sugar substitutes

Presented by: Dr. swati vermaMDS- Ist year

Contents

Introduction

Types of sugar substitutes

Classification

Ideal requirements

Sweet score & USDA Food pyramid

Health benefits of AS

FDA approved AS –benefits & toxic effects

Polyalcohols

Natural sweeteners

Tooth friendly sweet concept

References

INTRODUCTION

WSRO STATEMENT ,NOV.2011

Sugar (sucrose) being most acceptable sweetening

agent in use by mankind is considered as the “Arch

Criminal” in dental caries initiation.

Dental caries occur when acid-producing bacteria,

especially Mutans streptococci, Lactobacilli and

Actinomyces species, populate the sticky coating on

the surface of tooth.

Frequent consumption of fermentable

carbohydrates, including sucrose, has a role in the

aetiology of dental caries.

Sugar substitutes Artificial sweeteners are

called as sugar

substitutes

Added to foods to

provide sweetness

without adding extra

calories

2 kind of sweeteners

Nutritive

Non-nutritive

Types of nutritive sweeteners Sugar sweeteners

High fructose corn syrups

Glucose

Dextrose

Lactose

Maltose

Honey

Concentrated fruit juices

Reduced energy polyols or

sugar alcohols

Sorbitol

Xylitol

Mannitol

Hydrogenated starch hydrolysates(HSH)

CALORIC

Poly alcohols/sugar

alcohols.

Xylitol

Sorbitol

lactilol

Hydrogenated starch

hydrolysate

Lycasin

Palatinit

Coupling sugar

Sorbose

Palatinose

NON CALORIC

Saccharin

Aspartame

Sucralose

Neotame

Cyclamate

Classification

A)Natural

• 1. Monellin

• 2. Licorice

• 3. Dihydrochalcone

• 4. Miraculin

B)Artificial

• 1. Aspartame

• 2. Saccharin

• 3. Cyclamate

• 4. Sucralose

Based on their

origin

Pramod Yadav et al. sugar substitutes & health . IOSR

Journal of Dental and Medical Sciences (IOSR-JDMS)

Volume 13, Issue 8 Ver. III (Aug. 2014),

Ideal requirements

Should provide sweetness with no unpleasant after taste

Should have little or no calories

Should not be carcinogenic or mutagenic

Should be economical to produce

Should not be degraded by heat when cooked

SWEET SCORE SWEETS : FREQUENCY X SCORE

Liquid : _ x 5

Solid : _ x 10

Slowly dissolving : _ x 15

Total sweet score: —  Interpretation sweet score 

5 or less: excellent

10: good

15 or more: “watch out” zone  

Diet Counselling – A Primordial Level of Prevention of

Dental Caries. Journal of Dental and Medical Sciences

(IOSR-JDMS) Volume 13, Issue 1 Ver. II (Jan. 2014), PP

64-70

USdA FOOD PYRAMID

Health benefits of AS

Weight loss

Dental care

Diabetes

mellitus

Cost

5 Artificial sweeteners approved by

FDA

Saccharin

Aspartame

Acesulfame K

sucralose

Neotame

SACCHARIN

Discovered by Remsen &

Fahlberg in 1879

Oldest of artificial

sweeteners

200-700 times sweeter

than sucrose

Available in liquid & tablet

forms as a tabletop

sweetener, has a slightly

bitter taste

BenefitsCalorie free

Pharmacologically inert & is stable under

moist conditions encountered in food

preparations

Heat stable

Excretes almost without

metabolic alteration, 75% -

90% in urine

Brand name – Sweet ‘N

Low & Sugar Twin

Dental aspects Saccharin 0.5%

,when used as a

supplement to a

cariogenic diet , it

significantly reduced

both fissure and

smooth surface caries

in rats, apparently by

interfering with the

growth of S.mutans.

Adverse effects

Oral dose of 5-25 gm daily may cause anorexia, nausea & vomiting

Bladder cancer

FDA , 1972 – Set limits on the use of saccharin (1gm/day for a 155 lb person)

Reuber MD, 1977 – experimental group of rats which had 5% saccharin in their diet had higher incidence of bladder cancer than control group of rats.

