What is the healthiest sugar substitute? Aspartame, erythritol and … – USA TODAY

Artificial sweeteners may seem like a trend of the late 20th and 21st centuries, but they’ve been around for a lot longer.
The first artificial sweetener was saccharin, synthesized in 1879. It can be about 300 to 500 times sweeter than table sugar. Sugar substitutes like erythritol and aspartame are used in many everyday household goods – chewing gum, canned food, diet sodas jellies and dairy products – but they’ve had a controversial history and place in research. In July 2023, the World Health Organization concluded aspartame could potentially cause liver cancer and other health problems when consumed in large amounts.
Here’s what to know if you’re selecting sugar substitutes in your everyday diet:
There are many different kinds of sugar substitutes: Artificial sweeteners like aspartame, sucralose and saccharin are typically created in a lab. There are sugar alcohols created synthetically used to sweeten without adding many calories or carbs. Sugar alcohols are technically not artificial sweeteners; they can also be found in whole food sources like fruits and vegetables. Natural or novel sweeteners are also common: monk fruit and stevia, for instance, are extracted from plants. 
According to registered dietitian nutritionist Jill Weisenberger, focus less on the type of substitute and more on the amount. The healthiest sugar substitute, therefore, is a small quantity: A large amount of any sugar substitute could be harmful.
“The dose makes the poison,” Weisenberger says. 
So which sugar substitute should you pick? It could come down to your personal preference of taste, or you could regularly switch up your substitute of choice.
“They all have such different chemical structures, so they will all behave differently in the body,” Weisenberger says. “Adverse effects always come up with a dose amount … so anybody who’s concerned about the safety of it could sometimes use stevia, sometimes use sucralose and sometimes use monk fruit, just vary it around.”
Should I drink that Diet Coke?:What WHO says about the potential health risks of aspartame
Sugar itself isn’t bad for you – in fact, we need glucose to live, which our bodies create by breaking down carbohydrates, proteins and fats. But while there are natural sugars found in some foods, the added sugars found in soft drinks, sweetened coffee, candy and desserts can be harmful to our health.
Sugary drinks are the main source of added sugar in American diets, according to the Centers for Disease Control and Prevention. One soda contains just about the maximum amount of added sugar that should be consumed in a single day, the CDC says. 
“I’d much rather somebody have a Diet Coke than a regular Coke, but it doesn’t mean I want them to have either one,” she says.
A 12-ounce Coca-Cola Original contains 39 grams of sugar, or a little more than 9 teaspoons. A 12-ounce can of Diet Coke contains zero grams of added sugars – about 200 milligrams of aspartame. 
“Let’s say somebody uses one teaspoon of sweetener a day in tea or coffee; I don’t think it matters, use whichever one you like,” Weisenberger says. “But if you’re using volume, then we know without a doubt the hazards of too much added sugar, particularly for people with prediabetes and diabetes.”
If you have diabetes and are just looking to limit your sugar intake, Weisenberger offers these suggestions:
There’s limited research on long-term effects, though WHO’s July announcement about aspartame shows more than ever the adverse effects of sugar substitutes in large quantities.
Artificial sweeteners are used in many sugar-free or diet food products because they are sweeter than table sugar and require fewer amounts to achieve the same sweetness. Aspartame is about 200 times sweeter than sugar. 
The FDA has determined these sweeteners are safe, or not toxic, for the general public:
Plant- and fruit-based sweeteners stevia, monk fruit and thaumatin are also deemed safe by the FDA. Stevia leaf and crude stevia extracts, however, are not considered safe under FDA guidelines due to “inadequate toxicological information,” the FDA says. Steviol glycoside – what we call “stevia” – is a purified extract obtained from stevia leaves. 
According to the WHO, the occasional aspartame-sweetened drink, yogurt or piece of sugar-free gum is safe, USA TODAY previously reported. Heavy users of aspartame are recommended to cut down.
There is ongoing research about the potential health impacts of aspartame. A 2022 study published in BMJ found a link between high artificial sweetener consumption and increased cardiovascular disease. Guidelines from the World Health Organization show that sugar substitutes do not benefit weight loss goals in the long run, and a 2017 research paper concluded sweeteners may lead to weight gain.
According to the FDA, aspartame is generally recognized as safe, or not toxic, at “acceptable daily intake” levels. The ADI level for aspartame, which is found in brand-name sweeteners like Equal or Nutrosweet, is 75 packets per day. 
But “safe,” does not necessarily mean healthy, and as researchers previously told USA TODAY, you’re better off sticking with water and limiting your intake of both added sugar and substitutes.
Erythritol is a no-calorie sugar alcohol that our body produces at low levels, and it is present in low levels in some fruit and fermented foods. In larger quantities, erythritol is found in processed food and beverages and the sweetener Truvia.
A 2023 study found that people with the highest levels of erythritol in their blood had twice the risk for stroke, blood clot or death compared to those with the lowest levels. There’s not enough information to definitively say consuming erythritol causes problems, but researchers previously told USA TODAY they would not recommend using it.
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