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Sugar and Fat Replacers: The Fake Stuff
Marie Spano, MS, RD
As a nation, it seems as if we are obsessed with losing weight. Magazines, talk shows, segments on the evening news, and many, many conversations are devoted to new diets, how celebrities stay fit, and which herbs, pills, and diet bars will satiate our appetite on our quest for that "beach ready body." On the flip side, we are a nation obsessed with food. We want it fast, healthy, and aesthetically appealing. And food manufacturers are ready to deliver.
In the quest to meet consumer demand for low sugar, sugar-free, low-fat, and fat-free products, a large segment of the food manufacturing industry has been devoted to creating sugar and fat substitutes. Some of these ingredients have been in the food supply for years and others were recently created in food labs to mimic the sweet taste of sugar or the mouth feel of fat. Sugar and fat substitutes have the potential to help consumers decrease their calorie and/or fat consumption and keep their blood sugar in control without making drastic dietary changes or feeling deprived (5).
To ensure consumer safety, all sweeteners and fat substitutes must be listed as GRAS (Generally Recognized as Safe) or approved as a food additive (under the 1958 Food Additives Amendment to the Food, Drug, and Cosmetic Act) prior to their use in the food supply. Food additives are given an acceptable daily intake (ADI) which is an estimated quantity of the additive per kg of bodyweight that a person can consume daily without any adverse health risks. The ADI is an extremely conservative value (1, 4).
Ingredients which obtain either GRAS or FAP (Food Additive Petitions) approval are designated for specific uses in food (i.e. for use in savory snacks only) and may be used for those purposes only. If the food manufacturer desires to use their ingredient for other purposes, another food additive petition must be filed (5).
Sugar Substitutes
There are two main categories of sugar substitutes. These include intense sweeteners and sugar replacers (2). One trend in the food industry is to combine various substitutes creating a synergistic product which is even sweeter than the individual components (1). Products that indicate that they are "low in sugar," have "no added sugars," or are "sugar-free," most likely contain one or more sugar substitutes. These substitutes should be listed by name under "ingredients" on the food label.
Intense Sweeteners (Nonnutritive Sweeteners)
Intense sweeteners are low or no calorie, non cariogenic (does not cause dental caries) ingredients created in food labs. Although some may actually contain calories, their caloric contribution to the food they are in is negligible because they are so intense that very little quantities are needed to sweeten food. There are four intense sweeteners which have approval as food additives. These include: saccharin, acesulfame-K (also called acesulfame potassium), sucralose, and aspartame (1).
Saccharin was the first original intense sweetener. It is 200-700 times sweeter than sugar, is not metabolized, can be used in baking, and has been given an ADI of 5 mg/kg body weight. In the 1970s saccharin was banned for a brief period of time and then given the warning label: "Use of this product may be hazardous to your health. This product contains saccharin which has been determined to cause cancer in laboratory animals." Studies linking saccharin to cancer were conducted using rats and other small animals. Human studies examining this relationship indicate that saccharin does not lead to cancer (1). Saccharin can be found in cosmetics, pharmaceuticals, chewing gum, candy, beverages, baked goods, cake mixes, and of course those pink packets we use as a tabletop sweetener (1).
Aspartame (Equal, NutraSweet, NutraTaste) ranks as the most widely used sweetener. It is composed of the amino acids phenylalanine and aspartic acid, is 200 times sweeter than sugar, is metabolized in the body like regular food, cannot be used in cooking or baking at high temperatures, and has an ADI of 50 mg per kg bodyweight (the equivalent of 20, 12 oz. diet sodas for a 150 lb adult) (1). Although complaints of headaches, dizziness, and seizures have been reported by some individuals, research indicates that these claims unrelated to aspartame consumption (2). The only known hazard related to aspartame consumption is for those with phenylketonuria, a metabolic disease in which individuals are unable to metabolize phenylalanine (1). It may seem as if aspartame can be found in anything and everything these days but it is actually approved for use in: hot and cold beverages, breakfast cereals, gelatins, puddings, ice cream, regular and frozen yogurt, candy, chewing gum, pharmaceuticals, and of course, tabletop sweetener packets that are blue (1).
Acesulfame-K is approximately 200 times sweeter than sugar, is not metabolized by the human body, can withstand high cooking/baking temperatures, and has an ADI of 15 mg per kg bodyweight. It has been approved for use as a tabletop sweetener and as an additive in chewing gum, desserts, yogurt, sauces, alcoholic beverages, other cold beverages, and confections (1).
Sucralose (marketed as Splenda®) is made from sugar and yet is 600 times sweeter than sugar (1, 2). It has no calories and is not metabolized by the body, can be used in cooking and baking, and has an ADI 15 mg per kg of bodyweight. Sucralose can be found in desserts, confections, beverages, and tabletop sweeteners (1).
