A sugar substitute is a food additive that provides a sweet taste like that of sugar while containing significantly less food energy than sugar-based sweeteners, making it a zero-calorie or low-calorie sweetener. Artificial sweeteners may be derived through manufacturing of plant extracts or processed by chemical synthesis. Sugar alcohols such as erythritol, xylitol, and sorbitol are derived from sugars. In 2017, sucralose was the most common sugar substitute used in the manufacture of foods and beverages; it had 30% of the global market, which was projected to be valued at $2.8 billion by 2021.
In 1969, cyclamate was banned for sale in the US by the Food and Drug Administration. As of 2018, there is no strong evidence that non-sugar sweeteners are either unsafe or result in improved health outcomes.
When these sweeteners are provided for restaurant customers to add to beverages such as tea and coffee, they are provided in small colored paper packets (see image); in North America, the colors are typically blue for aspartame, pink for saccharin (US)[note 1] or cyclamate (Canada), yellow for sucralose, orange for monk fruit extract, and green for stevia. These sweeteners are also a fundamental ingredient in diet drinks to sweeten them without adding calories.
High-intensity sweeteners – one type of sugar substitute – are compounds with many times the sweetness of sucrose, common table sugar. As a result, much less sweetener is required and energy contribution is often negligible. The sensation of sweetness caused by these compounds (the "sweetness profile") is sometimes notably different from sucrose, so they are often used in complex mixtures that achieve the most intense sweet sensation.
If the sucrose (or other sugar) that is replaced has contributed to the texture of the product, then a bulking agent is often also needed. This may be seen in soft drinks or sweet teas that are labeled as "diet" or "light" that contain artificial sweeteners and often have notably different mouthfeel, or in table sugar replacements that mix maltodextrins with an intense sweetener to achieve satisfactory texture sensation.
In the United States, six high-intensity sugar substitutes have been approved for use: aspartame, sucralose, neotame, acesulfame potassium (Ace-K), saccharin, and advantame. Food additives must be approved by the FDA, and sweeteners must be proven as safe via submission by a manufacturer of a GRAS document. The conclusions about GRAS are based on a detailed review of a large body of information, including rigorous toxicological and clinical studies. GRAS notices exist for two plant-based, high-intensity sweeteners: steviol glycosides obtained from stevia leaves (Stevia rebaudiana) and extracts from Siraitia grosvenorii, also called luo han guo or monk fruit.
Cyclamates are used outside the United States, but are prohibited from manufacturing as a sweetener within the United States. The majority of sugar substitutes approved for food use are artificially synthesized compounds. However, some bulk plant-derived sugar substitutes are known, including sorbitol, xylitol and lactitol. As it is not commercially profitable to extract these products from fruits and vegetables, they are produced by catalytic hydrogenation of the appropriate reducing sugar. For example, xylose is converted to xylitol, lactose to lactitol, and glucose to sorbitol.
Sorbitol, xylitol and lactitol are examples of sugar alcohols (also known as polyols). These are, in general, less sweet than sucrose but have similar bulk properties and can be used in a wide range of food products. Sometimes the sweetness profile is fine-tuned by mixing with high-intensity sweeteners.
Acesulfame potassium (Ace-K) is 200 times sweeter than sucrose (common sugar), as sweet as aspartame, about two-thirds as sweet as saccharin, and one third as sweet as sucralose. Like saccharin, it has a slightly bitter aftertaste, especially at high concentrations. Kraft Foods has patented the use of sodium ferulate to mask acesulfame's aftertaste. Acesulfame potassium is often blended with other sweeteners (usually aspartame or sucralose), which give a more sucrose-like taste, whereby each sweetener masks the other's aftertaste and also exhibits a synergistic effect in which the blend is sweeter than its components.
Unlike aspartame, acesulfame potassium is stable under heat, even under moderately acidic or basic conditions, allowing it to be used as a food additive in baking or in products that require a long shelf life. In carbonated drinks, it is almost always used in conjunction with another sweetener, such as aspartame or sucralose. It is also used as a sweetener in protein shakes and pharmaceutical products, especially chewable and liquid medications, where it can make the active ingredients more palatable.
