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What Does 'Sugar-Free' Really Mean?

Know what you're eating.

A survey done in the mid-1990s found that the average American consumes 20 teaspoons of sugar a day. That's nearly half a cup! You may think you can protect your teeth by eating more "sugar-free" foods. In fact, almost 8 out of 10 U.S. adults consume some "sugar-free" products. But not all "sugar-free" foods are really sugarless.

Are sugar-free or sugarless foods and beverages always safe for your teeth?

No, they're not.

"Sugar-free" sometimes means that no sugar was added during processing. These foods may not be sugarless. They may contain natural sweeteners. Examples include honey, molasses, evaporated cane sugar, fructose, barley malt or rice syrup. Natural sweeteners have the same number of calories per serving as sugar does. They all are harmful to the teeth.

How can I find these hidden sugars?

Read labels carefully. Sugars that are found naturally in foods have different names, but they all end in the letters "ose." Therefore, if you read a label and see an ingredient that ends in "ose," the product contains sugar. (This doesn't include the artificial sweetener sucralose, sold as Splenda®). Sugars, including naturally occurring sugars, are listed under "sugars" or "carbohydrates" on the label. Read labels carefully to figure out how much sugar is in your food.

What are sugar alcohols?

Some food labels list ingredients such as xylitol, erythritol, isomalt, sorbitol, lactilol or mannitol. These are sugar alcohols. They often are used to sweeten sugar-free cookies, candy, chewing gum and other foods.

"The term 'sugar alcohol' refers to their chemical make-up, but they do not actually contain alcohol," says David Albert, D.D.S., M.P.H. Dr. Albert is an associate professor of dentistry and public health at the Columbia University Medical Center.

The U.S. Food and Drug Administration (FDA) says manufacturers can claim that products containing sugar alcohols do not promote tooth decay. Research shows that one sugar alcohol, xylitol, can protect children’s teeth against cavities.

How can xylitol taste sweet, yet protect against tooth decay?

Xylitol is a natural sweetener. It is found in fruit such as strawberries, plums and pears. Xylitol looks and tastes like sugar. For this reason, it's used to sweeten food and candy. Xylitol is used in chewing gum, candy, gumdrops, mints, medicated syrups and tablets, toothpaste and mouthwashes. It's also found in dietetic and diabetic foods. Several dental associations endorse sugar-free products that are at least 50% sweetened with xylitol. These products can reduce the amount of decay-causing bacteria found on the tooth surface.

When bacteria in your mouth combine with sugars, they produce acid. This acid damages teeth, causing cavities. Bacteria in your mouth can't break down xylitol, so no acid is produced.

Also, the sweetness of xylitol encourages salivation. Saliva washes out the mouth and helps prevent cavities.

Eating large amounts of products that contain xylitol may have a laxative effect. For example, having more than 10 to 20 pieces of candy or gum per day may cause this effect. This is the only known drawback to xylitol.

Are saccharin and other super-sweet sugar substitutes safe?

The body doesn't digest so-called high-intensity sweeteners in the same way as sugars. They contain no calories or very few calories. Saccharin, aspartame, acesulfame potassium, sucralose and neotame are accepted by the FDA. They do not promote tooth decay.

Saccharin was discovered in the late 19th century. It is 300 times sweeter than sugar, but often is formulated to be less sweet. For example, Sweet'N Low is 10 times sweeter than sugar.

Beginning in 1977, the FDA required that any food containing saccharin carry a warning label. The labels stated that saccharin had been shown to cause cancer in laboratory animals. In December 2000, Congress passed a law removing the warnings. Further research had shown that humans don't process saccharin in the same way as rats.

Currently, saccharin is used as a tabletop sweetener and in sodas and baked goods.

Aspartame (Equal) is 180 times sweeter than sugar. It is used in soft drinks, cereals, desserts and candy. Unlike saccharin, aspartame is not a good choice for baked goods. It degrades at high temperatures. It contains an amino acid, phenylalanine, that about one in every 16,000 people cannot break down.

Acesulfame potassium is 200 times sweeter than sugar. This sweetener is also called acesulfame K. It is sold under the brand name Sunett. In 1988, it was approved for use at the table and in chewing gum, drink mixes, instant coffee and tea, gelatins, puddings and nondairy creamers.

Sucralose (Splenda) is 600 times sweeter than sugar. It's used in cereals and soft drinks; fruit, dairy and alcoholic beverages; desserts; spreads; syrups and baked goods. The FDA approved Splenda in 1998. It has a good shelf life. It does not degrade in heat. Splenda does not affect blood glucose levels, so it is a good option for people with diabetes.

Neotame was approved in 2002 by the FDA. It is a high-intensity sweetener. Neotame is used in soft drinks, confections and frostings, chewing gums, jams, fruit juices and baked goods. It is 7,000 to 13,000 times sweeter than sugar.

In 2008, the FDA approved Truvia, a new sweetener, for use in the United States. It is derived from rebiana, an extract of the stevia plant. It is available in U.S. stores, but is not used as a sweetener in soft drinks or baked goods here.

sugar substitutes okay for dieters and diabetics?

The American Diabetes Association agrees with the FDA that aspartame, saccharine, acesulfame K and sucralose are safe. They can be used as part of a healthy diet for diabetics.

Calorie-free sugar substitutes do not contain carbohydrates. However, said Dr. Albert, "Some products that are sugar-free still contain carbohydrates. It is important to read the label."

Last updated Feb. 20, 2016