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B3,RD: How safe are artificial sweeteners?

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I know some of you have been wigging out waiting for this–so I’ll put you out of your misery.

Artificial sweeteners? Safe or the devil’s spawn? It’s a great question that’s racing through the minds of nutrition conscious people everywhere. Dietitians are divided in their thoughts. There’s the “I can’t live without my Diet Pepsi” crowd (many of my nutrition professors in our “Pepsi” school fit into this group), and there’s the “artificial sweeteners are going to be the end of Western civilization as we know it” crowd (although this crowd tends to not mind the end of Western civilization in other contexts).

Because this issue is such a divisive one–and one with so many different opinions–I’m going to give you the facts and my general recommendations, and then let you decide for yourself.

FDA Regulation of Food Additives

First of all, it’s important to be aware of how additives to our food supply (such as artificial sweeteners) are regulated. According to the rules of the 1958 amendment to the Food, Drugs, and Cosmetics Act of 1938, no chemical additive can be used in food if it has been “found to induce cancer in man…or in animals.” This means that, at least as far as cancer is concerned, we’re home free. If additives have been found to cause cancer in humans or in lab animals AT ANY LEVELS of exposure, they may not be used in the American food supply.

Once the additive has been determined to not cause cancer or other genetic changes, experiments are done to determine what levels of the additive are safe. Researchers find the highest “dose” that causes no observable health effects and then decrease that 100 times to determine the “Allowable Daily Intake” or “ADI”.

See the below table nabbed from the Mayo Clinic for more information on the ADIs.

Artificial sweetener ADI* Estimated ADI equivalent** OK for cooking?
Aspartame (NutraSweet, Equal) 50 milligrams (mg) per kilogram (kg) 18 to 19 cans of diet cola No
Saccharin (Sweet’N Low, SugarTwin) 5 mg per kg 9 to 12 packets of sweetener Yes
Acesulfame K (Sunett, Sweet One) 15 mg per kg 30 to 32 cans of diet lemon-lime soda*** Yes
Sucralose (Splenda) 5 mg per kg 6 cans of diet cola*** Yes

*FDA-established acceptable daily intake (ADI) limit per kilogram (2.2 pounds) of body weight.
**Product-consumption equivalent for a person weighing 150 pounds (68 kilograms).
***These products usually contain more than one type of sweetener.

You can see that the ADI limit for a 150 lb individual ranges from 6 to 30 cans of diet soda per day (for the rest of your life). Since ADIs are established at 100x LESS than the highest exposure at which no observable health effects can be noted–the actual “danger level” is somewhere around 600 to 3000 cans worth of diet soda per day. I think it’s safe to say that none of us consume that much artificial sweetener.

So, based on FDA regulations, artificial sweeteners are safe for use at the levels in which they are present in the food system.

The National Cancer Institute on Artificial Sweeteners

According to the National Cancer Institute’s fact sheet on artificial sweeteners, “there is no clear evidence that the artificial sweeteners available commercially in the United States are associated with cancer risk in humans.”

A few studies suggest correlations between artificial sweeteners and cancer risk, but these studies are generally poorly designed. It is unclear whether the vague results of these studies have any applicability. For example, a study suggested that national brain cancer rates rose as a result of the introduction of aspartame. However, the trend in rising rates began 8 years prior to the introduction of aspartame and occurred in a population unlikely to consume aspartame.

The American Dietetic Association (ADA) on Artificial Sweeteners

According to the ADA Evidence Analysis Library (which compiles and evaluates all of the best research on nutritional topics), “Limited research in humans, from peer reviewed journals, supports the safety of non-nutritive sweeteners for the general population. Considering the lack of high quality studies, continuing post-market surveillance of the safety of non-nutritive sweeteners is prudent.”

The phraseology is a bit bulky (that’s what happens when committees write a recommendation), but the gist is as such: “We don’t have a lot of good research in humans, but what we do have says that non-nutritive sweeteners are safe for the general population. However, since there isn’t a lot of good research available, we should continue watching for evidence one way or the other.”

How’s that for equivocation?

My opinion on the safety of artificial sweeteners

My opinion falls somewhere between the FDA’s “of course they’re safe”, the National Cancer Institute’s “all the studies that say they aren’t are flawed,” and ADA’s “we can’t really tell.”

I think that it is safe to believe that artificial sweeteners are unlikely to cause cancer. Because of the restrictions of the 1958 Delaney Clause, the FDA is required to conduct a great deal of research on the carcinogenic properties of potential food additives prior to approving them. The National Cancer Institute concurs that the artificial sweeteners that have been approved by FDA are unlikely to cause cancer.

However, only a limited body of research exists in other non-cancer areas of health. There are big blank holes in the research.

