What is Sucralose, and is it a Healthy Sugar Alternative?

Sucralose sold under the brand name Splenda®, is a sugar substitute. It is a widely used artificial sweetener. People often gravitate to sugar substitutes because they provide the sweetness without the calorie content in table sugar. Sucralose is frequently used as an ingredient in food and beverages commonly marketed as “sugar-free” or “diet” to reduce the overall calorie intake.

In this article, we explore:

• Sucralose as an artificial sweetener
• The introduction of sucralose into the food industry and integration into a diverse array of food and beverage products
• Sucralose as a sugar substitute with reduced calorie intake
• The long-term use, adverse effects, and potential health concerns associated with sucralose
• Encourage readers to weigh the benefits and risks of sucralose consumption based on personal health goals
• Emphasize moderating the use of sucralose

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What is Sucralose?

Sucralose is a widely used non-nutritive, zero-calorie artificial sweetener. Sucralose is artificially synthesized from sucrose (table sugar) through a multi-step process that selectively substitutes three atoms of chlorine for three hydroxyl groups in the sugar molecule. Subsequently, it is purified to approximately 98 percent (4). These chemical modifications ensure that sucralose is about 600 times sweeter than table sugar (5). The final product is a white, crystalline, high-potency artificial sweetener that is highly soluble in water. The high solubility of sucralose in water makes it very desirable to be incorporated into a wide range of processed foods: baked goods, beverages, chewing gum, gelatins, and frozen dairy desserts.

Individuals seeking an alternative sweetener often prefer sucralose to other artificial sweeteners such as aspartame and saccharin. As a derivative of table sugar, sucralose retains much of the familiar "sugar-like" taste while notably lacking the bitter aftertaste commonly associated with other sugar substitutes. The potent sweetness of sucralose makes a small quantity go a long way making it a popular choice for low-calorie diets.

Ingested sucralose in humans is minimally absorbed in the gastrointestinal tract and the primary route of excretion is unchanged sucralose in the feces. Therefore, there is no catabolic (breakdown) process, confirming that sucralose is not a source of energy (6) and or calories.

The Approval and Regulatory Status of Sucralose

In 1991, sucralose was first approved for use in Canada, followed by Australia in 1993, and New Zealand in 1996. In 1998, the U.S. Food and Drug Administration (FDA) approved sucralose for use in 15 food and beverage categories and expanded its use as a general-purpose sweetener for foods in 1999 (7). Sucralose received approval for use as a food additive in the European Union in 2004.

The FDA regulates sucralose as a food additive. Sweeteners must be safe for consumption under the federal Food, Drug, and Cosmetic Act. The FDA's determination of safety was based on extensive animal studies and clinical trials, assessing toxicology, teratogenicity (the ability to cause fetal abnormalities during pregnancy), and carcinogenicity. Based on the FDA’s recommendation, the Acceptable Daily Intake (ADI) level for sucralose was set at 5 mg/kg body weight per day (mg/kg/d) in the United States (7). 

Potential Benefits of Using Sucralose

Non-caloric Nature for Weight Management

Unlike table sugar, sucralose is not digested or broken down in the gastrointestinal tract (6) and does not act as a caloric fuel in our body. Therefore, sucralose is a popular choice for individuals seeking to replace table sugar (1 teaspoon or approx. 4.2 grams of table sugar contains 16 calories) and reduce their total calorie consumption. By incorporating sucralose into their diet, individuals can satisfy their sweet tooth without worrying about the extra calories, this is crucial for weight management. 

Suitability for the Management of Diabetes

Sucralose is not metabolized by our body for energy and does not contribute to spikes in blood glucose levels (6). Based on clinical studies of sucralose on diabetic patients, the FDA concluded that sucralose does not adversely affect short-term glycemic control in persons with Type 2 Diabetes. Additionally, a series of clinical studies demonstrated that sucralose did not affect long-term glucose homeostasis (measured by glycosylation of HbA1c) in patients with Type II Diabetes (7). Therefore, sucralose is a safe sweetening option for diabetics maintaining a low-carbohydrate diet. However, as with any dietary choice, an individual with diabetes must consult their integrative or functional medicine practitioner for a personalized dietary plan while monitoring any risk of hypoglycemia with sucralose intake (11).

