Artificial Sweeteners That Substance Or a Viable Are Used in Food and Drink Alternative to Sugar, There Across the World

@gulpNOW www.giveuplovingpop.org.uk

Executive Summary 3 Culinary Syrups 16 Introduction 4 Glucose-Fructose Corn 16 Syrup Intense Sweeteners 5 High Fructose Corn 16 - 17 Aspartame 6 - 8 Syrup Neotame 8 - 9 Use in Food 17 - 18 Saccharin 9 Production 18 Acesulfame Potassium 9 - 10 Consumption of 19 Sucralose 11 - 12 High Fructose Rebiana 12 - 13 Corn Syrup Bulk Sweeteners 14 Position Statement 20 What’s the difference 15 References 21 between fructose and normal sugar?

2 @gulpNOW www.giveuplovingpop.org.uk

There is much concern by consumers over the use of sweeteners in our food and there is great debate over whether the disadvantages of using sugar, such as tooth decay and obesity, are seen as less important as the chance of getting cancer from sweeteners. This briefing contains reviews of evidence from UK and European Scientific Committees that say there is no evidence that sweeteners at their present rate of consumption have any effect on our health.

Helen Turner 3 @gulpNOW www.giveuplovingpop.org.uk

Introduction acceptability of sweeteners. Whether you believe that There are a number of natural sweeteners are a dangerous and artificial sweeteners that substance or a viable are used in food and drink alternative to sugar, there across the world. really is no avoiding them. This document will establish Sweeteners can be found in an evidence-based position soft drinks, processed foods, by identifying and exploring cakes, chewing gum and even the sweeteners that are used toothpaste. in the UK, discuss whether But much like any alternative; there are any harmful effects sweeteners have met some and the future role they may resistance, being linked to play in our diet as we attempt cancer, increased risk of as a nation to reduce our stroke and high blood sugar consumption. pressure amongst others. None of these claims have stuck and sales of sugar-free products have been increasing for decades inferring the consumer

4 @gulpNOW www.giveuplovingpop.org.uk

As their name implies, intense sweeteners are many times sweeter than sugar. Examples include saccharin, aspartame and acesulfame K (ace-K) which are up to 200 times sweeter than sucrose (normal table sugar).

Sucralose and neotame have been more recently approved and are about 600 and 7000 times sweeter than sugar respectively. Blends of sweeteners (e.g. ace-K/aspartame) can also be used particularly in soft drinks to achieve particular taste profiles. Their use can result in a different ‘mouth feel’ to sugar.

5 @gulpNOW www.giveuplovingpop.org.uk Aspartame (e.g. that aspartame and its Nutrasweet) breakdown products are safe for human consumption at Aspartame is made by joining current levels of exposure. two protein components, Members of the Panel on aspartic acid and Food Additives and Nutrient phenylalanine, and a small Sources added to Food (ANS) amount of methanol. Aspartic Panel have concluded that acid and phenylalanine are the current Acceptable Daily the building blocks of protein Intake (ADI) of 40 mg/kg of and are found naturally in all body weight per day is protein-containing foods, protective for the general including meats, grains and population. dairy products. Methanol is Consumption surveys confirm found naturally in the body that intakes of low calorie and in many foods such as sweeteners are well below fruit and vegetable juices. the respective ADI values in The EFSA’s main conclusion is all population groups.

6 @gulpNOW www.giveuplovingpop.org.uk This is equivalent to 80 relevant ADI value. sachets (one sachet equals In patients suffering from the 40mg) every day for life or 14 medical condition cans of soft drink every day phenylketonuria (PKU), the [1]. ADI is not applicable, as they There have been more require strict adherence to a studies on the intakes of this diet low in phenylalanine (an sweetener than any other amino acid found in proteins). food additive. Studies have With respect to pregnancy, been performed in most the panel noted that there countries around the world was no risk to the developing including the UK [2]. In all foetus from exposure to cases the average intakes of phenylalanine derived from all sweeteners by all groups aspartame at the current ADI (including children and (with the exception of women diabetics) are well below the suffering from PKU) [3].

