Noncaloric Sweeteners in Children: A Controversial Theme.

Noncaloric sweeteners (NCS) are food additives used to provide sweetness without adding calories. Their consumption has become more widespread around the world in all age groups, including children. The aim of this study is to show the state of the art about the intake of noncaloric sweeteners in children, as well as their benefits and consumption risk. Scientific searchers were used (PUBMED, Scopus, and Scielo) to analyze articles that included keywords (noncaloric sweeteners/saccharin/cyclamate/acesulfame potassium/aspartame/sucralose/stevia/children) in English, Spanish, and Portuguese. Authors conclude that it is imperative that health professionals judiciously and individually evaluate the overall benefits and risks of NCS use in consumers before recommending their use. Different subgroups of the population incorporate products containing NCS in their diet with different objectives, which should be considered when recommending a diet plan for the consumer. In childhood, in earlier age groups, this type of additives should be used as a dietary alternative when other forms of prevention in obesity are not sufficient.

Artificial sweetener as a historical window to culturally situated health.

This article employs the history of artificial sweetener consumption in the United States as a window onto the ways in which American women defined health as a physical and cultural construct in the mid-20th century. It uses, as an evidentiary basis, two consumer case studies: the initial adoption of saccharin and cyclamates in the 1950s, and the defense of saccharin in the wake of pending FDA restrictions in 1977. These instances suggest that individuals have historically based their assessment of healthy food products on both their understanding of the products' physical impact and their set of held values, attitudes, and beliefs particular to a historical moment. They also suggest that gender, class, and geographic location are formative influences on how those values, attitudes, and beliefs are constructed. The history of artificial sweetener consumption points to the importance of considering health from a physical and cultural point of view in attempts to shape nutrition practice and policy in the United States.

Artificial sweetener consumption and urinary tract tumors in Cordoba, Argentina.

OBJECTIVE: To determine the role of the habitual use of the most common artificial sweeteners (AS) in the development of urinary tract tumors (UTT) in Argentina. METHODS: Case-control study of 197 patients with histologically confirmed UTT of transitional varieties, and 397 controls with acute, non-neoplastic, and non-urinary tract diseases, admitted to the same hospitals in Córdoba (Argentina) between 1999 and 2006. All subjects were interviewed about their use of AS and their exposure to other known or suspected risk factors for UTT. RESULTS: Fifty-one UTT patients (26%) and 87 controls (22%) used AS. The risk of UTT was significantly increased in long-term (> or =10 years) AS users compared with none-AS users. The OR (95% CI) for long-term consumers was 2.18 (1.22-3.89) and for short-term users was 1.10 (0.61-2.00) after adjustment for age, gender, BMI, social status. and years of tobacco use. CONCLUSION: Regular use of AS for 10 years or more was positively associated with UTT.

[Restless legs due to ingestion of 'light' beverages containing saccharine. Results of an N-of-1 trial]. / 'Restless legs' door inname van lightfrisdranken met sacharine. Resultaten van een N = 1-onderzoek.

To determine whether there was a connection between the complaint of restless legs and the ingestion of artificial sweeteners in a patient with these symptoms after drinking certain 'light' beverages, a randomised, double-blind, placebo-controlled N-of-1 trial with a crossover design was used. During a period of 48 days, the patient took 4 capsules per day containing either 150 mg of cyclamate, 22.5 mg of saccharine, both sweeteners, or placebo on two successive days. Between each of these 2-day periods there was a 2-day rest period during which no capsules were taken. The hospital pharmacist had prepared the capsules and determined the sequence of the 2-day periods on a random basis. The patient did not know which capsules he was taking. Every day on arising, starting 3 weeks before the trial period, the patient noted the intensity and duration of the symptoms in the late evening and previous night. For this notation he used an 11-point scale, from 0 (= no restless legs) to 10 (= almost total inability to sleep because of restless legs). A score of 1-3 corresponded to mild symptoms that had no effect on the patient's sleep; at a score of 4-6 his sleep was disturbed and at a score of 7-10 the patient hardly slept at all. The patient had symptoms more often while using saccharine or the combination of saccharine and cyclamate than when taking the placebo (4 and 4 versus 2 of the 6 nights); moreover, the average score was then statistically significantly higher (5.2 and 5.8 versus 3-3). It was concluded that there was a connection between the patient's complaints of restless legs and the use of saccharine, but not the use of cyclamate.

