Dear Doctor Column, May 31, 2004

Sugar Substitutes Safe, FDA-approved

Question:

Is it true that Equal and NutraSweet cause headaches, brain tumors, and cancer? What about Splenda?

Answer:

The sweetener used in Equal and NutraSweet is aspartame; Splenda contains sucralose. Both low-calorie sweeteners are approved by the Food and Drug Administration (FDA) (www.fda.gov). Prior to their FDA approval, aspartame and sucralose underwent some of the most thorough scientific reviews ever conducted.

Aspartame. Used in hundreds of foods and beverages in more than 90 countries, aspartame received FDA approval in 1981 and was introduced on the market as the tabletop sweetener Equal and as the food additive NutraSweet. Two hundred times sweeter than sugar, aspartame's flavor is closer to sugar than saccharin, which has a slight bitter aftertaste.

Aspartame's safety has been documented in more than 200 toxicological and clinical studies and reviewed by regulatory authorities, scientific associations, and health entities in more than 100 countries, including the FDA, American Medical Association, World Health Organization, European Commission's Scientific Committee on Foods, European Parliament, and the United Nations Food and Agriculture Organization.

Often spread on the Internet, rumors about aspartame continue to run rampant claiming the artificial sweetener causes everything from multiple sclerosis, epilepsy, and brain tumors to Alzheimer and Parkinson diseases, headaches, and blindness. The truth is, the FDA considers aspartame to be one of the most thoroughly tested and studied food additives the agency has ever approved.

That is not to say the public has not reported problems with aspartame: During the first few years after aspartame's release, more than 600 consumers registered complaints with the FDA about possible side effects. People reported symptoms ranging from hives and stomach upset to depression, severe headache, behavioral problems, and seizures. Investigated by the Centers for Disease Control and Prevention (www.cdc.gov), the complaints could not be attributed to aspartame.

Aspartame does contain phenylalanine, which should be avoided by the small number of people — about 1 in 16,000 — who have the hereditary disease phenylketonuria (PKU). People born in American hospitals are tested for PKU at birth. People with advanced liver disease and pregnant women with high levels of phenylalanine in the blood also may have trouble metabolizing the substance. The FDA requires any food containing aspartame to clearly state on the label that the product contains phenylalanine.

Sucralose. FDA approved in 1998, after reviewing more than 110 animal and human safety studies conducted over 20 years, sucralose was found to be safe for everyone, even pregnant and lactating women and people with diabetes.

Originally, sucralose was approved as a tabletop sweetener and for use in products such as baked goods, nonalcoholic beverages, chewing gum, frozen dairy desserts, fruit juices, and gelatins. A year after its approval, the FDA amended regulations to allow sucralose as a general-purpose sweetener for all foods.

Sucralose tastes like real sugar, only 600 times sweeter. Since it is not digested, it has no calories. But unlike aspartame, sucralose is stable at high temperatures, so it can be used in cooking and baking.

In July 2002, the FDA approved a new sweetener, neotame, for use as a general-purpose sweetener in a wide variety of food products, other than meal and poultry. Neotame is made by the NutraSweet Company.

Neotame is 7,000 to 13,000 times sweeter than sugar. Examples of uses for which neotame has been approved include baked goods, nonalcoholic beverages, chewing gum, confections and frostings, frozen desserts, gelatins and puddings, jams and jellies, processed fruit and fruit juices, toppings and syrups.

In determining the safety of neotame, the FDA reviewed data from more than 110 animal and human studies. The safety studies were designed to identify possible toxic effects, such as cancer-causing, reproductive, and neurological effects. From its evaluation, the FDA concluded neotame is safe for human consumption.

Other sugar sweeteners currently under FDA review include cyclamate and alitame.

Although sugar substitutes have a long history of controversy, the Calorie Control Council (www.caloriecontrol.org) says Americans are continually searching for good-tasting, low-calorie products as part of a healthy lifestyle. Although artificially sweetened products are not magic foods that will melt pounds away, they can be, experts say, a helpful part of an overall weight control program that includes exercise and other dietary factors.