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Position Statement on the Academy of Nutrition and Dietetics

It is the position of the Academy of Nutrition and Dietetics that consumers can safely
enjoy a range of nutritive and nonnutritive sweeteners when consumed within an eating plan that
is guided by current federal nutrition recommendations, such as the Dietary Guidelines for
Americans and the Dietary Reference Intakes, as well as individual health goals and personal
preference. Authors of this position include: Cindy Fitch, PhD, RD and Kathryn S. Keim PhD,
RD, LDN. The Academy of Nutrition and Dietetics first adopted this position October 18, 1992
and the position is effective until effective until December 31, 2015 (1).
Summary of the Academys Position
The Academys position on sweeteners states that a variety of nutritive and nonnutritive
sweeteners may be incorporated into a persons diet. The amount and type of sweetener
consumed would depend on the individuals dietary plan, personal preferences, and any health
considerations (namely diabetes). Federal recommendations coupled with personal taste
preferences and health goals should determine ones choice to consume nutritive or nonnutritive
sweeteners.
A nutritive sweetener is one that provides energy, contains carbohydrates, and can occur
naturally or be added to foods during processing (1, 2). Common nutritive sweeteners include:
sucrose, fructose, agave nectar, fruit juice, and honey. Nonnutritive sweeteners are those that
lack carbohydrates or energy and can sweeten foods several hundred to several thousand times
more than sucrose (1, 2, and 3). Polyol, which differ from nonnutritive sweeteners are sugar
alcohols such as xylitol and sorbitol, and compose a third, distinct type of sweetener. Polyols
occur naturally or can be added chemically to foods to sweeten them. These are classified as
nutritive sweeteners because they provide some caloric energy. However, some food labels

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which state that a product is "sugar free" may include sugar alcohols, nonnutritive sweeteners, or
both (2,3).
The mechanism of sweet taste preference in individuals is a determining factor of
nutritive or nonnutritive sweetener use. The academy explains the preference of sweet taste is
both instinctive and variable among people. There is little evidence to suggest sweet taste
inclinations are genetic, so they are thought to be environmental (1). The consumption amount
and frequency of sweeteners in individuals depends solely on their taste preference.
Regulations of Sweeteners in the United States
Nutritive and nonnutritive sweeteners are evaluated and regulated by the Food and Drug
Administration (FDA). Sweeteners fall into one of two categories the FDA uses to classify
sweeteners; food additives or Generally Regarded as Safe (GRAS) non-food additives (1, 3).
Many naturally occurring sweeteners are GRAS while most artificial sweeteners are food
additives (3). To gain approval from the FDA the (sweetener) manufacturer must give the FDA
safety data related to the use of the additive and its effects (1). To determine if the consumption
of the sweetener is safe, the FDA will use research on the intake, consumption, side effects, and
toxicological data to makes its safety determination. Currently, in the United States there are only
a handful of nonnutritive sweeteners that have been approved, regulated, and determined safe for
consumption. The approved nonnutritive sweeteners include: Acesulfame potassium
(acesulfame-K), Aspartame, Neotame, Saccharin, Sucralose, Stevia, and Luo han guo (1, 3, 4).
Effects of Sweetener Use on Health
Nutritive and nonnutritive sweeteners alike have a host of health concerns. The
Academys position paper touches on the concerns and effects of sweetener use during
pregnancy, dental caries (cavities), hyperactivity in children, and obesity. Using sweeteners

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during pregnancy was once thought to have lasting detrimental effects on fetal development.
However, after review and research, the Academys position on sweetener use during pregnancy
is that: both nonnutritive and nutritive sweeteners are acceptable; studies did not confirm any
negative side effects on fetal development (1).
Dental caries are another avenue of concern for those who have an inclination for sweets.
Cavities are spots of decay (damaged areas) on the tooth by materials acidic in nature from
bacterial breakdown of dietary carbohydrate. To prevent cavities one can avoid sugary foods,
snacks, and beverages. Additionally, the polyol, Xylitol a cavity inhibitor helps to prevent
cavities. The FDA approved the health claim that polyols are useful in cavity prevention after
many studies were conducted with encouraging results. The studies show chewing gum has
cavity inhibition effects and polyols prevent cavities by stimulating salivation (1,2).
Negative behavioral effects have been thought to be caused by sugars over the years.
However, such claims have not been confirmed. Studies have proven sugar does not affect the
behavior or cognition of children, including hyperactive children. Studies conducted on schoolaged children evaluated ranges of behavioral and cognitive functions with high sweetener diets.
Scientists evaluated the effects of above-average sweetener consumption in hyperactive children
and found not negative behavioral effects, concluding sweeteners were not a source of
hyperactivity (5). The Academy has determined sweeteners safe for all children to consume (1).
Nonnutritive and nutritive sweeteners were studied with evidence suggesting greater
consumption of sugar sweetened beverages is associated with increased body weight in adults.
However, added sugars of sugar substitutes were not any more likely to cause obesity than other
source of energy. For example, added sugars that can be found in beverages with nutritive
sweeteners are not different than other extra energy in the diet for energy intake and body

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weight. Reducing intake of all added sugars is recommended to reduce energy intake in
Americans (1,2).
The Role of Registered Dietitians
Based on the Academys position, the role of the Registered Dietitian is to help educate
consumers and patients on how to reduce both nutritive and nonnutritive sweetener intake.
Dietitians can educate individuals on sweetener information. Under the direction of a Dietitian,
a diabetic individual could be educated on alternative nonnutritive sweeteners. Diabetic
consumers who look to manage their blood glucose levels and maintain a healthy weight would
directly benefit from the seven FDA approved nonnutritive sweeteners. Their innate desire for a
sweet taste is being satisfied without adding extra energy to their diet or raising blood glucose
levels. The role of the Dietitian would also be to help individuals determine their energy
allowance based on personal all factors. All information Dietitians give their clients about
sweeteners should be evidence-based.
Personal opinion of the position
After review of the Academys position on nutritive and nonnutritive sweeteners and
other research articles one would agree with the Academy. The Academys position on aspects
regarding the different sweeteners has been extensively researched for accurate information.
Although nutritive and nonnutritive sweeteners both have health concerns, people have an
inclination for sweet tasting foods. It is the individuals choice to consume sweeteners; it is the
FDAs job to regulate the sweeteners for safety, and the Dietitians job to guide them on which
sweeteners are the best choice for them individually. All sweeteners are regulated by the FDA to
ensure safety and minimal side effects which is a great safety tool for individuals. Although
evidence suggests sugary beverages linked to obesity in adults, sweeteners were not any more

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likely to cause obesity than another other source of energy. Other than being an added energy
source to ones diet, sweeteners lack negative side effects that individuals usually associate with
them. The lack of side effects or sweetener use during pregnancy, on dental caries, and
hyperactivity in children; makes them acceptable for human consumption. Sweeteners should be
consumed in moderation and include an otherwise balanced and healthy diet.

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References
1. Position of the American Dietetic Association: Use of nutritive and nonnutritive
sweeteners. J Am Diet Assoc. 2012;112:739-758.
2. Shwide-Slavin C, Swift C, Ross T. Nonnutritive sweeteners: where are we today?
Diabetes Spectrum 2012;25(2):104.
3. Gale. Gale Encyclopedia of Diets 2nd ed. Detroit, MI: Gale, 2013, 81-86.
4. The Lowdown on Artificial Sweeteners. IDEA Fitness Journal. 2006;3(4):111
5. Kanarek R. Does Sucrose or Aspartame Cause Hyperactivity in Children? Nutrition
Reviews. (1994):173-175