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The COST of “Sugar-Free” Substitutes:

Zoe SchillingPharmD. Candidate, 2022


“ZERO calories” means I can eat or drink endless amounts, right? NO. Many products are misleading. Marketing strategies try to display their products as “calorie-free” and “healthy substitutes.” However, artificial sweeteners are simply that, artificial.

A “sugar-free” product is a chemically- configured product that provides zero calories by bypassing the body’s typical route of metabolism. Hence, they are not absorbed by the body and thus can be marketed as “zero calorie.”

There are many concerns regarding the consumption of artificial sweeteners. One concern is that people who use artificial sweeteners may compensate by replacing the lost calories through other food sources. For example, one might rationalize with his or herself "I’m drinking diet, so it’s okay to eat this brownie."

Artificial sweeteners also alter one’s taste perception, being up to 700 times sweeter than regular sugar. Likewise, you can imagine the body must be affected in some ways from this process. Because the body’s sense of taste perception is altered, you may actually over eat because your hunger-satisfying hormones are dysregulated. Research suggests that artificial sweeteners may prevent us from associating sweetness with caloric intake. As a result, we may crave more sweets, tend to choose sweet food over nutritious food, and gain weight. Participants in the San Antonio Heart Study who drank more than 21 diet drinks per week were twice as likely to become overweight or obese as people who didn’t drink diet soda.1

Animal studies have also demonstrated that artificial sweeteners may have an addictive component. In studies of rats who were exposed to cocaine, then given a choice between intravenous cocaine or oral saccharine, most chose the saccharin. 2

Elaborating further on the risks associated with consumption of artificial sweeteners, several studies have shown the link between fake sugars and an increase in sugar cravings and dependence, impaired caloric compensation resulting in appetite stimulation, increased consumption, weight gain, and glucose intolerance. 3-7

On the contrary, in 2018, the American Heart Association advised that short-term replacement of sugar-sweetened beverages (SSB) with beverages containing low-calorie sweeteners, including artificially-sweetened beverages (ASB), may be an effective and realistic approach to calorie reduction and weight loss in some adults.8

In other words, if an obese adult is already accustomed to drinking several cans of regular soda per day, then making the switch to diet soda would be a good start. Based on available evidence, the writing group concluded that, health care personnel should advise against prolonged consumption of artificially-sweetened beverages by children. Ultimately, water is the optimal beverage choice and there should be a focus on increasing the intake of water (plain, carbonated, and unsweetened flavored) over any type of soda. 8

There also seems to be a genetic component with the metabolism of the known artificial substitute, aspartame. Certain people with the genetic disease phenylketonuria (PKU), those with advanced liver disease, and pregnant women with hyperphenylalaninemia (high levels of phenylalanine in blood) have a problem with aspartame because they do not effectively metabolize the amino acid phenylalanine, one of aspartame's components. High levels of this amino acid in body fluids can cause brain damage.9,10 Thus, this patient population should be extra cautious when consuming artificial sweeteners.

The FDA has approved five artificial sweeteners: saccharin, acesulfame, aspartame, neotame, and sucralose.

Aspartame​ is the most common artificial sweetener and is 200 times sweeter than table sugar. It is marketed as Equal or NutraSweet (the blue packets).

Products: Diet Coke, Diet Pepsi, Diet Dr. Pepper, Diet Snapple Iced Tea

Sucralose​ is 600 times sweeter than sugar and is marketed as Splenda (the yellow packets) and Equal Sucralose.

Products: Ocean Spray Light, Flavored Propel Fitness Water, Diet V8 Splash, Yoplait Light, Yoplait Greek 100, Dannon Light & Fit, Breyer’s No Sugar Added, Smucker’s Sugar Free

Acesulfame​ ​potassium​ also known as Ace-K, is 200 times sweeter than sugar and is marketed as Sweet One. It is found in many products in combination with aspartame or sucralose.