[Restless legs due to ingestion of 'light' beverages containing saccharine; results of an N-of-1 trial]. / 'Restless legs' door inname van lightfrisdranken met sacharine; resultaten van een N = 1-onderzoek.

OBJECTIVE: To determine whether there was a connection between the complaint of restless legs and the ingestion of artificial sweeteners in a patient with these symptoms after drinking certain 'light' beverages. DESIGN: Randomised, double-blind, placebo-controlled N-of-1 trial with a cross-over design. METHOD: During a period of 48 days, the patient took 4 capsules per day containing either 150 mg of cyclamate, 22.5 mg of saccharine, both sweeteners, or placebo on two successive days. Between each of these 2-day periods there was a 2-day rest period during which no capsules were taken. The hospital pharmacist had prepared the capsules and determined the sequence of the 2-day periods on a random basis. The patient did not know which capsules he was taking. Every day on arising, starting 3 weeks before the trial period, the patient noted the intensity and duration of the symptoms in the late evening and previous night. For this notation he used an 11-point scale, from 0 (= no restless legs) to 10 (= almost total inability to sleep because of restless legs). RESULTS: A score of 1-3 corresponded to mild symptoms that had no effect on the patient's sleep; at a score of 4-6 his sleep was disturbed and at a score of 7-10 the patient hardly slept at all. The patient had symptoms more often while using saccharine or the combination of saccharine and cyclamate than when taking the placebo (4 and 4 versus 2 ofthe 6 nights); moreover, the average score was then statistically significantly higher (5.2 and 5.8 versus 3.3). CONCLUSION: There was a connection between the patient's complaints of restless legs and the use of saccharine, but not the use of cyclamate.

Artificial sweeteners--do they bear a carcinogenic risk?

Artificial sweeteners are added to a wide variety of food, drinks, drugs and hygiene products. Since their introduction, the mass media have reported about potential cancer risks, which has contributed to undermine the public's sense of security. It can be assumed that every citizen of Western countries uses artificial sweeteners, knowingly or not. A cancer-inducing activity of one of these substances would mean a health risk to an entire population. We performed several PubMed searches of the National Library of Medicine for articles in English about artificial sweeteners. These articles included 'first generation' sweeteners such as saccharin, cyclamate and aspartame, as well as 'new generation' sweeteners such as acesulfame-K, sucralose, alitame and neotame. Epidemiological studies in humans did not find the bladder cancer-inducing effects of saccharin and cyclamate that had been reported from animal studies in rats. Despite some rather unscientific assumptions, there is no evidence that aspartame is carcinogenic. Case-control studies showed an elevated relative risk of 1.3 for heavy artificial sweetener use (no specific substances specified) of >1.7 g/day. For new generation sweeteners, it is too early to establish any epidemiological evidence about possible carcinogenic risks. As many artificial sweeteners are combined in today's products, the carcinogenic risk of a single substance is difficult to assess. However, according to the current literature, the possible risk of artificial sweeteners to induce cancer seems to be negligible.

Cyclamate intake and cyclohexylamine excretion are not related to male fertility in humans.

Cyclamate and its metabolite cyclohexylamine affect male fertility in high dose animal studies, but this affect has not been investigated in epidemiological studies. This paper reports the first epidemiological study designed to investigate the possibility of a relationship between cyclamate and cyclohexylamine and male fertility in humans, in which 405 cases of clinically defined infertility in men and 379 controls were surveyed. Semen evaluation, urine analysis for cyclamate and cyclohexylamine and dietary questionnaires were compared between cases and controls. No evidence was found of a significant association between cyclamate intake and male infertility; neither high cyclamate nor high cyclohexylamine excretion were associated with elevated risk. The lack of association remained after adjusting by age, area of residence, education, total energy intake and other variables. No significant correlations were observed between cyclamate intake, metabolism or excretion, and sperm count and motility. The results demonstrate no effect of cyclamate or cyclohexylamine on male fertility at the present levels of cyclamate consumption.

[Artificial sweeteners--are they potentially carcinogenic?]. / Künstliche Süssstoffe--Haben sie ein kanzerogenes Potential?

BACKGROUND: Artificial sweeteners have rapidly evolved over the last 20 years and are added to a broad variety of food, drinks, drugs, and hygiene products. Since their introduction, especially mass media have reported about potential cancer risks, which has attributed to undermine the people's sense of security. It can be assumed that every citizen of the western countries is using artificial sweeteners--knowingly or not. A cancer-inducing activity of one of these substances would mean a health risk to an entire population. STUDIES: This article gives an overview about the most important publications dealing with the cancerogenic potential of artificial sweeteners.

