example, its ADI is 50 mg per kilogram of body weight
per day. An adult weighing 150 pounds would have to
drink 20 12-ounce containers of diet soft drink con-
taining aspartame, eat 42 servings of gelatin, or use 97
packets of tabletop sweetener to reach the ADI.
Some specific artificial sweeteners must be used
cautiously by certain groups of people:
Polyols: Some polyols—most commonly mannitol
and sorbitol—have a laxative effect in some people
if they are consumed in large amounts (more than
50 g/day of sorbitol or 20 g/day of mannitol). Per-
sons with diabetes may wish to limit their consump-
tion of products containing polyols or increase their
use gradually until they see how their bodies react to
these sweeteners.
Aspartame: Because aspartame is broken down in
the body to the amino acid phenylalanine, foods or
beverages containing aspartame should not be used
by persons with phenylketonuria (PKU), a rare
inherited disease that causes phenylalanine to accu-
mulate in the body. The FDA requires all products
containing aspartame sold in the United States to be
labeled with the following warning: ‘‘Phenylketonu-
rics: Contains Phenylalanine.’’ Although the break-
down products of neotame also include phenylalanine,
the amount is so small that it does not affect people
with PKU.
InteractionsThere are no known interactions with prescription
drugs caused by the use of nutritive or nonnutritive
sweeteners. As was noted above, some nonnutritive
sweeteners are considered useful excipients for medi-
cations precisely because they are chemically inert.
Parental concernsThere have been concerns expressed about the use
of artificial sweeteners by children because children
consume more sweeteners, both nutritive and nonnu-
tritive, per pound of body weight on a daily basis than
adults. The use of fruit juice and other sweet beverages
by children has greatly increased since the 1980s; how-
ever, studies indicate that even children who drink
large amounts of diet soda and other beverages usually
remain well below the ADI levels for aspartame and
other nonnutritive sweeteners. The chief risk to child-
ren’s digestive health is fructose, which is found in
such popular children’s drinks as apple juice. Fructose
is incompletely digested by children below the age of
18 months and may cause diarrhea in older children.
Children diagnosed with nonspecific diarrhea may
benefit from being given smaller amounts of fruit
juice to drink.
During the early 1990s, some researchers identified
a possible connection between high levels of aspartame
consumption and attention-deficithyperactivitydisor-
der (ADHD) in children. Two studies published in
1994 inPediatricsand theNew England Journal of
Medicinerespectively, however, found no connection
between aspartame and ADHD, even when the chil-
dren were given 10 times the normal daily amount of
aspartame. Aspartame and other nonnutritive sweet-
eners, however, may have an additive effect on nerve
cell development when they are combined with food
colorings. This possibility was suggested by a 2006
study of laboratory mice in the United Kingdom, but
the implications for humans are far from clear.
High intake of sweeteners added to food is of
greatest concern during adolescence. As people age,
they generally lower their intake of calories from
added sugars. Fewer than 10% of adults over age 50
derive more than 25% of their daily calories from
sugars, which is the maximal intake value established
by the IOM. Nearly a third of adolescent females
exceed this level, however, with almost a third of the
extra sugar intake coming from carbonated beverages
sweetened with high-fructose corn syrup. Although
the rise inobesityin children and adolescents is a
complex problem that cannot be attributed to a single
factor, preliminary studies suggest that nonnutritive
sweeteners may be useful in reducing adolescents’ con-
sumption of drinks sweetened with HFCS.Resources
BOOKS
Nabors, Lyn O’Brien, ed.Alternative Sweeteners, 3rd ed.
New York: M. Dekker, 2001.
PERIODICALS
‘‘Artificial Sweeteners: No Calories... Sweet!’’FDA Con-
sumer40 (July-August 2006). Available online at http://
http://www.fda.gov/fdac/features/2006/406_sweeteners.html
(accessed March 22, 2007).
Henkel, John. ‘‘Sugar Substitutes: Americans Opt for
Sweetness and Lite.’’FDA Consumer, February 2006.
Available online at http://www.cfsan.fda.gov/dms/
fdsugar.html (accessed March 22, 2007).
Lau, K., W. G. McLean, D. P. Williams, and C. V. Howard.
‘‘Synergistic Interactions between Commonly Used
Food Additives in a Developmental Neurotoxicity
Test.’’Toxicological Sciences90 (March 2006): 178–187.
Shaywitz, B. A., C. M. Sullivan, G. M. Anderson, et al.
‘‘Aspartame, Behavior, and Cognitive Function in
Children with Attention Deficit Disorder.Pediatrics 93
(January 1994): 70–75.Artificial sweeteners