Many parents have questions about the use of sugar substitutes in their children’s food.

According to the American Academy of Pediatrics, the number of foods and beverages made with nonnutritive (no- or low-calorie) sweeteners has grown four times in recent years.

In addition to all the diet soda and zero-calorie products, nonnutritive sweeteners also are used in a wide variety of reduced sugar or no-sugar-added school lunchbox favorites such as jelly and jams, yogurt, pudding, cookies and fruit cups.

What are artificial sweeteners and do they have side effects?

Artificial sweeteners provide the sweet taste of sugar without the calories. The Food and Drug Administration has approved eight different nonnutritive sweeteners. These “high intensity” sweeteners are between 180 to 20,000 times sweeter than table sugar (sucrose).

There are two broad categories of artificial sweeteners: sugar alcohols and high-intensity sweeteners. Sugar alcohols are structurally similar to sugars but are less easily digested. High-intensity sweeteners are small compounds many times sweeter than sugar. The high-intensity sweeteners include saccharin and aspartame.

Saccharin, the first artificial sweetener, was discovered by accident when, in 1879, Professor Ira Remsen from Johns Hopkins University noticed a sweet substance on his hands after working in his laboratory.

Saccharin, 200 times sweeter than sugar, became popular during World War II when sugar was in short supply and saccharin was cheap. Today, artificial sweeteners are central to a huge market of diet- and sugar-free food and drinks. Their attraction today isn’t only how inexpensive they are but their promise to fight obesity and its associated health problems.

There have been, and are many ongoing, studies about the possible side effects such as linking artificial sweeteners with cancer, ADHD or the effectiveness of nonnutritive sweeteners on weight loss. There have been no studies linking the use of sweeteners to cancer in humans. In addition, there has been no scientific evidence linking aspartame to ADHD or birth defects. (Individuals with phenylketonuria) should avoid foods and beverages with aspartame.)

In healthychildren.org’s discussion about sweeteners it said manufacturers list the nonnutritive sweeteners in their products, but they’re not required to say how much each products contains.

Many studies (mostly looking at short-term results) about weight loss when switching from sugar to sweeteners have shown a neutral to positive effect on weight loss, which are disappointing in that it’s not more dramatic. Some studies have even linked the use of nonnutritive sweeteners with weight gain.

They also discuss recent research suggest possible links between nonnutritive sweeteners and changes in appetite and taste preferences in children. These changes could affect weight and health. Other research show sweeteners can cause changes in the gut microbiome (“friendly bacteria”), which may affect blood sugar levels and lead to metabolic syndrome.

Sugar-free alternatives, particularly for sugary drinks, could be helpful for weight loss and a healthy diet. A diet drink might be better than a sugary one, but water might be even better.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital. This column isn’t intended to replace the advice of your child’s physician.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital. This column isn’t intended to replace the advice of your child’s physician.

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