Shape Up America! Newsletter
Sugar Substitutes: Are They Safe?1
by Ruth Kava, PhD, RD
Sugar substitutes comprise a heterogeneous group of
compounds—they include intensely sweet, synthetic
compounds, as well as a variety of naturally
occurring substances that are not as sweet (e.g.,
sugar alcohols such as mannitol). Concerns have been
raised primarily about the safety of the first
group—the intense sweeteners—although most have been
used for many years without evidence of harm.
Five intensely sweet sugar substitutes can legally
be used as food ingredients in the United States.
These are: acesulfame-K, aspartame, neotame,
saccharin, and sucralose. All are over 100 times as
sweet as sugar, so only tiny amounts are needed to
replace the sweetness of sugar (see Table 1).
Before manufacturers can add a new substance to the
US food supply, they must get approval from the Food
and Drug Administration (FDA). Approval rests on
convincing the FDA, by means of appropriate
scientific studies, that the substance will be safe
when used as intended.
Such safety tests are typically two-year long
studies of the substance conducted in laboratory
animals—at doses much higher than people would use.
They are designed to mimic the exposure of humans
who would consume the products every day for a
lifetime. Scientists examine the results for
evidence that the tested substance is toxic, that it
causes cancer, or that it causes mutations that
could lead to cancer. When a product has passed the
animal safety tests, and has been used in foods and
beverages, further studies are often conducted to
monitor its use by people.
Despite such studies, concerns have been raised
about intense sweeteners; frequent repetition by the
popular media and on the Internet has fanned anxiety
in many people. But the charges are typically
without merit, and have been dismissed by respected
scientific organizations and governmental regulatory
bodies—here and in other countries.
Ace-K (the K stands for potassium) is a heat-stable
compound that is about 200 times sweeter than sugar.
It can be used for cooking and baking, and is most
often used in combination with other
It was approved in 1988 for use in dry food
products,3 in 1998 for use in nonalcoholic
beverages,4 and in 2003 for use as a general
purpose sweetener.5 Some objections
filed with the
FDA in the 1980s and 1990s criticized these
approvals based on: 1) weaknesses of some of the
safety studies, 2) some animal experiments that
suggested ace-K might increase the risk of cancer,
and 3) concerns about a breakdown product that might
form in beverages during storage. The FDA responded
that although one of the studies was flawed, it had
been repeated correctly and did not suggest ace-K
caused illness in the animals. FDA did not find that
the objections to the cancer studies had merit.
Further, the breakdown product of most concern,
acetoacetamide, would be present in negligible
amounts, so is not a real safety issue. These issues
were addressed and dismissed by the European Union’s
Scientific Committee on Food.6
In 1997, Indian scientists reported that ace-K
caused mutations in bone marrow cells of
other researchers were unable to replicate these
results.6 When the original researchers
mixture of aspartame and ace-K in a second study,
they also found no evidence of bone marrow
Websites and anecdotal reports that attack the
safety of aspartame abound—assertions that the
sweetener causes diseases ranging from lupus to
cancer to fibromyalgia and neurotoxicity are common.
None of these accusations are true.
The human body does break down aspartame into the
amino acids phenylalanine and aspartic acid, and
methanol. The only valid safety issue related to
aspartame is that people with the rare inborn
metabolic disorder phenylketonuria should not use it
because they can’t utilize phenylalanine, and it
will build up in their blood. That is the reason all
products that contain aspartame carry a label
indicating that phenylalanine is present.
Since aspartame was first approved in 1981,9
charges have been leveled that it causes cancer of
various sorts, and that the methanol it contains is
toxic (which is true—but at high doses). People who
are concerned about this don’t realize that methanol
is found widely distributed in nature in amounts
that greatly exceed those that would result from the
breakdown of aspartame. It is a common component of
fruits and fermented foods and
In addition to the usual safety tests on animals,
there have been a number of tests of aspartame in
humans, including young children,12
elderly people,13 people with
as well as healthy
adults.16 None have found safety problems.
In 2005, a group of Italian researchers reported
that they found an increased incidence of some types
of cancer in rats fed aspartame at doses similar to
those that humans might encounter.17
Interpretation of the data from this study is not
simple, because it was performed with a non-standard
methodology that may not support the authors’
conclusions. The FDA as well as the European Food
Safety Authority are reviewing the data to see if
the study’s results are valid.