Products: Powerade Zero, Gatorade G2, Coke Zero, Sprite Zero, various yogurts

Saccharin​ was the first artificial sweetener to ever be made. It is 300 to 500 times sweeter than sugar and is marketed as Sweet’N Low (the pink packets), Sweet Twin, Necta Sweet, and Equal Saccharin.

Products: Toothpastes, baked goods, fountain sodas and low carb bars

FDA-approved natural​ ​sugar​ ​substitute:

Stevia​ is about 200-350 times sweeter than table sugar and has no calories. It is made from the Stevia rebaudiana plant of South America.

Products that contain forms of stevia: Trop50 orange juice, Honest Fizz, Coca Cola Life, Dannon Oikos Triple Zero Yogurt, Chobani Simply 100

Sugar​ ​Alcohols

● Erythritol

● Sorbitol

● Xylitol

Erythritol​ is 70% the sweetness of sugar and gives 20% of the calories per gram compared to table sugar. It is manufactured from cornstarch and is used mainly in confectionery and baked goods, chewing gum and some beverages.

Products: Halo Top ice cream, Enlightened ice cream, Elli Quark, Bai Beverages, Starbucks Refresher

Sorbitol​ ​is about half as sweet as table sugar and has about half the calories. It is commercially made from dextrose (glucose) produced from corn starch.

Products: Most toothpastes contain this according to NIH, sugar free gum and candies

Xylitol​ ​is about as sweet as table sugar, is absorbed slowly and only partially utilized so it has just over half the calories. It is a sugar alcohol found naturally in woody fibrous plant materials like corn cobs or hardwood.

Products: Nasal sprays, gums and candies


· Artificial sweeteners tend to ​cause​ ​sugar cravings​ and have an addictive component

· Fake sugars may disorient your​ ​natural​ ​sense​ ​of​ ​taste

· The hormone imbalance and increased food cravings could also lead to weight gain

· For people who need help reducing a regular soda addiction, diet may be a healthier alternative

· Diet and exercise is always the healthiest approach to weight loss

· People with PKU should avoid products that contain aspartame

· Water is always best


1. Jensen PN, Howard BV, Best LG, et al. Associations of diet soda and non-caloric artificial sweetener use with markers of glucose and insulin homeostasis and incident diabetes: the Strong Heart Family Study. Eur J Clin Nutr. 2020;74(2):322-327. doi:10.1038/s41430-019-0461-6

2. Lenoir M, Serre F, Cantin L, Ahmed SH. Intense sweetness surpasses cocaine reward. PLoS One. 2007;2(8):e698. Published 2007 Aug 1. doi:10.1371/journal.pone.0000698

3. Gardener H, Elkind MSV. Artificial Sweeteners, Real Risks. Stroke. 2019;50(3):549-551. doi:10.1161/STROKEAHA.119.024456

4. de Koning L, Malik VS, Rimm EB, Willett WC, Hu FB. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J Clin Nutr. 2011;93:1321–7.

5. Pereira MA. Sugar-sweetened and artificially-sweetened beverages in relation to obesity risk. Adv Nutr. 2014;5:797–808.

6. Swithers SE, Davidson TL. A role for sweet taste: calorie predictive relations in energy regulation by rats. Behav Neurosci. 2008;122:161–173.

7. Yang Q Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience 2010. Yale J Biol Med. 2010;83:101–8.

8. Johnson RK, Lichtenstein AH, Anderson CAM, Carson JA, Després JP, Hu FB, et al. Low-Calorie Sweetened Beverages and Cardiometabolic Health: A Science Advisory From the American Heart Association. Circulation. 2018;138:e126–e140.

9. Butchko HH, Stargel WW, Comer CP, et al. Aspartame: review of safety. Regul Toxicol Pharmacol. 2002;35(2 Pt 2):S1-S93. doi:10.1006/rtph.2002.1542

10. Janssen PJ, van der Heijden CA. Aspartame: review of recent experimental and observational data. Toxicology. 1988;50(1):1-26. doi:10.1016/0300-483x(88)90117-5

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