Artificial sweeteners

Acesulfame

Acesulfame is an artificial sweetener derived from aceto-acetic acid. It is used in a wide range of non-medicinal products [ ].

Aspartame

Aspartame is a dipeptide that is used as an artificial sweetener. It is completely hydrolysed in the gastrointestinal tract to methanol, aspartic acid, and phenylalanine [ ].

Aspartame appears to be a safe sweetener, and despite numerous studies of its safety during the past three decades, the incidence of serious adverse effects has been difficult to determine in controlled studies. Since one of the metabolic products of aspartame is phenylalanine, excessive use of aspartame should be avoided by patients with phenylketonuria [ ]. Toxicity of another possible metabolic product, methanol, is unlikely, even when aspartame is used in extraordinary amounts [ , ].

Aspartame has reportedly caused angioedema and urticaria [ ].

Cyclamates

Sodium cyclamate is a potent sweetening agent. It has been subjected to numerous safety and carcinogenicity studies. Animal data led to warning against excessive and indiscriminate use a long time ago, causing the World Health Organization in 1967 to adopt a safety limit of 50 mg/kg. However, in 1982 a joint FAO/WHO expert committee on food additives revised this recommendation to allow for a maximum daily intake of up to 11 mg/kg of sodium or calcium cyclamate (as cyclamic acid) [ ]. Nevertheless, since in certain climates and populations the amount of cyclamates in soft drinks and other beverages can exceed these limits, more epidemiological data are needed to evaluate, for example, a possible association with cancer of the uropoietic system [ ] and with histological and radiological abnormalities of the small intestine and malabsorption [ ].

Saccharin

Saccharin and its salts are potent sweeteners, about 300 times as sweet as sucrose. It is used to sweeten foods and beverages.

Sorbitol

Sorbitol, a polyhydric alcohol, is used as a sweetening agent in many oral medicinal liquids. In addition to enhancing the palatability of these liquids, it improves solution stability and reduces crystallization of syrup vehicles [ ]. It is used as a sweetener in many sugar-free food products and confectioneries. Sorbitol-containing food products are often recommended for patients with diabetes, because sorbitol does not raise blood glucose concentrations or require insulin for its metabolism [ ].