Role of Low Calorie Sweeteners in Maintaining Dental Health

Abstract

Low-calorie sweeteners (sometimes referred to as non-nutritive sweeteners, artificial sweeteners, or sugar substitutes) are ingredients added to foods and beverages to provide sweetness without adding a significant amount of calories. Their role in weight management is wiy known but their role in maintaining dental health is still hidden. The present article discusses about the well known artificial as well as natural sweeteners and their importance in maintaining dental health. Besides this microbes can also be used as a novel approach for the production of natural sweeteners.

Full text

Middle-East Journal of Scientific Research 11 (3): 342-346, 2012
ISSN 1990-9233
© IDOSI Publications, 2012
Corresponding Author: Charu Gupta, Amity Institute for Herbal Research and Studies,
Amity University, Sector-125, Noida-201303, India.
342
Role of Low Calorie Sweeteners in Maintaining Dental Health
Charu Gupta, Dhan Prakash, Sneh Gupta and Sudha Goyal
1 1 2 3
Amity Institute for Herbal Research and Studies, Amity University, Sector-125, Noida-201303, India
1
Department of Zoology, R.G. (P.G.) College, Chippi Tank, Meerut-250001, India
2
Department of Chemistry, R.G. (P.G.) College, Chippi Tank, Meerut-250001, India
3
Abstract: Low-calorie sweeteners (sometimes referred to as non-nutritive sweeteners, artificial sweeteners, or
sugar substitutes) are ingredients added to foods and beverages to provide sweetness without adding a
significant amount of calories. Their role in weight management is wiy known but their role in maintaining dental
health is still hidden. The present article discusses about the well known artificial as well as natural sweeteners
and their importance in maintaining dental health. Besides this microbes can also be used as a novel approach
for the production of natural sweeteners.
Key words: Natural sweeteners % Dental plaque % Xylitol % Microbes
INTRODUCTION in very small amounts and thus add only a negligible
Low-calorie sweeteners (sometimes referred to asthey can substantially reduce or completely eliminate the
non-nutritive sweeteners, artificial sweeteners, or sugarcalories in certain products such as diet beverages, light
substitutes) are ingredients added to foods and yogurt and sugar-free pudding. In addition, many low-
beverages to provide sweetness without adding acalorie sweeteners do not contribute to cavities or tooth
significant amount of calories. In fact, they can also playdecay.
an important role in a weight management program that
includes both good nutrition choices and physicalAcesulfame-Potassium (Ace-K): Ace-K is a combination
activity [1]. of an organic acid and potassium and is 200 times sweeter
In U.S. the most common and popular low-caloriethan sugar. It is a popular sweetener used in low-calorie
sweeteners permitted for use in foods and beveragessweetener blends to create an optimal flavor profile in
today are foods and beverages. Ace-K was approved by the U.S.
CAcesulfame potassium (ace-K) numerous food products and as a tabletop sweetener. In
CAspartame 1998, the FDA extended its approval to beverages and
CNeotame finally as a general purpose sweetener in 2003. Ace-K is
CSaccharin approved for use in nearly 90 countries. Ace-K is not
CStevia sweeteners broken down by the body and is eliminated unchanged by
CSucralose the kidneys. It has no effect on serum glucose, cholesterol
When added to foods and beverages, these low-include products containing ace-K in their diet.
calorie sweeteners provide a taste that is similar to that of
table sugar (sucrose) and are generally several hundred to Aspartame: Discovered in 1965, aspartame is used in
several thousand times sweeter than sugar. They arefoods and beverages in more than 100 countries
often referred to as “intense” sweeteners. Because of their worldwide. FDA approved aspartame for use in foods in
intense sweetening power, these sweeteners can be used1981, followed by beverages in 1983. In 1996 it received
amount of calories to foods and beverages. As a result,
Food and Drug Administration (FDA) in 1988 for use in
or triglycerides and people with diabetes may safely

