Is zero calorie diet Coke really healthier? Does it really help you lose weight? What are the side effects of sugar substitution? Who should not eat sugar substitute?
  1. What is it? What's it made of?
  2. No calories?
  3. carcinogenic risk
  4. Is Splenda for everyone?
  5. Sugar substitutes are suitable for all cooking methods

Our preference for sweetness has evolved over thousands of years. From a neuroscience perspective, after eating sugar, the brain releases dopamine, which produces pleasure. Of all the nutrients, sugar can be converted into energy the fastest to supplement physical strength. But in modern society, sugar has become readily available, and eating in large quantities can lead to different health problems such as obesity, so some people invented sugar substitutes to solve this problem. But is this sugar substitute really beneficial to human beings without harm? 

What is sugar substitute? What's it made of?

Sugar substitutes, also known as sweeteners, are food additives. The ingredients of sugar substitutes can be artificial chemicals or extracted from plants. Mention "sugar", you may think of the general market to provide granulated sugar, its main component is sucrose, and then through a series of refining process. Refined white sugar is high in calories, has a high glycemic index and is obesogenic; Splenda contains fewer calories than conventional white sugar and is many times sweeter than table sugar. Cyclamic Acid is about 30 times sweeter than sucrose, while Neotame is 7,000 to 13,000 times sweeter than sucrose. So you only need to add very little sugar substitute to provide the sweetness of sugar. So the appearance of sugar substitute has become a boon for diabetics and people who lose weight.

No calories in Splenda?

Not necessarily.
In simple terms, sugar substitutes are "nutritive sweetener" and "non-nutritive sweetener" two broad categories. "Nutritional sugar substitute" is with heat, that is, contains calories; They are broken down by the body into glucose and fructose, which are absorbed in the small intestine as heat and affect blood sugar levels. Examples include sugar alcohols such as xylitol, also known as xylitol, Sucrose, Agave, Fructose, High fructose corn syrup, and Honey [1].
"Non-nutritive sugar substitutes", also known as low-calorie sweeteners, can achieve low or even zero calories because they are more difficult to digest. Currently available sweeteners in Hong Kong [2] include: Acesulfame Potassium, Alitame, Aspartame, Aspartame, aspartame-Acesulfame Salt, Cyclamic acid Acid), Neotame (Neotame), Saccharin (Saccharin), Steviol Glycosides, Sucralose. [3] Therefore, it is important to know that only "non-nutritious sugar substitutes" can achieve zero calories.

Is camel gum "sugar-free" really sugar-free? Does it really help you lose weight?

Some gum that is advertised as "sugar-free" actually uses sugar substitutes instead of sucrose. Just read the ingredient list on the package carefully and it is not difficult to see that different sugar substitutes are added to the gum. Among them, sugar alcohol (sugar alcohol) is more common. Sugar alcohols are "nutritional sugar substitutes," which provide half as many calories as table sugar, but eating too much can still lead to weight gain. Too much polysaccharide alcohol can also lead to bloating, stomach pain and diarrhea. xylitol, also known as Xylitol, is one of the sugar alcohols, but there are other sugar alcohols, such as: erythritol, isomalt, lactitol, maltitol, mannitol and sorbitol. [4]
 

Are sugar substitutes harmful if consumed for a long time? Cancer risk?

Even if "non-nutritive sugar substitutes" are near zero calories, long-term supplementation may have other problems:

  1. Although not carcinogenic, there is an upper limit of intake: early animal studies suggested that saccharin could cause bladder cancer, but this theory was disproved after years of research. However, JECFA, the Expert Committee on Food Additives of the Food and Agriculture Organization of the United Nations, has set an intake limit for sugar substitutes, which is about 36.7 cans of Coke per can of Acesulfame Potassium and 119.67 cans of Aspartame per can of Coke. Although it is difficult to achieve in daily life, they all show that there is an upper limit for sugar substitution.
  2. Increased risk of coronary heart disease and long-term kidney disease: A 12-year follow-up study in the United Kingdom found that people who ate two servings of sugar substitutes per month had a higher chance of developing coronary heart disease and long-term kidney disease than those who ate only one serving of sugar substitutes per month. [5]
  3. Increased insulin release in the body: Recent studies have also found that obese people have a tendency to increase insulin release after their first consumption of sugar substitutes. [6]
  4. Increased risk of obesity: A large 2008 study (5,158 subjects) confirmed that non-obese people who consumed sugar substitutes for a long period of time had a 30% higher risk of obesity than those who did not, which may not help with fat loss. [7]