Sugar Replacers (Nutritive Sweeteners)
Sugar replacers are lab-synthesized carbohydrates that are often referred to as sugar alcohols (also known as reduced-energy polyols) and have names ending in -ol (with the exception of hydrogenated starch hydrolysates and isomalt). However, they are composed of neither sugar nor alcohol (1, 2).
Sugar alcohols can be found in a number of foods including candies, chewing gum, jams/jellies, various diet products, energy bars, baked goods, frozen confections, pharmaceuticals, and hygiene products such as toothpaste and mouthwash (1). Information about sugar alcohols may be voluntarily placed on the "Nutrition Facts" food label. However, manufacturers are not required to indicate the grams of sugar alcohols within a foodstuff unless a specific claim (such as "sugar free" or "no sugar added") is made about sugar alcohols (7). Sugar alcohols are not completely digested or absorbed and therefore provide less calories per gram than table sugar (sucrose) (1). However, incomplete absorption does not come without a drawback. Your intestinal flora (think of that healthy bacteria in your gut) feed on sugar alcohols through fermentation. This process may result in flatulence, bloating, and cramping (1). In addition, sugar alcohols create an osmotic effect in the gut drawing water into your intestines leading to the potential for diarrhea (2). All products containing sorbitol and/or mannitol may carry the following warning on their label: "excess consumption may have a laxative effect." While studies indicate that it takes more than 50 grams of sorbitol or 20 grams of mannitol per day to lead to diarrhea, gastrointestinal symptoms that may result from polyol consumption are different for each individual (1). Some people experience side effects from consuming a few grams of sugar alcohols while others may be able to consume 40 or more without experiencing untoward symptoms.
The good news is that, while doubled over in pain due to the digestive side effects of your sugar-free candy consumption, your blood sugar won't rise quite so rapidly as it may with other carbohydrates. Also, polyols (especially xylitol) may reduce your risk for dental caries (1).
Fat Substitutes
Creating low-fat and fat-free foods that taste good and are more palatable than styrofoam has been a challenge for food manufacturers. However, older versions of fat substitutes combined with newly synthesized substitutes have come close.
Three main categories of fat substitutes include: carbohydrate-based, protein-based, and fat-based substitutes. Food manufacturers often use a combination of fat substitutes in foods to help achieve the desired texture, taste, and function of fat in food (5). If a product indicates that it is reduced-fat or fat-free, you may have to do some detective work to find out which, if any, fat substitutes have been added. Once again, the ingredient list on the food label is your friend as long as you are familiar with the types of substitutes that are used.
Carbohydrate-Based Ingredients
Carbohydrate-based fat replacers help thicken food, provide the mouth feel of fat, and act as bulking agents, moisturizers, and stabilizers (4, 5). Common carbohydrate-based fat replacers include maltodextrins, starches, gums, polydextrose, carrageenan, cellulose, gelatin, gels, and starches (6). The caloric contribution of a carbohydrate-based fat replacer varies from 0 to 4 calories per gram depending on the particular substitute and it's degree of fluid content (4, 5). Carbohydrates such as cellulose and xanthan gum can only be digested by bacteria in the lower intestine and therefore contribute few, if any, calories (5). Because some carbohydrate substitutes are not completely digested and absorbed in the gastrointestinal tract, consumption of large amounts of carbohydrate-based fat substitutes may lead to gas, bloating, cramping and other gastrointestinal symptoms. Carbohydrate-based fat substitutes can be found in lower-fat and fat-free desserts, cheeses, baked goods, salad dressings, sauces, gravies, processed meats, sour cream, yogurt, and pudding (5).
Protein-Based Ingredients
Through a process called microparticulation, proteins are heated and broken down into tiny particles that mimic the creaminess of fat. Protein-based fat substitutes also help stabilize emulsions (such as salad dressings, sauces, and spreads) (4). Soy, whey, and egg whites are familiar protein-based fat replacers. Protein-based fat replacers range in calories from 1 to 4 per gram and can be found in spreads, salad dressings, cheese, butter, mayonnaise, sour cream, refrigerated and frozen desserts, baked goods, yogurt, and cheese (5).
One popular protein-based fat replacer is Simplesse. Simplesse is made from egg whites and/or milk, water, sugar, pectin and citric acid. The egg whites are pulverized into particles smaller than the tongue can detect giving them a creamy mouth feel. It is digested and absorbed just like other dietary sources of protein, contains no fat and adds fewer calories to food than would regular fat (1 to 2 calories per gram vs. 9 calories per gram). Because Simplesse is made from ingredients that are already in the food supply, it is considered safe for consumption. Only those who have an allergy or intolerance of eggs or milk should avoid foods containing Simplesse.
