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Harvard Health Publications -- Harvard Medical School HEALTHbeat
March 30, 2005

Dear HEALTHbeat subscriber,

Many of us want to cut calories, and more of us than ever need to keep blood sugar under control. Because it can be so hard give up that burst of sweetness in our coffee, cereal, yogurt or baked goods, individuals — and food manufacturers — often turn to artificial sweeteners. This issue of HEALTHbeat tackles the risks and benefits of both older products like saccharine and aspartame, and newer ones like Splenda.

Also in this issue, Dr. Celeste Robb-Nicholson, editor of the Harvard Women's Health Watch, answers a question on whether exercise is safe for people with varicose veins.

Best wishes,
The Editors
The editors of Harvard Health Publications
Harvard Medical School

In This Issue
1 Are sugar substitutes safe?
2 Notable from Harvard Medical School:
* Diabetes: A plan for living
* Exercise: A program you
   can live with
3 A Harvard Medical School physician answers:
Can I exercise if I have varicose veins?

From Harvard Medical School
Healthy Eating for Type 2 Diabetes

One of the most frequent questions people with diabetes ask is “What can I eat?” This report tells you how to develop a diet strategy to prevent or manage the most common form of diabetes — type 2 diabetes. The report teaches you how to recognize portion distortion, make wise choices while dining out, and stay on track with your weight-loss plan. Best of all, there are 40 original recipes so you can put this advice into practice — starting today.

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Buy our special health reports online and save $8 off the cover price—that's 33%!

1\ Are artificial sweeteners safe?

Artificial sweeteners are everywhere, from sodas to breakfast cereals. Although FDA-approved, and widely used, may people wonder about the safety of sugar substitutes. But with rare exceptions, they appear to pose little or no risk when used in moderation.

How do they work?

Artificial sweeteners add sweetness without calories in two ways. First, they are so sweet — 160 to 13,000 times sweeter than sugar — that you need only a tiny bit to achieve the equivalent taste. You consume a fraction of a calorie to get the sweetness of many more calories worth of sugar. Second, because the body doesn’t fully absorb them, it also doesn’t fully absorb the few calories they contain.

Low-calorie sweeteners contain only a few calories per gram. Also known as sugar alcohols or polyols, they are 50%–92% sweeter than sugar. These sweeteners are found strictly in packaged goods — look for sorbitol, mannitol, xylitol, erythritol, and D-tagatose on the ingredients list. All sugar alcohols are absorbed slowly and incompletely by the intestine, which is why they have little caloric effect. However, this property can also cause gas and diarrhea if you consume too much. For many people, more than 50 grams per day of sorbitol or 20 grams per day of mannitol can cause these problems.

What about some of the other sweeteners, termed "no-calorie"? Here’s a rundown of the evidence on some of the most popular.

Acesulfame K (Sunett, Sweet One): Incorporated in hundreds of products, acesulfame K is 200 times sweeter than sugar and can be used in baked goods. According to the FDA, its safety is backed by more than 90 studies.

Saccharin (Sweet ’N Low, Sugar Twin, others): Saccharin was almost banned in 1977 because of studies in rats linking it to bladder cancer. Since then, the National Cancer Institute and the FDA have concluded that its use is not a major risk for bladder cancer in humans. Saccharin is 200–700 times sweeter than sugar.

Aspartame (Nutra-Sweet, Equal, others): Despite anecdotal reports of adverse effects, the American Medical Association and the FDA have both concluded that aspartame is safe at recommended levels. However, people with a disorder called phenylketonuria (PKU) should avoid it. These people cannot metabolize an amino acid found in aspartame, allowing it to accumulate in the body to dangerous levels. Aspartame is 160–220 times sweeter than sugar.

Sucralose (Splenda): Sucralose, which is 600 times sweeter than sugar, is marketed as being “made from sugar.” Its manufacturers do use sugar as the starting point. However, they convert sugar to the non-caloric sucralose by changing its chemical makeup, so it’s not actually sugar any longer. Granulated Splenda can be substituted for sugar, spoon-for-spoon, in baking and cooking. Although it’s called a “no-calorie” sweetener, sucralose does have a small fraction of a calorie. There is also a new product called Splenda Blend that is half sugar, half Splenda.