You may say, since the "non-nutritive sugar substitute" is already nearly zero calories, and the small amount of sugar substitute has reached enough sweetness, why do I still gain weight? Experts explain that some people's eating habits do not completely replace sugar substitute sucrose, eating sugar substitute on one side, and eating refined sucrose on the other side, so they still consume too much sugar; The use of sugar substitutes is also easy to fall into the trap of thinking that they have replaced some calories and eat more other foods, thereby eating more calories in disguise. On top of that, the reason sugar is so irresistible to humans is that it produces addictive chemicals in the brain (like dopamine) and makes you want to eat more when you're happy. Substitute sugar is no exception, the mouth more and more sweet, the more food. [8] 

Is sugar substitute safe? For everyone? Bad for who

In general, as long as sugar substitutes are used appropriately, it is suitable for everyone. However, the following people should be careful:
  1. People with phenylketonuria must avoid Aspartame because they cannot metabolize phenylalanine. Phenylalanine, which accumulates in the blood, affects brain function. People with phenylketonuria should consider other sugar substitutes, such as Acesulfame Potassium (Acesulfame K) or Neotame, which are not metabolized by the body and remain. [9]
  2. A Danish study found that the consumption of artificially sweetened beverages by pregnant women is associated with the risk of premature birth. [10]
  3. Although eating a moderate amount of sugar substitutes during breastfeeding is not harmful, breastfeeding mothers must be careful not to diet too much so that the baby does not get enough nutrition. [11]
  4. Because young children are lighter in weight, they will consume more sugar substitutes per kilogram than adults, so they are prone to obesity. [12]
  5. For people with diabetes, "non-nutritive sweeteners" not only do not help control diabetes, but may be harmful to them. A small 2007 study found that people with diabetes who ate Aspartame had no higher glycemic index or insulin levels than those who ate sucrose, meaning that aspartame was not effective in lowering blood sugar. [13]
  6. Sucralose has been found to induce migraines. [14]
  7. The use of sugar substitutes in patients with epilepsy is controversial. Studies have found that Aspartame reduces neurotransmitters in the body that reduce seizures and induce epilepsy. So once had a history of epilepsy, or eat less is better. [15]

So pregnant women, breastfeeding women, children, people with diabetes, migraines or epilepsy should consult your doctor or dietitian first if they want to replace sugar with pills.

 

參考資料：       

  1. https://www.nal.usda.gov/fnic/nutritive-and-nonnutritive-sweetener-resources
  2. https://www.fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states （2018）
  3. Sweeteners in Food Regulations (Cap. 132, sections 55 and 143) 1970
  4. https://www.diabetes.co.uk/sweeteners/nutritive-and-nonnutritive-sweeteners.html
  5. Weihrauch MR, Diehl V. Artificial sweeteners – Do they bear a carcinogenic risk? Ann Oncol. 2004;15:1460–5.  
  6. Gardner C, Wylie-Rosett J, Gidding SS, Steffen LM, Johnson RK, Reader D, et al. Nonnutritive sweeteners: Current use and health perspectives: A scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2012;35:1798–808.
  7. Pepino MY, Tiemann CD, Patterson BW, Wice BM, Klein S. Sucralose affects glycemic and hormonal responses to an oral glucose load. Diabetes Care. 2013;36:2530–5. 
  8. Fowler SP, Williams K, Resendez RG, Hunt KJ, Hazuda HP, Stern MP. Fueling the obesity epidemic. Artificially sweetened beverage use and long-term weight gain? Obesity （Silver Spring） 2008;16:1894–900. 
  9. Pearlman, M., Obert, J., & Casey, L. （2017）. The association between artificial sweeteners and obesity. Current gastroenterology reports, 19（12）, 64.
  10. https://medlineplus.gov/ency/article/001166.htm
  11. Halldorsson TI, Strøm M, Petersen SB, Olsen SF. Intake of artificially sweetened soft drinks and risk of preterm delivery: A prospective cohort study in 59,334 Danish pregnant women. Am J Clin Nutr. 2010;92:626–33.
  12. https://www.mottchildren.org/health-library/hw130509
  13. Renwick AG. The intake of intense sweeteners – An update review. Food Addit Contam. 2006;23:327–38. 
  14. Ferland A, Brassard P, Poirier P. Is aspartame really safer in reducing the risk of hypoglycemia during exercise in patients with type 2 diabetes? Diabetes Care. 2007;30:e59.
  15. Newman LC, Lipton RB. Migraine MLT-down: An unusual presentation of migraine in patients with aspartame-triggered headaches. Headache. 2001;41:899–901. 
  16. http://theepilepsynetwork.com/seizures-and-diet-soda/
  17. Wani, M. M., & Bhat, T. A. （2019）. Sugar substitutes and artificial sweeteners. JMS SKIMS, 22（1）, 90-92.