1. Nutritive and Nonnutritive Sweeteners Jenna Guadagna and Yimy Rodrieguez Dr.DeNysschen Introduction to Dietetics Summer 2015

2. Nutritive vs. Nonnutritive Sweetener  Nutritive Sweetener  Carbohydrate  Energy  Natural, Processed, Added  Polyols Nonnutritive Sweetener Minimal or No Carbohydrate Content 7 Generally Regarded as Safe in the United States

3. Added Sugars  Sugars and Syrups  14.6% of adults energy in the U.S comes from added sugar

4. Nutritive Sweeteners  Monosaccharides and Disaccharides  Sugar  Sugar Caloric Sweeteners  Added Sugars

5. Nutritive Sweeteners Recognized by the FDA  Glucose  Fructose  Galactose  Sucrose  Lactose  Maltose  Corn Based  Agave Nectar Brown Sugar Confectioner’s Powdered Sugar Raw Sugar Sucrose White Granulated Sugar Corn Syrup Corn Syrup Solids High Fructose Corn Syrup Dextrose Fruit Nectars Honey Invert Sugar Honey Malt Syrup Maple Syrup Pancake Syrup

6. Other Nutritive Sweeteners  Cane Juice  Evaporated Corn Sweetener  Fruit Juice Concentrate  Crystal Dextrose  Glucose  Liquid Fructose  Sugar Cane Juice  Fruit Nectar

7. High Fructose Corn Syrup  Produced from Corn Syrup  Enzymatic Processing to Increase Fructose  Mixed With Glucose  Baked Goods – 42%  Beverages – 55%  Academy Evidence Analysis Library (EAL)  Compared high fructose corn syrup with other nutritive sweeteners  Association with obesity and metabolic or adverse effects within the body  Fair amount of data  Effects are similar to other nutritive sugars

8. Polyols  Sugar alcohols  Sorbitol  Mannitol  Xylitol  Erthritol  D-Tagatose  Lacitol  Isomalt  Why are they used?  Absorbed slowly and incompletely  Sugar free foods Academy Evidence Analysis Library (EAL)  Compared sugar alcohols with other nutritive sweeteners  Association with obesity and metabolic or adverse effects within the body  Limited data  Moderate intake is tolerated  10-15grams per day

9. Chronic Health Issues  Added Sugars + Solid Fats + Excess Intake = Chronic Health Issues  Inflammation  Pre-diabetes  Overweight  Type 2 Diabetes  Obesity  Cardiovascular Disease

10. Main Contributors of Added Sugars in Our Diet  #1  Soda  Energy Drinks  Sports Drinks  #2  Grain-Based Desserts  #3  Fruit Drinks  #4  Dairy Desserts  #5  Candy

11. Consumption of Sucrose, Glucose, and Fructose  National Health and Nutrition Examination Survey  NHANES  Economic Research Service  ERS

12. Intake of Total Added Sugars by Different Population Groups  Lower Socioeconomic Status = Higher Intake of Added Sugars  Lower Income  Lower Level of Education  Ethnic Minority Groups Teenagers years of age – 13 years of age 25% total energy Boys- 31.2% Girls – 27.8% Men > Women African American and Mexican American African American – 32.3% Mexican American – 39%

13. Nutritive Sweeteners and Behavioral Issues  Is there a negative influence between added sugars and the behavior or cognition in children with behavioral issues?  Evidence with refined sugars and attention deficit hyperactivity disorder (ADHD)  Outside research  Behavioral issues are more connected with environmental factors outside of nutrition.  Diets  Removing additives

14. Food Consumption Patterns of Added Sugars  The 2010 Dietary Guidelines for Americans  DGA  16% Total Population  National Health and Nutrition Examination Survey (NHANES)2005- 2006  14.6% Total Population  National Health and Nutrition Examination Survey (NHANES) 2007- 2008

15. High Fructose Corn Syrup Change in Availability  Increased  1970-1999  Decreased  2005  Why?

16. Recommendations  Institute of Medicine  American Heart Association  World Health Organization  Dietary Guidelines for Americans  ChooseMyPlate  MyFood-a-pedia

17. Non Nutritive Sweeteners 17

18. Why do we produce and consume Nonnutritive sweeteners?  Economical  Limits Caloric Intake  Beneficial for Diabetes patients, as it better monitors carbohydrate intake 18