IARC Monographs, volume 73: some chemicals that cause tumours of the kidney or urinary bladder in rodents and some other substances - summary of data reported and evaluation.

It presents data reported and results of carcinogenicity evaluation for humans and experimental animals of some chemical compounds.

IARC Monographs, volume 22: some non-nutritive sweetening agents - summary of data reported and evaluation.

It presents data reported and carcinogenicity evaluation for humans and animals of cyclamates, saccharin, and other sweetening agents.

Use of artificial sweeteners to promote alcohol consumption by rats.

Cirrhosis may be reliably produced in rats by exposing them intermittently to low levels of carbon tetrachloride vapour while feeding alcohol in the Lieber-DeCarli liquid diet. Providing the alcohol in drinking water that has been sweetened with sucrose is a cheaper and more convenient method but it does not yield reliable results. This study aimed to determine whether alcohol in drinking water sweetened with artificial sweeteners would give adequate alcohol intake to achieve the desired hepatic effects. Rats were fed alcohol (8% v/v) in drinking water sweetened with sucrose (5% w/v) (n = 12), or with one of the artificial sweeteners aspartame (0.025%), saccharin (0.025%) or cyclamate (0.05%) (n = 8 per agent). During the alcohol treatment the animals were exposed to carbon tetrachloride vapour, 40 ppm, six hours per night for five nights per week, over a period of 14 weeks. All groups achieved good alcohol intakes of 5-6 g/kg/day. Only one rat, in the aspartame group, became cirrhotic; all the others had varying degrees of fibrosis which did not differ significantly among the treatments. Although it was not effective in reliably achieving cirrhosis, sweetening the alcohol solution with artificial sweeteners led to reasonable alcohol intakes with resultant hepatic fibrosis, and without the high carbohydrate intake which occurs when sucrose is used.

[Abuse of artificial sweetener as differential diagnosis of lactose intolerance]. / Süssstoffabusus als Differentialdiagnose der Laktoseintoleranz.

A two year old dystrophic boy with chronic diarrhea was described. At the age of 6 month the boy developed a severe gastroenteritis with a secundary lactase deficiency. Dietary treatment was however not successful and consequently the boy became dystrophic. At last, an abuse of sweetener was diagnosed.

Erupción fija pigmentaria por jugos artificiales / Fixed pigmentary drug eruption due to artificial juices

Se presentan tres pacientes entre siete y once años de edad, que desarrollaron una erupción fija pigmentaria tras al ingesta durante más de tres años de jugos artificiales dietéticos. Se realizó estudio histológico, que fue de compatibilidad en el primer y segundo caso, mostrando un patrón liquenoide en el tercero. Se discute el rol de los edulcorantes contenidos en estos jugos artificiales, como así su asociación con las sulfas

[Changes in cytomembrane and surface cells of the large intestine resulting from the action of sweetening agents]. / Alteraciones en la citomembrana y células de superficie del intestino grueso por acción de los edulcorantes.

Saccharin and cyclamates have been proved to cause organic damage. This work attempt to describe drug-induced changes brought about by drugs in 1/1000 saccharin and cyclamate-fed rats for 90 days. The ultrastructural findings show: microvilli hypertrophy; membranous mitochondrial increase in absorptive cells; and secretion changes in calciform cells. Such changes are cell-response phenomena to interference or mutagenic action on nuclear DNA or on cytoplasmatic metabolism.

Alteraciones en la citomembrana y celulas de superficie del intestino grueso por accion de los edulcorantes / Changes of cytomembrane and surface cells of the large intestine by sweetening agents action

Se ha demostrado que la sacarina y los ciclamatos provocan lesiones en el organismo. Describimos en este trabajo las alteraciones producidas por estas drogas en ratones alimentados con una solución de sacarina y ciclamato al 1/1000, durante 90 días. El estudio ultraestructural revela: Hipertrofia microvellositaria e incremento membranoso mitocondrial en las células absortivas y alteraciones en la secreción de células calciformes. Estas modificaciones son fenómenos de respuesta celular por interferencia o acción mutágena sobre el ADN nuclear o metabolismo citoplasmático. Los autores agradecen a la señora Carolina S. de Santolaya por el apoyo técnico realizado. Esta investigación fue apoyada financieramente por el Consejo de Investigación de la Unviersidad Nacional de Tucumán