• It’s not just sugar — kids are exposed to a variety of sweeteners that are bad for their health. 
• There are at least eight sweeteners that the AAP wants parents to know about. 
• These sweeteners often hide in foods that are advertised as having less sugar.

Parents looking for alternatives to sugar should be careful when selecting foods that promise less sugar. You may be getting less sugar, but your family could be eating questionable sugar alternatives. 

Today, the American Academy of Pediatrics (AAP) published “The Use of Nonnutritive Sweeteners in Children.” The report calls for more research into the sweeteners and their effect on kids, especially when it comes to the risk for type 2 diabetes and obesity. 

The AAP is also pushing for products to list the amount of the sweeteners on product labels so families know exactly what they’re consuming. Currently, food manufacturers only have to name nonnutritive sweeteners on the ingredient list.

“Considering how many children are regularly consuming these products — which have become ubiquitous — we should have a better understanding of how they impact children’s long-term health,” Dr. Carissa Baker-Smith, lead author and a pediatric cardiologist, said in a statement. 

What are non-nutritive sweeteners?

At least 1 in 4 children consumes a nonnutritive or artificial sweetener, the AAP reported. And about 80 percent of children consume them daily.

There are eight nonnutritive sweeteners that are approved by the Food and Drug Administration (FDA). (The first six were approved as food additives; the latter two were under a different designation.)

1. Saccharin: It’s often added to yogurt and low-sugar jelly. According to the Center for Science in the Public Interest (CSPI), this along with aspartame, acesulfame potassium, and sucralose should be avoided. “Their analysis is based on the fact that there is a lack of research on safety for some of these sweeteners. In some cases, such as with aspartame, sucralose, and saccharin, there have been studies linking it to cancer risk and other health problems,” noted Sharon Palmer, a registered dietitian nutritionist from California.
2. Aspartame: This is in many brands of diet soda, as well as Jell-O, Equal, and NutraSweet.
3. Acesulfame potassium: You’ll find this in some packaged fruits that say no sugar is added, as well as SlimFast and some diet sodas. It came in second for being in the most products surveyed, and also goes by the name acesulfame K.
4. Sucralose: Often found in diet soda, Lean Pockets, and Splenda. It was in the most amount of products studied. 
5. Neotame: This is found in Sunny D, some chewing gum, and protein shakes.
6. Advantame: Derived from aspartame, it’s often in beverages and beverage powders as well as cooking and baking products.
7. Stevia: This was approved as “generally recognized as safe” by the FDA and is on CSPI’s safe list.
8. Luo Han Guo/Monk Fruit: Also “generally recognized as safe” by the FDA, this is on the CSPI’s list to be cautious of due to a lack of testing. 
   

What’s missing?

Evidence isn’t clear on whether using nonnutritive sweeteners can control weight or cause it. Some research suggests the sweeteners can change appetite and taste preferences as well as the gut microbiome, and that can affect the metabolic system.

Though children are consuming the sweeteners, parents may not be in the know. According to one study, just 23 percent of parents were able to identify food products that contained nonnutritive sweeteners. While 53 percent of parents sought “reduced” sugar items, but most didn’t know that a nonnutritive sweetener was substituted to give the product sweetness.

Another issue about the sweeteners and lack of research is that children — with a smaller body weight — could exceed acceptable daily intake established for some sweeteners. Most of the nutritional research on them is available only for adults — and kids have unique metabolic and physiologic needs, Palmer said.

Palmer agrees that more research is needed to understand the potential cancer risk behind some of the products.

That said, it’s important to consider use — especially how often. “If it is used in the diet frequently and consistently, it increases exposure,” she added. 

When it comes to giving more details on the sweeteners via labels, Shu Wen Ng, PhD, a health economist whose research centers on nutrition, is all for it.

“Consumers and parents have the right to know what types and how much nonnutritive sweeteners are in products so that they have the ability to make informed choices,” Ng told Healthline.

She mentioned that Chile requires products that contain nonnutritive sweeteners to list the type and amount on labels. This is possible to do, she said.

Doing so will also help researchers better measure and track population level exposure to the various types of nonnutritive sweeteners in foods. This can help us understand the health impacts of nonnutritive sweeteners over time, Ng said.

What to give your kids

Palmer recommends training a child’s palate to prefer foods that are less sweet. “Research shows that exposure to less sweet foods can help children change their preference,” she said.

“It is a struggle being a parent and trying to make healthful choices,” Palmer admitted.

When children do want something sweet, try unsweetened fruit, diluted fruit juice (within the recommendations per day based on age), or fruit-infused waters, she said. Children shouldn’t have more than six teaspoons of sugar per day and no more than eight ounces of a sugary beverage per week. 

“Read labels, and look for pure, unsweetened foods more often,” Palmer suggested. “Buy plain yogurt and add fruit. Skip the sweetened and artificially sweetened beverage and make your own fruit-infused waters. Use applesauce and bananas to sweeten muffins and brownies. Get kids used to the flavors of real, unsweetened foods, such as fruits.”

Try to choose foods that are minimally processed. Look for healthful protein sources such as beans and lentils, whole grains such as oats and quinoa, as well as vegetables, fruits, and nuts. 

“Choose food products made from these whole foods, with as few artificially produced ingredients as possible,” Palmer said. 

“Let children learn to like the flavors of real foods. Research shows that exposing children to healthful foods, like vegetables, helps them to include them in the diet. So, don’t give up,” she added. “Read those labels and avoid artificial sweeteners, as well as added sugars.”