Hidden Sweets and Sweetners in Kids' Diets
By Marie Collier

As a nation, Americans consume more sweeteners than any other food additive-well over 125 pounds per person each year! And that amount is on the rise. Increased consumption has been driven by an increase in consumption of sweetened beverages and a dramatic increase in the supplies of corn sweeteners used in processed and already prepared foods and condiments. Many of these sugars are "hidden," in that the ingredients list for a product does not list "sugar," but uses other terms referring to the specific type of sweetener (see the sidebar for a list of commonly used sweeteners).

Human Desire for Sweetness
Research on infant taste and development indicates that people are born liking the sensation of sweetness. Studies have showed positive facial expressions in infants given sweet-tasting stimuli. Breast milk has a natural sweet taste. Most foods that naturally contain sugar (such as fruits and dairy products) also contain important nutrients to support health. Sweetness can be a cue to the body to provide fuel for metabolic needs, growth, and physical activity. Though a desire for sweet taste is innate, the preferred level of sweetness does vary due to a number of factors such as genetics, age, exposure during childhood, cultural background, economic status, health status, availability, hunger level, and possible addiction.

Sugars can occur naturally, be generated during the cooking process, added intentionally to improve taste, or used as a preservative, such as in jams and jellies. Because of our love for sweets, food manufacturers often use added sugars to make commercial foods more appealing to our palates. Even non-sweet foods like ketchup, salad dressings, crackers, breads, and luncheon meats often contain added sugars.

Concerns About Sweeteners-Are They Safe? 
The biggest problem with processed sugar is that it is stripped of vitamins, minerals, and fiber. What are left are calories. Increased intake of sweetened beverages and foods can provide excess calories, contributing to becoming overweight or obesity in both children and adults. Both significantly increase the risk of many health problems, such as diabetes, high blood pressure, heart disease, certain kinds of cancer, and sleep apnea.

There have been several well-controlled studies that have not found an association between sugar and hyperactivity. A recent study published in the American Journal of Public Health indicated an association between soft drink intake and hyperactivity in adolescents, but caffeine was not ruled out as a possible trigger for the symptoms.  More research in this area is clearly needed. Analyses of some studies have noted a relationship between sugar consumption and major depression. There is interest in the "addictive" effect of sweeteners. Animal data suggests that sucrose consumption creates neurochemical changes in several brain areas, including those involved with pleasure-seeking behaviors.  To date, few human studies have been conducted, making applications to people difficult. Sorbitol and manitol have a laxative effect on the body and can cause bloating and loose stools. Too much fructose causes diarrhea in young children.

Artificial sweeteners may help with weight management, control of blood glucose, and prevention of dental cavities. The Food and Drug Administration (FDA) considers the approved artificial sweeteners to be generally recognized as safe. Aspartame contains the amino acid phenylalanine, and people who need to monitor their intake of phenylalanine (with the rare genetic disorder phynylketonuria, PKU) should avoid aspartame. There have been some reported allergic reactions to aspartame; however, two double-blind studies failed to reproduce allergic reactions. Reviews of other studies have indicated that aspartame is not a carcinogen and is not associated with neuro-behavioral disorders. People with sensitivity to aspartame may experience headaches. 

Some past animal studies indicated that very high amounts of saccharin might cause cancer. However, it would be difficult for a person to consume such relatively large amounts of saccharin (the equivalent of about 850 cans of saccharin-sweetened soda per day) and there has been no identified cancer connection in humans. The Food and Drug Administration (FDA) regulates the amount of saccharin that may be added to beverages and processed foods. The National Toxicology Program of the National Institutes of Health has removed saccharin from its list of potential carcinogens. It has been suggested that caregivers should limit intake of saccharin by young children because of the limited amount of data available for its use in children. The FDA concluded from a review of more than 110 studies in people and animals that Sucralose (the main ingredient in Splenda) does not pose carcinogenic, reproductive, or neurologic health risks to human beings.

Trends in beverage consumption among children and adolescents suggest that soft drinks and sport drinks have been replacing more nutritious beverages such as milk and plain water. A Harvard School of Public Health study that reviewed 30 papers published from 1966 through May 2005 suggests that soft drink consumption increased by 135 percent between 1977 and 2001 in the United States. Results from the Bogalusa Heart Study indicate that milk consumption patterns of Americans have changed markedly over the past half-century. In 1945, Americans drank four times more milk than soft drinks, whereas in 1997, they drank nearly 2.5 times more soft drinks than milk. Between 1977 and 1994, milk consumption among boys and girls decreased by about one third. Sweetened beverages may contribute excess calories, are low in nutritional value, promote tooth decay, and increase risk of bone fractures/osteoporosis if calcium intake is low (partly due to poor milk intake). One study concluded that for every additional serving of a sugar-sweetened beverage consumed each day, the odds of becoming obese may increase by as much as 60 percent. Artificially sweetened beverages such as diet soda don't provide many calories, but they are still low in nutritional value and may contribute unhealthy amounts of sodium and caffeine.

For more information and resources, go to The American Dietetic Association's website at www.eatright.org. Your sweet tooth could lead to an unhealthy diet if you're not careful and don't check and study what you consume.

Marie Collier of Boise is a licensed registered dietitian with over 20 years of focused clinical nutrition experience.