Sugar substitutes, some of which are known as artificial sweeteners, may be in a food or drink, and the manufacturer can list zero sugars in the Nutrition Facts Table. Yes, even though a sweetener has been introduced to the food or drink, the item can be labeled as if it is sugar free, making it a smile or half-smile food. This labeling is correct because these sugar-substitute sweeteners are nonnutritive, as explained below. Some may feel confusion about this due to the controversy surrounding certain types of sugar substitutes. Artificial sweeteners have developed a bad reputation, some claiming they are the cause of a variety of diseases, including cancer. So why can they be considered part of a smile food? Let’s start with the basics.
What are nutritive sweeteners? Sugars and sugar substitutes fall into two categories: nutritive and nonnutritive sweeteners. Sugars fall into the former category (nutritive sweeteners), while sugar substitutes may be either nutritive or nonnutritive sweeteners.
Nutritive sweeteners include regular sugar, such as sucrose, high-fructose corn syrup, etc., all of which provide calories and raise blood sugar (1). Sugar alcohols, such as mannitol, sorbitol, and xylitol (all end in “ol”), have recently been used as sugar substitutes, and you may see them listed on “sugar free” packages. Importantly, these sugar alcohols are also considered nutritive sweeteners because they still provide some calories. However, they provide about 50% of the calories found in regular table sugar and cause a smaller rise in blood sugar because they are slowly absorbed (1). These sugar alcohols are regulated by the FDA and are considered safe (2). Moderate consumption of sugar alcohols is usually well tolerated; however, for some individuals, these sweeteners, particularly sorbitol and mannitol, may cause gas, diarrhea, and stomach pain (1). If you are concerned this may be a symptom you experience, then be sure to check the nutrition label for these types of sweeteners.
What are nonnutritive sweeteners? Nonnutritive sweeteners (also called “sugar substitutes” or “artificial sweeteners”) provide few or no calories but have a greater intensity of sweetness compared to regular sugar, so smaller quantities are needed for flavoring foods and beverages (1). They are nonnutritive for the simple reason that they provide zero (or nearly zero) calories and do not raise blood sugar. Eight nonnutritive sweeteners are approved for use in the United States and are considered safe by the FDA: acusulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, sucralose, and advantame (1).
Are sugar substitutes safe to consume? FDA-approved sugar substitutes, whether nutritive or nonnutritive, are considered safe in the amounts that people typically eat or drink (1). The FDA goes through an extensive review process that takes all of the following into account for each substance: the probable intake, cumulative effect from all uses, and toxicological data such as absorption, distribution, and metabolism of each substance (1). The FDA has set an acceptable daily intake (ADI) for each of these substances, which is the maximum amount of sweetener that can be consumed each day over a lifetime without causing harm with a 100-fold safety factor (1). Exceeding the ADI based on normal consumption for low-calorie foods and beverages is virtually impossible for the average consumer. For example, one would have to drink roughly 19 cans of diet soda per day for the rest of their lives to reach the ADI for aspartame (3). Many of these sweeteners have been studied for long periods of time in human populations yielding no evidence that these sweeteners cause harm, particularly cancer (1). Many large health organizations such as the Academy of Nutrition and Dietetics, American Diabetes Association, American Heart Association, and National Cancer Institute agree that many of these sugar substitutes are better alternatives for health and weight than added sugar.
In summary, smile foods may contain some sugar substitutes (such as sugar alcohols) or artificial sweeteners (such as aspartame), but you do not need to be overly concerned about these additives. The FDA extensively reviews each sugar substitute and artificial sweetener for its safety and appropriate use to be sure you are safe. When it comes to beverages, try to choose water as often as you can for optimal hydration, but do not feel ashamed or afraid if you enjoy beverages or other products with added artificial sweeteners at times. If you are concerned that you may have sensitivity to some of these sweeteners such as sugar alcohols, be sure to check the nutrition label so that you can make an informed choice. For more information or questions regarding sugar substitutes feel free to Contact Us or visit the FDA’s website:
References
- Fitch C, Keim KS. Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners. Journal of the Academy of Nutrition and Dietetics 2012;112:739–58.
- Food and Drug Administration. High-Intensity Sweeteners. FDA [Internet] FDA; 2020 [cited 2022 Jan 31]; Available from: https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners.
- Nutrition C for FS and A. Additional Information about High-Intensity Sweeteners Permitted for Use in Food in the United States. FDA [Internet] FDA; 2020 [cited 2022 Jan 31]; Available from: https://www.fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states.