what is the best sweetener for health? doctors respond

A spoonful in coffee, a few sachets in juice, especially when the fruit is citrus: sugar is part of the Brazilian diet. According to the Family Budget Survey, 85.4% of the population adds the product to food and beverages in the country. But, to overcome the diseases that consumption in excess is proven to cause, the replacement by sweeteners has been increasing — it is estimated that sweeteners are present in 13.4% of Brazilian tables, according to data from the National Research of Access, Use and Promotion of Rational Use of Medicines. The biggest consumers are women, especially from the Southeast and Northeast, from economic class A/B.

From natural to artificial, the options are sweet with very few calories. Globo sought out specialists to detail the differences between them, from origin to the best function of each one in the kitchen – and the impact on health.

— Sweeteners have completely different origins. They can come from sugar cane and amino acids, while others are chemically produced. They are sweeter than sugar, with 200, 300 and or even 500 more potent. So, for example, 1 gram of aspartame is 200 times sweeter than 1 gram of sugar — explains Daniel Magnoni, nutritionist at Hospital do Coração, in São Paulo.

For those looking to lose weight, products sweetened with sweeteners can be an alternative, as long as they are associated with a hypocaloric diet and physical activity.

“In a recent systematic review, the use of sugar-sweetened beverages with sweeteners as a substitute for sugar-sweetened beverages resulted in a small improvement in cardiometabolic risk factors (risk of diabetes and heart disease),” says the vice president of the Department of Diabetes at the Brazilian Society of Endocrinology and Metabology (SBEM), Melanie Rodacki.

But the benefits do not outweigh the risks. Cyclamate, for example, one of the main sweeteners in some soft drinks, had its marketing banned by the Federal Drug Administration (FDA) in the United States in the 1980s, due to the risk of bladder cancer in rats. In Brazil, on the other hand, cyclamate is one of the 17 sweeteners authorized for use in food supplements by the National Health Surveillance Agency (Anvisa).

— The industry claims that the work was done on animals and not on humans. Actually, 1 gram of cyclamate for a mouse is much more than for a human, which is why it would need more work, more research. But I tell my patients to avoid cyclamate – says nutrologist Magnoni.

The doctor also suggests caution with sucralose in some situations. Recent studies indicate that the compound can release toxic substances when exposed to temperatures greater than 120° (baking in the oven should therefore be avoided). Another important alert is for the use of aspartame by those who have phenylketonuria, a congenital disease in which the person is unable to metabolize phenylalanine (the excess exerts a toxic action on several organs).

As for the impacts on the body, endocrinologist Rodacki points out that more recent evidence shows a possible impact of artificial sweeteners on the intestinal microbiota, in addition to increasing appetite.

— In studies with rats, the consumption of artificial sweeteners increased the desire for sugar-sweetened foods and body weight. A study in men of normal weight indicated that the ingestion of drinks sweetened with a sweetener induced a greater desire to eat and a lesser feeling of fullness, says the doctor.

Research conducted by Harvard University, in the United States, at the request of the World Health Organization, came to the conclusion that artificial and low-calorie sweeteners may not help with weight loss.

“Long-term studies are needed to assess the effects on overweight and obesity, the risk of diabetes, cardiovascular disease and kidney disease,” said the responsible researchers, in a publication in the British Medical Journal.

The best health products, according to experts, are those of natural origin, such as stevia, xylitol and erythritol. They have established safety and usually confer a sweetness similar to sugar, in addition to having few side effects and being stable at cooking temperature. But doctors are unanimous in stating that the ideal is food with its own flavor, without added sugar, whether natural or artificial.

Check sweetener specifications

Saccharin: It has a sweetness 300 to 500 times greater than sugar, therefore requiring a very small amount. It is resistant to the cooking temperature of food, has a metallic aftertaste and, in this sense, is normally used together with another type of sweetener.

Cyclamate: Resistant to temperature, it has a sweetness 30 to 40 times greater than sugar. It can be combined with saccharin, providing a sweeter taste. In the 1980s, it was banned in the United States due to animal studies that associated its ingestion with the development of bladder cancer. It is allowed in Brazil.

Acesulfame Potassium: It has 200 times more sweetness than sugar. Of all, it has the best flavor. Stable in pasteurization and sterilization.

Aspartame: It has 200 times more sweetness than sugar. When subjected to temperatures greater than 180ºC, it acquires a bitter taste. It is contraindicated for patients with phenylketonuria (a congenital disease in which the person cannot metabolize phenylalanine – the excess exerts a toxic action on several organs).

Sucralose: It has 600 times more sweetness compared to sugar. It has no aftertaste and is heat stable. Despite this, recent studies show that when subjected to temperatures greater than 120º, they can release toxic substances. Despite coming from sugar cane, it is not natural, because it undergoes chemical reactions.

Stevia: It has 300 times more sweetness than sugar and can be cooked in the oven. Extracted from the Stevia rebaudiana plant, a plant native to South America, common in southern Brazil. It has a slightly bitter taste, which often limits its use. It is among the best for health.

Erythritol: Virtually zero calories: 0.2 per gram. It has a well tolerated intake and is mostly used in the food industry (it is heat stable). It has 300 to 400 times more sweetness than sugar. Studies show that 90% of the compound is eliminated in the urine, the rest is fermented by intestinal bacteria. It is natural, extracted from sugar cane. It tastes a lot like sugar.

* intern under the supervision of Adriana Dias Lopes