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Sugar Substitutes: Are They Safe?

By Brooke Douglas, RDN, CD

Artificial sweeteners are found everywhere, from sodas to yogurt and even in some breakfast cereals. Although FDA approved and widely used, many people wonder about the safety of sugar substitutes. Based on worldwide, solid scientific research, they appear to pose little or no risk when used in moderation.

In fact, the FDA-approved sugar substitutes are recommended by the American Heart Association and the American Diabetes Association. The acceptable daily intake (ADI) displayed in the chart below is the amount that you can consume over a lifetime that will not result in injury, even after a lifetime of exposure.

 Name  Examples  ADI

(per day)

 ADI for a

150-lb person


 FYI – Additional



(blue packet)

 Equal®  50 mg/kg

body weight

 97.4 packets/day  Inappropriate for

people with



(pink packet)



 15 mg/kg

body weight

 28.4 packets/day  Can cross the

placental barrier

in pregnancy

 Sucralose  Splenda®  5 mg/kg

body weight

 28.6 packets/day  Heat stable, good

for baking

kg=kilogram, lb=pound, mg=milligram
*aspartame is not safe for people who have the rare hereditary disease called phenylketonuria (PKU). Products that contain aspartame must carry a PKU warning on the label, and individuals with PKU should avoid consuming aspartame.

How they work

Artificial sweeteners add sweetness without calories in two ways. First, they typically are anywhere from 160 to 13,000 times sweeter than sugar. Therefore, you need only a small amount to achieve the same taste. You consume a fraction of a calorie to get the sweetness of many more calories worth of sugar. Secondly, because the body does not fully absorb them, your body does not fully absorb the few calories they contain.

Weight gain

Keep in mind that removing the sugar in a food does not necessarily mean that it is low calorie or low fat. If you eat too many reduced-sugar foods, you may get more calories than you need. In addition, if you replace healthy foods such as fruits and vegetables with these products, you may miss out on many nutrients that your body needs.


John Henkel’s article Americans Opt for Sweetness and Lite refers to the National Cancer Institute’s Cancer Facts, which documents that “epidemiological studies do not provide clear evidence” to link sugar substitutes to human cancer. Typical intakes of the approved sugar substitutes at normal levels for adults show no evidence of a public health problem.

A study described in the Henkel article raised the issue that aspartame consumption is possibly related to an increase in brain tumors. Henkel cautions that this followed the FDA’s approval of the sweetener in 1981. Analysis of the National Cancer Institute’s database on cancer incidence showed that cases of brain cancers began increasing in 1973, well before aspartame was approved, and continued to increase through 1985.


The FDA has called aspartame (Equal) one of the most thoroughly tested and studied food additives the agency has ever approved. More than 200 studies have confirmed that aspartame is safe for the general population.

Despite wide spread ‘myth-information’ medical research and sound science shows artificial sweeteners to be safe for 98% of the public consuming them (the 2% are those individuals with intolerances to artificial sweeteners much like intolerances to dairy or eggs.) Let’s look more closely at these ‘non-nutritive’ sweeteners (also known as artificial sweeteners or sugar substitutes):

  • Offer the sweet taste of sugar without the calories or an increase in blood glucose levels.
  • Can help increase the variety of foods people with diabetes can consume.
  • Add some sweetness to beverages without adding carbohydrates.
  • Because “sugar substitutes” are much sweeter than sugar, it takes a much smaller amount to create the same level of sweetness in foods made with them, when compared with sugar.

The US Food and Drug Administration (FDA) has approved seven non-nutritive sweeteners to date. All have different functional properties that affect their taste and use. The following are approved by the FDA (several others are currently under development or awaiting approval):

  • Aspartame
  • Saccharin
  • Acesulfame-K
  • Neotame
  • Sucralose
  • Luo han guo
  • Stevia

Are foods containing non-nutritive sweeteners calorie free?

