Are artificial sweeteners a good sugar alternative?

Q. More and more nutrition advice seems to be anti-sugar these days. So are artificial sweeteners a good alternative?

A. Sugar in all its forms may be the single most important dietary cause of obesity and heart disease in the American diet today. Stripped of fiber and antioxidants, table sugar (sucrose) and high fructose corn syrup cause big jumps in blood glucose and insulin. They also raise levels of triglycerides, lead to inflammation, and create free oxygen radicals. In addition, the fructose found in most types of sugar may damage the liver and cause insulin resistance.

Artificial sweeteners include:

• acesulfame
• aspartame
• neotame
• saccharin
• stevia plant extract
• sucralose.

Most people consume artificial sweeteners because they want to lose weight. Replacing concentrated sugar with products that have very few, if any, calories should tilt energy balance in favor of weight loss. And some studies suggest that artificial sweeteners may have that effect.

But other research raises concern that they may do just the opposite and actually promote weight gain. How so? Artificial sweeteners are extremely sweet — hundreds to thousands of times sweeter than table sugar. So people who habitually consume them may wind up desensitized to sweetness.

Healthful, satiating foods that are less sweet — such as fruits and vegetables — may become unappetizing by comparison. As a result, the overall quality of the diet may decline. The calories removed from the diet by the sugar-for-sweetener swap may sneak back in, in the form of refined carbohydrates and low-quality fats.

In addition, some research has identified sweetness receptors in fat tissue. This raises the possibility that artificial sweeteners could cause weight gain by directly stimulating the growth of fat cells.

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