicine—saccharin was quickly adopted and used in many food products by the first decade of the twentieth century. Others soon followed, including cyclamate, which was discovered in 1937 and made commercially available in 1950. Soda makers made use of these products beginning in 1953, starting a new market for diet sodas.

Numerous other artificial sweeteners were created over the next seventy-plus years, including aspartame, sucralose, acesulfame potassium, neotame, and advantame. In 1972, the US Food and Drug Administration (FDA) briefly removed saccharin from the “Generally Recognized as Safe List” over concerns that it caused cancer; it was later reinstated after a groundswell of support from citizens in the 1970s. It remains on the market.

In addition to the temporary sanction on saccharin, cyclamate was banned from sale and use in the United States in 1969 after studies indicated that it caused bladder cancer in test mice. Although these test results were disputed by other researchers, cyclamate remains banned in the United States. It remains in use in many other countries.

Sugar substitutes are available to consumers in many forms. They are used in the manufacture of processed foods such as baked goods, soft drinks and drink mixes, and non-food products such as mouthwashes and liquid medicines. They are also available in individual packages for use in beverages such as coffee and tea and in larger packaging for home bakers to use in place of sugar.

Sugar alcohols are another type of sugar substitute. They are neither sugars nor alcohols but are so named because their chemical structure resembles that of both sugar and alcohol. Sugar alcohols occur naturally in some foods but are also manufactured under product names such as xylitol, sorbitol, lactitol, maltitol, isomalt, mannitol, erythritol, and hydrogen starch hydrolysates (HSH). They are used mainly in processed food and products such as cough drops and chewing gum. They are generally less sweet than artificial sweeteners and sugar, but some are about the same. Some have calories but not as many as sugar. They also provide bulk and substance to products that include them.

Of all the possible sugar substitutes, natural substitutes have existed the longest. Honey, for example, was likely used as a sweetener long before sugar was. Fossilized honey bees more than one hundred fifty million years old have been found, and cave paintings done in 7000 BCE depict beekeeping activities. Honey was the primary sweetener until sugar began to spread across the world.

Honey contains about twenty-two calories per teaspoon, but those calories contain less fructose, which is the part of sugar believed to create the most health issues, and include other healthy trace elements picked up by the bees who make it. It is a more complex form of sugar, which means fewer calories are retained because it takes the body more energy to break it down. It is sweeter than sugar, so generally less is used to get the same sweetening effect. Thus, while honey is roughly equal to sugar in calories, it can be considered more nutritious than sugar. However, consuming an excess of natural sweetners can still lead to health problems including poor nutrition, as well as increased triglycerides, tooth decay, and obesity. Honey should not be given to children under the age of one because it can contain botulism-producing bacterial spores.

The same is true of most other natural sugar substitutes. These include agave from the agave plant, molasses from sugarcane or sugar beets, maple syrup from the maple tree, extract from the monk fruit (luo han guo), and other plant-based syrups such as malt, cane, brown rice, corn, golden, and barley syrups. Some sweeteners, such as stevia, are processed from plant leaves. All of these contain some calories, but most are believed to include additional substances that provide more nutrition than sugar.

In 2019, a study was published in the BMJ, a leading medical journal, that suggested that the differences in health outcomes between consuming sugar and consuming sugar substitutes were not significant. The study looked at body weight, body mass index, blood sugar levels, eating behavior, heart disease, and cancer, and found that the outcomes of subjects who ate sugar were very similar to those of subjects who ate other sweeteners. However, the researchers stated that larger, longer-term studies were necessary to confirm this.

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