A common misperception is that sugar is uniquely fattening.Because the taste of sugar is so pleasant, some rationalize that sugar becomes irresistible to the point of overconsumption or addiction. However, most individuals have a limit as to how sweet they like their foods and how much they can consume in a given period.
   No evidence exists that carbohydrates or sugars are a cause of obesity. A higher intake of whole grains (about three servings daily) was associated with healthier body weights and tat stores. Excessive caloric intake leads to obesity, whether from carbohydrates, proteins, fats, or alcohol. Although excessive energy intake from sugar may lead lo obesity, epidemiological studies and several individual studies have shown that obese patients actually consume less sugar than thin patients. Many sweet foods contain large amounts of fat. Too much carbohydrate is likely to be consumed when fat is limited and overall food intake is not restricted to some degree.

Dental Considerations

Scientific studies do not support the claim that sugars interfere with bioavailability of vitamins, minerals, or trace nutrients, or the notion that dietary imbalances are preferentially caused by increased sugar consumption. Do not assume that because a person is obese, increased sugar intake is the culprit.

 Nutritional Directions

  • A well-balanced diet that contains adequate nutrients with appropriate amounts of fruits and vegetables and milk and dairy products is advisable.
  • Several organs depend on glucose to function. A change to a minimal-carbohydrate, high-protein, high-fat diet may result in an inadequate intake of numerous nutrients.



The practice of flavoring foods without additional kilocalories is one of many approaches to the problems of excess energy intake and a sedentary lifestyle. The use of sugar substitutes also has beneficial ramifications for dental hygiene. The desire to decrease sugar consumption is being met through widespread and increasing use of numerous sugar substitutes. Consumption of low-calorie sweeteners is increasing faster than that of caloric sweeteners.
   These products are used principally for their sweetening power, but they also make some foods more palatable. The large variety of sweeteners is desirable because each has certain advantages and limitations. Because each sweetener has different properties, the availability of various products helps satisfy various flavor and texture requirements in foods and beverages. Sweeteners may be combined because of their synergistic effect—that is, when combined, sweeteners yield a sweeter taste than that provided by each sweetener alone.
   Although taste buds may be fooled by their sweetness, non-nutritive sweeteners do not produce a prolonged feeling of satiety and could prompt overeating. An emerging body of scientific evidence suggests artificial sweeteners offer little help to dieters and may help promote weight gain. Concerns have been expressed that nonnutritive sweeteners may promote energy intake and contribute to obesity. Most of the possible mechanisms by which this occurs are not supported by available evidence. Resolution of this important issue will require long-term randomized controlled trials.
   Use of these non-nutritive sweeteners may or may not decrease the total kilocalorie intake, depending on other food choices. Making compensatory food choices, such as drinking a diet carbonated beverage to permit a piece of cheesecake, is ineffective in weight control, whereas replacing a high-calorie food with a low-calorie food, watching other food intake, and engaging in some form of exercise may be beneficial.
   Many people question the safety of these products. All products on the market have been extensively researched and are safe for most people if consumed in moderation except for aspartame. Aspartame should be avoided by patients who havephenylketonuria, a genetic disorder characterized by an inability to metabolize the amino acid phenylalanine.

Dental Considerations

  • Sugar substitutes can reduce the energy content and decrease cariogenicity of a product. Used in moderation, sugar substitutes are beneficial for many people, especially patients with diabetes.
  • Because aspartame contains phenylalanine, aspartame-containing products are labeled to warn patients with phenylketonuria to avoid their use.
  • Use of sugar substitutes is especially advocated for between-meal snacks to decrease frequency of exposure of the teeth to sugar. For individuals who do not need to decrease energy intake, sugar alcohols may be recommended.
  • Sugar substitutes are nonfermentable and do not promote caries formation; antimicrobial activity has not been observed. Saccharin and aspartame exhibit microbial inhibition and caries suppression.


