Healthy Living

Sweeteners and Sugar Substitutes: Parent FAQs

When it comes to sugar substitutes, parents have a lot of questions―especially as more low-calorie food and drinks come on the market.

In fact, according to a report from the American Academy of Pediatrics, the number of foods and beverages made with nonnutritive (no- or low-calorie) sweeteners has quadrupled in recent years. In addition to all the diet soda and zero calorie products, nonnutritive sweeteners are also used in a wide variety of reduced sugar or no-sugar-added school lunchbox favorites like jelly and jams, yogurt, pudding, and fruit cups.

Frequently Asked Questions: Nonnutritive Sweeteners & Too Much Added Sugar in Kids' Diets

Is there an acceptable amount of sweeteners kids can eat or drink daily?

The FDA sets an acceptable daily intake for approved products people eat or drink, based on body weight. The limit is set above what researchers think would usually be consumed. For example, a 40-pound child would have to drink four 12-ounce cans of diet soda every day to reach the limit, according to the Academy of Nutrition and Dietetics. Products often contain different combinations of nonnutritive sweeteners, which reduces the risk of consuming more than the limit for each individually.

Children with a rare inherited condition called phenylketonuria (PKU) should avoid aspartame.

PKU prevents the body from being able to properly break down an amino acid called phenylalanine, which is used to make aspartame. Labels on aspartame-containing foods and beverages are required to have a statement about this.

How do I know how much nonnutritive sweetener is in a product?

Right now, it takes some guesswork. Manufacturers list nonnutritive sweeteners among ingredients, but they aren't required to say how much each product contains. The American Academy of Pediatrics (AAP) advocates for the inclusion of nonnutritive sweeteners on all food labels; parents have a right to know what they are feeding their families.

How many different no- and low-calorie sweeteners are there?

There are 8 nonnutritive sweeteners currently approved by the US Food and Drug Administration (FDA). These "high intensity" sweeteners, which are between 180 and 20,000 times sweeter than table sugar (sucrose).

Nonnutritive Sweeteners Approved by the U.S. Food and Drug Administration
Name:	Brand:	Examples of products it is used in:
Saccharin	Sweet'N Low Necta Sweet Sweet Twin	Diet sodas, "low sugar" or "reduced sugar" jellies and jams, cookies, chewing gum, yogurt.
Aspartame	NutraSweet Equal Sugar Twin	Sugar-free gelatin, diet sodas, flavored drink mixes, reduced-calorie fruit juice, energy drinks, breakfast cereals, sugar-free ice cream.
Acesulfame potassium (Ace-K)	Sweet One Sunette	Diet shake mixes, sugar-free hard candies, no-sugar-added fruit cups, electrolyte replacement drinks, diet sodas, baked goods, salad dressings.
Sucralose	Splenda	Diet sodas energy drinks, flavored drink mixes, sports drinks, sugar-free puddings and gelatins, no-sugar-added ketchup.
Neotame	Newtame	Flavored fruit drinks, protein shakes, chewing gum
Stevia (steviol glycosides from leaves of stevia plant)	Trivia PureVia	Protein shakes, diet sodas and flavored waters, vitamin-enriched flavored drinks.
Luo han guo (extracts of Siraitia grosvenorii Swingle fruit, also called monk fruit)	Monk Fruit in the Raw Nectress PureLo Enliten	Coffee and protein beverages, yogurt, frozen desserts, teas.
Advantame	No brand name yet	Approved in 2014, it is beginning to be used in products such as sports drinks.

Is it true artificial sweeteners cause cancer?

While early animal studies raised concerns about possible cancer links from consuming large amounts of some artificial sweeteners, no studies have found a link between use of these sweeteners and cancer in humans. Similarly, despite some concerns raised, there is no scientific evidence showing aspartame is tied to attention deficit hyperactivity disorders, birth defects, or lupus.

What are the negative health effects of sweeteners on children?

Recent research suggests possible links between nonnutritive sweeteners and changes in appetite and taste preferences in children. This, in turn, could affect weight and health. Other research is looking into whether these sweeteners cause changes in the gut microbiome―which is made up of "friendly" bacteria--and may affect blood sugar levels and lead to metabolic syndrome, insulin resistance, and diabetes.

Can nonnutritive sweeteners help with weight-loss?

Parents often believe "zero-calorie" sweeteners are the key to weight loss. Most studies show swapping nonnutritive sweeteners for sugar-sweetened foods and beverages can help reduce weight gain or lead to small amounts of weight loss in children. However, most of these studies only looked at short-term results; other studies have linked nonnutritive sweetener use with weight gain.

It is currently unclear whether there are any long-term health effects from these products on children.

The AAP is advocating for more research and reminds parents that nonnutritive sweetener use alone, without other diet and lifestyle changes changes, probably won't lead to significant weight loss.

Remember: If you have questions about your child's diet, talk with your pediatrician.

Additional Information:

How to Reduce Added Sugar in Your Child's Diet: AAP Tips
Preventing Tooth Decay
High-Intensity Sweeteners (U.S. Food and Drug Administration)
Nutritive and Nonnutritive Sweetener Resources (USDA)

Last Updated: 10/28/2019

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.