Low-Calorie Sweeteners:
What's News, What's New

Hope S. Warshaw, MMSc, RD, CDE

This article highlights recent news regarding low-calorie sweeteners. It also provides the basics about a low-calorie sweetener that recently obtained Food and Drug Administration (FDA) approval and one that is now in the hands of FDA reviewers. Guidelines for helping clients learn how to fit foods with low-calorie sweeteners into their food plans are provided along with valuable Internet resources.

What's in a Name?
Through the years, we have used several terms to refer to sweeteners without calories: artificial sweeteners, sugar substitutes, nonnutritive sweeteners, low-calorie sweeteners, and high-intensity sweeteners. Is there one correct term? No, but there are preferred terms. The American Diabetes Association uses the term nonnutritive sweeteners in its position statement "Nutrition Recommendations and Principles for People with Diabetes Mellitus,"¹ and the term sugar substitutes in its consumer publications.² The term low-calorie sweeteners began being used when aspartame was approved in the early 1980s. Aspartame is not truly nonnutritive because it contains a minute number of calories due to its protein origins. From an industry perspective, the terms artificial sweetener and sugar substitute are not preferred or used. For clients, low-calorie sweetener is easier to understand than nonnutritive sweetener. Certainly the term sugar substitutes registers with clients. All names considered, low-calorie sweeteners might be the ideal for all audiences.

What Does the American Diabetes Association Say?
The wording regarding nonnutritive sweeteners in the American Diabetes Association's position statement "Nutrition Recommendations and Principles for People With Diabetes Mellitus" has undergone slight, but noteworthy, changes since the most recent major revision of the statement in 1994. The 1994 statement read:

"Saccharin, aspartame, acesulfame K, and sucralose are approved for use by the Food and Drug Administration (FDA) in the U.S. The FDA also determines an acceptable daily intake [ADI] for approved food additives, including nonnutritive sweeteners. Nonnutritive sweeteners approved by the FDA are safe to consume by all people with diabetes."³

The current version¹ adds more detail about ADI. It also places the responsibility of safety of nonnutritive sweeteners on the FDA approval process and adds a notation about actual intake relative to ADI. The current version reads:

"Saccharin, aspartame, acesulfame K, and sucralose are approved for use in the U.S. by the Food and Drug Administration (FDA). For all food additives, including nonnutritive sweeteners, the FDA determines an acceptable daily intake (ADI), which is defined as the amount of a food additive that can be safely consumed on a daily basis over a person's lifetime without any adverse effects and includes a 100-fold safety factor. Actual intake by individuals with diabetes for all nonnutritive sweeteners is well below the ADI."

Aspartame: A Lesson Learned
By the time this article is published, an allegation that swept through the Internet will likely be old news. But the incident can still teach us a lesson. In mid-December 1998, I was reviewing e-mail messages when I noticed several that detailed another aspartame scare. I read the first few sentences, discarded them as bunk, and struck the delete key. A few weeks after my aspartame e-mail alerts, colleagues began to raise questions. Was there merit to it? Should we caution people about the use of products with aspartame? This scare escalated wildly due to the speed and wide dissemination capabilities of the Internet. It has had a lingering effect. Nearly a year later, I still hear people questioning the use of aspartame and aspartame-sweetened products.

The allegations were made by Nancy Markle in a lecture she presented at a "World Environmental Conference." The e-mail raised the allegation that the two breakdown products of aspartame—methanol and formate—are causing an epidemic of multiple sclerosis and systemic lupus. Monsanto, the manufacturer of the NutraSweet brand of aspartame,⁴ the FDA via a communication with the Calorie Control Council,⁵ the Multiple Sclerosis Foundation,⁶ and the American Diabetes Association⁷ disclaim any truth to these allegations and continue to support the safety of aspartame.

What should concern us more than this one allegation is that our relatively new electronic communication vehicle—the Internet—has its downfalls. On the Internet, anyone can present themselves as an authority, and their messages of misinformation can speed to millions in minutes.

When we hear an allegation that seems "fishy," it is our responsibility to ask questions rather than to accept the information as truth and foster the campaign of misinformation with a click of the e-mail "forward" button. First determine the source or author of the information and that person's authority or credentials. Then verify the content with reliable sources. Using this Internet story about aspartame as an example, reliable resources would have been the American Diabetes Association, the FDA, Monsanto, the Multiple Sclerosis Foundation, the Calorie Control Council, and the International Food and Information Council. A list of valuable Internet resources appears in Table 1.

