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Are Artificial Sweeteners Harmful to Kids?

Sharon Palmer

It’s tough being a parent, worrying about a whole world of environmental threats they are exposed to, from plastic compounds in bottles, to pesticides in produce, to the very air they breathe. One food ingredient that has been of concern time and time again is artificial sweeteners. Are they good for children? Do they pose any health risks? Those are the questions posed to me recently, as a new statement from the American Academy of Pediatrics was recently released. I’m weighing in my best nutrition advice.

Question: Are artificial sweeteners harmful to kids? Are some better than others? What advice do you give parents about sweeteners in their children’s diets? –Kristin

Answer:

There is some reason to be concerned about many artificial sweeteners in your children’s diets. The health organization CSPI ranks the artificial sweeteners acesulfame K, aspartame, sucralose, and saccharin on the “avoid” list. However, CSPI does list stevia leaf extract on their “safe” list. I would tend to go by this rule of thumb in my overall recommendations for the use of artificial sweeteners for children. The CSPI analysis is based on the fact that there is a lack of research on safety for some of these sweeteners. In some cases, such as with aspartame, sucralose and saccharin, there have been studies linking it to cancer risk and other health problems.

Some studies have found that these sweeteners might have negative impacts on the gut microbiome, which could lead to a range of issues that might lead to health risks. In addition, young children—with a smaller body weight—could exceed the acceptable daily intake established for some sweeteners if they are consuming it regularly. Some science has found that some of these sweeteners have been linked with tumors in rats. A recent review of aspartame recommended that children should not consume it. We need more science to understand the mechanism of action behind the potential cancer risk of these compounds. But it’s also important to consider use—if it is used in the diet frequently and consistently it increases exposure. And then there is the hypothesis that artificial sweeteners may impact taste perceptions and hunger response, so this brings other concerns.

Naturally sweetened fruits should be kids’ daily dessert.

My recommendation is to train children’s palates to prefer less sweetened foods altogether. I would recommend that when children do want something sweet, it should be in the form of unsweetened fruit, diluted fruit juice (within the recommendations per day based on age), and fruit-infused waters. They can have sugar within their allowed limit (no more than 6 teaspoons per day and no more than 8 ounces of sugary beverage per week). Research shows that exposure to less sweet foods can help children change their preference.

Herbal Lemon-Lime Mint Water

So which artificial sweeteners should you stock in your home? Stevia is on the OK list by CSPI, though I recommend that you use this in moderation for all of the reasons I just stated. Monk fruit is on the “caution” list by CSPI, because of lack of scientific testing.

This comes in time for the recent recommendation by the American Academy of Pediatrics, which reports that food product labels need to do a better job of communicating how much artificial sweeteners are in products, and that more research needs to take place in order to understand potential health risks. I believe this is a good recommendation for the public, given the lack of research and potential health risks identified in some studies. In addition, much of our research in nutrition is on adults, not children, with unique metabolic and physiologic needs. There could be many artificial sweeteners hiding in foods that parents may not be aware of—increasing the consumption of these in their diets.

Winter Berry Smoothie Bowl is naturally sweetened with fruits.

Read labels, and look for pure, unsweetened foods more often. Buy plain yogurt and add fruit. Skip the sweetened and artificially sweetened beverages and make your own fruit-infused waters. Use applesauce and bananas to sweeten muffins and brownies. Get kids used to the flavors of real, unsweetened foods, such as fruits.

It is a struggle being a parent and trying to make healthful choices. It’s always best to choose foods that are minimally processed—things like healthful protein sources (beans, lentils), whole grains (oats, whole wheat bread, quinoa), vegetables, fruits, nuts. Choose food products made from these whole foods, with as few artificially produced ingredients as possible. Let children learn to like the flavors of real foods. Research shows that exposing children to healthful foods, like vegetables, helps them to include them in the diet. So, don’t give up. Read those labels and avoid artificial sweeteners, as well as added sugars.

Here is the report on artificial sweeteners from the AAP:

American Academy of Pediatrics Looks at Use of   Nonnutritive Sweeteners   by   Children 

AAP   policy statement   evaluates what’s known, along with gaps in evidence, about   their   effects on   children’s health.  