Neotame: The most recently approved sweetener, neotame is 7,000–13,000 times sweeter than sugar. It is made by the same company that produces NutraSweet (aspartame). It is derived from aspartame, but with one chemical change. This enables the body to metabolize neotame differently than aspartame, so products containing neotame are not required to carry the PKU warning.

Should you use sweeteners?

The American Dietetic Association has approved the use of all five FDA-approved artificial sweeteners for people with diabetes, pregnant women, and children. Although artificial sweeteners are considered generally safe, some experts remain wary. These experts believe that there’s not enough evidence on the sweetener aspartame to be sure that it’s completely safe and that animal studies linking saccharin to cancer are a reason to ban it.

In moderation, foods containing artificial sweeteners can satisfy a craving for sweets while limiting the number of calories consumed. You'll still want to keep an eye on total calories, because sugar-free does not mean calorie-free. If you're uncomfortable about using artificial sweeteners, despite current scientific evidence, you can get by without them. Try the following:

  • Drink flavored seltzer water instead of diet soda.
  • Cut back on the sugar you add to foods. With a little time and training, your taste buds can learn to enjoy other ways of sweetening food, like blueberries in your oatmeal instead of maple syrup.
  • Compare grams of sugar when buying packaged foods. Some brands may have less sugar than others.
  • Read labels and packaging carefully. Many products contain artificial sweeteners when you might not expect them to; likewise, some reduced-sugar products do NOT use artificial sweeteners.

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2\ Notable from Harvard Medical School
** Diabetes: A plan for living

A diagnosis of diabetes means a new way of life. This report will help you better understand and manage your diabetes. Among other things, you’ll learn the basics of how your body metabolizes sugar, the tools of diabetes control, and the fundamentals of nutrition and exercise. You’ll also get up-to-date information on new products, medications, and techniques that may further revolutionize diabetes care. Perhaps most importantly, you’ll see that it’s not just possible to live with diabetes; it’s possible to live well.

** Exercise: A program you can live with

By now, most people know that exercise can benefit everything from your heart health to your mood. But too many of us still haven’t found ways to make exercise a part of our lives. A report from Harvard Medical School, Exercise: A program you can live with, will help you do just that. It explains what exercise does for the body, the different types of exercise you need, how to build your program, how to get started, and stick with it, and how to keep safe—everything you need to know to find a program that works for you.


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3\ Q&A: Exercise and varicose veins

Q: I am a 56-year-old woman with serious varicose veins. What exercises will help increase my lower body strength without making my varicose veins even worse?

A: Most kinds of exercise are fine for women with varicose veins. In fact, exercise helps prevent the problem, while excessive sitting and standing tend to aggravate it. The contraction of muscles in the legs during exercise helps to compress the veins and move blood in the proper direction.

These simple steps can make any exercise more comfortable on your legs. The special hose that compress the lower legs more than the thighs are not only helpful during normal daily activity, but also during exercise. After exercise, try to elevate your legs above the level of your heart for 10–15 minutes. You should also avoid wearing garments that constrict your upper leg or groin, which will intensify the problem.

With regard to aerobic exercise, which improves your cardiovascular fitness, you may find that high-impact activities, such as jogging, are uncomfortable. But you may enjoy low-impact alternatives like brisk walking, bicycling, cross-country skiing, rowing, Nordic track, and swimming.

Virtually all strength training or resistance exercises are fine. Resistance exercises help to preserve bone mass, add muscle mass, and improve strength and balance. These exercises involve the use of weight machines, free weights, or resistance equipment like specially made rubber bands.

If you are just starting a regular exercise program, start slowly and increase your aerobic and resistance workouts gradually.

Celeste Robb-Nicholson, M.D.
Editor in Chief, Harvard Women's Health Watch


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Harvard Medical School offers special reports on over 50 health topics. Visit our website at to find reports of interest to you and your family.

Copyright 2005 by the President and Fellows of Harvard College.
Harvard Health Publications
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