7 @gulpNOW www.giveuplovingpop.org.uk

However PKU is rare—it is extremely potent, rapidly estimated to affect 1 in every metabolised, completely 10,000 babies born in the UK. eliminated and does not The opinion makes clear that appear to accumulate in the the breakdown products of body. aspartame (phenylalanine, It is chemically similar to the methanol and aspartic acid) artificial sweetener are also naturally present in aspartame, but is used at other foods. The contribution vastly lower levels and is of breakdown products of more stable. It reduces the aspartame to the overall production of phenylalanine dietary exposure to these during metabolism of the substances is low. chemical and as a result it is Neotame safe for consumption by those who suffer from Neotame is an artificial phenylketonuria. sweetener made by Over 100 scientific studies Nutrasweet that is between were done to establish the 7,000 and 13,000 times safety of neotame. A sweeter than sugar and comprehensive battery of approximately 30 to 60 times safety studies in animals and greater than that of humans demonstrated no aspartame, depending upon adverse effects from the food application. In the neotame. European Union, it is known by the E number E961. It is People of all ages, including 8 @gulpNOW www.giveuplovingpop.org.uk pregnant or breastfeeding about a particular additive. women, teens and children, Some years ago saccharin was and people with diabetes can claimed to be a carcinogen. enjoy products sweetened Researchers had found that with neotame while when it was fed to rats in maintaining a healthier diet. huge quantities, the rates of The EFSA Panel established cancer in the rats increased. an ADI of 0-2mg/kg of body We are very unlikely to eat weight per day. that much saccharin and so it Saccharin (e.g. Sweet ‘n is unlikely to cause cancer in Low) people, but far fewer foods contain it now than did just a Most additives are not few years ago. thought to affect cancer risk. Colours, flavours and Acesulfame Potassium sweeteners are constantly This non-nutritive artificial investigated by researchers sweetener is approximately and if any are thought to be a 200 times sweeter than sugar real risk, they are withdrawn. at low concentrations but Sometimes there is a scare tends to become bitter at higher levels. It is normally used in sweetener blends to produce a more sugar-like taste than that of any of the low calorie sweeteners alone.

9 @gulpNOW www.giveuplovingpop.org.uk

The ingredient also helps the of the European Union. blend retain its sweetness Acesulfame potassium has during baking or heat been thoroughly tested in processing. several long-term animal Acesulfame potassium helps studies. The tests, which used blends sustain their amounts of the ingredient sweetness over time, thereby that are far higher than a increasing the shelf life of person would normally products. This sweetener is consume, clearly found no not metabolised or stored in evidence of cancer or the body. After it is tumours [4]. consumed, it is quickly The ADI has been set at absorbed by the body and 15mg/kg of body weight per then rapidly excreted. day. For a 60 kg person, this Acesulfame potassium has corresponds to 900mg of been approved for use in 90 acesulfame potassium every countries including the day for a lifetime or United Kingdom, Germany, approximately 200 grams Australia and Canada. It has (one-half pound) of sugar been reviewed and found equivalent each day. At safe by the Joint Expert current average usage levels Committee on Food Additives in beverages, for example, of the World Health this amount would Organisation and the correspond roughly to two Scientific Committee for Food gallons of beverage daily.

10 @gulpNOW www.giveuplovingpop.org.uk Sucralose (Splenda) conclusively determined that sucralose is safe for everyone Sucralose is the only low- to consume. Sucralose was calorie sweetener made from approved by the joint FAO/ sugar. It is about 600 times WHO Expert Committee on sweeter than sugar and can Food Additives (JECFA) in be used like sugar in a broad 1990 and also by prominent range of foods. Sucralose can regulatory authorities be used in place of sugar to throughout the world, and eliminate or reduce calories has been consumed by in a wide variety of products, millions of people including beverages, baked internationally since 1991. goods, desserts, dairy products, canned fruits, Sucralose is derived from syrups and condiments. sugar through a patented, multistep process that selectively substitutes three chlorine atoms for three hydrogen-oxygen groups on the sugar molecule. The tightly bound chlorine atoms Sucralose (for example create a molecular structure Splenda) was discovered in that is exceptionally stable 1976. More than 100 and is approximately 600 scientific studies conducted times sweeter than sugar. over a 20 year period have Although sucralose is made