Middle-East J. Sci. Res., 11 (3): 342-346, 2012
343
approval as a general purpose sweetener. Aspartame is aglycosides, which make up the sweetest part of the stevia
molecule consisting of two amino acids-phenylalanineplant. In December 2008, the FDA stated it had no
and aspartic acid. People who have a rare hereditaryquestions regarding the conclusion of an expert panel that
condition called phenylketonuria (PKU) cannot metabolize steviol glycosides are generally recognized as safe
phenylalanine; therefore, all products containing(GRAS) for use as general purpose sweeteners. Prior to
aspartame must carry a statement warning people withthis, stevia (in its unpurified form) was only permitted for
PKU of the presence of aspartame on the label [2,3].use as a dietary supplement in the U.S. Stevia sweeteners
Aspartame provides four calories per gram. However, it is are natural, contain zero calories and are 200-300 times
used in very small amounts, contributing negligiblesweeter than sugar. Stevia sweeteners are approved for
calories to the diet. Aspartame is approximately 180 times food and beverage use in several countries and can be
sweeter than sugar. It is not heat-stable and is notfound in the U.S. in many food and beverage products,
suggested for use in cooking or baking [4]. including some juice and tea beverages, as well as some
Neotame: Neotame is also a derivative of aspartic acid and
phenylalanine. It is approximately 7,000 to 8,000 timesSucralose: In 1998, FDA approved sucralose for use in 15
sweeter than sugar, although some report a sweeteningfood and beverage categories - the broadest initial
power of up to 13,000 times that of sugar [5]. It is partially approval ever given to a food additive. In 1999, FDA
absorbed, but rapidly metabolized and excreted from theextended the approval to all categories of foods and
body. Neotame was approved by FDA in July 2002 as abeverages as a general-purpose sweetener. Six hundred
general purpose sweetener. Neotame has also receivedtimes sweeter than sugar, the intense sweetness of
favorable evaluation by JECFA and is approved for use in sucralose is made from a process that begins with regular
other countries, including most parts of Eastern Europe,table sugar (sucrose); however, it is not sugar. It is
Australia, Russia, Mexico and several South Americanproduced through a process whereby three hydrogen-
countries. Because of the extraordinary sweetening power oxygen groups on the sugar molecule are replaced with
of a small amount of neotame, the level of exposure tothree chlorine atoms. Sucralose is not recognized by the
phenylalanine as it is released into the bloodstream isbody as a carbohydrate. It is poorly absorbed and is
considered clinically insignificant. Therefore, productsexcreted unchanged from the body. As a result, sucralose
sweetened with neotame are not required to carry aprovides no calories. Because sucralose is very stable, it
statement on the label alerting persons with PKU to thecan be used almost anywhere sugar is used, including in
presence of phenylalanine. cooking and baking.
Saccharin: Originally discovered in 1878, saccharin isXylitol: is a natural substance found in fibrous vegetables
considered the oldest of the low-calorie sweetenersand fruit, as well as in corn cobs and various hardwood
approved for food and beverage use. Today saccharin istrees like birch. It is a natural, intermediate product which
still used safely and widely and often in combination with regularly occurs in the glucose metabolism of man and
other sweeteners. Saccharin is 300 times sweeter thanother animals as well as in the metabolism of several
sugar, although some reports have indicated it can be upplants and micro-organisms. Xylitol is produced naturally
to 700 times sweeter than sugar. It is not broken down by in our bodies. Studies suggest that human body can make
the body and is eliminated without providing any calories. up to 15 grams daily during normal metabolism. Xylitol
Saccharin is heat stable, therefore making it suitable fortastes and looks exactly like sugar and is really sugar's
cooking and baking. mirror image. Xylitol is a five-carbon sugar, which means
Stevia Sweeteners: The stevia plant is native to SouthWhile sugar is acid forming, xylitol is alkaline enhancing.
America and today, it can be found growing in many All other forms of sugar, including sorbitol, another
countries including China, Brazil, Argentina, Paraguay,popular alternative sweetener, are six-carbon sugars
India and South Korea. Hundreds of foods and beverageswhich feed dangerous bacteria and fungi. It also builds
consumed around the world are sweetened with steviaimmunity, protects against chronic degenerative disease
sweeteners. Stevia sweeteners are highly purified stevioland has anti-ageing benefits. Xylitol has 40 per cent fewer
tabletop sweeteners [6].
it is an antimicrobial, preventing the growth of bacteria.