Aspartame was discovered in 1965 by James M. Schlatter at the G.D. Searle company. He was working on an anti-ulcer drug and accidentally spilled some aspartame on his hand. When he licked his finger, he noticed that it had a sweet taste. Torunn Atteraas Garin oversaw the development of aspartame as an artificial sweetener. It is an odorless, white crystalline powder that is derived from the two amino acids aspartic acid and phenylalanine. It is about 180–200 times as sweet as sugar and can be used as a tabletop sweetener or in frozen desserts, gelatins, beverages, and chewing gum. When cooked or stored at high temperatures, aspartame breaks down into its constituent amino acids. This makes aspartame undesirable as a baking sweetener. It is more stable in somewhat acidic conditions, such as in soft drinks. Though it does not have a bitter aftertaste like saccharin, it may not taste exactly like sugar. When eaten, aspartame is metabolized into its original amino acids. Because it is so intensely sweet, relatively little of it is needed to sweeten a food product, and is thus useful for reducing the number of calories in a product.
The safety of aspartame has been studied extensively since its discovery with research that includes animal studies, clinical and epidemiological research, and postmarketing surveillance, with aspartame being one of the most rigorously tested food ingredients to date. Although aspartame has been subject to claims against its safety, multiple authoritative reviews have found aspartame to be safe for consumption at typical levels used in food manufacturing. Aspartame has been deemed safe for human consumption by over 100 regulatory agencies in their respective countries, including the UK Food Standards Agency, the European Food Safety Authority (EFSA) and Health Canada.
In the United States, the Food and Drug Administration banned the sale of cyclamate in 1969 after lab tests in rats involving a 10:1 mixture of cyclamate and saccharin (at levels comparable to humans ingesting 550 cans of diet soda per day) caused bladder cancer. This information, however, is regarded as "weak" evidence of carcinogenic activity, and cyclamate remains in common use in many parts of the world, including the European Union and Russia.
Mogrosides, extracted from monk fruit and commonly called luo han guo, are recognized as safe for human consumption and are used in some commercial products in the United States. As of 2017, it is not a permitted sweetener in the European Union, although it is allowed as a flavor at concentrations where it does not function as a sweetener. In 2017, a Chinese company requested a scientific review of its mogroside product by the European Food Safety Authority. Some products incorporating it are Nestlé's Milo in Asia and certain Kellogg cereals in the United States. It is also the basis of McNeil Nutritionals's tabletop sweetener Nectresse in the United States and Norbu Sweetener in Australia.
Apart from sugar of lead (used as a sweetener in ancient through medieval times before the toxicity of lead was known), saccharin was the first artificial sweetener and was originally synthesized in 1879 by Remsen and Fahlberg. Its sweet taste was discovered by accident. It had been created in an experiment with toluene derivatives. A process for the creation of saccharin from phthalic anhydride was developed in 1950, and, currently, saccharin is created by this process as well as the original process by which it was discovered. It is 300 to 500 times as sweet as sugar (sucrose) and is often used to improve the taste of toothpastes, dietary foods, and dietary beverages. The bitter aftertaste of saccharin is often minimized by blending it with other sweeteners.
Fear about saccharin increased when a 1960 study showed that high levels of saccharin may cause bladder cancer in laboratory rats. In 1977, Canada banned saccharin due to the animal research. In the United States, the FDA considered banning saccharin in 1977, but Congress stepped in and placed a moratorium on such a ban. The moratorium required a warning label and also mandated further study of saccharin safety.
Subsequent to this, it was discovered that saccharin causes cancer in male rats by a mechanism not found in humans. At high doses, saccharin causes a precipitate to form in rat urine. This precipitate damages the cells lining the bladder (urinary bladder urothelial cytotoxicity) and a tumor forms when the cells regenerate (regenerative hyperplasia). According to the International Agency for Research on Cancer, part of the World Health Organization, "Saccharin and its salts was [sic] downgraded from Group 2B, possibly carcinogenic to humans, to Group 3, not classifiable as to carcinogenicity to humans, despite sufficient evidence of carcinogenicity to animals, because it is carcinogenic by a non-DNA-reactive mechanism that is not relevant to humans because of critical interspecies differences in urine composition."
