Sugar Substitutes SWEET BUT DEADLY?

Health Concerns and Risks of Using Sugar Substitutes

Sweets and sugar-sweetened pop or soft drinks have recently been blamed for an increasing number of negative health conditions, such as overweight and diabetes. This has led solid soft drink consumers to turn to artificially sweetened soft drinks as substitutes. The safety of artificial sweeteners or sugar substitutes has been questioned but the impact of high intakes of artificial sweeteners on pregnant women has hardly been addressed.

The association between intakes of sugar-sweetened and artificially sweetened soft drinks and preterm delivery will be investigated.

Prospective cohort analyses of 20,000 women from the Buenos Aires national birth cohort (2012-2014) will be conducted. Their soft drink intake for more than 10 years will be assessed in mid-pregnancy through the use of a food-frequency questionnaire. The primary outcome measure will be preterm delivery at less than 37 weeks. Other information will be assessed through telephone interviews.

Conceptual Framework - The study will stress the importance of gaining knowledge about what foods are right to eat, especially during pregnancy and right after delivery, for both mothers and their offspring.

Expected Results -- will suggest a possible connection of the excessive intake of both artificially sweetened and non-carbonated drinks to an increased risk of preterm delivery. But additional research to bolster the expected results will be recommended.

Introduction

Background and Significance - Most everyone has a sweet tooth and most everyone loves to drink refreshingly cool soft drinks when it is humid or to quench thirst. When the obesity epidemic hit the news, sweets lovers easily welcomed the offer of artificial sweeteners as replacement of ordinary sugar. More so when the FDA issued a list of approved artificial sweeteners, which not only replace the dreaded sugar but also offer to solve weight problems. But the continued consumption of sweet soft drinks presents a particular problem concerning pregnant women and preterm delivery.

The Problem and Its Importance -- Preterm delivery is a major pregnancy complication and major cause of perinatal deaths and diseases. Current research states that both artificially sweetened soft drinks and sugar-sweetened soft drinks link to hypertension, a known risk for preterm delivery. Some evidence also suggests that these shorten gestation due to high blood glucose concentrations and low-dose methanol exposure.

Research Question -- How the regular intake of artificially sweetened soft drinks for more than 10 years will affect the preterm delivery of the respondents

Hypothesis - Both sugar-sweetened and artificially sweetened soft drinks may be related to an increased risk of preterm delivery.

Research Objective -- The study will explore the association between maternal soft drink consumption in pregnancy and preterm delivery

Literature Review

Food Additives

Food additives are defined as substances made part of a food product during processing or production of that food (Zieve, 2012). They are either direct or indirect. Direct additives are placed during processing to make that food more appealing. They are either man-made or natural. Indirect additives are either already found in food during or after processing. Strongest concern goes to man-made ingredients added to foods, especially artificial sweeteners or sugar substitutes, such as aspartame, saccharine and sodium cyclamate (Zieve).

The U.S. Food and Drug Administration or FDA publishes a list of tested food additives it finds safe (Zieve, 2012). These substances are described as "generally recognized as safe" or GRAS. At present, there are approximately 700 items of this kind in the list. Congress endorses these substances safe and of "reasonable certainty" that ingesting them will result in no harm. The list is regularly re-tested and sugar is one of them. Some of these, which are found harmful to people or animals, may be allowed if the level of harm is 1 out of 100. People with allergies or food intolerances are advised to check the labels for their protection. These reactions may be mild or severe (Zieve).

The FDA and the Department of Agriculture are the supervising and regulating agencies of food additives sold in the country (Zieve, 2012). But they caution those with allergies or intolerances and under special diets to exercise caution in choosing and buying their food products. For their production, the U.S. government requires all manufacturers to list and label all the ingredients on their products (Zieve).

Artificial Sweeteners and FDA

These are added to food and drinks are options to natural sugar in satisfying the craving for something sweet (ADA, 2012). They are also called low-calorie sweeteners, sugar substitutes or non-nutritive sweeteners....