Aspartame's Safety Again Affirmed
Aspartame was initially approved by FDA in 1981 for use in a few products. Since then, the FDA has affirmed the safety of aspartame as a food additive in the American food supply by allowing its use in many products from 1981 to 1995. On June 27, 1996, FDA approved the use of aspartame as a "general purpose sweetener," meaning that aspartame could now be used in any food or beverage where the standards of identity do not preclude its use. (Note: there are many foods that must contain or not contain specific ingredients. These foods, which include mayonnaise, margarine, and ice cream, are said to have "standards of identity.")

Sucralose: A Newly Approved Low-Calorie Sweetener
Sucralose, discovered in 1976, is the only no-calorie sweetener made from sugar. Sucralose is derived from sugar through a multi-step patented manufacturing process that selectively substitutes three atoms of chlorine for three hydroxyl groups on the sugar molecule. The change prevents sucralose from being broken down like sucrose. It produces a sweetener that has no calories, yet is 600 times sweeter than sucrose. Of interest to diabetes care practitioners is that research demonstrates that sucralose has no effect on short- or long-term blood glucose control.⁸

The advantage of sucralose for the food industry and consumers is its stability. It retains its sweetness over a wide range of temperature and storage conditions and in solution over time. The stability of sucralose allows its use in a wide variety of foods and beverages. For this reason, food manufacturers can use sucralose to create a number of foods and beverages in categories in which there are currently few products sweetened with a low-calorie sweetener, such as canned fruit, fruit drinks, baked goods, sauces, and syrups. Sucralose can also be used in home cooking and baking.

The diabetes community is just becoming familiar with sucralose. Sucralose was granted FDA approval on April 1, 1998. The approval was for the use of sucralose in 15 food and beverage categories. This is the broadest initial approval ever granted by FDA for a food additive. In addition, FDA requires no warning or informational label on products with sucralose. On Aug. 12, 1999, just 16 months after the initial approval of sucralose, the FDA approved sucralose as a general purpose sweetener, meaning that sucralose can now be used in any food or beverage where the standards of identity do not preclude its use.⁹ In addition, sucralose has been approved for use in foods and beverages in more than 30 countries, including Canada, Mexico, and Australia.

Sucralose is manufactured and marketed in the United States by McNeil Specialty Products Company, a Johnson & Johnson Company. Sucralose is available to food manufacturers for use in food and beverages as Splenda brand sweetener. Currently, a range of products sweetened with Splenda are already on supermarket shelves, such as carbonated soft drinks, low-calorie beverages, and maple syrup. Additional products sweetened with Splenda will continue to be brought to market. Splenda low-calorie sweetener in packets and granular form will be available nationally by early 2001. The granular form can be used as a one-to-one replacement for sugar. At present, McNeil Specialty Products Company is providing people with diabetes the opportunity to purchase the two forms of Splenda via the Internet at www.lifescan.com.

Neotame: On the Horizon
Neotame is a no-calorie sweetener composed of two elements of protein: the amino acids L-aspartic acid and L-phenylalanine combined with two organic functional groups, one known as a methyl ester group and the other as a neohexyl group. These components are joined together to form neotame, a sweetener that is about 6,000 times sweeter than sucrose. Due to its heat stability, it will be able to be used in home cooking and baking and may have greater stability than aspartame in beverages.

Neotame is quickly metabolized and fully eliminated by the body via the stool and urine. A clinical trial conducted in people with diabetes demonstrated no effect on insulin or glucose levels or on glycemic control. The results of this study were submitted to the FDA as part of Monsanto's food additive petition for neotame.

Monsanto filed a food additive petition at FDA for the use of neotame in tabletop sweeteners in December 1997 and a petition at FDA for the approval of neotame as a general-use sweetener in any food and beverage category in February 1999. Historically, the FDA has taken at least 10 years to approve food additives.

Acesulfame Potassium: A New Use
Acesulfame potassium, often abbreviated as ace K, was initially approved in 1988 for use in a limited number of food and beverage categories. Since then, several additional categories have been approved, such as baked goods, yogurt, frozen desserts, and sauces and toppings. On July 6, 1998, ace K received the coveted and long-awaited FDA approval for use in soft drinks. This led PepsiCo, Inc. to introduce Pepsi One with an advertising splash during the summer of 1998. Pepsi One is sweetened with a blend of aspartame and ace K.

Until the FDA approval of ace K in soft drinks, this blend was not possible in the United States. The ace K and aspartame blend is also now used in gelatin, ice tea, and other soft drinks.