In 2001, the United States repealed the warning label requirement, while the threat of an FDA ban had already been lifted in 1991. Most other countries also permit saccharin, but restrict the levels of use, while other countries have outright banned it.
The EPA has officially removed saccharin and its salts from their list of hazardous constituents and commercial chemical products. In a 14 December 2010 release, the EPA stated that saccharin is no longer considered a potential hazard to human health.
Stevia leaves have been widely used as a sweetener in South America for centuries and in Japan as an extract since 1970. It has no glycemic index and supplies no calories, and its use as a sweetener is common in many countries. In 1987, the FDA issued a ban on stevia because it had not been approved as a food additive, although it continued to be available as a dietary supplement. After being provided with sufficient scientific data regarding side-effects of using stevia as a sweetener from companies, such as Cargill and Coca-Cola, the FDA gave a "no objection" approval for generally recognized as safe (GRAS) status in December 2008 to Truvia, for use of the refined stevia extracts as a blend of rebaudioside A and erythritol (developed by Cargill and The Coca-Cola Company), as well as PureVia (developed by PepsiCo and the Whole Earth Sweetener Company, a subsidiary of Merisant), both of which use rebaudioside A derived from the stevia plant. In Australia, the brand Vitarium uses Natvia, a stevia sweetener, in a range of sugar-free children's milk mixes.
In August 2019, the FDA placed an import alert on stevia leaves and crude extracts – which do not have GRAS status – and on foods or dietary supplements containing them due to concerns about safety and potential for toxicity.
The world's most commonly used artificial sweetener, sucralose is a chlorinated sugar that is about 600 times as sweet as sugar. It is produced from sucrose when three chlorine atoms replace three hydroxyl groups. It is used in beverages, frozen desserts, chewing gum, baked goods, and other foods. Unlike other artificial sweeteners, it is stable when heated and can therefore be used in baked and fried goods. Discovered in 1976, the FDA approved sucralose for use in 1998.
Most of the controversy surrounding Splenda, a sucralose sweetener, is focused not on safety but on its marketing. It has been marketed with the slogan, "Splenda is made from sugar, so it tastes like sugar." Sucralose is prepared from either of two sugars, sucrose or raffinose. With either base sugar, processing replaces three oxygen-hydrogen groups in the sugar molecule with three chlorine atoms.
The "Truth About Splenda" website was created in 2005 by The Sugar Association, an organization representing sugar beet and sugar cane farmers in the United States, to provide its view of sucralose. In December 2004, five separate false-advertising claims were filed by the Sugar Association against Splenda manufacturers Merisant and McNeil Nutritionals for claims made about Splenda related to the slogan, "Made from sugar, so it tastes like sugar". French courts ordered the slogan to no longer be used in France, while in the U.S. the case came to an undisclosed settlement during the trial.
There are few safety concerns pertaining to sucralose and the way sucralose is metabolized suggests a reduced risk of toxicity. For example, sucralose is extremely insoluble in fat and, thus, does not accumulate in fatty tissues; sucralose also does not break down and will dechlorinate only under conditions that are not found during regular digestion (i.e., high heat applied to the powder form of the molecule). Only about 15% of sucralose is absorbed by the body and most of it passes out of the body unchanged.
Sugar alcohols, or polyols, are sweetening and bulking ingredients used in manufacturing of foods and beverages, particularly sugar-free candies, cookies, and chewing gums. As a sugar substitute, they typically are less-sweet than sugar and supply fewer calories (about a half to one-third fewer calories) than sugar, are converted to glucose slowly, and do not spike increases in blood glucose.
Sorbitol, xylitol, mannitol, erythritol, and lactitol are examples of sugar alcohols. These are, in general, less sweet than sucrose, but have similar bulk properties and can be used in a wide range of food products. The sweetness profile may be altered during manufacturing by mixing with high-intensity sweeteners.
Sugar alcohols are carbohydrates with a biochemical structure partially matching the structures of sugar and alcohol, although not containing ethanol. They are not entirely metabolized by the human body. They are found commonly in small quantities in some fruits and vegetables, and are commercially manufactured from different carbohydrates and starch.
