One cannot imagine a day without sugar especially when one is "non-diabetic". The moment someone is diagnosed with Diabetes, the person instantly quits sugar and switches to some alternative sweeteners. After all, the 'sweet taste' is inevitable! Not only individuals with Diabetes, but also many weight watchers prefer sweeteners in the diet instead of sugar to cut down some more calories! But are these sweeteners healthy and safe to consume? Let's take a deeper look at various sweeteners available in the market and dig out some interesting facts!Virtually every food we eat can be converted to sugar (glucose i.e. the purest sugar) at the end of the digestion (you may sense sweetness hidden in grains if you chew thoroughly!). This means we end up eating a lot of sugar at the end of the day!But, the food we eat is a source of all other important nutrients too. But this does not stand true for processed sugar..The top sugar (table sugar or jaggery or honey) that we add to the food is just for the sake of the 'taste'. Apart from calories, these sugars seldom provide any nutrients (empty calories).It is therefore recommended to include sugar that is naturally existent in fresh foods than processed forms. To do so, fruits and dry fruits are the best bet. They impart sweetness to the dish and offer various vitamins, minerals, antioxidants and fibres too. Especially fruits like banana, sapodilla (chikoo), dates, custard apple, mango, berries and dry fruits like raisins, apricots, figs go well with various sweet dishes. How sweeteners workSweeteners or sugar substitutes are substances that have more intense sweetness but provide fewer carbohydrates and calories than sugar (sucrose). They are similar to sugar to sit on the sweetness receptors of the tongue but they are metabolised differently than sugar.That is, our body cannot break them down to calories, which means, sweet taste without calories! Due to these properties, sweeteners can easily replace sugar even if they are used in smaller quantities. Due to lesser carbohydrates, their immediate effect on blood sugar levels is lesser and due to lesser calories, they are claimed to help in weight loss.These sweeteners are extensively used in various food products, beverages and dietary supplements marketed as 'sugar-free' or 'diet'. Many medicines (especially syrups), toothpaste, mouthwashes also contain sugar substitutes as sweet taste improves the acceptability of the product without affecting oral health and blood sugar levels.Types of sweetenersThere are currently six sweeteners approved by the food and drug administration (FDA) and are generally recognised as safe (GRAS). They are - aspartame, saccharin, sucralose, acesulfame-K, neotame and stevia. The following table provides a comparison of sweeteners available in the market to sugar:sweeteners do not affect insulin or blood sugar levels, some studies have reported that ingestion of sweeteners for a prolonged period can lead to the development of glucose intolerance by altering the gut microbiome. Some animal studies havealso shown a link between sweeteners and the risk of cancer. Some artificial sweeteners can also lead to side effects like headache, stomach upset and depression.But most of these studies have shown harmful effects only in animals and not in humans while some studies had limitations like smaller sample size, borderline significant results or use of very high dosages.Sweeteners and addictionLike sugar, sweeteners can also be addictive. Artificial sweeteners are much sweeter than sugar and thus can reset the taste buds. Our body slowly adapts to the sweeteners, builds up tolerance and overuse is very likely. As previously discussed, sweeteners can also make one overeat (a kind of addictive behaviour) by affecting the hunger signalling mechanisms.Some reports suggest that sweeteners can overstimulate the taste buds as they are multiple times sweeter than sugar. This overstimulation can lead to resistance to less intensely sweet, natural foods like fruits and vegetables. So giving up sweeteners may not be easy!Cooking with sweetenersMore commonly, artificial sweeteners are used to sweeten beverages like tea, coffee, milk, buttermilk, lime water and sodas.Sweeteners can easily be used in halwa, kheer, basundi, custards and puddings too. They are not exposed to very high temperatures when they are added to beverages or semisolid foods (ideally sweeteners are added at the end of the cooking, preferably when the food comes down to room temperature).On the contrary, baking is a cooking method in which the cooking temperature can rise to more than 200 C. Unfortunately many sweeteners are not suited for such high temperatures. Intense heat can break them down and turn bitter. Some may not impart the desired texture or browning while baking.•\tAspartame loses its sweetness if exposed to high temperature•\tSaccharin gives a metallic aftertaste and makes baked food lumpy•\tAcesulfame-K can be used for baking but turns slightly bitter.•\tStevia is heat stable but does not give a good browning effect.•\tNeotame holds up the sweetness at hightemperatures and does not give a bitter taste (best choice for baking).•\tSucralose can also be used for baking (it is made from sugar itself!).LimitationsThe American Dietetic Association (ADA) recommends that sweeteners should not be used in children especially those below2 years of age. The reason is children have higher food and beverage intake (so does the sweetener intake) per kilogram of their body weight.Pregnancy and lactation are the other two contraindications where the use of sweeteners should be discouraged though some of the sweeteners are declared as 'not unsafe'. Those with kidney failure, epilepsy or susceptibility to migraine attacks should better avoid sweeteners or consult a nutritionist before deciding the type of sweetener.Aspartame should be avoided by those with phenylketonuria (a birth defect that causes phenylalanine amino acid build up in the body).The final messageSo far we have discussed different types of sweeteners in great detail. Now it's time to mull over a question - 'do we really need sweeteners' and 'should one use sweeteners regularly?'. Though sweeteners give a lot of 'psychological comfort' to those withobesity and Diabetes, their physiological effects, in the long run, may not be that soothing. They are not magic pills and thus should be used in moderation with a holistic lifestyle. Rather than continuous use, occasional use in moderation is the best bet.One must remember that sweetener is just one ingredient in the dish. Other ingredients matter too! So adding sweeteners to other unhealthy ingredients like soda, maida, refined flours and fatty foods may not serve the purpose! Also, it is important to consider that sweeteners are least useful when they are used to substitute healthy and nutrient-dense foods such as milk or fruits.The next important point is the food marketed as 'sugar-free' may not be healthy and 'calorie-free'. It may cause weight gain and blood sugar spikes. Processed food, even if it is sugar-free, may not offer the health benefits of natural foods.A consumer should be encouraged to use appropriate sweeteners for an existing health condition at an appropriate dose for the required duration. All positive, as well as negative aspects of sweeteners, must be discussed with the consumer in detail before prescribing them. "Being calorie-conscious" may not be a qualification for sweetener usage!Over-the-counter use of sweeteners may not be appropriate and the opinion of the expert must be taken before purchasing and using any sweetener. Food labels should be read thoroughly before buying any packaged food to know the presence, type and quantity of sweetener used.In short, don't look at food as just calories. It is information! Know it, read it and understand it before you eat it. And program your taste buds wisely right from childhood! This will help you rely less onsugar and sweeteners. Take sweeteners with a pinch of salt!! Dr Teyas Limaye, (M.&.PhD. RD), is a Clinical Nutritionist and a Certified Diabetes Educator.