Potential Health Concerns and Side Effects

Although sucralose has undergone safety evaluations by regulatory bodies, the safety of sucralose regarding its potential health impact has frequently sparked debate. Particularly the toxicology studies assessing the impact on glucose regulation, neurotoxicity, and carcinogenicity done on animals have often attracted speculation. In this discussion, we deep-dive into long-term human studies to better understand the potential health implications of sucralose.

Metabolic Health Considerations

Studies show that artificial sweeteners, including sucralose, stimulate sweet-taste receptors expressed on pancreatic β-cells to secrete insulin, particularly in the absence of glucose. Sucralose has also been shown to induce GLP-1 secretion. GLP-1 is crucial in glucose homeostasis and normally augments glucose-mediated insulin secretion. Over time, the increased levels of insulin in the blood upon exposure to sucralose can eventually lead to insulin resistance due to decreased receptor activity.

Impaired glucose homeostasis (regulation of blood glucose levels) and decreased insulin sensitivity are key features associated with metabolic disorders. The persistent inability to efficiently reuptake glucose disrupts blood sugar regulation and the subsequent development of metabolic conditions such as type 2 diabetes, obesity, and dyslipidemia. Moreover, the risk of cardiovascular disease markedly increases.

Gut Health and Microbiome Effects

Sucralose is considered “metabolically inert” as it is not absorbed but is eliminated unchanged in the feces. This makes it an unlikely substrate for gut microbiota. However, evidence suggests that sucralose exposure can indirectly alter our gut microbiome through impaired glycemic control or potential immune-mediated response.

Several animal studies suggest gut microbial dysbiosis with the consumption of non-nutritive sweeteners (NNS); showing an increase in the abundance of pathogenic bacteria and a decrease in the abundance of beneficial gut bacteria. However, extrapolating animal data to humans must be done cautiously as their applicability to human health and disease may be limited.

A clinical trial aimed at studying the effect of short-term (14-day intervention period) consumption of sucralose on glucose metabolism also explored the effect of repeated daily intake of NNSs on the gut microbiota. The study concluded that sucralose was not causing dramatic changes in gut microbiota richness or evenness. Conversely, another short-term, randomized-controlled trial suggested that dietary supplementation with NNSs can impact the functional potential of the human microbiome, with the most prominent effects observed with sucralose.

However, it is important to note that both clinical trials studied the effects of short-term supplementation of NNSs (including sucralose), and longer exposure periods are required to fully understand the health ramifications of NNS supplementation on the human gut microbiome. The long-term effects of sucralose and other NNSs on the human gut microbiome is an ongoing area of research.

Neurological Aspects and Appetite Regulation

Although considered calorie-free, sucralose stimulates the sweet taste receptors induces the secretion of insulin from the pancreas, and begins a metabolic cascade mimicking a fed state. The persistent secretion of insulin secretion in the absence of glucose rewires our metabolic equilibrium and brain chemistry. Our taste buds are tricked into thinking we are consuming real sugar. In a randomized crossover trial, obese female participants showed increased brain activity in the regions associated with food cue reactivity and reward processing resulting in an increase in caloric intake after sucralose consumption. This study provides compelling evidence linking the consumption of sucralose and other artificial sweeteners to increased appetite and cravings, overeating, and consequent weight gain and obesity. 

