Are Sugar Substitutes Okay For Your Kidneys?

By Sara Fenton, RD
Satellite Healthcare San Francisco
 
Humans crave sweets. We evolved to enjoy sweetness because it meant lots of calories in times of famine. Unfortunately, in an age of plenty, our prehistoric cravings are backfiring on us. Excessive sugar intake could be contributing to many health conditions including obesity, diabetes, high blood pressure, heart disease and kidney disease.
 
The difficult search for the perfect sugar substitute continues. However, despite all the products on the market today, there still does not seem to be an easy answer to the sugar dilemma.

Artificial sweeteners

Artificial sweeteners, such as Saccharin (Sweet’N Low), Aspartame (NutraSweet and Equal) and Sucralose (Splenda) are some of the most well-known sugar substitutes. The advantages of these is that they are zero-calorie, do not raise blood sugar levels, and do not contribute to tooth decay.
 
Based upon animal studies, artificial sweeteners have been criticized for the potential to cause various health problems including cancer. However, the U.S. Food and Drug Administration (FDA) has established an acceptable maximum daily intake considered safe to consume.  

Sugar alcohols

Sugar alcohols such as xylitol, sorbitol and maltitol are not usually used in home cooking, but commonly found in processed foods to add sweetness. The biggest drawback of sugar alcohols is that they can cause bloating, intestinal gas and diarrhea, especially when eaten in large amounts. They also do contain calories, and can raise blood sugars, even if to a lesser degree than regular sugar.
 
Products claiming to be “sugar free” may contain these sweeteners. But be aware: These foods do still have calories and can contribute to weight gain and increased blood sugars. Always read your food labels to determine the carbohydrate content.

New sweeteners

Newer sweeteners, such as stevia (Truvia, Pure Via) have been approved as “generally recognized as safe” in the isolated chemical form. The FDA has not approved stevia leaves or "crude stevia extracts" for use as food additives.  These sweeteners do not raise blood sugars, but since they are relatively new products, it is advised to use them in moderation. Some studies have shown negative effects on the kidneys.

Potential risks

Despite the growing number of artificial sweeteners on the market, skepticism remains that these sweeteners are helping us achieve our health goals. New research is showing that consuming foods and drinks sweetened with low calorie sugar substitutes may actually be contributing to weight gain, stroke, hypertension, and cardiovascular disease.
 
Although artificial sweeteners do not cause the spike in blood sugar that real sugar does, it may actually be hijacking our taste buds, stimulating our appetites and causing us to overeat.

Natural sugar alternatives

Using more natural sugar alternatives such as honey, maple syrup and agave nectar are very safe from a health perspective, but will raise blood sugars similarly to sugar. When using these substitutes, it is a good idea to use in moderation.
Sweetening baked goods naturally with applesauce, ripe bananas, dates, or prunes is an excellent option instead of sugar. These foods add beneficial nutrients and fiber that plain sugar lacks.  

Bottom line

There is no magic bullet in sugar replacements, and should always be used in moderation. The best way to avoid health issues is to drastically cut back on sugar all together; artificial and “real” sugar alike. By sticking to whole foods, such as fruits, vegetables, legumes, whole grains you can change your taste buds to enjoy the sweetness found in nature, while avoiding negative health consequences.
 

References:

1. Garner C. et al Nonnutritive sweeteners: Current use and health perspectives. A Scientific Statement from the American Heart Association and American Diabetes Association Circulation. 2012; 126:509
2. Artificial sweeteners and Cancer. National Cancer Institute. 
3. Low-Calorie Sweeteners May Contribute to Weight Gain. Consumer Reports. 
4. High Intensity Sweeteners. US Food and Drug Administration.