We do know, based on other chemicals, that most substances have dose-dependent responses. Even the best of things, when consumed in excess, can be toxic. Much of the nation was startled to learn of water intoxication in 2002 when Cassandra Killpack died after being force-fed excess quantities of water by her adoptive parents. Even water, the chemical most essential for life, is toxic in large quantities. On the other hand, in low doses, many potential toxic chemicals have little effect.

It makes sense that we should control the DOSES of artificial sweeteners that we consume. If you are close to or above the FDA ADIs, you might consider backing off on the artificial sweeteners.

Also, since children have lower body weights, they are more susceptible to overdosing on anything–so it makes sense to watch children’s intake more carefully. Pregnant and lactating mothers may want to watch their intake more carefully as well, as we do not know what effect any artificial sweeteners might have on rapidly growing babies.

So, my general recommendation, is that artificial sweeteners are likely to be safe when consumed in moderation. As a quick rule of thumb, I would say that if you are consuming more than three servings of foods made with artificial sweeteners (half the ADI for Splenda for a 150 lb individual), you might want to back off. But if you’re consuming less than three servings of artificial sweeteners in a day, the benefit of consuming fewer calories is probably greater than the risk of some unknown health issue.

Your B3,RD challenge for today (although today is nearing its end–sorry folks, this one took longer than I expected) is to calculate up approximately how much artificial sweetener you consume in an average day. Do you top my recommendations? How about the FDA’s?

Categories B3RD

B3,RD: On Alternative Sweeteners

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You see them everywhere in dizzying arrays. Little pink or blue or yellow pouches. The grocery store shelf containing alternative sweeteners is growing larger every year. And diet products are forever announcing that they’re “now made with [insert name of alternative sweetener here]!”

It’s hard for anyone to keep track of all the many sweeteners that are available–which is why I’m going to focus today’s B3,RD post on simply understanding what’s available.

Alternative sweeteners are non-sugar substances that can be used in place of sugar to provide sweetness with fewer calories. They do this one of two ways. Some alternative sweeteners are indigestible or only partly digestible and are passed through the digestive system with only minimal calorie absorption; while others contain the same number of calories per gram as sugar, but are so much sweeter than sugar that much less of them can be used (thereby allowing them to contribute fewer calories to the food item).

The main characters in the first group (that are only partly digestible) are sugar alcohols. These contain somewhere between 1.5 and 3 calories per gram; less than sugar’s 4 calories per gram. Sugar alcohols are often used in hard candy or chewing gum because they do not promote cavities like regular sugar does. In fact, they do the exact opposite and inhibit cavity development. Sugar alcohols include sorbitol, xylitol, isomalt, mannitol, maltilol, and lactilol. Because these products are only partially digested, they can create unpleasant gastrointestinal effects (such as diarrhea and gas) if consumed in large quantities.

In the second group (those alternative sweeteners that are much sweeter than sugar), we have a whole smattering of artificial and “natural” sweeteners. Below is a quick chart with pertinent information about these “non-nutritive sweeteners”.

Common name
(Brand Names)		 Times sweeter than sugar Heat stable? Approved by FDA
Acesulfame-K
(Sunnette, Sweet One, Swiss Sweet)		 200x Yes 1988
Aspartame
(Nutrasweet, Equal, Natrataste)		 160-200x No 1996
Neotame 800-13000x No 2002
Saccharin
(Sweet’n’Low, Sugar Twin)		 200-700x Yes 2000
Stevia
(Truvia, PureVia)		 300x Yes 2008
Sucralose
(Splenda)		 600x Yes 1999

Some of these non-nutritive sweeteners (especially saccharin) have a bitter aftertaste that can be quite unpleasant.

Modest evidence supports the notion that consuming foods made with non-nutritive sweeteners instead of higher calorie foods made with sugars can help individuals cut calories. While some people claim that non-nutritive sweeteners induce people to eat more than they normally would (thus consuming more calories overall), the evidence appears to contradict this statement. Replacing caloric foods and/or beverages with ones made with alternative sweeteners does not cause increases in intake, but rather promotes modest decreases in caloric intake.

SO…if preventing obesity and obesity-related complications is your main health concern, replacing a sugar-loaded snack with a lower-calorie one made with artificial sweeteners is probably a good idea.

Today’s B3,RD challenge only applies if you are generally a consumer of regular soda or sugared gum: Purchase a sugar-free variety of your favorite soda or gum and taste test it to see how you like it. If you like the alternatively-sweetened version, you can save some calories by switching over.

Stay tuned for more information on the safety of artificial sweeteners tomorrow!

Categories B3RD

B3,RD: Demystifying HFCS

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You’ve probably heard warnings about high-fructose corn syrup (HFCS). You’ve heard that HFCS is responsible for the obesity epidemic. You’ve heard that you should go for products made with regular sugar instead.

Perhaps someone has cited studies that link high fructose diets with heart disease. They’ve talked about how fructose doesn’t act the same way as glucose in the body.