Guidelines for Sucralose Consumption

Sucralose is generally recognized as safe (GRAS) for its intended use within the recommended ADI of 5 mg/kg bw/day. Although sucralose is considered a zero-calorie sweetener, it does not have any beneficial nutritional value including vitamins, fiber, minerals, or antioxidants. A diet rich in whole foods will help curb sugar cravings and help steer away from reaching for the sucralose sachet. Here are some recommendations for using sucralose as a sugar alternative: 

Moderation: While sucralose is a non-caloric sweetener that can reduce overall caloric intake, excessive long-term consumption may have potential health implications. It is more important to promote a balanced diet by incorporating fresh, whole fruits and vegetables, lean meats, fish, and whole grains. It is best to minimize the consumption of added sugars and processed food.

Read Nutrition Labels: Sucralose is a common ingredient used in diet sodas, yogurt, baked goods, chewing gum, and condiments. It is important to diligently read nutrition labels to identify products containing sucralose and ensure to stay within the recommended ADI and minimize overall consumption. 

Nutritional Education: Empowering ourselves with information on the importance of making healthy food choices, understanding food labels, and the role of nutrients in the body will lead to improved health outcomes and quality of life. 

Consult with a Functional Medicine Practitioner: A functional or integrative medicine practitioner has a wealth of knowledge about the complex dietary requirements essential for managing various health conditions, particularly metabolic syndromes. It is recommended to collaborate with a functional medicine practitioner to tailor a dietary protocol, including the use of sucralose as a sugar substitute, to manage any underlying metabolic conditions and dietary restrictions and promote a healthy gut microbiome.

Perspectives from Health Experts

Functional health practitioners and nutritional experts recommend exercising caution with the daily consumption of artificial sweeteners such as sucralose for overall health maintenance. This guidance stems from the limited long-term evidence available regarding the effects of sucralose consumption on our health.

The World Health Organization (WHO) recently released guidance recommending against the use of non-sugar sweeteners (NSS), including sucralose, suggesting increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults from long-term use of NSS. The recommendation is for all individuals except those with pre-existing diabetes. Francesco Branca, WHO Director for Nutrition and Food Safety advises, "People should reduce the sweetness of the diet altogether, starting early in life, to improve their health."

Although sucralose is deemed safe and effective for consumption by the U.S. Food and Drug Administration (FDA), the European Food Safety Authority (EFSA), and other global regulatory bodies, moderate intake as part of a well-balanced, whole-food diet is encouraged. The potential health concerns associated with the long-term use of sucralose are yet to be explored. 

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Key Takeaways

• Sucralose, marketed as Splenda®, is a widely used non-nutritive, calorie-free sugar substitute that is 600 times sweeter than table sugar and is commonly used in food and beverage products.
• Sucralose is deemed safe for consumption in the United States by the FDA, adhering to the Acceptable Daily Intake (ADI) level of 5 mg/kg body weight per day (mg/kg/d).
• For individuals managing an underlying health condition that necessitates a low-carbohydrate, calorie-restricted diet, sucralose is a suitable zero-calorie sugar alternative that does not impact short-term blood sugar levels.
• While considered safe for consumption, the long-term use of sucralose as a sugar substitute may be associated with impaired glucose metabolism, insulin resistance, altered gut microbiome composition, and increased appetite.
• Sucralose must be consumed in moderation while staying below the recommended daily intake levels.
• It is important to prioritize nutritional education and scrutinize nutrition labels to identify sucralose used as a “hidden” ingredient.
• Individuals looking to manage their weight and maintain healthier dietary habits, especially those with pre-diabetes and diabetes, must consult with a functional or integrative healthcare practitioner to tailor a dietary protocol that aligns with their specific health goals and needs.
• The World Health Organization (WHO) cautions against the consumption of non-sugar sweeteners (NSS), including sucralose, with exceptions for those with pre-existing diabetes.
• Regulatory bodies such as the U.S. Food and Drug Administration (FDA), and the European Food Safety Authority (EFSA) emphasize moderate intake of sucralose as part of a well-balanced diet.
• Emphasizing a well-balanced diet rich in fresh, whole fruits and vegetables, lean meats, fish, and whole grains takes precedence over consuming artificial sugar substitutes.