19. Approved by the FDA 7 NNS  Saccharin- use in diet sodas, 300 times sweeter than sucrose  Acesulfame K- from baked goods to ice cream, 200 times sweeter  Aspartame - beverages, degrades during heating,160-220 times sweeter  Luo Han guo extract- tabletop sweetener, no ADI stablished, 150-300 sweeter  Neotame- use in food processing, 7000-13000 sweeter  Stevia- common in cereals, 250 times sweeter  Sucralose (splenda)- heat stable, general purpose, 600 times sweeter 19

20. Nonnutritive Sweetener reviewed by organizations  Dietary Guidelines for Americans 2010  American Diabetes Association  National Cancer Institute 20

21. Academy Evidence Analysis Library (EAL) reviewed  In adults, does using foods or beverages with non nutritive sweetener in an energy-restricted or ad libitum diet affect energy balance (weight)?  Conclusion Statement:  Aspartame- Grade I=Good, good evidence that it does help with weight management  Saccharin- Grade III= Limited  Sucralose- Grade III= Limited 21

22. EAL continued…  In adults, does using foods or beverages with nonnutritive sweeteners affect appetite or food intake?  Conclusion Statement:  Aspartame, Grade I=Good, there is good evidence that it doesn't affect it  Saccharin, Grade III= Limited  Sucralose, Grade III= Limited 22

23. EAL continued…  What is the evidence from human subjects research that nonnutritive sweeteners consumption is associated with adverse effects in the general population?  Conclusion Statement:  Aspartame, Grade I=Good, good evidence that it doesn't cause adverse effects  Saccharin, Grade III=Limited  Sucralose, Grade III= Limited 23

24. Outside Research  According to Mattes and Popkin  Nonnutritive sweeteners enhances palatability  Increases acceptability of sugar free foods to increase their intake over more energy dense versions. 24

25. Overall point  Dietitians should be familiar with the different types of nonnutritive sweeteners  Important in diabetes education 25

26. The Academy of Nutrition and Dietetics' Position of Nutritive and Nonnutritive Sweeteners  “It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive and nonnutritive sweeteners when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as Individual health goals and personal preference. “

27. References Briefel R. Reducing Calories and Added Sugars by Improving Children's Beverage Choices. Journal of the Academy of Nutrition and Dietetics. 2013-02-01;113:269-275. Chattopadhyay S, Raychaudhuri U, Chakraborty R. Artificial sweeteners – a review. Journal of Food Science and Technology. 2014;51(4):611-621. doi:10.1007/s13197-011-0571-1. Fitch, Cindy, and Kathryn S. Keim. "Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners.” Journal of the Academy of Nutrition and Dietetics 112.5 (2012): 739-58. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms R. DMattes - B. MPopkin - American Journal of Clinical Nutrition – 2008 Schab D.W., Trinh N.H.T. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta- analysis of double-blind placebo-controlled trials. J. Dev. Behav. Pediatr.2004;25:423–434. doi: 10.1097/00004703- 200412000-00007. Welsh JA. Consumption of added sugars is decreasing in the United States1234. The American journal of clinical nutrition. 2011-09-01;94:726-734. Woo HD. Dietary patterns in children with attention deficit/hyperactivity disorder (ADHD). Nutrients. 2014-04-01;6:1539- 1553. Briefel R. Reducing Calories and Added Sugars by Improving Children's Beverage Choices. Journal of the Academy of Nutrition and Dietetics. 2013-02-01;113:269-275. Chattopadhyay S, Raychaudhuri U, Chakraborty R. Artificial sweeteners – a review. Journal of Food Science and Technology. 2014;51(4):611-621. doi:10.1007/s13197-011-0571-1. Fitch, Cindy, and Kathryn S. Keim. "Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners.” Journal of the Academy of Nutrition and Dietetics 112.5 (2012): 739-58. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms R. DMattes - B. MPopkin - American Journal of Clinical Nutrition – 2008 Schab D.W., Trinh N.H.T. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta- analysis of double-blind placebo-controlled trials. J. Dev. Behav. Pediatr.2004;25:423–434. doi: 10.1097/00004703- 200412000-00007. Welsh JA. Consumption of added sugars is decreasing in the United States1234. The American journal of clinical nutrition. 2011-09-01;94:726-734. Woo HD. Dietary patterns in children with attention deficit/hyperactivity disorder (ADHD). Nutrients. 2014-04-01;6:1539- 1553. 27