11 @gulpNOW www.giveuplovingpop.org.uk from sugar, the body does not sugar or as a carbohydrate. It recognise it as sugar or is not metabolised by the another carbohydrate. The body for energy and does not sucralose molecule passes affect blood glucose levels. through the body unchanged, Sucralose has no effect on it is not metabolised, and is blood glucose utilisation, eliminated after carbohydrate metabolism or consumption. insulin production. Sucralose Studies have shown that the can be used by everyone, amount of sucralose which including pregnant women might be consumed by and breastfeeding mothers individuals, even if consumed and children. every day throughout a Rebiana (Truvia) person’s lifetime, would still Rebiana is the trade name for be considered safe by a wide high-purity rebaudioside A, a margin by U.S. and Steviol glycoside which when international health used as a non-nutritive authorities. The ADI for sweetener is 200 times sucralose is 5mg/kg of body weight per day. Numerous studies have shown that sucralose can be safely consumed by people with diabetes. Sucralose is not recognised by the body as

12 @gulpNOW www.giveuplovingpop.org.uk sweeter than sugar. Steviol Stevia is now used in some glycosides are high intensity soft drinks in the UK, enabling sweeteners, 250-300 times production of lower calorie sweeter than sugar. They are alternatives by blending sugar isolated and purified from the and stevia to reduce calories leaves of the stevia plant by up to a third. Stevia (Stevia rebaudiana Bertoni), extracts can have a bitter where it is present at levels taste and therefore a number up to 13%. Stevioside is of commercially available another steviol glycoside and stevia based sweeteners along with rebeaudioside A is blend in other sweeteners to converted in the improve their taste and may gastrointestinal tract to include: dextrose, steviol, which is subsequently maltodextrin, sucrose (sugar) converted to glucuronide natural flavourings and sugar which is not further alcohols. metabolised but efficiently excreted [5]. EU Regulation 1131/2011, which came into force on 2 December 2011, permits steviol glycosides to be used in certain specified foods at permitted maximum levels (expressed as steviol equivalents).

13 @gulpNOW www.giveuplovingpop.org.uk

Sugar alcohols are not non-nutritive sweeteners, they contain 2.6 calories per gram (roughly half of which are digested), but they do not cause tooth decay like table sugar. Although they are generally less sweet and caloric than sugar, eating large amounts (particularly of mannitol) can cause bloating and diarrhoea. They’re often used in sugar-free foods marketed to diabetics, because they contain fewer carbohydrates than table sugar. They do contain some carbohydrates, so eating them in excess may increase blood sugar. They can also be found in sugar free chewing gum, sugar free sweets and cough syrups.

14 @gulpNOW www.giveuplovingpop.org.uk What’s the difference between fructose and normal sugar? Fructose—a monosaccharide and is the primary sugar found in fruit. It too doesn’t have to be broken down by the body and is processed in the liver. Glucose—is a monosaccharide and is a carbohydrate in its simplest form. It doesn’t have to be broken down and is immediately absorbed into the bloodstream. Glucose is used as the primary energy source and enters the cells with the help of the hormone insulin. Sucrose—sometimes known as normal or table sugar, isa disaccharide, made up of one glucose molecule and one fructose molecule. When eaten, sucrose is broken down by enzymes to produce glucose and fructose which are then absorbed into the bloodstream.

15 @gulpNOW www.giveuplovingpop.org.uk Culinary Syrups 50%, the products becomes Fructose-Glucose syrup (FGS). Syrups are found in many food and drinks, for their These syrups are made sweetening characteristics, typically from wheat or maize but also because they contain starch, by first making glucose a large amount of dissolved syrup, then through a process sugars but show little called ‘hydrolisation’, which tendency for crystallisation, involves freeing glucose producing a better ’mouth- molecules. With the use of feel’ and preventing sweets enzymes, some of these from sticking to their glucose molecules are then wrappers. changed into fructose. Glucose-Fructose Syrups High Fructose Corn (GFS) Syrup (HFCS) Glucose-Fructose syrup (GFS) In the United States, this type is a liquid sweetener used in of product is produced from the manufacturing of foods the wet milling of corn. Maize and beverages. It is starch is converted to a syrup composed of different sugars, that is nearly all glucose. mainly glucose and fructose, Enzymes are then applied, with varying compositions, reorganising the atoms in the with a fructose content glucose molecules in order to ranging from 5—50%. If the produce a 42% fructose syrup fructose content exceeds called HFCS-42.