Sugar substitutes are used instead of sugar for a number of reasons, including:
- Dental care – Carbohydrates and sugars usually adhere to the tooth enamel, where bacteria feed upon them and quickly multiply. The bacteria convert the sugar to acids that decay the teeth. Sugar substitutes, unlike sugar, do not erode teeth as they are not fermented by the microflora of the dental plaque. A sweetener that may benefit dental health is xylitol, which tends to prevent bacteria from adhering to the tooth surface, thus preventing plaque formation and eventually decay. A Cochrane review, however, found only low-quality evidence that xylitol in a variety of dental products actually has any benefit in preventing tooth decays in adults and children.
- Diabetes mellitus – People with diabetes have difficulty regulating their blood sugar levels, and need to limit their sugar intake. Many artificial sweeteners allow sweet-tasting food without increasing blood glucose. Others do release energy but are metabolized more slowly, preventing spikes in blood glucose. A concern, however, is that overconsumption of foods and beverages made more appealing with sugar substitutes may increase risk of developing diabetes. A 2014 systematic review showed that a 330ml/day (an amount little less than the standard U.S can size) consumption of artificially sweetened beverages lead to increased risks of type 2 diabetes. A 2015 meta-analysis of numerous clinical studies showed that habitual consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice increased the risk of developing diabetes, although with inconsistent results and generally low quality of evidence. A 2016 review described the relationship between non-nutritive sweeteners as inconclusive.
- Reactive hypoglycemia – Individuals with reactive hypoglycemia will produce an excess of insulin after quickly absorbing glucose into the bloodstream. This causes their blood glucose levels to fall below the amount needed for proper body and brain function. As a result, like diabetics, they must avoid intake of high-glycemic foods like white bread, and often use artificial sweeteners for sweetness without blood glucose.
- Cost and shelf life – Many sugar substitutes are cheaper than sugar in the final food formulation. Sugar substitutes are often lower in total cost because of their long shelf-life and high sweetening intensity. This allows sugar substitutes to be used in products that will not perish after a short period of time.
Acceptable daily intake levels
In the United States, the FDA provides guidance for manufacturers and consumers about the daily limits for consuming high-intensity sweeteners, a measure called Acceptable Daily Intake (ADI). During their premarket review for all of the high-intensity sweeteners approved as food additives, FDA established an ADI defined as an amount in milligrams per kilogram of body weight per day (mg/kg bw/d), indicating that a high-intensity sweetener does not cause safety concerns if estimated daily intakes are lower than the ADI. FDA states: "An ADI is the amount of a substance that is considered safe to consume each day over the course of a person’s lifetime." For stevia (specifically, steviol glycosides), an ADI was not derived by the FDA, but by the Joint Food and Agricultural Organization/World Health Organization Expert Committee on Food Additives, whereas an ADI has not been determined for monk fruit. FDA also published estimates of sweetness intensity, called a multiplier of sweetness intensity (MSI) as compared to table sugar.
For the sweeteners approved as food additives, the ADIs in milligrams per kilogram of body weight per day are:
- Acesulfame potassium, ADI 15, MSI 200
- Advantame, ADI 32.8, MSI 20,000
- Aspartame, ADI 50, MSI 200
- Neotame, ADI 0.3, MSI 7,000 to 13,000
- Saccharin, ADI 15, MSI 200 to 700
- Sucralose, ADI 5, MSI 600
Stevia (pure extracted steviol glycosides) has an ADI of 4 and a MSI of 200 to 400, where for monk fruit, no ADI has been determined and the MSI is 250 to 400.
The sweetness levels and energy densities are in comparison to those of sucrose.