In contrast, Lim and colleagues18
the results of a study of over 500,000 American
adults. They found no correlation between the
participants’ consumption of aspartame in beverages
and the occurrence of the types of cancer reported
in the recent Italian study. It is possible that
even if the results of the Italian rat study are
valid, the mechanism by which such cancers are
caused in rats does not occur in humans. This could
explain the discrepancy between the two studies.
Approval of neotame was based on the results of over
100 scientific studies in both animals and humans.
It is considered safe for all segments of the
population. Perhaps because it is so new, and has
not yet appeared on the US market, challenges to
neotame’s safety have not occurred.
The newest and sweetest of the sugar substitutes is
neotame. Like aspartame, it contains the amino acids
phenylalanine and aspartic acid, but has a different
chemical structure.19 Neotame is at
times sweeter than sugar, and 30 times sweeter than
aspartame—so only extremely small amounts are needed
to replace sugar’s sweetness. Neotame was approved
by the FDA as a general-purpose sweetener in
2002.19 Australia, New Zealand, Russia,
South Africa, several South American countries and
most of the countries of Eastern Europe have also
Saccharin has been used in the United States longer
than any other sugar substitute—since the turn of
the 20th century.20 It is 300 times
sugar. The human body does not break down saccharin,
so it provides no calories.21
In 1977, the FDA attempted to ban saccharin, in
spite of its long history of use, because of studies
showing that it caused bladder cancer in
rats.22,23,24 However, because of a public
Congress imposed a moratorium on the proposed ban
and instead required warning labels on any foods and
beverages containing saccharin. This moratorium was
repeatedly extended, and the sweetener was never
actually banned. More recent research determined
that while at very high doses, saccharin causes
bladder cancer in rats, the mechanism by which it
does so doesn’t occur in humans.25,26,27
studies have sought to find a relationship between
saccharin use and bladder cancer in humans; but none
has been detected.28,29,30,31
Because saccharin causes cancer in animals by a
mechanism foreign to humans, and since the human
data have not demonstrated a link between cancer
risk and saccharin use, saccharin is no longer
considered a potential human carcinogen.32 In
Congress mandated that the warning label on
saccharin-containing beverages and foods be
Sucralose is made from sucrose (table sugar) by the
substitution of three atoms of chlorine for three
hydroxyl (OH) groups. The human body does not digest
sucralose, and so it provides no calories. It is
about 600 times sweeter than sugar.19
was approved by the FDA as a general purpose
sweetener in 1999, which means it can be used in all
categories of food and beverage, as well as a table
Sucralose’s safety was demonstrated by the results
of over 100 scientific studies before the FDA
approved it. Since approval, research has further
substantiated it as safe for all segments of the
population, including people with diabetes who would
be expected to be heavy users of the
Some websites have raised fears about the fact that
sucralose contains chlorine—an element that is
poisonous in the gaseous state. Such claims are
without merit. Even though pure chlorine is
poisonous, it is still essential for humans when
combined with other dietary components. Table salt,
for example, is about one half chlorine by weight.
The five intensely sweet sugar substitutes described
above have been extensively tested and, in some
cases, retested to affirm their safety. Still, many
complaints have been voiced that since these
products are synthetic, they are somehow more
dangerous than substances that occur naturally. This
argument is also without merit.36 There
naturally occurring compounds that are lethal at low
doses—arsenic, cyanide and botulism toxin, for
example, and many are naturally found in our foods
in tiny amounts.37
Because they either cannot be metabolized by the
human body, or are used in such small amounts that
their caloric contribution is nil, intense
sweeteners can help people decrease their calorie
intake. Thus, they have an important role to play in
Americans’ ongoing battle against overweight and
TABLE 1. Intense Sweeteners Currently Approved in
the United States
||Date Approved by FDA
||Potency (times sweeter than sugar)
||Sunett, Sweet One
||NutraSweet, Equal, others
||In use for more than 50 years before Food
Additives Amendment of 1958
||Sweet’N Low, Sweet Twin, Sugar Twin, others
*Although aspartame and neotame provide 4 calories
per gram, the amount used in foods and beverages is
so small that they contribute a negligible number of
calories to the diet.19
Ruth Kava, PhD, RD, is Director of Nutrition at the
American Council on Science and Health.
by Michael Roussell
Last month we started training the upper arms with
variations on bench dips for the triceps. This
month we will focus on the biceps.
