Sweeteners are ingredients that are added to food to enhance sweetness. They are divided into two groups: those which contain carbohydrate and provide energy (nutritive sweeteners) and those that offer little or no energy when ingested (non-nutritive sweeteners).

Nutritive sweeteners - sugars
There are many different types of nutritive sweeteners, and they are usually referred to as ‘sugars’ or ‘added sugar’. They can appear in the ingredient list on product packaging as:

Honey, brown sugar, white sugar, glucose, sucrose, maltose, fructose, high fructose corn syrup, agave syrup, dextrose, molasses and maltodextrin.

These nutritive sweeteners will have varying effects on blood glucose levels, weight and blood fats. There is no advantage in using one type of sugar over another, such as honey instead of sugar.

Ideally, the intake of any of these sugars should be restricted to a minimum. However, dietary guidelines allow for 5 - 10% of our total energy intake being from added sugars, so there is no need to be concerned about the small amounts of sugar that are added to products like bran flakes and baked beans, as long as this intake is part of a balanced and healthy meal. It is the excessive intake of these sugars in the form of products such as sweetened drinks, sweets and chocolates that should be avoid on a day to day basis.

Nutritive sweeteners - sugar alcohols
Sugar alcohols are a group of carbohydrates called "polyols" which are used as alternative food sweeteners to sugars. Technically, they are not sugars, so foods containing sugar alcohols are often labelled as ‘sugar free’.  Sugar alcohols do contain carbohydrates and provide energy, but they are lower in calories than regular sugar, and their effect on blood glucose levels is negligible.  Note however, that if used in excess, these sugar alcohols can have a laxative effect.

They can appear in the ingredients list of food packaging as:
Erythritol, isomalt, maltitol, mannitol, lactitol, sorbitol and xylitol.

Non-nutritive sweeteners 
Non-nutritive sweeteners, also called artificial sweeteners, offer the sweetness of sugar, but without the calories.  Due to their strong sweetening effect - artificial sweeteners are many times sweeter than sucrose or table sugar – so only minute amounts are necessary to achieve the same sweet taste.

Non-nutritive sweeteners do not affect blood sugar levels. In fact, most artificial sweeteners are considered "free foods". Remember, however, other ingredients in some foods containing artificial sweeteners, such as sugar-free biscuits and chocolates, can still affect your energy intake and blood glucose level.

These sweeteners are commonly used to make sugar-free drinks and cordials, sugar-free sweets and biscuits, unsweetened yoghurts and chewing gum. They are also available as table top sweeteners, and some are also available in a "granular" version, which are ideal for cooking and baking. They include:

- Aspartame (Equal®; EquiSweet®; Canderel®)

- Saccharin (Hermestas®, Natreen)

- Sucralose (Splenda®; Canderel® with sucralose, Selati sucralose)

- Acesulfame-K (Hulett’s Sugalite, Selati, Equal)

- Cyclamate (Sweet’N Low®)

- Stevia (Canderel® green with stevia, Equisweet stevia)

Possible health concerns with non-nutritive sweeteners
Non-nutritive sweeteners have been scrutinized intensely for decades. Critics say that they cause a variety of health problems, including cancer. However, according to the National Cancer Institute and other health agencies, there's no sound scientific evidence that any of the non-nutritive sweeteners approved for use cause cancer or other serious health problems. Numerous research studies have confirmed that artificial sweeteners are generally safe in limited quantities, even for pregnant women.

Non-nutritive sweeteners are regulated by the Food and Drug Administration (FDA) as food additives. They must be reviewed and approved by the FDA before being made available for sale.

Moderation is key with sugar substitutes
When choosing sugar substitutes, get informed and look beyond the hype. While artificial sweeteners may help with diabetes and weight management, they aren't a magic bullet and should only be used in moderation.  Try to get into the habit of drinking all your hot beverages, such as tea, coffee and cocoa without sweetener and remember that water is the best drink for hydration.  As a guideline, use no more than 3-6 sachets or tablets of sweeteners a day, and limit diet cold drinks to a maximum of one 250ml glass a day.

Finally, food that is labelled as ‘sugar-free’, does not mean that it is free of energy or saturated fat, and the more processed foods, which often contain sugar substitutes, generally don't offer the same health benefits as do whole foods, such as fruits and vegetables.  Focus on whole foods primarily in your daily eating plan, and only use sweeteners or sweetened foods in moderation, for variety, and not every day.

Did you know?
Pick n Pay is committed to promoting health and wellbeing among South Africans, and employs a Registered Dietitian to provide free nutrition-related advice to the public.  Contact Leanne Kiezer via the Pick n Pay Health Hotline on 0800 11 22 88 or healthhotline@pnp.co.za to start your nutrition conversation.

You can also visit www.adsa.org.za to find a dietitian in your area who is registered with the Association for Dietetics in South Africa (ADSA).