|Name||Sweetness by weight||Sweetness by food energy||Energy density||Notes|
|Curculin||1250||Protein; also changes the taste of water and sour solutions to sweet|
|Hydrogenated starch hydrolysates||0.65||0.85||0.75|
|Miraculin||A protein that does not taste sweet by itself but modifies taste receptors to make sour foods taste sweet temporarily|
|Monatin||3,000||Sweetener isolated from the plant Sclerochiton ilicifolius|
|Monellin||1,400||Sweetening protein in serendipity berries|
|Sorbitol||0.6||0.9||0.65||Sugar alcohol, E420|
|Stevia||250||Extracts known as rebiana, rebaudioside A, a steviol glycoside; commercial products: Truvia, PureVia, Stevia In The Raw|
|Name||Sweetness (by weight)||Trade name||Approval||Notes|
|Acesulfame potassium||200||Nutrinova||FDA 1988||E950 Hyet Sweet|
|Alitame||2,000||approved in Mexico, Australia, New Zealand and China.||Pfizer|
|Aspartame||180||NutraSweet, Equal||FDA 1981, EU-wide 1994||E951 Hyet Sweet|
|Salt of aspartame-acesulfame||350||Twinsweet||E962|
|Sodium cyclamate||40||FDA Banned 1969, approved in EU and Canada||E952, Abbott|
|Dulcin||250||FDA Banned 1950|
|P-4000||4,000||FDA banned 1950|
|Saccharin||350||Sweet'N Low||FDA 1958, Canada 2014||E954|
|Sucralose||660||Kaltame, Splenda||Canada 1991, FDA 1998, EU 2004||E955, Tate & Lyle|
|Name||Sweetness relative to
|Food energy(kcal/g)||Sweetness per food energy,
relative to sucrose
|Food energy for equal
sweetness, relative to sucrose
Numerous reviews have concluded that the association between body weight and non-nutritive sweetener usage is inconclusive, as observational studies tend to show a link to high body weight, while randomized controlled trials instead show a small causal weight loss. Other reviews concluded that use of non-nutritive sweeteners instead of sugar reduces body weight.
Sugar alcohols, or polyols, are sweetening and bulking ingredients used in manufacturing of foods and beverages. As a sugar substitute, they supply fewer calories (about a half to one-third fewer calories) than sugar, are converted to glucose slowly, and do not spike increases in blood glucose.
Comparison to sugar
Reviews and dietetic professionals have concluded that moderate use of non-nutritive sweeteners as a safe replacement for sugars can help limit energy intake and assist with managing blood glucose and weight.
- One U.S. brand of saccharin uses yellow packets.
- Business Wire (31 March 2017). "Sweetener Market Projected to Be Worth USD 2.84 Billion by 2021: Technavio". Yahoo Finance. Archived from the original on 25 April 2017. Retrieved 10 January 2018.
- Toews, Ingrid; Lohner, Szimonetta; Küllenberg de Gaudry, Daniela; Sommer, Harriet; Meerpohl, Joerg J (2 January 2019). "Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies". BMJ. 364: k4718. doi:10.1136/bmj.k4718. PMC 6313893. PMID 30602577.
- "Artificial sweeteners. What's the difference?". tribunedigital-chicagotribune.
- "High-Intensity Sweeteners". US Food and Drug Administration. 19 May 2014. Retrieved 11 January 2018.
- "Generally Recognized as Safe (GRAS)". U.S. Food and Drug Administration. 14 July 2014. Retrieved 17 September 2014.
- EFSA National Experts (May 2010). "Report of the meetings on aspartame with national experts". EFSA Supporting Publications. 7 (5). doi:10.2903/sp.efsa.2010.ZN-002.
- Mitchell, Helen (2006). Sweeteners and sugar alternatives in food technology. Oxford, UK: Wiley-Blackwell. p. 94. ISBN 978-1-4051-3434-7.
- Magnuson BA, Burdock GA, Doull J, Kroes RM, Marsh GM, Pariza MW, Spencer PS, Waddell WJ, Walker R, Williams GM (2007). "Aspartame: a safety evaluation based on current use levels, regulations, and toxicological and epidemiological studies". Crit. Rev. Toxicol. 37 (8): 629–727. doi:10.1080/10408440701516184. PMID 17828671.
- "Food Standards Australia New Zealand: Aspartame – what it is and why it's used in our food". Archived from the original on 14 October 2008. Retrieved 9 December 2008.
- Butchko HH, Stargel WW, Comer CP, Mayhew DA, Benninger C, Blackburn GL, de Sonneville LM, Geha RS, Hertelendy Z, Koestner A, Leon AS, Liepa GU, McMartin KE, Mendenhall CL, Munro IC, Novotny EJ, Renwick AG, Schiffman SS, Schomer DL, Shaywitz BA, Spiers PA, Tephly TR, Thomas JA, Trefz FK (April 2002). "Aspartame: review of safety". Regul. Toxicol. Pharmacol. 35 (2 Pt 2): S1–93. doi:10.1006/rtph.2002.1542. PMID 12180494.