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Table: Low-Calorie Sweeteners At-A-Glance
Date Sweeter Brand
Sweetener Approved Than Sugar Name(s)
Ace-K 1988 200x Sunett®, Sweet One®
Aspartame 1981 180x NutraSweet®, Equal®,
Others
Neotame 2002 7,000x n/a
Saccharin Years prior to 300x Sweet ’N Low®, Sweet
1958 Twin, Sugar Twin®,
Others
Stevia 2008 200x TruviaTM, PureViaTM,
Sweeteners Sun Crystals®
Sucralose 1998 600x Splenda®
Sources: Comprehensive Reviews in Food Science and Food Safety, IFT,
2006 Food and Chemical Toxicology, 2008
calories and 75 per cent fewer carbohydrates than sugar
and is slowly absorbed and metabolized, resulting in very
negligible changes in insulin. About one-third of the
xylitol that is consumed is absorbed in the liver.
The other two-thirds travel to the intestinal tract where it
is broken down by gut bacteria into short-chain fatty
acids.
Besides these, polyols (or sugar alcohols) are low
calorie, but contain carbohydrates and calories and need
to be counted as part of meal plan. Examples of sugar
alcohols include erythritol, polyglycitol, isomalt, lactitol,
maltitol, mannitol, sorbitol and xylitol. Sugar alcohols are
found in some sugar-free foods, including sugar-free
chewing gum [7].
Unlike other forms of carbohydrates that provide four
calories per gram, sugar alcohols provide only about two
calories per gram because they are not completely
absorbed by the body.
Low Calorie Sweeteners Contribute to Dental Health:
Diet plays a major role in dental heath. Excess of sugar in
the diet weakens the immune system and creates an acidic
environment; thus oral health suffers. Most of oral
bacteria are benign, but when sugar enters the scene it
feeds the destructive strains, allowing them to proliferate.
Periodontal disease is basically caused by bacteria.
These deposits permit the growth of bacteria that cause
inflammation of the gums. The bacteria also release minute
amounts of toxins that break down gum tissue, thereby
helping the infection to progress. Plaque is an invisible,
sticky film of saliva and food residue that constantly
forms on the teeth. Ongoing low-grade bacterial infection
also burdens the immune system. Gum infection can also
lead to other serious health problems. It doubles the risk
of stroke, triples the risk of heart attack, increases the
incidence of premature, low-weight babies and also
contributes to bronchitis, pneumonia and emphysema.
The main advantage of low calorie sweeteners is in
maintaining good oral hygiene [8]. Even if teeth cannot be
brushed after every meal, low calorie sweeteners will not
cause tooth decay. This is because they are not fermented
into harmful acids by oral bacteria. Under neutral
conditions, tooth enamel is very durable. All
carbohydrates which can be broken down, however, are
fermented into acids by the bacteria in plaque, which
forms naturally in the mouth [9].
The more we come into contact with carbohydrates,
the more active are our oral bacteria. How quickly and
thoroughly the acids that the bacteria produce complete
their destructive work also depends on the condition of
the teeth and on the care they receive, so good dental
hygiene remains very important.
Since low calorie sweeteners do not contain
fermentable carbohydrates, they do not add to the
production of acids by oral bacteria. In fact, low calorie
sweeteners are also used to improve the taste of products
for dental and oral hygiene, thus contributing to caries
prevention. It is well known that toothpastes and
mouthwashes with an agreeable taste are used more
consistently and frequently than products with a
"medical" taste, especially by children.
Xylitol is another low calorie natural sweetener that
is effective in preventing tooth decay and maintaining
good oral hygiene. Using xylitol helps to raise plaque pH,
thereby reducing the time that teeth are exposed to
damaging acids as well as starving harmful bacteria of
their food source. Xylitol looks, feels and tastes exactly
like sugar and leaves no unpleasant aftertaste. It is
available in many forms. In its crystalline form, it can
replace sugar in cooking, baking or as a sweetener for
beverages. It is a mint-flavoured sweetener used in
chewing gum, toothpaste, mouthwash, nasal spray and
other products. It is used as a sugar substitute because it
imparts fewer calories, has a cool mint flavor, helps fight
cavity-causing bacteria and can pass through the human
gut without involving insulin. Because xylitol is only
slowly absorbed and partially utilized, a reduced calorie
claim is allowed: 2.4 calories per gram or 40% less than
other carbohydrates. Xylitol use reduces tooth decay
rates both in high-risk groups (high caries prevalence,
poor nutrition and poor oral hygiene) and in low-risk
groups (low caries incidence using all current prevention
recommendations). Xylitol is not only a safe, natural
sweetener without the bad side-effects of sugar and
artificial substitutes; it is also good for teeth, stabilizes
insulin and hormone levels and promotes good health.
Xylitol reverses all these destructive effects of sugar on

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oral health. Xylitol is non-fermentable and thereforeAnother sweetener aspartame found in thousands of
cannot be converted to acids by oral bacteria, thus itproducts worldwide, can also be created using genetically
helps to restore a proper alkaline/acid balance in themodified (GM) bacteria. Monsanto, the largest biotech
mouth. This alkaline environment is inhospitable to all the corporation in the world, uses GM bacteria to produce
destructive bacteria, especially the worst variety,aspartame in their US production plants. The process in
Streptococcus mutans. It also inhibits plaque formation.which aspartame is created involves combining an amino
Using xylitol right before bedtime, after brushing and acid known as phenylalanine with aspartic acid. The
flossing, protects and heals the teeth and gums. Unlikebacteria require aspartame for the sole purpose of
sugar, it can even be left on the teeth overnight. Withproducing phenylalanine. Monsanto discovered that
proper use, xylitol actually stops the fermentation process through genetically altering the bacteria, phenylalanine
leading to tooth decay. Long-term use suppresses thecould be created much more quickly. They have two
most harmful strains of oral bacteria, making a long-lasting strains of bacteria - one is traditionally modified and the
change in those bacterial communities. Xylitol even hasother is genetically modified. The genetically modified
the ability to enhance the mineralization of the enamel.bacteria have a modified enzyme with one amino acid
It is most effective in treating small decay spots. different.
Xylitol stimulates saliva flow and helps keep salivary
minerals in a useful form. Its prolonged use increases theCONCLUSION
buffering capacity and protective factors in saliva.
Increased saliva production is especially important forSince the safety and efficacy of genetically modified
people suffering with a dry mouth due to illness, ageingorganisms (GMOs) is still controversial, the best way is to
or drug side-effects. choose natural alternatives such as palm sugar, xylitol or
Since the oral environment becomes less acidic withstevia. Thus it can be safely concluded that low calorie
continued xylitol use, it is advisable to chew xylitol gumsweeteners can make a significant contribution to dental
or suck a xylitol mint after every meal or after eating sweet health.
snacks. The best thing is that studies have shown that
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