There exist several FDA-approved sugar substitutes, but as usual, consumers are confused about their health benefits. There is clearly the need for research on this issue. This NutriNeat article presents information on the advantages and side effects of erythritol, xylitol, and stevia.
According to the facts published in The Journal of Nutrition by The University of Toronto, two-thirds of adults in the United States are overweight or obese. Americans are gaining an average of 1 – 2 lb every year. If this continues, by the year 2030, 86.3% of adults in the US will be overweight or obese.
One gram of refined table sugar contains 4 calories, while most artificial sweeteners have zero calories per gram. These sugar substitutes play an important role in weight loss diets. They also help control diabetes. They can be hundred times or even thousand times sweeter than table sugar ‘sucrose’.
Statistics show that in less than 4 decades, the prevalence of obesity in the US has increased by over 50 %. More and more adults and children are suffering from weight-related health problems. Obesity has emerged as a worldwide epidemic. Accordingly, there is an ever-increasing demand for zero-calorie sweeteners. Manufacturers are busy producing myriad varieties of low-calorie and calorie-free sugar substitutes.
What is Erythritol?
Erythritol is a sugar alcohol (a kind of alcohol prepared from sugar) which was discovered in 1848. It occurs naturally in melons and pears. It is commonly used as a ‘food additive’ and as a ‘tabletop sweetener’ to sweeten beverages. It is quite popular in Japan, where it is used in candies, chocolates, yogurt, fillings, jellies, jams, beverages, etc. Industrially, it is produced from glucose by fermentation with a yeast called Moniliella pollinis. As about 90% of it is absorbed into the bloodstream in the small intestine, it does not lead to an upset stomach. It is often used as a medium in which high-intensity sweeteners are delivered, especially stevia derivatives. The combination helps provide both bulk and a flavor exactly like that of man-made sugar. Beverages usually contain erythritol and another main sweetener. Studies show that it is easier to digest than xylitol, but it is not commonly available in the market.
What is Xylitol?
This is also a sugar alcohol that occurs naturally in low concentrations in fibers of various fruits and vegetables. Industrially, it is obtained from xylan, a hemicellulose extracted from hardwoods or corncobs. It is also extracted from corn husks, sugarcane bagasse, mushrooms, berries, oats, etc. Xylitol, that is used for medicinal purposes, is obtained from birch wood. In Europe, it was launched as a safe sweetener for diabetics. It is used in ‘sugar-free’ chewing gums, mints, and candies.
What is Stevia?
Like erythritol and xylitol, stevia is not a sugar alcohol. It is a man-made sugar substitute. It is made from the leaves of the plant Stevia rebaudiana. It is popular as a low-carb, low-sugar sweetener. Steviol glycoside extract can be 300 times sweeter than sugar. The Japanese have been using it as a sweetener since decades. There, it was first introduced in the market in 1971. Since 1984, the sweetener produced from Stevia rebaudiana is widely used in South East Asia. Traditionally, it was used as a sweetener in ‘Yerba Mate’, by the GuaranĂ people of Paraguay. In some countries, it is used as a food additive and dietary supplement, while in others, it is used only as a food additive. A highly purified form of stevia plant, called Rebaudioside A, which has been approved by the FDA as a ‘generally recognized as safe’ (GRAS) ingredient, is sold under different brand names, like Truvia and PureVia. Stevia is used in sodas, sports drinks, and baking blends.
| Advantages | Disadvantages |
| Erythritol | |
| It is 60-70% as sweet as table sugar. It is heat stable up to 160 degrees C, so can be used for baking. | It is not as soluble as sucrose. Since it is not ‘very sweet’, in the food industry, it is often combined with other sweeteners… sometimes artificial sweeteners like aspartame. Also, the production cost is very high as compared to other sugar alcohols. |
| It does not affect blood sugar levels. It is a non-glycemic food additive (zero on the glycemic scale) and is suitable for diabetics. | Very high doses can result in abnormal fluctuations in blood sugar levels. |
| As it cannot be metabolized by oral bacteria, it does not lead to tooth decay. | It has the tendency to crystallize, and hence, manufacturers of foods need to choose other ingredients carefully. |
| It contains 0.24 kilo-calories per gram (95% less than sugar), but as the human body cannot break it down, it virtually provides no calories. | As a result of an allergic reaction, one may develop skin hives after consumption of erythritol. But such cases are very rare. |
| About 90% of erythritol is absorbed before it enters the large intestine. So, it is less likely to cause laxative effects and gastric distress. It is easily absorbed in the body, and yet not metabolized (it is excreted unchanged through urine and stools). Therefore, it is considered more effective than other sugar alcohols. | Excessive intake (doses over 50 g or 1.8 oz) can cause nausea and stomach rumbling. Excessive consumption of so-called ‘waters of vitamins’ that contain erythritol and some other ingredients can lead to headache, stomach pain, and diarrhea. |
| It has a strong cooling effect. It does not have carcinogenic properties. In fact, it exhibits antioxidant properties and helps cancel the adverse effects of free radicals. | As the cooling effect is not always desired, manufacturers of food products add other ingredients (for example, inulin for warming effect as it generates heat when added to water) to negate the effect. |
| Xylitol | |
| It is almost as sweet as table sugar, but has 33% less calories than it. Diabetics can use it as a sweetener. While glucose has a glycemic index (GI) of 100, xylitol has an extremely low GI of 7. it is non-carcinogenic. | One gram of xylitol contains 2.4 kilo-calories (kcal), while one gram of sugar contains 3.87 kcal. Xylitol is not completely calorie-free. |