- "Aspartame". UK FSA. 17 June 2008. Retrieved 23 September 2010.
- "Aspartame". EFSA. Retrieved 23 September 2010.
- "Aspartame". Health Canada. 5 November 2002. Retrieved 23 September 2010.
- Taubes, Gary (2017). The Case against Sugar. London, England: Portobello books. pp. 143–144. ISBN 9781846276378.
- "Cyclamic acid". PubChem, US National Library of Medicine. 6 January 2018. Retrieved 10 January 2018.
- "Worldwide status of cyclamate". Calorie Control Council. Retrieved 10 January 2018.
- Lyn O'Brien-Nabors (2011). Alternative Sweeteners. CRC Press. pp. 226–227. ISBN 978-1-4398-4614-8.
- Rachel Wilson (26 July 2011), "New and Emerging Opportunities for Plant-Derived Sweeteners", Natural Products Insider
- "Search; Siraitia grosvenorii". Novel Food Catalogue, European Commission. 2017. Retrieved 27 July 2017.
- Michail, Naimh (3 August 2017). "Chinese supplier Layn to bring monk fruit to Europe". FoodNavigator.com. Retrieved 18 February 2018.
- Christopher Adams (28 August 2012), US launch sweet news for kiwi supplier, The New Zealand Herald
- Sweet on Stevia: Sugar Substitute Gains Fans Archived 8 July 2011 at the Wayback Machine, Columbia Daily Tribune, 23 March 2008
- Curry, Leslie Lake. "Agency Response Letter GRAS Notice No. GRN 000287". Retrieved 26 October 2017.
- "Has Stevia been approved by FDA to be used as a sweetener?". US Food and Drug Administration. 28 April 2017. Retrieved 26 October 2017.
- Newmarker, Chris (18 December 2008). "Federal regulators give OK for Cargill's Truvia sweetener". Minneapolis / St. Paul Business Journal. Retrieved 18 December 2008.
- "du Chocolat -". vitarium.com.au.
- "Import Alert 45-06: Detention without Physical Examination of Stevia Leaves, Crude Extracts of Stevia Leaves and foods Containing Stevia Leaves and/or Stevia Extracts". US Food and Drug Administration. 16 August 2019. Retrieved 23 November 2019.
- FDA approves new high-intensity sweetener sucralose Archived 20 May 2005 at the Wayback Machine
- "Bitter Battle over Truth in Sweeteners". LiveScience.com.
- Truth About Splenda Archived 22 April 2005 at the Wayback Machine, Sugar Association website
- Grotz VL, Munro IC (2009). "An overview of the safety of sucralose". Regulatory Toxicology and Pharmacology. 55 (1): 1–5. doi:10.1016/j.yrtph.2009.05.011. PMID 19464334.
- Daniel JW, Renwick AG, Roberts A, Sims J (2000). "The metabolic fate of sucralose in rats". Food Chem Toxicol. 38 (S2): S115–S121. doi:10.1016/S0278-6915(00)00034-X. PMID 10882824.
- Ghosh, S; Sudha, M. L (2012). "A review on polyols: New frontiers for health-based bakery products". International Journal of Food Sciences and Nutrition. 63 (3): 372–9. doi:10.3109/09637486.2011.627846. PMID 22023673.
- "High-intensity sweeteners". US Food and Drug Administration. 19 May 2014. Retrieved 23 November 2019.
- "Eat any sugar alcohol lately?". Yale-New Haven Hospital. 10 March 2005. Retrieved 25 June 2012.
- "Sugar alcohols fact sheet". IFIC Foundation. Food Insight. 15 October 2009. Retrieved 23 November 2019.
- "Sugar alcohols". US Food and Drug Administration. Retrieved 23 November 2019.
- Riley, P; Moore, D; Ahmed, F; Sharif, M. O; Worthington, H. V (2015). "Xylitol-containing products for preventing dental caries in children and adults". Cochrane Database of Systematic Reviews (3): CD010743. doi:10.1002/14651858.CD010743.pub2. PMID 25809586.