The Blending Age is Here
Blends of two or more sweeteners in one product, which have been used internationally for many years, are quickly becoming more common in the United States for several reasons. First, four low-calorie sweeteners—ace K, aspartame, saccharin, and sucralose—are now available. Second, these four sweeteners are approved for use in a wide array of foods and beverages. Third, with these options, manufacturers can use the low-calorie sweetener(s) that are best suited for the manufacturing and storage conditions of various foods and beverages. Fourth, there is a synergistic effect between some sweeteners. This enables a manufacturer to use a smaller amount of each of two or more sweeteners, which results in more sweetening power than expected.

Historically, a few blends of low-calorie sweeteners have been used. However, it has been most common in the United States for products to be sweetened with just one low-calorie sweetener. In the early years of use of low-calorie sweeteners, cyclamate and saccharin were blended. Cyclamate was used to decrease the bitter aftertaste of saccharin. In addition, for many years aspartame and saccharin have been blended in fountain carbonated diet soft drinks. In this blend, aspartame provides the clean sweet taste, and saccharin provides the stability to maintain the sweetness over time in an acidic solution. In soft drinks with the ace K and aspartame blend, ace K provides the sweetness stability in carbonated soft drinks, while aspartame provides the clean sweet taste.

Teaching Principles and Tools
Clearly, most of our clients with diabetes are going to use products with low-calorie sweeteners. For many, the safety of these products is their initial concern. We can allay consumers' concerns by discussing the FDA approval process and the safe use of these sweeteners by millions of people worldwide for many years. Next, people need to learn how to fit foods with low-calorie sweeteners into their meal plans. Simple guidelines using the three categories below can be used.

1.  Tabletop sweeteners: Packets and the bulk forms of low-calorie sweeteners usually have about 2 calories for the equivalent sweetness of 2 teaspoons of sugar. The calories in tabletop sweeteners are not from the low-calorie sweetener; they are from the dextrose or maltodextrin used to provide the product with bulk or volume. The calories from the bulking agent are negligible. Thus, a reasonable amount of low-calorie sweeteners in this form can be used freely.

2.  Foods and beverages with low-calorie sweeteners that contain minimal calories: Foods and beverages, such as diet soda, diet gelatin, chewing gum, fruit drinks, and powdered drink mix, which contain <20 calories and <5 grams of carbohydrate per serving, can be considered free foods when consumed in reasonable amounts.

3.  Foods sweetened with low-calorie sweeteners containing other ingredients that may contribute carbohydrates, other nutrients, and calories: Foods and beverages, such as hot cocoa mix, refrigerated yogurt with fruit, maple syrup, baked goods, frozen desserts, canned fruit, and fruit drink juice blends, which contain >20 calories and >5 grams of carbohydrate per serving should be appropriately fitted into the meal plan according to the nutrition information provided in the Nutrition Facts panel.

The American Diabetes Association recently developed a helpful and inexpensive teaching booklet titled A Guide to Fitting Foods with Sugar Substitutes and Fat Replacers Into Your Meal Plan. This booklet can help teach clients about the different low-calorie sweeteners, foods in which low-calorie sweeteners are used, and guidelines for fitting foods into the meal plan. Sample exercises to practice using the guidelines are included. To order call 1-800-232-6733. Booklets are only available in lots of 25. Member price is $12.95, nonmember price is $10.95 per lot.

References

¹American Diabetes Association: Position statement: Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care. 22 (Suppl 1): S42-45, 1999.

²American Diabetes Association: American Diabetes Association Complete Guide to Diabetes. Alexandria, Va., American Diabetes Association, 1997.

³American Diabetes Association: Position statement: Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 17:519-22, 1994.

⁴Monsanto Company response to the allegations about aspartame at www.monsanto.com.

⁵Letter from FDA available on Calorie Control Council's Internet site—www.caloriecontrol.org.

⁶Multiple Sclerosis Foundation response to the allegations about aspartame at www.msfacts.org/aspartame.htm  

⁷American Diabetes Association statement regarding aspartame at www.diabetes.org.

⁸Mezitis N, Koch P, Maggio C, Quoddoos A, Pi-Sunyer FX: Glycemic response to sucralose, a novel sweetener, in subjects with diabetes mellitus. Diabetes Care 19:1004-1005, 1996.

⁹Federal Register, Aug. 12, 1999. 64 (155):43908-43909, 1999.

Acknowledgments

The author wishes to express her gratitude to Lyn O'Brien Nabors and Maggie Powers, MS, RD, CDE, for their review of this article.

Hope Warshaw, MMSc, RD, CDE, is a diabetes educator and freelance writer in Alexandria, Va.

Note of disclosure: Ms. Warshaw is a paid consultant to the McNeil Specialty Products Company, which manufactures sucralose.

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Last updated: 12/99
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