Sugar substitute suspicions: Fact and fiction

Be careful and conscientious about the food you're eating. You can't over-indulge in anything without some effect.
We've heard the rumors and have even forwarded those scary e-mails: Artificial sweeteners are responsible for all types of health disasters from migraines to brain tumors, Alzheimer's, neurological maladies, liver cancer, lymphoma and leukemia.

Aspartame, the most popular sweetener, even has been blamed for Gulf War Syndrome. And more trouble follows the sweet food additives, those products with some nutritional value like fructose and sorbitol.

Latest research

"No study has confirmed those findings," says Deepa A. Vasudevan, M.D., an assistant professor in family medicine at The University of Texas Medical School at Houston. Vasudevan, who has a special interest in the study of obesity adds, "However, I have had patients who report that their headaches went away when they stopped using products with aspartame or saccharine."

Aspartame is the most maligned sweetener in the "send to everyone you know" e-mail category and the subject of countless Web sites. Sold under the names Equal and NutraSweet, it's also known affectionately as the blue packet. The newer yellow-packet darling of the artificial sweetener industry, Splenda, (sucralose) was more recently introduced and hasn't been followed as long as older products.

Yet, saccharine was introduced in the late 1800s, and as early as 1911, was the subject of controversy. To add to the confusion, many of the studies on product safety are financed by the corporations that manufacture them.

The most recent study was conducted on humans, not animal models, by the National Cancer Institute and shows no link between aspartame consumption and lymphoma or leukemia, which contradicts a large European study released last May.

The seven-year, $1 million study by the European Ramazzini Foundation of Oncology and Environmental Sciences in Bologna, Italy, suggested that we again should investigate the 25-year-old sugar substitute.

According to this European study, aspartame was associated with high rates of lymphoma, leukemia and other cancerous tumors in rats -- even in relatively small doses (the equivalent of three soft drinks a day for women or four soft drinks for men). The FDA stands by its earlier reviews of years of studies of aspartame.

Meanwhile, an advisory group for the European Commission, the European Food Safety Authority, is currently reviewing the 900-page report of the Italian study with plans to publish its evaluation later this spring.

Aspartame is used in thousands of products worldwide, from packaged food to medications and cosmetics. Because aspartame has a long shelf life in products that don't require heating or cooking, it's the most popular flavor enhancer for diet soft drinks, a beverage staple -- often the only beverage -- for many Americans.

The National Cancer Institute study looked at 340,045 men and 226,945 women, ages 50 to 69. Participants filled out copious surveys about their food and beverage consumption, detailing how they used aspartame and how often.

Participants were followed over the next five years and though 376 brain tumors and 2,106 blood-related cancers developed, the number of cases are consistent with the average cancer rate in the general population. No link was found to these or other cancers from aspartame.

How much? How little?

While educated consumers have become accustomed to reading the labels on food products, the amounts of various artificial sweeteners are not listed.

"You will find the ingredient, but the label doesn't tell you how much of a certain sweetener is in that product," says Alison D. Gernand, registered dietitian, in the Human Nutrition Center at the UT School of Public Health. "It would be a difficult process to find the amount of artificial sweetener in each brand of diet drink or sugar-free dessert without contacting the manufacturer or searching their Web site," says Gernand.

The U.S. Food and Drug Administration has established daily intake levels for sweeteners and food additives, however. An acceptable daily intake (ADI) as defined by the FDA is an estimate of the amount of a particular food additive that can be ingested every day for a lifetime without negative effects. The ADI of aspartame is 50 mg/kg of body weight per day. That translates to 22 cans of a diet soft drink for a 175 lb. man or 15 cans for a 120 lb. woman.

Splenda is sure to be next on the list of dietary suspicions. The manufacturer boasts, The no-calorie sweetener that tastes like sugar, because it's made from sugar. While this may be true, chlorine atoms bind with sucrose in the making of sucralose. Some consumer groups already have voiced rabid warnings.

When to avoid sweeteners

Vasudevan warns that pregnant women should watch how much they consume and try to limit the consumption of artificial sweeteners. "Also, children are a main concern. They are smaller, with higher metabolisms, and they can tolerate less," says Gernand. She estimates a 40 lb. child would reach the FDA's recommended daily limit for aspartame with four 12 oz. cans of diet soda. Artificial sweetener may also be in individual packages of gelatin and pudding, as well as other handy products parents give their children.

A rare genetic disorder called phenylketonuria (PKU) doesn't allow a person to break down the phenylalanine in aspartame, thus toxic levels can build up in the body. Since this condition is generally diagnosed at infancy, those with PKU know to avoid phenylalanine. Products with aspartame have a printed warning.

Use responsibly

So, with aspartame in 6,000 products and sucralose in 4,000 products, amidst an obesity and diabetes epidemic, how do we practice safe sweets?

Gernand suggests that we use responsibly. "Make small changes. Read labels. Why not reduce the sweetener you add, or even use just a little sugar to enhance taste?"

Vasudevan, who works with patients on weight control, adds, "If you don't need them, don't use them. Be careful and conscientious about the food you're eating. You can't over-indulge in anything without some effect. Reducing sugar or sugar substitutes won't hurt us.

And about those three or four diet soft drinks a day, a final thought from Vasudevan: "What's wrong with drinking water?"

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