Many foods containing artificial sweeteners contain calories and can affect your blood glucose level, because of other carbohydrates or protein in the food. So be sure to understand and read the labels! For example:

  • Artificially-sweetened yogurt contains milk sugar (lactose)
  • Sugar-free chocolates and candy may contain “sugar alcohol” sweeteners, such as sorbitol, mannitol, or xylitol
  • Sugar-free cookies and baked goods usually contain flour (starch)


Table sugar is sucrose. Sugar Free does not mean calorie free or carbohydrate free. What is means is SUCROSE FREE. There are other forms of nutritive (calorie containing) sugars & carbohydrates so people with diabetes need to be aware that sugar free does not mean it is a free food.

Learn to like food that is less sweet…

Although artificial sweeteners such as aspartame are declared safe for human consumption, many people choose not to use them because of taste or other personal reasons. Here are some tips on how to reduce sugar intake without using artificial sweeteners.

  • Replace ¼ to 1/3 of the sugar called for in recipes with nonfat dry milk.
  • Cakes and cookies:
    • For each 1 cup (C) of flour, use no more than a ½ C of sugar in cakes. Muffins and quick breads: For each 1 C of flour, use no more than 1 tablespoon of sugar.
  • Yeast breads:
    • For each 1 C of flour, use no more than 1 teaspoon sugar.
  • Use spices and herbs:
    • Try using cinnamon, cardamom, or nutmeg to enrich the flavor of foods.
  • Add fresh fruit:
    • Mix fresh fruit into unflavored oatmeal and yogurt. Instead of using maple syrup, make your own toppings for pancakes and waffles by pureeing fresh fruit and adding a bit of water and vanilla extract.
  • Sweeten foods with juice:
    • Use fruit juice or frozen juice concentrates to sweeten foods.
  • Consider using honey or molasses:
    • Honey and molasses taste sweeter than table sugar. Using them instead of sugar may help you reduce the total sugar content of a recipe, but by weight, they contain as much sugar as table sugar.
  • Serve cooked fruits and vegetables:
    • Cooking fruits and vegetables can make them taste sweeter than eating them in the raw state.
  • Make your own beverages:
    • Make your own reduced-sugar beverages by mixing together carbonated water and fresh fruit juice.
  • Eat bitter foods:
    • Eating bitter foods more frequently will make naturally sweet foods, such as fresh fruit, taste even sweeter. Try this out by adding arugula, radicchio, endive, chicory, broccoli, collard greens, kale, or mustard greens to your diet.
  • Get plenty of rest:
    • Chronic lack of sleep causes people to crave more sugary foods. Make sure to get plenty of rest whenever you are trying to reduce the amount of sugar that you consume.
  • Cut your sugar intake gradually:
    • Do not try to go as low as possible right away. Doing so could even make you not feel well.
  • Eat at least every 4 hours:
    • Never go more than 4 hours without eating. Going for too long without eating increases the chance of you reaching for a sugar-laden food to get an energy boost. You also may experience hypoglycemic symptoms, such as headache, shakiness, or dizziness.

If you have a medical condition or would like to lose weight, consider meeting with a Registered Dietitian at Nutrition Authority. We have 5 locations to better serve you (Renton, Enumclaw, Tacoma, Eatonville, and Puyallup). Most insurance plans allow for multiple consults with a nutrition expert. Is your insurance plan one of these? Contact us at OR 1-855-EAT-4LIFE and we will look in to your level of insurance coverage for you. Your personal nutritionist is waiting to meet with you!

References and Recommended Readings

Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: use of nutritive and non-nutritive sweeteners. J Acad Nutr Diet. 2012;112:739-758.
Academy of Nutrition and Dietetics Evidence Analysis Library. Diabetes and glycemic response: non-nutritive sweeteners. Available to subscribers at:
Harvard Health Publications. Are artificial sweeteners safe? Available at:
Henkel J. Sugar substitutes: Americans opt for sweetness and lite. Available at: Mayo Clinic. Artificial sweeteners: a safe alternative to sugar? Available at:
Colorado State University Extension. Sugar and sweeteners. Available at:
North Carolina State University and North Carolina A&T State University Cooperative Extension. Heart & soul: a collection of heart healthy Southern foods; cuttin’ the sugar. Available at:
Wholeliving. Break the sugar habit. Available at:

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