VOLUME 10 NUMBER 4 • NOVEMBER 2013
139
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Keep and Copy Series
NON-NUTRITIVE SWEETENERS:
GOOD OR BAD?
S Afr J Diabetes Vasc Dis
2013;
10
: 139–141
H
umans have a natural preference for foods
that taste sweet. The most commonly used
substance to sweeten foods is sucrose. In
2010 about 300 million people were estimated to
have type 2 diabetes mellitus (T2DM) globally and
this number is expected to rise to nearly 450 mil-
lion by 2030. In 2009 the American Heart Associa-
tion (AHA) released a scientific statement calling for
a reduction in sugar intake as a way of decreasing
obesity and heart disease.
1
A high-sugar, high-fat diet is one of the factors
to be blamed for the rise in T2DM and obesity.
2,3
As a result of the negative effects of sugar, an
alternative many patients are consuming is non-
nutritive sweeteners (NNS).
2
However, how useful NNS
are in improving dietary choices is controversial.
4
According to the Academy of Nutrition and Di-
etetics, NNS have caused many concerns among
healthcare practitioners and the general public.
5
The
Calorie Control National Consumer Survey which
was conducted in the USA found that of nearly 200
million consumers in the USA, 85% of the population
use NNS, and 8–11% of consumers do not use NNS
due to concerns over their health.
6
DEFINITION OF A NNS
A NNS offers little or no energy when it is ingested.
They are also known as low-calorie sweeteners,
artificial sweeteners, non-caloric sweeteners and
Ruwaida Amod
Dietitian, Pietermaritzburg
e-mail:
intense sweeteners.
5,7
An ideal artificial sweetener
should not affect glucose homeostasis and have no
hormonal effects pertaining to hunger.
4
NNS are many times more intense than sucrose,
at approximately 30 to 13 000 times sweeter.
2
As an
example, sucralose, which is one of the most cur-
rent sweeteners on the market, is about 600 times
sweeter than sucrose.
8
The first NNS to be introduced to the commercial
market was saccharin in the late 1800s.
9
Common
artificial sweeteners currently on the market are as-
partame, sucralose and acesulfame-K.
10
A new NNS
that has emerged on the market, Stevia, has extracts
from the plant
Stevia rebaudiana
and shows great
promise as a natural NNS.
7
NNS can be found in
a number of commercially manufactured products
such as beverages, ice cream, chewing gum, choco-
late, jams and yoghurts.
2
USES OF NNS
Some of the most common uses of NNS include:
to sweeten foods so that individuals with diabe-
•
tes can enjoy a variety of foods and beverages
without the increases in kilojoules in the diet
2,9
to achieve the aim of good blood glucose con-
•
trol
to achieve energy control in patients who are
•
aiming to lose weight
to increase the palatability of foods.
•
2,5,9
There is much debate surrounding the use of non-nutritive sweeteners (NNS) among
consumers and more so in the diabetic population. Previous uses of artificial sweeteners
included to improve glycaemic control, achieve energy balance and assist in weight
reduction. Current research is examining whether the benefits of utilising NNS to achieve
these goals outweigh the risks, primarily on a long-term basis.
