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Consumer Reports: Are sugar substitutes hiding in kid-friendly foods?

American Academy of Pediatrics calls on manufacturers to be more transparent

If you’re a parent trying to limit sugar and avoid sugar substitutes, such as sucralose, in your children’s diets, making informed choices could be a challenge. Research has shown that -- thanks in part to misleading label language -- parents aren’t always sure which products contain sugar substitutes and which don’t, and gaps remain in our understanding of how these sweeteners may affect kids.

In an effort to clear up confusion and promote transparency, the American Academy of Pediatrics (AAP) issued a new policy statement Oct. 28 on the consumption of sugar substitutes (also called nonnutritive sweeteners) by children.

Already, about a quarter of children in the U.S. consume nonnutritive sweeteners, according to the most recent data from the National Health and Nutrition Examination Study (NHANES). Eighty percent of those children do so on a daily basis.

And the numbers may be on the rise. Starting in January, manufacturers will be required to include the amount of added sugars a product contains on the Nutrition Facts label. “It’s possible that more manufacturers will add sugar substitutes -- along with sugar -- to make the added sugar number lower and more appealing to consumers,” says Amy Keating, M.S., R.D., a Consumer Reports dietitian.

The new policy statement from the AAP summarizes some of the current evidence on the potential benefits and risks of these additives and calls for more research. The group also recommends that product labels clearly list the amounts of nonnutritive sweeteners a food or beverage contains -- something not currently required by existing labeling regulations.

“We need to know how much children are actually consuming in order to do more accurate research on the possible benefits or risks of nonnutritive sweeteners,” says Carissa Baker-Smith, M.D., lead author of the AAP statement and associate professor of pediatrics, division of pediatric cardiology, at the University of Maryland School of Medicine in Baltimore. “And we want parents to be informed about what’s in the products they decide to buy for their families.”

The Calorie Control Council, an industry group representing the manufacturers of low-calorie food and beverages, took issue with the AAP’s recommendations. According to a statement from the Council’s president, Robert Rankin, the group “maintains its longstanding position that, when consumed as part of a healthy and balanced diet, the consumption of [sugar substitutes] may serve as a tool for managing overall caloric and sugar intake.”

Here’s what you need to know about what the AAP recommends -- and how to look out for these sweeteners in your kids’ food.

What the research says

The authors of the AAP statement analyzed the current body of research on the effect of nonnutritive sweetener consumption on weight, diabetes, taste preference, cardiac disease, and other health issues.

They found no evidence linking sugar substitutes to an increased risk of cancer, autism, or attention deficit hyperactivity disorder in children.

The evidence on weight loss in children who consumed nonnutritive sweeteners is mixed. Sugar substitutes may help to stabilize weight or result in small decreases in weight when combined with regular exercise, portion control, and healthy diet. “But consuming them without other lifestyle changes is unlikely to lead to substantial weight loss,” Baker-Smith says.

Most of the studies looking at nonnutritive sweeteners and their impact on diabetes and cardiovascular risk did not include children. But there is some evidence that consuming nonnutritive sweeteners may change the bacteria in our digestive systems, negatively altering the microbiome and the way our bodies metabolize sugars.

“Even though the evidence isn’t crystal clear, when it comes to child health, we need to err on the side of caution,” says Vasanti Malik, Sc.D., an assistant professor of nutritional sciences at the University of Toronto. “We don’t know yet if long-term use -- consuming them starting in utero and continuing over a lifetime -- can have a metabolic impact that may lead to the development of diseases as a child gets older.”

Better Than Sugar?

Parents who are concerned about added sugars or worried about childhood obesity may think they’re doing the right thing by swapping sugary snacks and beverages for ones that contain nonsugar sweeteners. “The data on the dangers of too much sugar is very clear and consistent,” Malik says. But based on current research, it’s not clear that simply consuming nonsugar sweeteners instead is healthier.

There is some troubling evidence that nonnutritive sweeteners may have a lasting effect on children’s developing taste preferences.

“Children innately prefer sweet tastes, and these sweeteners are multiple times sweeter than sugar,” Baker-Smith says. “Consuming them starting very early in life could help form preferences for sweeter tastes.”

Baker-Smith also says there is almost no data on the safety (or benefit) of nonnutritive sweeteners in children younger than 2.

Sniffing Out Nonsugar Sweeteners

According to the AAP statement, the number of consumer products containing nonnutritive sweeteners has quadrupled over the past several years. Another report [PDF], just issued by the UConn Rudd Center for Food Policy and Obesity in Hartford, Conn., found that 74 percent of sweetened drinks marketed to children contained nonnutritive sweeteners and 38 percent contained both sugar and nonsugar sweeteners.

There are currently eight nonsugar sweeteners approved for use by the Food and Drug Administration. They are: saccharin, aspartame, acesulfame-potassium, sucralose, neotame, advantame, stevia, and luo han guo (monk fruit).

“Unless you read the ingredients and recognize the names of the sweeteners, you might not know they’re in there,” says Maria Romo-Palafox, Ph.D., R.D., assistant professor of nutrition and dietetics at Saint Louis University and one of the authors of the Rudd Center report. “In fact, there is often label language that makes you think they aren’t in there.” For example, “less sugar,” “reduced sugar” or “low in sugar” may mean that the manufacturer has cut the amount of sugar in the product—and then added nonnutritive sweeteners to maintain its sweetness. Other products may offer no clues on the front of package that both sugar and nonnutritive sweeteners are listed among the ingredients.

“The best advice for parents is to carefully check the ingredients list for any sweeteners you want to avoid,” Keating says. “Or better yet, choose whole unprocessed foods and opt for water or other nonsweetened beverages as much as possible.”