They’re right–except that they’re wrong.

High fructose diets are linked with heart disease. And fructose does act differently than glucose. But High Fructose Corn Syrup is not the problem.

There are two types of HFCS: a syrup that is 42% fructose (HFCS-42), and a syrup that is 55% fructose (HFCS-55). HFCS-42 is used in baked goods and non-carbonated drinks, whereas HFCS-55 is used primarily in carbonated drinks.

Table sugar, on the other hand, is 50% fructose. So, depending on which “version” of HFCS you’re talking about, HFCS either has slightly more or slightly less fructose than “regular sugar”.

So a high fructose DIET might cause problems–but high fructose CORN SYRUP is not the culprit (since high fructose corn syrup and sugar contain very similar proportions of fructose.)

Increased sugar intake is the problem, regardless of its source. Americans are consuming more calories than ever, and more and more of those calories are coming from sugar (either HFCS or table sugar). This is contributing to an overall increase in fructose consumption–and an overall increase in calorie consumption.

So, if you want to do what’s best for your health, don’t worry about choosing BETWEEN regular sugar or HFCS. Instead, work on cutting down sugar intake altogether (regardless of the source).

Today’s B3,RD challenge is to avoid the anti-HFCS hype and instead work on choosing a lower-sugar version of your favorite snack or soft-drink (or just eat/drink less of the high-sugar version.)

Categories B3RD, Books, Rants

B3,RD: THE Nutrition Professionals

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Three years ago, when I started my venture to read every book in Eiseley library, I used Pearl Buck’s rules to give myself an out. If, after reading 50 pages of a book, I was not interested in continuing on, I had permission to stop.

After three years and over 1400 books, I am using that rule for the very first time. Because I absolutely cannot stand Oz Garcia’s The Healthy High-Tech Body.

The Healthy High-Tech Body

Garcia’s biography in the back of the book states that he is “one of the best-known nutritionists and health authorities in America.” Problem is, he’s an absolute quack. Sure, he can throw around chemical names like no other and give incomprehensible explanations for why we should follow his recommendations–but the real science behind his recommendations is tenuous at best.

I know this because I’ve devoted the last six years of my life to learning the science of food, nutrition, and health behavior change. But what’s the average consumer to think? If you can’t trust “one of the best-known nutritionists and health authorities in America”, who can you trust?

That’s where the Registered Dietitian comes in. You see, anyone can call themselves a nutritionist–even someone with marginal education and no credentials (for instance, Oz Garcia.)

The designation Registered Dietitian (RD), on the other hand, carries distinct educational and professional requirements. RDs are required to complete a core curriculum in nutrition, food science, and health behavior change from an accredited university. RDs are required to undergo at least 900 hours of supervised practice. RDs are required to pass a Registration Exam and complete at least 75 hours of continuing professional education every five years in order to attain and maintain their credentials. Additionally, RDs are bound by a Professional Code, which, among other things, insists that they provide evidence-based nutrition services.

You wouldn’t go to your next door neighbor–or even Oprah–to get your broken arm set. Your next door neighbor is nice enough–and Oprah is popular enough–but neither have the credentials to set your broken arm. You’ll go to someone who does have the credentials: an MD (Medical Doctor), a PA (Physician Assistant), or a NP (Nurse Practitioner).

Likewise, no matter how nice or how popular a “nutritionist” might be–they don’t have the credentials unless they’ve got an RD behind their name.

So next time you’re looking at an article or a book, or evaluating something someone is saying on the television or online, look for the RD behind the name. Because RDs are THE food and nutrition professionals.

Today’s B3,RD challenge is to think critically about the nutrition information you see and hear today. Ask yourself whether the speaker has the credentials–an RD behind their name.

A search for Garcia’s education and credentials produced only the most tenuous results.

Mr. Garcia is occasionally ascribed a Ph.D, but I have been unable to find any explanation for this designation. He has certainly never listed where he attained his doctorate or what his doctorate is in.

Categories B3RD

B3,RD: Am I hungry?

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Confession: I, Rebekah Menter, Registered Dietitian, don’t just eat when I’m hungry. Sometimes, I eat because I’m tired, because I’m stressed, or because I’m bored–even though I’m not hungry.

And that’s okay.

I attended a fantastic session at FNCE that dealt with this very issue. Megrette Fletcher, RD and Michelle May, MD spoke on “Improving Self-Management with Mindful Eating.”

Megrette Fletcher Michelle May

Ms. Fletcher and Dr. May had a number of insights for dietitians, but one thing Dr. May said struck me as being worth sharing with my readers. She encouraged us (and our clients) to ask ourselves one question before eating.

Before eating, ask yourself: “Am I hungry?”

Many of you are probably rolling your eyes right now, thinking “I’ve heard this before–Eat only when you’re hungry, stop when you’re full.”