 Nonnutritive or artificial sweeteners   are   a   growing   part of U.S.   diets, now   consumed by at least one in four children. A new American Academy of Pediatrics   (AAP)   policy   statement   offers a summary of the existing data around nonnutritive sweeteners and recommends future research into how they   affect   children’s   weight,   taste preferences, the risk for diabetes, and long-term safety. 

The AAP policy statement “The Use of Nonnutritive Sweeteners in Children” published   in the November 2019   Pediatrics   (published   online Oct. 28), recommends that the amount of   these no- or low-calorie   sweeteners be listed on product labels so families and researchers can   better   understand   how   much   children are consuming and any possible health effects.  

“Looking at the evidence, we found there’s still a lot to learn about the impact of nonnutritive sweeteners on children’s health,” said Carissa Baker-Smith, MD, MPH, FAAP, lead author of the AAP policy statement. “We   need more research into   the use of nonnutritive sweeteners and the risk for obesity and Type 2 diabetes, especially in children.   Considering how many children are regularly consuming these products – which have become ubiquitous — we should have a better understanding of how they impact children’s long-term health.” 

Nonnutritive sweeteners were introduced into the food supply more than 60 years ago to mimic the taste of sucrose (table sugar) without adding calories.   Eight   nonnutritive sweeteners   are   approved   by the U.S. Food and Drug Administration (FDA).   Saccharin, aspartame, acesulfame-potassium, sucralose, neotame and   advantame were approved as food additives, while stevia   and luo han guo (monk fruit)   are   approved under the “generally recognized as safe” (GRAS) designation.   These   products are 180 to 20,000 times sweeter than sugar. 

When nonnutritive sweeteners were first introduced, health concerns focused on a potential risk of cancer, which was   not borne out in subsequent research. Health concerns around these products now has shifted. As the obesity epidemic has driven increased use of these products, attention is directed at conflicting evidence over whether   nonnutritive sweeteners   actually help control weight.  The majority of   short-term studies suggest that substituting a nonnutritive sweetener for sugar may reduce weight gain and promote small amounts of weight loss in children, according to the AAP. However, data is limited. There is also   research suggesting possible links between nonnutritive sweetener use and weight gain. In addition, some studies   suggest links between nonnutritive sweetener use and changes in appetite and taste preferences, as well as in the gut microbiome, which may affect blood sugar levels and lead to metabolic syndrome, insulin resistance, diabetes and weight gain. But findings remain inconsistent.  

The AAP recommends that food and beverage manufacturers   report   nonnutritive   sweetener   content on food and beverage labels, rather than just listing them among ingredients, since they are now so   widely available and consumed. The   National Health and   Nutrition Examination Survey   2009-2012 showed that more than one-quarter of U.S. children reported consumption of   non-nutritive sweeteners, with 80 percent of these children   reporting daily use.  

“It   is currently hard to know how much nonnutritive sweetener   is   in a product since manufacturers aren’t required to specify,” Dr. Baker-Smith said. “Listing the amount of nonnutritive sweetener   a   product contains   would help families and researchers understand how much   is   actually being consumed by individuals and populations and   further evaluate potentially related health effects,” Dr. Baker-Smith said.  

Research suggests many parents aren’t aware their child is consuming these products.  One study found that only 23% of parents   can   correctly identify food products that contain nonnutritive sweeteners.  In addition, 53% of parents said they seek items labeled “reduced sugar,” but   most did not recognize that the sweet taste was instead being provided by a nonnutritive sweetener.   

Knowing   the amounts of nonnutritive sweeteners   in products   would   also   help   ensure   children’s   consumption remains below acceptable daily   intake levels, Dr. Baker-Smith said.   Research   suggests that   most children’s   nonnutritive sweetener intake   is   within   the   acceptable   level, but some   has   found, based on estimated consumption from 24-hour dietary recall, that intake of nonnutritive sweeteners may exceed the acceptable daily   intake.    

Live and Eat Well,

Sharon

Check out more nutrition questions I’m answering at The Plant-Powered Dietitian:

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How Can I Choose Sustainable Foods?
Does Roasting Veggies Ruin Nutrients?

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