To locate your biceps, stand with your arms extended
down at your side with your palms facing forward;
your biceps muscles are the part of your upper arm
that is also facing forward. Next, bend your elbow
and touch your shoulder with your hand. This
movement is mediated by the biceps muscles.
To complete this exercise, you will need two plastic
grocery bags and several books, cans, or bottles of
water for added weight. With these items, you will
be able to assemble your own “dumbbells.” You may
think these homemade dumbbells are hokey, but don’t
buy the media hype that you need high tech,
expensive equipment to get a good workout. Your
muscles can’t tell the difference. All they know is
To get started, double bag the grocery bags to
ensure the cans or books won’t rip through. Next,
you will need to add some weight. Cans are good
because they usually have their weight written on
the labels. A bonus to making your own weights is
that you can easily adjust the amount to better suit
your level of strength and fitness. Once you are
strong enough, you can place a one-gallon jug of
water into the bags; this weighs about eight pounds.
Begin by filling your bag with a weight that you
feel comfortable with; it is better to start out
lighter because you can always add weight. Now hold
the bag at arms length. If the bag has a plastic
handle and you are concerned about the handle
hurting your hand, you can place a wash cloth or
dish towel between your hand and the plastic bag.
Keep your elbow tight to the side of your body
throughout the entire up and down movement. Curl
the weight up as high as you can. Be sure not to
“cheat” by moving your shoulder. When you get to
the top of the movement, pause for one second and
lower the weight back down in a controlled manner.
When you have lowered the weight to the bottom, you
have completed one rep. Be sure to complete the
entire movement in a controlled manner to avoid
Your first goal is to complete a set of 8-10 reps.
If you cannot do this without swinging the weight or
using your shoulder to help get the weight up, then
take some weight out of the bag and try again.
After you complete one set with one arm, switch the
weight to the other side and complete a set with the
other arm. Over time, you will be ready to take on
more weight and more reps. Your final goal is to
complete three sets of 8-10 reps with each arm.
Don’t be frustrated if one arm is stronger than the
other; this is the case for most people. Like other
resistance exercises, you should perform this
exercise only twice a week.
Next month we will cover our last major muscle group
-- the shoulders.
Meeting of the Society for the Study of Ingestive Behavior
Researchers involved in the regulation of food
intake are invited to attend the 13th annual meeting
of the Society for the Study of Ingestive Behavior
(SSIB), to be held July 18-22, 2006, at the Naples
Grande Resort & Club in Naples, Florida.
The program will cover a broad spectrum of basic and
clinical research in ingestive behavior, including
genetic, physiological, behavioral, subjective and
social analyses of normal and disordered eating.
Topics include hunger and satiation, food reward,
thirst, salt appetite, obesity, eating disorders,
alcohol intake, food selection, and habits and
beliefs. For more information and to register: http://ssib.org/naples06.htm.
Recipe of the Month
For a taste of the Caribbean, try this spiced chicken made with pineapple and flaked coconut.
CARIBBEAN SPICE CHICKEN
- 1 can (20 oz) pineapple slices
- 1 tsp. each of ground ginger, curry powder,
- ¼ tsp. cayenne pepper
- 1 tsp. cornstarch
- 1 tsp. vegetable oil
- ¼ cup each of flaked sweet coconut, slivered
Drain pineapple juice into a large measuring cup.
Combine spices in a small bowl. Stir ¼ tsp. spice
mixture, along with cornstarch, into pineapple
juice. Set aside.
- Sprinkle all remaining spice mixture over
chicken. Drizzle oil over chicken. Place on roasting
pan rack. Bake in a 400 degree oven for 15 minutes.
Arrange pineapple slices on rack. Bake 5 minutes
- Meanwhile, stir pineapple juice mixture.
Microwave, uncovered, 2 to 4 minutes until sauce
boils and thickens.
- Arrange chicken and pineapple on 4 serving
plates. Spoon pineapple sauce over, and top with
coconut and onions.
Serve with ½ cup dark green
Nutrition Information Per Serving:
298 calories, 7 grams fat, 75 milligrams
cholesterol, 3 grams fiber, 84 milligrams sodium
Source: 5 A Day recipe,