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Everyday Health Diabetes Series

Everyday Health Diabetes Series

I recently had the privilege of working with on a video piece they produced to educate their visitors on diabetes management.  The team included myself as the diabetes educator, another dietitian, a fitness trainer, and a physician, as well as a couple of patients living with diabetes.   In the videos we impart practical information on how to live well with diabetes and prevent the progression and complications of the disease.  The video is now posted on and you can access it by clicking here:

Everyday Health Diabetes Videos


All About Sweeteners

Americans eat far too much sugar, approximately 170 pounds per year total.  Although we do have room for some added sugars in our diets, approximately 6tsp per day for women and 9tsp per day for men, (the amount of sugar in a 12-oz soda or in 2 Twinkies), the average American far exceeds that amount.  To follow this recommendation would place someone well within the limits of “everything in moderation.”  But what about those who want more?  For those of us used to sweetened iced tea, sugar in our coffee, desserts, or a soda now and then, there options other than compromising our waistlines and health by consuming too much sugar.


There are currently several artificial sweeteners approved by the FDA (Food and Drug Administration).  These sweeteners have been tested by the FDA and have not been shown to cause health problems in the amounts normally consumed.  I always tell my clients that this is not a guarantee.  Because many of these sweeteners have not been studied over an entire human lifespan, but instead on rats or mice, we are all the “guinea pigs” on long-term human research.  Having said that, keep in mind that this is true with many of the additives in our food, as well as chemicals in the food packaging, many skin products we use, and compounds we breathe in.  In this article, I’ve outlined the most recent information regarding each of these sweeteners so you can make a reasonable and informed decision regarding your use of artificial sweeteners.

The ADI, or Accepted Daily Intake, is the amount of a food additive that can be ingested daily over a lifetime without incurring a health risk. To determine the ADI of a product, it is tested on animals, and a “No Observable Adverse Effect Level” (NOAEL) is determined.  It is then scaled down by a safety factor of 100 (factor of 10 to account for differences between animals and humans and another 10 to account for differences between humans).  The higher the ADI value, the safer the product is. Each ADI value represents 100 times less then the smallest amount that may cause a health concern. The ADI’s of the sweeteners discussed in this article are displayed in the table below.  An ADI has not been agreed upon thus far for Stevia, as the value may be different for its two sweetening compounds, stevioside and rebaudioside A.  ADI’s are conveyed in terms of grams per kg of body weight of the person consuming the product.

Sweetener ADI (Accepted Daily Intake) Product Equivalent based on a 150lb consumer
Stevia TBD ***
Sucralose 5mg/kg body weight 6 cans diet soda
Aspartame 50mg/kg body weight 18-29 cans diet soda
Acesulfame K 15mg/kg body weight 30-32 cans diet soda
Saccharine 5mg/kd body weight 9-12 sweetening packets


Stevia is the newest artificial sweetener to be approved by the FDA and hit the market.  The Southern-American Stevia plant contains 2 chemical compounds which contribute to the sweetness of its leaf:  stevioside and rebaudioside A.  One or both of these compounds may be used as sweeteners.  Current brands of sweetener made from Stevia include Truvia, PureVia, and SweetLeaf.  Stevia is 200-300 times sweeter than sucrose (table sugar) yet provides 0 calories because although it is absorbed, our body does not metabolize it.  You may find it being marketed as a “natural” sweetener because it is from a plant, but keep in mind that in itself does not ensure that its extracts are safe in the quantities consumed.  Prior to its recent approval by the FDA, Stevia was available for purchase only as a “dietary supplement,” for which the safety guidelines are much looser.  Early studies on Stevia suggested its use may lead to reproductive problems, cancer, and a disruption in carbohydrate metabolism, but with further research those concerns have been laid to rest. Stevia tastes like sugar, but has a licorice-like aftertaste.  Stevia is currently used mostly in beverages, specifically some Coca-Cola products.


Sucralose is often advertised as “made from sugar” which implies it, too, is natural.  However, sucralose is made by adding a chlorine molecule to a sucrose molecule, thus changing its chemical structure.  So, it is no longer sugar at all, and because our bodies don’t recognize it, it is not metabolized into energy.  Therefore, sucralose is not any more “all-natural” than any other artificial sweetener.  Sucralose is marketed as Splenda, and is 600 times sweeter than sugar.  It has a synergistic sweetening effect when combined with other artificial sweeteners, meaning the sweetness factor increases exponentially when paired together.  It tastes the same as sugar without any off-tastes, however the sweetness lingers, much like with aspartame.  Sucralose has passed animal testing and has been deemed safe for consumption by the FDA.  Because sucralose is stable for food processing, it is used in many products, including frozen desserts, yogurt, soda, other reduced-calorie beverages, cookies, syrup, and gums.