Nutritional Directions

  • Non-nutritive sweeteners may not have cariogenic potential. However, bulking ingredients that allow them to pour and measure more like sugar and other constituents of a product may have cariogenic potential because of the presence of fermentable carbohydrates.
  • Non-nutritive sweeteners do nothing to appease the appetite, but they do provide the pleasure of sweetness. They may enable people to choose a wide variety of foods while managing their caloric or cariogenic intake.
  • When deciding whether a young child should be given foods sweetened with a non-nutritive sweetener, consider the child’s body weight, and limit the sweetener to below recommended levels (500 mg/day for saccharin, 50mg/kg body weight for aspartame, and 15mg/kg body weight for Acesullame-K).
    One packet of Sweet’n Low (Cumberland Packing Corp) contains 40 mg of saccharin; one packet of Sweet One (Stadt Corp), 50 mg of acesulfame; and one packet of Equal (Nutrasweet Co), 35 mg of aspartame. (Because there are no known side effects for sucralose, no maximum limits have been established for children). Remember, children need energy for growth and development.
  • Combinations of sweeteners can produce a sweet taste more similar to that of sugar than can a single high-intensity sweetener.
  • During pregnancy, saccharin is not recommended because it is known to cross the placenta. Refer a pregnant patient to her obstetrician for counseling about use of any non-nutritive sweeteners.

Health Application – High-Fructose Corn Syrup

In recent years, the lay press has drawn a lot of attention to several studies regarding high-fructose corn syrup (HFCS)and its association with the current obesity epidemic, diabetes mellitus, and other maladies. HFCS has been labeled “the devil’s candy.” “the crack of sweeteners,” and “a sinister invention.” Consumers are specifically concerned about HFCS; many of their changes in food choices are driven by an effort to lose weight.
    HFCS was so named because it is made from corn; however, it is different from regular corn syrup, which is composed of glucose and glucose polymers. Some of the glucose molecules in corn are changed into fructose, making MFCS sweeter. The enzymatic processes involved in the production of HFCS are used to produce other foods and ingredients that are considered natural. The U.S. Food and Drug Administration (FDA) has stated that HFCS may be labeled as a natural ingredient.
   HFCS has a ratio of fructose to glucose identical to sucrose and honey; in other words, it contains nearly equal amounts of fructose and glucose. It is comparable to sugar and honey in its sweetness and the way it is processed in the body. It was designed to be equal to sucrose in sweetness so that they could be used interchangeably in foods and beverages. HFCS has been used principally in carbonated beverages and fruit preparations because of its stability in acidic products. After fructose and glucose (from sucrose, HFCS, or honey) are absorbed from the intestinal tract, each enters into its own metabolic pathway, just as the fructose and glucose molecules from sucrose. After fructose and glucose reach the bloodstream, the human body cannot distinguish these sweeteners from one another. Many studies have shown that HFCS does not prompt the production of hormones that help regulate appetite and fat storage, and scientific evidence does not indicate that HFCS alters metabolism uniquely to promote deposition of body fat. Fructose can produce elevated levels of triglycerides, which have been linked to an increased risk of heart disease.
   The Center for Food, Nutrition and Agriculture Policy organized an expert panel to discuss the relationship between the consumption of HFCS or “soft drinks” and weight gain. After studying the published scientific literature, the expert panel concluded that HFCS does not seem to contribute to overweight and obesity any differently than do other energy sources.
   HFCS currently accounts for about 10% of sweetener used around the world. Many other countries are seeing increasing rates of obesity and diabetes even though little or no HFCS is present in their food supply. As a result of the availability of HFCS, sucrose use has declined from 80% of total caloric sweetener in 1970 to 40% in 1997. Body mass index (BMI) values continued to increase between 1997-2004, whereas per capita consumption of HFCS remained stable. Over consumption of either sweetener, or any caloric-containing food or beverage, along with fats and decreased physical activity contribute to weight gain.