This article, by Dr Irene Berman-Levine, is adapted from one of her recent Newsletters. This weekly free newsletter, Dr. Irene's Nutrition Tidbits, helps you understand the confusing world of nutrition and motivates you to choose healthy foods. You can sign up for the newsletter by clicking here
Dr Irene has also packaged many of her newsletter articles into a book, which you can order for US$16 by clicking here . Robert Griffith, Editor.

It's comical that I'm writing an article on sugar substitutes while entertaining seven 13-year old girls for the entire weekend at my daughter's birthday sleepover. It's certainly not a sugar-free event. I just stuffed a pinata with all the things you can imagine to really make it a once a year treat. Don't worry. I also diluted the candy with things like packages of sunflower seeds and water balloons (I may be sorry about that choice) and super balls. I've plenty of activities to make sure that sugar is burned before bedtime. These include a raft race on a lake and a long scavenger hunt which purposefully sends them from one end of the lot to the other and from the top to the bottom of the house, at least five times. I'm exhausted just thinking about hiding the clues!

Nutritive sweeteners

In an earlier article on sugar alcohols I omitted the description of hydrogenated starch hydrolysates. Hydrogenated starch hydrolysates (HSH) are a family of products found in a wide variety of foods. Included in this group are some glucose syrups, maltitol syrups, and sorbitol syrups. They are created by breaking down starch found in corn. HSH are used in candy, baked goods and mouthwashes because they don't crystallize. HSH sweetness varies between 40% to 90% of the sweetness of sugar.

The sugar alcohols are examples of nutritive sweeteners or sweeteners that contain calories. Two other common nutritive sweeteners are aspartame and sucralose (Splenda®). You don't have to be concerned with the calories, even though they fall into the category of nutritive sweeteners. They are so much sweeter than table sugar that the calories you consume are almost negligible.

Aspartame, often seen marketed under the brand name "NutraSweet®", is 180 times as sweet as table sugar. It's actually a protein, since it's made by combining two amino acids: phenylalanine and aspartic acid. These two amino acids are found naturally in all foods containing protein. There is an inherited metabolic disorder called PKU (phenylketonuria) in which the enzyme is missing that normally allows the amino acid phenylalanine to convert to another amino acid, tyrosine. If this conversion doesn't occur, phenylalanine levels increase and cause mental retardation. All babies are tested for PKU and, if diagnosed, are placed on a low phenylalanine diet. This special low protein diet allows infants to have normal brain development. This is an amazing example of medical nutrition therapy. It's because of this relatively rare disorder that a warning is on the label of foods containing aspartame. Example wording on a diet soda is "Phenylketonurics: contains phenylalanine".

Recently you may have seen many foods with a trade name called Splenda. In fact, I just drank a glass of ginger ale that was sweetened with Spenda. The name of the actual sweetener is sucralose, a substance that is 600 times sweeter than sugar but can't be digested, so it adds no calories to food. It was approved in 1998 as a tabletop sweetener and for use in some products like baked goods and fruit juices. It was later approved as a general-purpose sweetener for all foods.

Non-nutritive sweeteners

Sweeteners that contain no calories are called non-nutritive, meaning you cannot derive any nutrition from them, including energy. The two most common artificial sweeteners that contain no calories are saccharin and acesulfame-K. Saccharin is made from coal tar derivatives and is 300-700 times as sweet as table sugar (sucrose). It is one of my least favorite choices because it has been shown to cause bladder cancer in laboratory animals. Foods containing saccharin are required by law to state this warning.

Acesulfame-K (K standards for potassium) is a substance that is 200 times sweeter than sugar but is not absorbed by humans and is excreted essentially unchanged. It was discovered in the laboratory in 1967, went through the FDA approval process and is now most commonly marketed under the name Sunette® or Sweet One®. One of its main attractions is that it doesn't break down under heat so it can be used in making baked goods and candy.

Newer sweetener

On July 5, 2002, The Food and Drug Administration approved a new non-nutritive sweetener, neotame, for use as a general-purpose sweetener. Neotame is a non-nutritive, high intensity sweetener that is manufactured by the NutraSweet Company. Depending on its food application, neotame is approximately 7,000 to 13,000 times sweeter than sugar. I haven't experienced it yet in food products so I can't tell you much more.

Two more

Here are two other substitutes for table sugar (sucrose) that are nutritive sweeteners.

Fructose is found in table sugar. Table sugar or sucrose is made of two molecules: one glucose and one fructose. The name fructose might also be familiar because it is the sugar responsible for the sweet taste of fruit. Fructose is sold as a sweetening agent. Because it's a carbohydrate it contains 4 calories per gram, but since it's a little sweeter than sugar, you use less.

Glycerine: I decided to include glycerine under the discussion of sugar substitutes because it can cause increases in blood sugar for those with diabetes. Glycerine actually makes up the backbone of a lipid or fat molecule. There's a bit of a disagreement between some of the food manufacturers and the FDA as to the category of glycerine. The FDA says it's a carbohydrate and you need to include it as such in labeling foods. Some food manufacturers say it isn't, and therefore they don't count it. This is a major reason why a recent Consumer Labs study found the carbohydrate content of many "nutrition bars" was much higher than that declared on the label.

It is a concern when the carbohydrate content of food labels is not accurate. Individuals with diabetes need to know the carbohydrate content to determine appropriate portion size. Those on insulin pumps or giving themselves insulin several times a day by injection base the amount of insulin on the amount of carbohydrates the food contains. If the amount in the food is actually higher, then their blood sugars may go above desirable limits.