Sugar alcohols, or pylols, are made of a sugar molecule combined with hydrogen.  They are partially absorbed, but not as well as sugar, so they still provide some calories, but less than what sugar provides.  Examples of sugar alcohols include sorbitol, xylitol, mannitol, maltitol, lactitol, and erythritol.  The different compounds vary in their degree of absorption, and therefore how many calories they provide.  In the U.S., the calorie amount for sugar alcohols is generally accepted to be about 3 calories per gram, as compared to regular sugar’s 4 calories per gram.  There are no significant health risks associated with sugar alcohol consumption, other than the fact that since some of the sugar alcohol is not absorbed, it passes through your intestinal tract instead, and if consumed in large amounts, may cause diarrhea.  For this reason, I don’t recommend consuming large amounts of sugar free ice cream or candy made with sugar alcohols.  You can check the ingredient list for any of the specific sugar alcohols listed above, and the earlier they are listed, the more the product contains.  Sugar alcohols are used mostly in ice cream, candy, cookies, and gums.




Aspartame is a combination of two amino acids (the building blocks of protein), phenylalanine and aspartic acid.  These amino acids are naturally-occurring in large quantities in many of our foods, especially meats.  Aspartame is completely broken down in the body into the two amino acids and methanol.  Methanol is also found in many foods in greater quantities than in the amount of aspartame used to sweeten a beverage.  For example, a glass of tomato juice contains 6 times the amount of methanol that would be present in the same quantity of diet soda.  Aspartame is marketed as NutraSweet and Equal.  It has been more thoroughly tested than any other artificial sweetener, and has been deemed safe in the amounts usually consumed.  It is also considered safe for pregnancy.

Aspartame actually does contain calories, as it is digested and metabolized for energy.  But, because of how intensely sweet it is, very small amounts are needed, so the amount of calories delivered is insignificant.  For example, the amount of aspartame that is equivalent in sweetness to 1 tsp of sugar (which has 16 calories) only has 1/10th of a calorie.  Aspartame is 160-200 times sweeter than sucrose, and tastes similar to sucrose without the off-taste sometimes associated with saccharine.  There is a slightly delayed onset of taste as compared to sucrose. Aspartame is not heat stable, so is not suitable for cooking or baking, although it can be added after the fact to the end-product.  Aspartame enhances other flavors, especially fruity and citrus flavors.  It is used in ice creams, yogurts, sodas, other sugar-free beverages, gelatin, and gum.

Although some people report getting headaches when they consume aspartame, research has not proven that aspartame causes headaches.  People with PKU (phenylketonuria) cannot utilize phenylalanine and should avoid aspartame.  Studies show that aspartame in the amounts normally consumed does not raise the risk of cancer, although new studies show that when used in large amounts it may raise the risk of cancer, although not to a statistically significant degree.  This finding, though, has caused enough concern that the CSPI (Center for Science in the Public Interest) is recommending avoiding aspartame until further research is done. Aspartame remains on the market and is considered GRAS (generally recognized as safe) by the FDA.


Acesulfame K is made from acesulfame potassium.  It is not metabolized, and is excreted by the kidneys unchanged, rendering it calorie-free.  It is marketed as Sweet One or Sunett, and is 200 times sweeter than sucrose.  It has a taste similar to sucrose with bitter and metallic attributes that are at least as strong as those associated with saccharine.  It has a good shelf-life and is heat-stable enough to be used in food processing and baking.  It has not been as widely tested as other sweeteners, so although it is considered GRAS by the FDA, CSPI recommends avoiding it until further testing is done.


Saccharine, otherwise known as Sweet & Low, Sweet Twin, or SugarTwin, tastes similar to sugar but with a bitter and metallic element to it, which 1/3 of the population is super-sensitive to.  Saccharine is 300-500 times sweeter than sugar, and also has a synergetic sweetening effect when combined with other sweeteners.    It is absorbed slowly and not metabolized by the body.  Therefore it is excreted intact by the kidneys, and is considered calorie-free.  Rat studies done in the 1970’s showed that bladder tumors developed when rats were administered extremely high doses of saccharine, the human equivalent of about 750 cans of diet soda daily for a lifetime.  All studies since then have shown it to be safe in humans in the quantities normally consumed.  Saccharine, however, is not recommended for pregnant women as it can cross the placental barrier.  Saccharine is heat stable, so is suitable for cooking and baking, and has a good shelf life.

Which artificial sweeteners do you normally consume?  Do you feel artificial sweeteners are safe?  Let us know your thoughts!