Alternative sweetener use is widespread – we review their use and the evidence around their effects.

The rise of low-sugar and sugar-free products has led to significant growth in the use of alternative sweeteners.

Sweetener trends

Globally, high intensity sweeteners are projected to grow in both foods and beverages, with greater growth in foods, according to Inkwood Research. The growth is attributable to the rise of health issues such as obesity, diabetes and dental caries, and the implementation of sugar taxes. China is the biggest producer and exporter of high-intensity sweeteners in the Asia-Pacific region, accounting for 78% of global production in 2018.

Euromonitor International reports alternative sweeteners experienced an increase in demand in Australia during 2020 as consumers aimed to consume less sugar. According to a Mordor Intelligence report, aspartame is the leading sweetener in the Australian market. It has experienced around 10% growth in the past 5 years (from 2016) and is predicted to grow a further six percent between 2021-2024.

Types of sweeteners

Sweeteners are classified as:

• Nutritive (such as sucrose, glucose, fructose),
• Non-nutritive sweeteners with low or no kilojoule content (such as aspartame, sucralose, cyclamate), also known as artificial sweeteners, intense sweeteners, low calorie sweeteners; or LCS),
• Sugar-alcohols used for bulking (such as sorbitol, xylitol, erythritol), which also have a low kilojoule content.

An emerging group of non-nutritive sweeteners are called natural intense sweeteners because they are sourced from plants. Examples include steviol glycosides from stevia and monk fruit extract. When the sweet molecules are extracted and concentrated, they are between 200-400 times sweeter than sucrose.

Sugar alcohols

Sugar alcohols are used as a bulking agent to thicken or stabilise foods as well as for their sweetness (they are less sweet than sugar). They are often used in combination with non-nutritive sweeteners. Food applications include confectionery, gum and ice confection. Because they are only partially digested, excess consumption can have a laxative effect and foods containing sugar alcohols must carry a warning on the label to this effect. They are recommended as food ingredients to avoid for people on low FODMAP diets. See our article on the  The Low FODMAP Diet.

What sweeteners are approved for use in Australia & New Zealand?

Food Standards Australia and New Zealand (FSANZ) conduct thorough safety assessments of all food additives including alternative sweeteners before they are approved for use in food. Like other food additives, non-nutritive or intense sweeteners are allocated an additive code number that can be used in food labels (monk fruit extract is relatively new and has not yet been allocated a number).

Intense sweeteners and additive code numbers approved for use in Australia and New Zealand

Acesulphame potassium (950)

Advantame (969)

Alitame (956)

Aspartame (951)

Aspartame-acesulphame salt (962)

Cyclamate (952)

Monk fruit extract

Neotame (961)

Saccharin (954)

Steviol glycosides (960)

Sucralose (955)

Thaumatin (957)

Find out more about intense sweeteners from the FSANZ website.

Can alternative sweeteners assist sugar reduction?

An expert workshop in the UK assessed the options in the Public Health England ‘Sugar reduction’ report, including how the food and drink industry could help. They concluded that sugar reduction to 5% of energy (as per the WHO ‘conditional’ recommendation) is unlikely to be achieved anytime soon but a gradual reduction from current intakes is feasible. They suggest starting with reformulation of high-sugar, low nutrient products. They say there is most potential for replacing free sugars in beverages with non-nutritive, intense sweeteners and possibly via gradual reduction in sweetness levels.

What does the evidence tell us so far?

Weight: One of the reasons for choosing foods and drinks with alternative sweeteners instead of sugar is for weight control. The systematic review conducted for the US Scientific Report of the 2020 Dietary Guidelines advisory committee found, “limited evidence suggests that low- and no- calorie sweetened beverage consumption is associated with reduced adiposity in adults”. In an expert consensus on low calorie sweeteners published in 2020 it was agreed that LCS can help people reduce their energy intake and manage body weight if used as a sugar substitute.

Diabetes: The expert consensus also agreed that LCS have no impact on blood sugar regulation and are a useful sugar substitute for people with diabetes. Several studies have shown positive associations between LCS use and the risk of type 2 diabetes, however the experts agreed the relationship is not causal. Reverse causality is a likely explanation for the association; people with high blood glucose levels are likely to be choosing foods and drinks containing LCS.

Microbiota: Another hot topic in nutrition is gut health and there have been suggestions that LCS may be detrimental. The expert consensus was LCS do not have adverse effects on human gut bacteria. Read a published 2019 review here.

Appetite: The experts agreed LCS beverages have similar impact to water on appetite and energy intake.

Is there a link with cancer?

While there are numerous frightening tales online, the Cancer Council Australia and the American Cancer Society says there’s no clear evidence that artificial sweeteners cause cancer. Aspartame (branded as Nutrasweet® and Equal®) in particular has been the target of much controversy and online conspiracy theories, despite the fact it is one of the most studied sweeteners with over 200 studies attesting to its safety. Aspartame has been approved safe for use by regulatory agencies in more than 100 countries around the world.

What do we still need to find out?

The expert consensus report identified issues requiring more research before firm conclusions could be made.

• What are the long-term effects of LCS on body weight and health, including metabolic and gut function?
• Do the effects vary between individuals?
• Does the dietary context matter?
• Will less exposure to sweetness affect food choice and intake?
• Can LCS help improve long term diabetes management?

For a good desktop reference, check out The Ultimate Guide to Sugars and Sweeteners by Dr Alan Barclay and Philippa Sandall (Shwide-Slavin)