With the ever-increasing attention on sugar in the American diet, it is common to want to replace its sweet taste with a sugar substitute, and there are quite a few to choose from. They appear in a variety of food products, from beverages to baked goods, and are available for home use.

One type of sugar substitute is the natural sweeteners, such as agave nectar, honey, maple syrup and molasses. These are considered safe but still classified as “added sugar,” since they contain calories and nutrients similar to sugar. Consuming too much can lead to the same health problems as too much sugar: dental cavities, weight gain, higher blood sugar and increased triglycerides. Use these sparingly.

Sugar alcohols are semi-nutritive sweeteners. Despite their name, they do not contain ethanol and are not alcoholic. They include sorbitol, xylitol, erythritol, lactitol, maltitol and mannitol. Used to sweeten candy, cookies, bars and chewing gum, they contain on average only half as many calories as sugar, and have a smaller effect on blood sugar. Beware, as they may cause bloating, gas and diarrhea when as few as 10 grams are consumed.

Non-caloric artificial sweeteners, non-nutritive sweeteners and high-intensity sweeteners are the terms used for the calorie-free substances that are many times sweeter than table sugar. These include saccharin (Sweet’N Low), aspartame (Equal), sucralose (Splenda), acesulfame potassium (Sweet One), neotame (Newtame) and advantame. These are approved and regulated by the FDA as safe food additives.

There are Acceptable Daily Intake (ADI) levels for each of these, much higher than even the heaviest user will likely consume in one day. For example, researchers say an adult can safely consume hundreds of packets of aspartame, sucralose or saccharine daily, or more than a 12-pack of diet soda without an increased risk of cancer. Nonetheless, many people experience headaches or other signs of intolerance, and should listen to their own bodies.

Another concern is the effect of these sweeteners on the digestive tract. Sufferers of irritable bowel syndrome are advised to avoid both sugar alcohols and fructose, as these appear to trigger symptoms. You should consult your favorite dietitian for information to address these and other possible symptom-triggering foods.
In addition, it is hypothesized that continual use of semi-nutritive and non-nutritive sweeteners will alter bacterial content of the gut. By disrupting the natural balance of good bacteria in the digestive tract, the body becomes susceptible to glucose intolerance, inflammation and metabolic syndrome (the combination of diabetes, heart disease and obesity that affects millions of Americans). Research is still emerging, and the effects vary from person to person.

The final category of sugar substitutes is novel sweeteners, including stevia (Truvia) and monk fruit (Nectresse) extracts; these are accepted by the FDA as generally recognized as safe (GRAS). Research is limited, so it is too soon to declare their impact on the gut or other health issues.