16 @gulpNOW www.giveuplovingpop.org.uk

Further refinement produces sweetness and GFS with such a 90% HFCS which is blended a high level of fructose is not with HFCS-42 to make a third available in the EU in syrup, HFCS-55. sufficient quantities. Use in Food Production This is because in the EU, the production of GFS that GFS is mainly found in contain more than 10% of confectionary, beverages, fructose is limited by the EU jams and preserves, baked sugar regime to 5% of total goods, cereal products, EU sugar production. Its use is yoghurts and other dairy therefore more limited. In the products, condiments and US, no production limit exists canned and packaged goods on GFS, and HFCS today such as McVitie’s HobNobs, constitutes up to 50% of US McVitie’s Jaffa Cakes, Carte sugar consumption. Its main D’Or ice cream and Mr. application is in soft drinks. Kipling Bakewell Slices. It often appears in ingredients The American Medical lists as ‘glucose-fructose Association clearly stated in syrup’, ‘high fructose corn June 2008 that ‘high fructose syrup’ or HFCS. syrup does not appear to contribute to obesity more Its use in soft drinks in the EU than other caloric has been limited because soft sweeteners,’ a view drinks need a fructose supported by the American content of at least 42% to Dietetic Association who achieve their desired level of 17 @gulpNOW www.giveuplovingpop.org.uk noted that ’High Fructose number of calories (4 per Corn Syrup’ is nutritionally gram) and consist of about equivalent to sucrose. Both equal parts of fructose and sweeteners contain the same glucose.

18 @gulpNOW www.giveuplovingpop.org.uk

The low consumption of HFCS in the UK was reported ina paper published in 2012 in Global Public Health entitled:

High Fructose Corn Syrup and diabetes prevalence:

A global perspective [6].

It found that diabetes rates were 20% higher in countries that consumed high rates of HFCS compared to those who consumed little. The U.S had the greatest consumption, amounting to 25kg per person per year compared to 0.5kg per person per year in the UK.

19 @gulpNOW www.giveuplovingpop.org.uk Position Statement The body of scientific evidence indicates that artificial sweeteners consumed at current levels are safe. According to PHE [7] and the SACN report on carbohydrates and health [8], consumption of sugar-sweetened drinks compared to non-sugar sweetened drinks, results in greater weight gain and increases in body mass index in children and adolescents due to increased energy consumption. However there is some emerging evidence to suggest that artificial sweeteners may not aid weight loss; individuals may compensate for the energy deficit when consuming non-calorie drinks. Further evidence suggests that the palatability of both sugar- sweetened beverages and artificially sweetened drinks increases subjective hunger and hence energy intake—this requires further study [9].

20 @gulpNOW www.giveuplovingpop.org.uk

1. EFSA (2013). Scientific Opinion on the re-evaluation of aspartame (E 951) as a food additive. 2. Magnuson et al. (2007). Aspartame: A Safety Evaluation Based on Current Use Levels, Regulations, and Toxicological and Epidemiological Studies. Critical Reviews in Toxicology, 37, 629-727. 3. EFSA (2013). Scientific Opinion on the re-evaluation of aspartame (E 951) as a food additive. 4. Scientific Committee on Food (2000). Re-evaluation of acesulfame K with reference to the previous SCF opinion of 1991. 5. Ensuring the safety of sweeteners from stevia. (Accessed 14/07/2015 from: http://www.ift.org/food-technology/past-issues/2011/april/features/ensuring- the-safety-of-sweeteners-from-stevia.aspx?page=viewall) 6. Goran et al. (2013). High Fructose Corn Syrup and diabetes prevalence: a global perspective.Global Public Health, 8 (1), 55-64. 7. PHE (2015). Sugar Reduction: The evidence for action. 8. SACN (2015). Carbohydrates and Health 9. Malik, V. S., et al. (2006). Intake of sugar-sweetened beverages and weight gain. American Journal of Clinical Nutrition, 84 (2), 274-288.

21 @gulpNOW www.giveuplovingpop.org.uk

Health Equalities Group To reference this document 2nd Floor, 151 Dale Street please cite: Liverpool Give Up Loving Pop (2015). Artificial Sweeteners. L2 2JH

T: 0151 237 2686 W: www.hegroup.org.uk Tw: @healthequalgrp

22 @gulpNOW www.giveuplovingpop.org.uk