Howe et al, 1977 – conducted a study on hospitalized patients with bladder cancer. Risk of bladder cancer was 60% higher among men who had used saccharin tablets

Aspartame

Combination of amino acids

Aspartic acid & Phenylalanine

It is about 180-200 times

sweet as sucrose

Caloric value of 4 cal/gm

Kroger et al (2006)-low calorie sweeteners & other substitutes- a review of

safety issue .vol.5

ADI- 50 mg/kg/d

Effective in enhancing acid

fruit flavors & extending sweet

taste as in chewing gums

Brand names – Nutrasweet,

Equal

Food containing Aspartame

Toxic effects

Acute Headache

dry mouth

dizziness

mood change

nausea

Vomiting

thrombocytopenia

Chronic Lymphomas

Liver dysfunction

Whitehouse et al.(2008)the potential toxicity of artificial sweeteners-

vol.56.No.6

Disadvantages

Risk of fetal abnormalities & mental

retardation if blood levels of phenylalanine

are not carefully maintained below

12mg/100ml, during pregnancy for persons

with PKU (FDA, 1981)

Acesulfame K

200 times sweeter than

sucrose

First approved by FDA in

1988 for use as a sweetener

in dry food products .

Used in yogurt,

refrigerated desserts,syrups.

ADI- 15 mg/kg/d

Brand names – Sunett &

Sweet one

Advantages Calorie free

No evidence of

carcinogenicity,

mutagenicity, cytotoxicity &

teratogenicity

Excellent shelf life so it is

used in candies,canned

food and alcoholic

beverages

Disadvantages

Headache

Sucralose Discovered in 1976

Non- nutritive, non caloric derivative of sucrose

6oo times sweeter than sucrose

Sold under the trade name SPLENDA

Widely used throughout the world in tea, coffee, carbonated & non- carbonated beverages, chewing gums etc.

ADI- 5 mg/kg/d

Advantages

Non-cariogenic

Nutritive value is zero calories

Disadvantages

Diarrhoea

Dizziness

Stomach pain

NEOTAME Newest of the low calorie sweeteners

8000 times sweeter than sucrose

ADI- 2 mg/kg/d

• Found in baked foods, soft drinks, chewing gum, frosting, frozen desserts, jams, jellies, gelatins, puddings, processed fruits, toppings, and syrups.

TOXIC EFFECTS

• Headache

• Hepatotoxicity at high doses

Polyalcohols

Sorbitol Occurs naturally in cherries,

plums ,pears, apples.

Prepared from glucose by high pressure hydrogenation or by electrolytic reduction.

• 1 gm sorbitol yields 4 calories

• Recommended intake by Food & Agricultural organization ( WHO) 150mg/kg/day

oxidoreductase

Sorbitolfructose

Advantage

Can be used by only 5-10% of bacteria in

plaque – less acid production ( Kalfas et al,

1990)

Disadvantage

Too much sorbitol consumption ( >20-30gm)

can cause diarrhoea. It act as a laxative

because of osmotic transfer of water into the

bowel.

Xylitol Obtained commercially from

birch trees.

Naturally in fruits and

vegetables (strawberries,

raspberries, plums), oats,

certain mushrooms.

Commonly used by diabetic

patients.

High dosage causes

diarrhoea.

The recommended dose for

dental caries prevention is 6–

A study conducted in Turku, Finland,

evaluated the effectiveness of xylitol on

dental plaque reduction in 1970.

xylitol has been widely researched and

globally accepted as a natural sweetener

approved by the US Food and Drug

Administration (FDA) and the American

Academy of Pediatric Dentistry.

Guideline on Xylitol Use in Caries Prevention.by

AAPD (2011)

xylitol is incorporated into the cells of MS as xylitol-5-phosphate, through the phosphoenolpyruvate phosphotransferasesystem. This results in inhibition of both growth and acid production.

Nayak et al.(2014)The effect of xylitol on dental

caries

and oral flora. Clinical, Cosmetic and Investigational

Dentistry

MECHANISM OF ACTION

Xylitol reduces the levels of mutans streptococci in plaque and saliva by disrupting their energy production processes, leading to cell death.

It reduces the adhesion of these microorganisms to the teeth surface and also reduces their acid production potential.

promotes mineralization by increasing the salivary flow when used as chewing gum

Xylitol alcohol has been shown to impact growth of nasopharyngeal bacteria such as S. pneumonia and S. mitis, and hence has a role to play in nasopharyngeal pneumonia

Oral health benefits

Decreases incidence of caries by ng salivary

flow

Reducing

Cariogenic bacteria

Plaque level

Xerostomia

Gingival inflammation

Erosion

Milgrom et al.studied the effect of habitual

consumption of

xylitol gummy bear snacks (11.7 g/d) in reducing

cariogenic

microorganisms in school-going children. And found

significant reduction in S. mutans and S. sobrinus.

Murthykumar reported in 2013 that xylitol in milk

demonstrated a beneficial anticaries effect and is

well accepted by both children and adults.

Shikhar kumar et al (2013) concluded that Children

consuming the sugar-free (xylitol) chewing gum

showed a marked increase in the pH of saliva.