But that isn’t what I said. I said, “Before eating, ask yourself: ‘Am I hungry?'”

The point is not that you only eat when you’re hungry. The point is that you are aware of whether you are hungry or not when you’re eating. The point is KNOWING. The point is being mindful.

Sometimes, we eat because we’re tired, because we’re stressed, or because we’re bored–even though we’re not hungry. But none of us should eat without knowing why we’re eating.

We can talk about when to eat and when not to later. For now, let’s just focus on being aware.

Today’s B3,RD challenge is simply to ask yourself before eating: “Am I hungry?”

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B3, RD: The foods that don’t fit

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The Rock Solid kids had a problem when they got to sorting their food items into the appropriate food groups. They couldn’t figure out where some of the items belonged.

What food group does caramel syrup belong to? Where do jelly beans fit? What about Gatorade?

These foods don’t fit into the five food groups. They aren’t grains, vegetables, fruits, milk, or meats and beans. They’re…something else. So what do you do with them?

I’m sure you’ve dealt with the same dilemma. Some foods just don’t fit into our nutritional rubrics. But we like them–oh do we like them.

Yesterday, we learned that we need to have items from each of the five food groups EVERY SINGLE DAY in order to be healthy. So what about those things that don’t fit into the five food groups?

A lot of the kids said they would LIKE to have jelly beans every single day–but jelly beans aren’t necessary in order to be healthy. Jelly beans are extras.

Does this mean that we should eat jelly beans? Absolutely not. Jelly beans might be extras when it comes to a healthy diet–but they’re not always extras when it comes to enjoying life.

There are two keys to dealing with the foods that don’t fit:

1. Focus on the foods that fit

You’ve heard the illustration of a guy who had a number of items that he was trying to fit into a jar. He had some big rocks, some medium sized rocks, some pebbles, and some sand. If he poured in the sand first, he didn’t have enough room for the big rocks. But if he started with the big rocks, he could fit them in and still have room to pour the sand around them.

It’s the same way with food. Think of the big rocks as the foods that fit into the five food groups. These are foods that you need in order to be healthy. You need to make sure that you’re getting all of those. The sand is the stuff that doesn’t fit into the five food groups. This is the (literal and figurative) icing on the cake. Focus on the five food groups and you’ll still have room for the foods that don’t fit. Focus on the foods that don’t fit, and you’ll be missing out on the stuff that does.

Remember how your Mom wouldn’t let you have a snack right before supper because you’d “spoil your appetite”? It’s the same concept here. If you fill up on candy so that you don’t have any room for vegetables, you’ve done yourself a double disservice: you’ve consumed a lot of empty calories and you’ve denied yourself the beneficial nutrients and fiber from vegetables.

So, in your quest to deal with the foods that don’t fit, choose first to focus on the foods that fit.

2. Fully enjoy the foods that don’t fit.

Now that you’ve made sure that you’re getting the foods that DO fit, take the time to enjoy the foods that are “extras.”

Pour yourself a little handful of dark chocolate chips (or one of YOUR favorite “foods that don’t fit”) and take the time to savor them.

Too often, we hole away guiltily with a bag of chocolate chips and discover 15 minutes later that we’ve eaten the whole bag–without really tasting any of it. What a shame!

These extras are too good to waste by inhaling them in shame-induced silence.

So, pat yourself on the back for paying attention to the foods that DO fit, pour yourself a portion of something that DOESN’T fit, and enjoy the “extras” in life.

Today’s B3,RD challenge is to put the above principles into action today. Focus on the foods that fit–but take the time to enjoy the foods that don’t.

Categories B3RD

B3, RD: Every single day

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Yesterday evening, I did my first presentation as a newly minted RD. I talked to the kids at Rock Solid about the five food groups.

We went through the five food groups, sorted some food items from my grocery bags into their appropriate food groups, and discussed how often we need to eat foods from each group.

The kids started to catch on after we’d gone through a couple of groups.

Q: How often do we need to eat things from the grains group?
A: Every single day!

Q: How often do we need to eat things from the vegetables group?
A: Every single day!

Q: How often do we need to eat things from the fruits group?
A: Every single day!

Q: How often do we need to eat things from the milk group?
A: Every single day!

Q: How often do we need to eat things from the meat and beans group?
A: Every single day!

In order to be healthy, we should be eating from ALL FIVE food groups every single day.

Yet even I, a dietitian, sometimes find this hard to do. I get to the end of the day and find that I haven’t had anything from the dairy group. Or I’ve been snacking and skipped the meats and beans group. You know what I mean.

Today’s B3, RD challenge: eat from ALL FIVE food groups today

(P.S. For those with dairy allergies, I know you can’t have milk. But you can choose Calcium-rich nondairy foods like fortified soy milk, tofu, or one of the many fortified juices. The rest of you have no excuse–there’s something in every group that you can eat!)