Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, MD
 21 June 2006

ARTIFICIAL SWEETENERS

            In a column several months ago, I noted the statistic that the average sugar intake in the United States is 150 pounds per year.  If one calculates this out, it amounts to 750 calories per day.  Considering that there are 250 calories in a 20 ounce cola drink and many people would drink 3 of these a day, that is not a hard statistic to believe considering all the other places in our diets where sucrose would be found.  Everything from sugar coated breakfast cereal to sweet rolls, to cake to ice cream to cookies to candy, jellies and jams, all have sucrose in them.  The problem with sucrose is not just the large number of calories but it is the large amount of immediate sugar released into the blood stream constantly challenging the pancreas to keep up with enough insulin.  Considering that about 7% of our population is diabetic in this country, there are definite disease considerations regarding the excessive amount of sucrose in our diets.  Saccharin was the first artificial sweetener discovered many years ago.  Through years of testing and follow up this time, this sweetener which is more than 300 times more potent than sucrose on a weight basis has been found to be safe.  Claims that it caused cancer have been studied and found negative. The only real knock on saccharin is the bitter after taste that many people experience.  Restaurants today usually have small packets of saccharin on the tables to use in place of table sugar.  The trade name for saccharin is Sweet N Low.

            Because of the bitter aftertaste that came with saccharin, a second product called acesulfame-K came on the market in the late 1980’s.  It sold under the trade name “Sweet N Safe” or “Sweet One”.  Unfortunately, this product also has a bitter aftertaste and has never really gained wide acceptance.  It is a component of the sweetener in several no sugar soft drinks such as Diet Coca-Cola or Diet Pepsi-cola.  This product also has no demonstrated adverse health effects.

            In the early 1990’s, a product called aspartame was introduced to the market with trade names “Nutra Sweet” or “Equal”.  This product is about 200 times sweeter than sugar on a weight basis.  It has very wide distribution in our society and is often on the countertops or tables in restaurants for use to sweeten coffee or tea or other foods that might be consumed.  This product has the limitation of not being used by people who have a rare hereditary disease called phenylketonuria.  Aspartame is made up of two chemicals called amino acids and one of these is called phenylalanine.  Phenylalanine is a product that is poisonous for people that have phenylketonuria.  By the time that these individuals are adults, they usually know enough not to use products such as this.

            Soon after this product came out, there was a host of articles that appeared in the lay journals and Internet damning aspartame as causing cancer and other various abnormalities.  None of these accusations has ever been substantiated by any scientific study.  On review of the medical literature the National Library of Medicine yields no health risk for this product other than for those with phenylketonuria.

The latest widely used artificial sweetener is sucralose which is sold under the trade name Splenda.  Different then saccharin or aspartame, Splenda has a true sugar like structure that closely simulates the structure of sucrose.  The difference is that sucralose cannot be metabolized by the body for energy purposes.  It is very poorly absorbed from the bowel and thus excreted in the stool.  It has no caloric value at all.  It is now widely used in many products available commercially and for home cooking and bakery purposes also.

            The other artificial sweeteners in our society are called polyols such as sorbitol. Sorbitol. is a component of some of the hard candies that are sold over the counter as sugar free.  The only side effect from these products is diarrhea if one eats too much of it.  Sorbitol is not absorbed from the bowel at all and it is excreted in the stool.

            The reason for this column was a recent inquiry by a patient trying to lose weight.  She indicated that she had cut down on the amount that she was eating but that she was afraid to use artificial sweeteners because she had heard that they cause cancer.  To this time, there is no information in the medical literature supporting any link between artificial sweeteners and cancer.  I explained to her the importance of sucrose in her every day diet and how easy getting 750 calories a day from sucrose is when she is drinking sugar containing pop along with various other sucrose containing products in her diet.  Simply changing to dietary carbonated beverages can quit substantially cut down on the daily caloric intact.  I noticed recently that the Sioux Falls school district has taken the sugar containing carbonated beverages out of the schools to cut down on the obesity epidemic in our schools today.

            A substantial fringe benefit from artificial sweeteners is a decrease in the incidence of tooth decay.  Sugar containing beverages and foods contribute to the growth of bacteria around our teeth.  This is substantially decreased by the use of artificial sweeteners as mentioned above.

            I inquired with the patient where she had gotten the idea that artificial sweeteners caused cancer and she said that she remembered in the late 1960’s that a product called cyclamate was taken off of the market because it was noted to cause cancer in rats.  Our government has a policy through the Food and Drug Administration that any chemical that causes cancer in animals cannot even be tested in humans.  In the 1960’s cyclamates were found to cause liver tumors in rats when the amount of cyclamate was 10 times that amount which would ever be used in humans.  Therefore cyclamates were taken off of the market as soon as this information was available in 1970.  However, cyclamates are still consumed in substantial quantities in Canada, Europe, Australia, and New Zealand.  To this time, there has not been information coming from these countries suggesting that cyclamates cause cancer in humans.  The original thought was that perhaps cyclamates would cause cancer of the bladder.  This has not developed into a reality.

            In summary, the most important use of artificial sweeteners is for diabetics who need to avoid the intake of sugar products.  But these artificial sweeteners can also be used for those involved in trying to control their weight and those struggling with tooth decay.  The lay press suggestions that artificial sweeteners cause cancer or behavior disorders in our children have no medical or scientific basis.