ARTIFICIAL sweeteners, or sugar substitutes, are popular as more people aim to maintain a healthy weight or reduce sugar consumption without compromising the flavour of food and drinks.
One of the oldest and most commonly used artificial sweeteners is aspartame, an artificial non-saccharide sweetener that comes in the form of a white, odourless powder. It is about 200 times sweeter than sugar, so just a very small amount is needed for flavour.
Products containing aspartame or other artificial sweeteners often come with labels such as "diet" or "sugar-free" to appeal to the so-called health-conscious consumer.
Used since the 1980s, aspartame is approved for use in more than 100 countries. It is found in more than 6,000 products, but concerns remain about its health impact.
A 2013 study published in the journal Food and Chemical Toxicology notes no links between aspartame and cancer and heart conditions. However, it has been linked to behavioural and cognitive problems, including learning problems, headaches, seizures, migraines, irritable moods, anxiety, depression and insomnia, according to a 2017 study published in the journal Nutritional Neuroscience.
The Health Ministry's Food Safety and Quality Division senior director Norrani Eksan says aspartame is a food additive that has been approved for use in Malaysia as a sweetener or flavour enhancer since the Food Regulations 1985 came into force.
Norrani says on top of products with labels like "low calorie" or "sugar free", aspartame can also be added to other products, including cocoa and cocoa products, soft drinks and candy.
STICK TO SAFE LIMITS
She says aspartame and its metabolites are safe for human consumption at the acceptable daily intake (ADI) of 40 mg per kg of body weight per day. However, consumption of aspartame above the ADI may pose a risk.
The risk associated with ingesting aspartame is in the toxicity of its metabolites (aspartic acid, phenylalanine, and methanol).
"One of its metabolites, phenylalanine, is not recommended for people with phenylketonuria because their ability to metabolise phenylalanine is impaired and may cause mental retardation, mood disorders and behavioural problems," says Norrani.
Most artificial sweeteners, such as acesulfame potassium, cyclamate and sucralose, are allowed to be added to food intended to be sold in Malaysia with a permitted maximum amount, she adds.
Malaysian Medical Association president Dr Muruga Raj Rajathurai says according to the United States Food and Drug Administration (FDA), there are more than 100 studies showing aspartame to be safe for most people.
"We are aware that over the years, there have been a number of studies suggesting its consumption may have some negative effects on health. However, more research and human studies are needed to support these findings."
Nevertheless, people with phenylketonuria and tardive dyskinesia should avoid consuming aspartame, he says.
Dr Muruga Raj says phenylketonuria is a genetic metabolic disorder that increases levels of the essential amino acid phenylalanine in the blood, while tardive dyskinesia is a neurological disorder that causes sudden, uncontrollable jerking movements of the face and body.
Consultant dietitian, Indra Balaratnam, says the truth is that we don't know enough about aspartame to say that as a food additive, it won't be harmful if consumed regularly over a long period of time.
"There is documented research that aspartame may be linked to numerous health disorders. However, researchers find it hard to make a direct association," she says.
As aspartame is used in many popular non-sugar beverages and foods, people can potentially consume much more aspartame than is intended as safe, she explains.
And aspartame is not the answer to reducing sugar in our diet, stresses Indra.
"I often advise my clients to use fruit - either fresh fruit or dried fruit like raisins, dates or prunes to add natural sweetness to their daily diet."
MORE INFORMATION NEEDED
Clinical dietitian Rozanna M Rosly says knowledge about the advantages and disadvantages of aspartame is crucial to assess the risk of its harmful impact on health.
Artificial sweeteners can induce glucose intolerance by altering gut microbiota, according to a 2014 study published in Nature, while artificially sweetened beverage consumption during pregnancy is linked to higher body mass index for babies, according to a 2016 paper in JAMA Pediatrics.
"Taking into account that aspartame is a widely used artificial sweetener, it seems appropriate to continue research on its safety," says Rozanna.
IMU School of Health Sciences, division of nutrition and dietetics, senior lecturer, Dr Harvinder Kaur, says there is evidence showing the detrimental effect of aspartame, such as its link to the exacerbation of diabetes, headaches, seizures, depression, arthritis and other medical conditions.
Aspartame has also been associated with increased risk of cancers in some studies while other studies found no association, she adds.
"The health effects of aspartame or any other artificial sweeteners are inconclusive, with research showing mixed findings."
ASPARTAME
*Main ingredients are aspartic acid and phenylalanine.
*Aspartic acid is produced naturally by our body while phenylalanine is an amino acid from food.
*Has been the subject of extensive research for over 30 years.
*However, studies so far have not found any clear link between aspartame and cancer or other adverse health effects.
*Approved for consumption by regulatory bodies in many countries including the US Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA).
COMMON ARTIFICIAL SWEETERNERS
*Saccharin
*Acesulfame potassium (Ace-K)
*Sucralose
*Neotame
*Newtame
*Advantame
*Stevia
*Erythritol
NATURAL SUGAR SUBSTITUTES
*Dates/ figs/ raisins
*Honey
*Fresh sweet fruits (apple/banana/watermelon/mango)
*Vegetables (carrots/sweet potatoes/ tapioca)
*Maple syrup
*Fresh sugar cane/sugar beet root/molasses
*Coconut palm sugar/gula melaka
*Chicory root fibre
*Agave nectar
EVERYDAY PRODUCTS WITH ASPARTAME
*Diet soda/low-sugar fruit juice/zero-calorie drinks
*Toothpaste
*Breakfast cereals
*Light yoghourt/low-fat flavoured milk
*Vitamins/medicines/sugar-free cough drops
*Desserts mixtures/ puddings
*Breath mints/sweets
*Biscuits/confectionery
*Reduced sugar sauces/syrups/ketchups
*Sugar-free ice cream/popsicles
Sources: FDA (fda.gov.my) healthline.com, EFSA (https://www.efsa.europa.eu), American Cancer Society (www.cancer.org), medicalnewstoday.org, livestrong.com
HISTORY OF ASPARTAME
1965 - accidentally discovered by chemist James Schlatter
1981 - FDA approves its use in certain foods
1983 - FDA expands approval to include carbonated soft drinks.
1996 - FDA allows aspartame as a general-purpose sweetener for foods and beverages.
Source: Aspartame.org