- Imamura, F; O'Connor, L; Ye, Z; Mursu, J; Hayashino, Y; Bhupathiraju, S. N; Forouhi, N. G (2015). "Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: Systematic review, meta-analysis, and estimation of population attributable fraction". BMJ. 351: h3576. doi:10.1136/bmj.h3576. PMC 4510779. PMID 26199070.
- Lohner, Szimonetta; Toews, Ingrid; Meerpohl, Joerg J. (8 September 2017). "Health outcomes of non-nutritive sweeteners: analysis of the research landscape". Nutrition Journal. 16 (1): 55. doi:10.1186/s12937-017-0278-x. ISSN 1475-2891. PMC 5591507. PMID 28886707.
- Coultate, T. (2009). Food: The chemistry of its components. Cambridge, UK: The Royal Society of chemistry
- "Additional Information about High-Intensity Sweeteners Permitted for Use in Food in the United States". US Food and Drug Administration. 19 December 2017. Retrieved 11 January 2018.
- Godswill, Awuchi (February 2017). "SUGAR ALCOHOLS: CHEMISTRY, PRODUCTION, HEALTH CONCERNS AND NUTRITIONAL IMPORTANCE OF MANNITOL, SORBITOL, XYLITOL, AND ERYTHRITOL" (PDF). International Journal of Advanced Academic Research. 3 (2): 31–66. ISSN 2488-9849.
- Brown, R. J.; de Banate, M. A.; Rother, K. I. (August 2010). "Artificial sweeteners: a systematic review of metabolic effects in youth". International Journal of Pediatric Obesity. 5 (4): 305–312. doi:10.3109/17477160903497027. PMC 2951976. PMID 20078374.
- Azad MB, Abou-Setta AM, Chauhan BF, Rabbani R, Lys J, Copstein L, Mann A, Jeyaraman MM, Reid AE, Fiander M, MacKay DS, McGavock J, Wicklow B, Zarychanski R (July 2017). "Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies". CMAJ. 189 (28): E929–E939. doi:10.1503/cmaj.161390. PMC 5515645. PMID 28716847.
- Rogers PJ, Hogenkamp PS, de Graaf C, Higgs S, Lluch A, Ness AR, Penfold C, Perry R, Putz P, Yeomans MR, Mela DJ (1 March 2016). "Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies". International Journal of Obesity. 40 (3): 381–94. doi:10.1038/ijo.2015.177. PMC 4786736. PMID 26365102.
- Miller PE, Perez V (September 2014). "Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies". The American Journal of Clinical Nutrition. 100 (3): 765–777. doi:10.3945/ajcn.113.082826. PMC 4135487. PMID 24944060.
- Pepino, M. Yanina (1 December 2015). "Metabolic effects of non-nutritive sweeteners". Physiology & Behavior. 152 (Pt B): 450–455. doi:10.1016/j.physbeh.2015.06.024. ISSN 1873-507X. PMC 4661066. PMID 26095119.
Taken as a whole, despite several epidemiological studies showing an association between NNS consumption and metabolic disorders [9– 14], and strong data supporting causality between NNS exposure and metabolic disorders in animal models [18–24,43–45], there is no clear evidence that NNSs cause metabolic disorders in human subjects.
- Mishra, A; Ahmed, K; Froghi, S; Dasgupta, P (December 2015). "Systematic review of the relationship between artificial sweetener consumption and cancer in humans: analysis of 599,741 participants". International Journal of Clinical Practice. 69 (12): 1418–26. doi:10.1111/ijcp.12703. PMID 26202345.
- Shankar, Padmini; Ahuja, Suman; Sriram, Krishnan (1 December 2013). "Non-nutritive sweeteners: review and update". Nutrition. 29 (11–12): 1293–1299. doi:10.1016/j.nut.2013.03.024. PMID 23845273.
- Fitch C, Keim KS, Academy of Nutrition and Dietetics (May 2012). "Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners" (PDF). Journal of the Academy of Nutrition and Dietetics. 112 (5): 739–758. doi:10.1016/j.jand.2012.03.009. PMID 22709780.