LactilolSugar alcohol used as a

replacement bulk sweetener

for low calorie foods

40% as sweet as sucrose

Provides 2.4 cal/g

Used in sugar-free candies,

cookies (biscuits), chocolate,

and ice cream

Advantages

Highly stable, can be used in baking

Promotes colon health as a prebiotic

Laxative and is used to prevent or treat

constipation

Disadvantages

Cramping, flatulence & diarrhoea

High fructose corn syrup(HFCS)

Mixture of glucose & fructose

Produced from corn syrup

2 most common types

HFCS 42 = 42% fructose, 58%

glucose

HFCS 55 = 55% fructose, 45%

glucose

ROLE OF HFCS Baked goods – give a brown

crust, enhances flavour in fruit

fillings

Yogurt – enhances flavor,

controls moisture.

Sauces & condiments –

enhances flavor & balance

Canned & frozen fruit – Protect

the firm texture of canned fruit,

reduces freezer burns on frozen

fruits

Beverages – Provide greater

stability than sucrose in acidic

carbonated sodas .

Toxic effects Fat deposits in liver

Narrowing of blood vessel

Triggers asthma, food allergies

and damages immune system

Accelerates the ageing process

Mercury poisoning as HFCS

contains mercury.

Dr.mercola- Bad to the Last Drop: Refiners Squeeze

Dangerous Additives from Corn

Natural sweeteners

Stevioside Found in leaves of stevia rebaudiana.

Calorie free, non-cariogenic

300 times sweeter than sucrose

Brand name – pure via, truvia

Miraculin

Shrub grown in West Africa

produces berries that have

property of causing sour

substances to taste sweet

Active ingredient

(miraculin)is a glycoprotein

with a molecular weight of

about 44,000

Effective in sweetening citrus fruits,berries,yogurt etc.

Trade name- miralin miracle fruit drops

Licorice (ammoniated glycyrrhizin)

Derived from licorice root( glycyrrhiza glabra)

50 times as sweet as sucrose

Used as expectorant & pharmaceutical vehicles

Reduce the solubility of enamel & prevent fall in

pH during incubation of saliva-glucose mixtures

Monellin Red berries growing in

grape like cluster.

Serendipity berries

3000 times sweeter than

sucrose

Loses its sweetness

within about a day, if left

standing at room

temperature

Tooth friendly sweet concept

Started in switzerland in 1989.

To provide consumers with easy guidance to

toothfriendly products, the Toothfriendly ("Happy

Tooth") label was created.

Lollipops

mints

chewing gums

Pastilles

Tooth friendly bubble gum

concept was presented by

BENEO with palatinose .

These chewing gums are

derived from sugar beet

low glycemic response which

is approved by EHA.

Reduced stickiness

References Pediatric dentistry priciples & practice- MS muthu 2nd

edition

Cariology –Ernst newburn ,1st edition

Textbook of pediatric dentistry- Nikhil marwah -2nd

edition

Roshan NM, Sakeenabi M. Practical problems in use

of sugar substitutes in preventive dentistry. JISPPD

2011;1(1): 1-8

Bray GA et al. Consumption of high fructose corn

syrup in beverages may play a role in the epidemic of

obesity. Am J Clin Nutr 2004;79:537-43

Kroger M. Low calorie sweetners & other sugar

substitutes: A review of safety issues. Comprehensive

reviews in food science & food safety 2006(5): 35-47

AAPD. Policy on the use of xylitol in caries

prevention. Reference manual; 34(6): 45-47

Whitehouse et al. The Potential Toxicity of

Artificial Sweeteners. American Association of

Occupational Health Nurses Journal. 2008;

56(6),251-259.

Raben Anne et al. Sucrose compared with

artificial sweeteners. The Americal journal of

Clinical Nutrition. 2002; 76,721–729.

Matsukubo and Takazoe: Sucrose substitutes and

their role in caries prevention, International Dental

Journal (2006) Vol. 56/No.3.

Pramod Yadav et al. sugar substitutes & health .

IOSR Journal of Dental and Medical Sciences (IOSR-

JDMS) Volume 13, Issue 8 Ver. III (Aug. 2014).

Oku T et al. Digestion, absorption, fermentation &

metabolism of sugar substitutes. Pure Appl Chem,

2002; 74(7): 1253-61

• Guideline on Xylitol Use in Caries Prevention.by

AAPD (2011)

Kumar, et al.: Effects of xylitol on salivary and

dental plaque pH in children. JISPPD OCT-DEC

2013 ,vol.31.issue 4 .

• Nayak et al.(2014)The effect of xylitol on dental

caries

and oral flora. Clinical, Cosmetic and

Investigational Dentistry

• Diet Counselling – A Primordial Level of

Prevention of Dental Caries.Journal of Dental and

Medical Sciences (IOSR-JDMS) Volume 13,

Issue 1 Ver. II (Jan. 2014), PP 64-70