| It exhibits some health-promoting properties. It curbs the growth of Streptococcus pneumoniae. It prevents Haemophilus influenzae from attaching to the nasopharyngeal cells. It is used as a medicine to prevent acute middle ear infection in young children. But, it may not be able to prevent ear infections if it is given after noticing the symptoms of an acute respiratory infection. Xylitol nasal sprays are available in the market. | Very high doses (more than 50 g per day), when taken for extended periods of time (more than three years) can cause tumors. Some individuals may suffer from acid reflux after consumption of xylitol-containing food. |
| It is added to chewing gums or oral care products, as it helps prevent tooth decay and dry mouth. It promotes remineralization of damaged teeth. Consumption of 6-20 grams of xylitol per day through things like chewing gum, candies, and toothpaste can significantly reduce the rate of cavity formation in both, adults and children. But, if very little amount of xylitol (in milligrams) is ingested, it won’t help prevent tooth decay. | As it is not fully broken down during digestion, it may act like a laxative. The severity of the effect may vary from person to person. A study shows that 4 out of 13 children experienced diarrhea, when more than 65 g of xylitol was consumed in a day by each one of them. Some temporary side effects like bloating, flatulence, and diarrhea can also be experienced. |
| It is present in some feeding formulas (especially those that are fed by tubes) as a source of energy. When consumed in proper proportions, it also promotes fast recovery after vigorous exercise. | It is not toxic to human beings, but it can be toxic to dogs. If your dog eats a product (candy or anything) that contains xylitol, you should immediately take the dog to a veterinarian. Excessive intake of xylitol by a dog can result in life-threatening conditions like ‘liver failure’ or ‘hypoglycemia’ (low blood sugar). This can further lead to loss of coordination and seizures. Within half an hour, the dog may collapse. |
| Stevia | |
| It is a no-calorie sweetener and it does not raise blood sugar levels. It is useful in low-carb diets. It is sold as a ‘tabletop sweetener’. | It is usually combined with a bulking agent, and that agent might raise blood sugar levels (if it is erythritol, then it won’t raise blood sugar). |
| It is 200-300 times as sweet as sugar. Truvia and PureVia are popular stevia-based sweeteners. WHO has announced that the acceptable daily intake of steviol glycoside can be up to 4 milligrams per kilogram of body weight. | In 1991, the FDA refused to approve this substance for use. It is suspicious that when companies like Coca Cola and PepsiCo were involved, FDA approved the use of rebaudioside compounds that are derived from the stevia plant. Whole-leaf stevia is not approved as a food additive. |
| Certain studies show that stevioside and related compounds can help stabilize blood pressure and blood sugar levels. They exhibit diuretic and immunomodulatory properties. They also help lower inflammation and prevent the formation of tumors. They can lower the symptoms of diarrhea. | To produce a branded sweetener, stevia leaves are highly processed. The process involves the use of chemicals like acetone, methanol, ethanol, acetonitrile, isopropanol, etc. Some of these chemicals may cause cancer, although as of today, there is no clear evidence that the artificial sweeteners are associated with cancer risk in humans. |
| It does not raise blood sugar levels. So, it is useful in low-carb diets. It is sold as a ‘tabletop sweetener’. | Some of the stevia extracts leave a bitter or unpleasant aftertaste. |
Choosing the Right Sweetener
One has to be very careful while choosing a sweetener, as so many products are available in the market. Even certified organic sweeteners can have some sneaky ingredients. One such sweetener contains more organic agave inulin (a highly processed fiber derivative from the blue agave plant) than the stevia extract itself. Silica, that improves the flow of the powdery substance, can cause irritation of the digestive tract.
Although erythritol occurs naturally in various fruits, manufacturers don’t use the natural sources. They produce it through fermentation (a very long process) of genetically engineered corn. PepsiCo’s ‘Pure Via’ contains dextrose, a sweetener which is also derived from genetically engineered corn. So, the labels like ‘Natural’ or ‘Pure’ are actually misleading.
‘Natural flavors’ need to be added to powdered and liquid stevia products, because processed stevia leaves are likely to have a metallic taste. The flavors are so synthesized that they not only kill the metallic taste, but they also make you crave for more. A 2004 study on rats shows that the use of low-calorie sweeteners in their food led them to overeat. The researcher also mentioned that long-term use of artificial sweeteners in a diet may lead to health problems, including metabolic syndrome, which can be a precursor to diabetes.
Even though you choose a calorie-free sweetener, the food or drink you enjoy can have calories. There is also not enough evidence at this time to determine whether the use of no-calorie natural sweeteners leads to weight loss or lowers heart disease risk. More research is needed to prove the health benefits.
People who regularly take blood pressure or diabetes medicines and use stevia (or other sweeteners) should be monitored closely by a qualified health care professional. The sweeteners may interact with various other medicines too. More studies are required to prove such side effects. Each sweetener has something valuable to offer, but it also comes with some side effects or has some risks associated with it. Whatever you choose, it is better and safer to consume it in moderation.
Disclaimer: This article is for informative purposes only, and does not in any way attempt to replace the advice offered by a medical professional.