They are used in place of sugar and for fewer calories and carbohydrates. They are at least 100 times sweeter than ordinary or natural sugar, so one needs to use only a small amount. All sweeteners except aspartame are not metabolized by the body. This means that they cross body systems without getting digested. Thus, they do not provide calories (ADA).
The current list of FDA-approved artificial sweeteners reflects acesulfame K, aspartame, saccharin, sucralose and neotame (ADA, 2012). Food companies use them to make diet drinks, baked goods, frozen desserts, candy, light yogurt and chewing gum. They are also used as sugar substitute on the table. Stevia or Reb -- A is a product derived from the stevia plant, which is many hundred times sweeter than ordinary sugar. The USFDA recognizes it as generally safe for use as a food additive and sugar substitute in appropriate amounts. These substances contain no carbohydrates and, thus, do not raise blood glucose levels (ADA).

FDA Position on Aspartame Study

The USFDA (2007) reviewed the long-term carcinogenicity study of this artificial sweetener conducted by the European Ramazzini Foundation in Bologna, Italy. The USFDA did not find grounds to support the Foundation's conclusion that aspartame is cancer-causing. The USFDA thus retained its position on the safety of aspartame for use as artificial sweetener (USFDA).

The USFDA (2007) included aspartame among its list of approved artificial sweeteners in 1981. The body metabolizes this substance into amino acids aspartic acid, phenylalanine and methanol, which are produced also in the metabolism of other common foods. FDA requested the ERF for the data of the study but received only some of these data on February 28, 2006. It sought for the rest and for the review of the pathology slides of the study in June that year. Nut ERF did not send them as it did not agree to FDA's reviewing the slides. FDA had to make a position by using available data. It found significant shortcomings in the design, procedure, reporting and interpretation, which rendered its conclusion unreliable. Moreover, the data provided did not support the pathological findings of infection in test animals. FDA finds these changes incidental and spontaneous. None of the histo-pathological changes related to the use of aspartame. FDA suggested the conduct of another examination by an internationally-sponsored pathology working group on the tissue slides of the study to provide additional insight (USFDA).

Results from multiple studies on the safety of aspartame use include five, which reported negative chronic carcinogenicity (USFDA, 2007). One of them was a large epidemiology study, which found negative association between aspartame use and the occurrence of tumors. Based on these findings, it finds no reason to reverse its previous conclusion and position on the general safety of aspartame as a general-purpose food sweetener (USFDA).

Gender and Artificial Sweeteners

Women may appear to be the larger users of these substances, especially when they first broke into the market in the 50s and the 60s (Pena, 2012). But with the introduction of NutraSweet and the spread of great-tasting low-calorie products, these were as heavily markets to men. Children themselves are now users of the artificial sweetener sucralose Splenda in healthy family menus and for baking (Pena).

For their part, men play an important role in developing and marketing these substances (Pena, 2012). The chemists, salesmen and technologists in pharmaceutical, food and beverage companies were men. When the first two of these substances were accidentally discovered and developed in the 1870s and 1930s, men forged partnerships with food and beverage companies to use these substances as low-calorie sweeteners for sale to consumers. The partnerships spread to fruit canning (Pena).

General Health Issues and Artificial Sweeteners

Official position on these substances says that the choice of blend is irrelevant (Meister, 2006). The only consideration is taste or cost but all the artificial sweeteners listed by the FDA are all well-tested and found safe to use. Their consumption levels need not be limited for safety. But since they have minimal nutritional value, the health-minded should limit consumption so that these sweeteners do not replace nutritious foods, especially milk, by children and adolescents. On the other hand, their use may also improve one's nutrition if by drinking a zero-calorie diet soft drink allows him to eat or drink a more nutritious food with sufficient amount of calories. Results from 2 national diet surveys show that American adults who do so have better diets through higher vitamin and mineral intakes than those who are not on a diet and consume the equivalent foods and beverages. The effect of sugar substitutes on weight control was controversial for a while. A 1986 British study claimed that those who consumed aspartame-sweetened water increased the…