Natural sources don't offer options to satisfy our sweet cravings without increasing our calorie intake. White sugar, brown sugar, honey, and jaggery all have similar calorie content. Sugar substitutes, however, help reduce calorie intake, as many of them have close to zero calories. For instance, a 500 ml can of cola contains approximately 12 spoons of added sugar - almost 220 calories - whereas a can of diet cola has zero calories! Theoretically, sugar substitutes are an attractive proposition. However, they are not without controversy.
There are two common types of sugar substitutes: artificial sweeteners and sugar alcohols. Artificial sweeteners are synthetic substitutes, including saccharin, cyclamate, aspartame, sucralose, acesulfame, and neotame. The other type of sugar substitute is plant-derived sugar alcohols, such as erythritol, mannitol, and sorbitol. In addition to sweetness, sugar alcohols add texture to food. Their sweetness varies from 25% to 100% compared to regular sugar. Consuming large quantities of sugar alcohols can cause bloating, loose stools, or diarrhea, though tolerance typically develops over time.
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Stevia and monk fruit sugar are considered "natural" sweeteners because they are derived from plant sources. Sugar substitutes are widely used in processed foods, including soft drinks, cookies, chocolates, and jams. Some, like sucralose, can also be used in baking or cooking. However, a "sugar-free" label on a product can sometimes be misleading, as it may lead us to believe the product is "zero-calorie," resulting in overconsumption. For example, a bar of sugar-free chocolate contains about 60% of the calories of a regular chocolate bar due to its fat content.
It remains unclear whether replacing dietary sugar with artificially sweetened products can reverse the health consequences of sugar overconsumption, such as obesity, diabetes, and heart disease. Some studies have shown that artificial sweeteners may increase the risk of diabetes and obesity, while others have found no such evidence. A 2022 WHO report observed modest associations between consuming beverages with artificial sweeteners and conditions like cholesterol abnormalities and high blood pressure. It has also been suggested that these sweeteners may alter gut flora, potentially increasing the risk of weight gain and diabetes.
A 2022 French study linked artificial sweetener intake to an increased risk of heart disease, stroke, and cancer. Saccharin was once associated with cancer in rats, and aspartame with brain tumors, though these claims lack solid evidence. Concerns about adverse effects on kidneys, memory loss, dementia, and stroke have been reported but remain unproven. Additionally, mixing alcohol with artificially sweetened beverages has been shown to raise blood alcohol levels, increasing the risk of intoxication.
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Artificial sweeteners may also affect how our brains respond to sweetness, making naturally sweet foods like fruits less appealing and increasing our cravings for sweeter substances. For those who consume large amounts of sweetened beverages and are trying to reduce their intake, artificially sweetened beverages can be used temporarily while gradually transitioning to water. People with bowel disorders or those who have undergone bariatric surgery should avoid them altogether.
So, what should those of us trying to lose weight or control diabetes do? The best approach is to eliminate sugar entirely. If sweet cravings persist, it is generally safe to consume sweeteners in small amounts. A daily intake of 1-2 servings of sweeteners is considered safe, though conclusive data is lacking. Plant-derived sweeteners like monk fruit sugar or stevia may be safer options, but this too is yet to be proven.
About The Author: Dr. Ambrish Mithal is the Chairman and Head of Endocrinology and Diabetes at Max Hospital, Saket.