The whole truth about sweeteners in the diet - should we be afraid of them? Dr Hanna Stolińska, MD, PhD, clinical dietitian

If they are so unhealthy and carcinogenic, why does the Polish Diabetes Association recommend using them instead of regular sugar, for example in cases of obesity and diabetes.

To help clear up the confusion, here are the answers to frequently asked questions about artificial sweeteners. But first, let's review some basics.

Sweetening substances

Sweetening substances are, according to the definition given by the European Parliament in 2008, compounds used to give foods a sweet taste or used in table sweeteners. They can be made from naturally occurring substances, such as a plant, herb, or sugar itself. Artificial sweeteners are considered intense sweeteners because they are several times sweeter than regular sugar.

Sugar substitutes are an attractive alternative because they contain almost no calories. In addition, you only need a small amount compared to table sugar to achieve the same level of sweetness. Artificial sweeteners are widely used in processed foods such as soft drinks and other beverages, baked goods, sweets, puddings and yogurts, canned foods, and sweet spreads such as jam.

Sugar substitutes can be divided into three groups:

• Natural: this group includes, among others: stevia, fructose, palm sugar, licorice, agave syrup, and maple syrup.
• Semi-synthetic:  mannitol, sorbitol, and xylitol, which are compounds naturally occurring in plants such as the rhizome of the common chicory, birch, and plum. They are less sweet than white sugar and also lower in calories. 1 g of polyol provides an average of 2.4 kcal, while 1 g of sugar provides 4 kcal. The addition of polyols increases the volume of the product, making it lower in calories. In addition, these compounds (mainly xylitol) provide a pleasant cooling effect in products such as candies and chewing gum.
• Synthetic: they can be used by diabetics, people trying to lose weight, and... maintain a beautiful smile, because sweeteners, unlike sugar, do not cause tooth decay. The most commonly used include aspartame and acesulfame K. They contain no calories.

Are artificial sweeteners harmful to health?

Concerns about artificial sweeteners began in the 1970s, when studies showed a link between the artificial sweetener saccharin and bladder cancer in laboratory rats. However, according to the National Cancer Institute and other health agencies, there is no strong scientific evidence that any artificial sweeteners approved for use cause cancer or any other serious illness. Several studies show that artificial sweeteners are generally safe in limited amounts, even for pregnant women. The average adult usually does not exceed the acceptable intake of artificial sweeteners.

Will artificial sweeteners help you lose weight?

One of the main reasons people choose to consume artificial sweeteners is to help lose or control their weight. Reducing overall daily calorie intake is a challenge for most people.

Replacing calories from sweet foods with zero-calorie sweeteners seems like an easy solution.  Some researchers believe that artificial sweeteners increase appetite and disrupt the body's natural ability to decode calorie intake. However, many studies are inconclusive due to the concept of reverse causality, which makes it difficult to determine a cause-and-effect relationship.

Regardless, many high-quality scientific studies show that replacing sugar with artificial sweeteners helps reduce body weight, fat tissue, and waist circumference.

In my opinion, the best way to lose weight is to moderately reduce daily calorie intake (by about 300-400 calories) and increase calorie expenditure through exercise (burning 200-300 calories). This will create a larger daily calorie deficit and is a more sustainable approach in the long term.

Artificial sweeteners and diabetes

Although studies are mixed, current evidence generally supports the use of artificial sweeteners among people with diabetes. It should be remembered that "sugar-free" or "reduced sugar" products do not always contain few carbohydrates or calories. Diabetes-friendly foods may still contain other types of sugar, such as refined flour, milk, or fruit, which count toward daily carbohydrate intake.

 Which artificial sweetener is best?

There is a lot to consider when deciding which artificial sweetener is best for you. Generally, it is recommended to use the smallest possible amount of any sweetener. Do you want to reduce your overall dependence on sweet foods and drinks? Just like with salty or fatty foods, you train your palate for what you crave. So, if you consistently consume very sweet dishes, you will probably continue to crave them.

Sugar alcohols and digestion

Some people may be sensitive to certain artificial sweeteners called sugar alcohols. Sorbitol, xylitol, lactitol, mannitol, erythritol, and maltitol are found in sugar-free candies, cookies, ice cream, beverages, and chewing gum. They can cause diarrhea, stomach cramps, gas, and bloating, especially if consumed in large quantities.

Natural artificial sweeteners

If you are looking for a more "natural" artificial sweetener, you can opt for those derived from organic substances. Stevia is made from the Stevia rebaudiana plant, which comes from South America. The leaves produce chemical substances called steviol glycosides. It contains a concentrated sweet taste that is 200 to 400 times sweeter than table sugar.

Your choice comes down to taste preferences. Some produce a bitter aftertaste that people do not tolerate. In such a case, it may be better to opt for a natural sweetener such as honey, maple syrup, or coconut sugar, but in a smaller amount.

If your goal is to work toward a healthier, less processed diet, choose whole foods such as fruits and vegetables. Many of them are naturally sweet and have the added benefit of essential vitamins and minerals that the body needs every day. This contrasts with artificial sweeteners, which have no nutritional value.