Fat-Based Ingredients
Fats which are modified to contribute fewer calories can be used to replace real fat in foods while closely mimicking the sensory properties such as taste, texture, and the mouth feel of real fat (5). Fat-based fat substitutes include caprenin, salatrim, monoglycerides, diglycerides and olestra (6). The calorie range of fat-based fat substitutes is from 0 to 9 calories per gram and they can be found in chocolate, confections, margarine, chocolate coatings, spreads, sour cream, salted snacks (potato chips, Doritos, tortilla chips), and cheese (5).
Olestra is probably the most widespread and well researched fat-based fat substitute (6). It is a sucrose polyester made from sugar and long-chain fatty acids that have been combined to produce a bulky molecule which passes through the digestive system unabsorbed providing no fat or calories to food. Although Olestra is not digested by the body, it tastes like fat since it contains fat, is heat-stable, and can be used to fry foods. Foods containing Olestra (often marketed under the brand name Olean) include salty and spicy snacks (6).
Because it is not digested, vitamins A, D, E, and K as well as some fat soluble phytochemicals are not available for absorption with olestra present. When the FDA approved the use of the olestra in 1995 it required that the fat-soluble vitamins A, D, E and K be added to foods containing olestra. Because olestra is not absorbed, it may cause gastrointestinal distress including diarrhea, gas, cramping, and bloating (5, 6). All products containing olestra must carry a label warning that reads: "This product contains Olestra may cause abdominal cramping and loose stools. Olestra inhibits the absorption of some vitamins and other nutrients. Vitamins A, D, E, and K have been added."
No Help in the Battle of the Bulge Although it seems logical to believe that sugar and fat substitutes may help us fight the battle against obesity, or at least manage it, sweeteners and fat substitutes have been around for a number of years and our nation as a whole is only getting heavier (1, 3, 5). In addition, studies examining alterations in overall calorie intake per day or over a longer period of time created by the consumption of decreased calorie foods containing sugar and/or fat substitutes are inconclusive (1, 5).
In summary, fat and sugar substitutes may play a role in our diet but they are not a panacea for those of us trying to lose or maintain weight, control diabetes, or decrease our risk for cardiovascular disease. New food products that are low in calories may be enticing but they are far from magical. Instead, the age-old advice of exercising, increasing your activities of daily living, decreasing stress, and eating a diet high in fruits, vegetables, and whole grains, with moderate amounts of fish, low-fat meats and dairy, still applies.
So next time you decide to sit at home and have your fat and sugar free groceries delivered to you at the click of a mouse, why not get up and actually go to the grocery store or farmer's market and walk around the aisles? You may find that there are a number of naturally low-fat and low-sugar items out there that help meet your dietary needs.
References
Position of The American Dietetic Association: Use of nutritive and nonnutritive sweeteners. J Am Diet Assoc 98(5):580-587; 1988
McNutt K. What clients should know about sugar replacers. J Am Diet Assoc 10(4):466-468; 2000.
Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The spread of the obesity epidemic in the United States, 1991-1998. JAMA 282(16):1519-1522; 1999.
Finn SC. Fat: can't live with it, can't live without it. J Women's Health 7(108):1211-1214; 1998.
International Food Information Council Foundation Review. Uses and nutritional impact of fat reduction ingredients. Sept. 1997.
Position of the American Dietetic Association: fat replacements. J Am Diet Assoc 91(10):1285-1288; 1991.
Warshaw HS; Powers MA. A search for answers about foods with polyols (sugar alcohols). The Diabetes Educator 25(3):307-321; 1999.
Author Biography
With degrees in both Exercise and Sport Science as well as Nutrition Science, Marie Spano, MS, RD, works at the Centers for Disease Control and Prevention and is a freelance writer on various nutrition topics. You can reach Marie at (404) 639-2534 or mspano@cdc.gov.
Marie Spano, MS, RD
As a nation, it seems as if we are obsessed with losing weight. Magazines, talk shows, segments on the evening news, and many, many conversations are devoted to new diets, how celebrities stay fit, and which herbs, pills, and diet bars will satiate our appetite on our quest for that "beach ready body." On the flip side, we are a nation obsessed with food. We want it fast, healthy, and aesthetically appealing. And food manufacturers are ready to deliver.
In the quest to meet consumer demand for low sugar, sugar-free, low-fat, and fat-free products, a large segment of the food manufacturing industry has been devoted to creating sugar and fat substitutes. Some of these ingredients have been in the food supply for years and others were recently created in food labs to mimic the sweet taste of sugar or the mouth feel of fat. Sugar and fat substitutes have the potential to help consumers decrease their calorie and/or fat consumption and keep their blood sugar in control without making drastic dietary changes or feeling deprived (5).
To ensure consumer safety, all sweeteners and fat substitutes must be listed as GRAS (Generally Recognized as Safe) or approved as a food additive (under the 1958 Food Additives Amendment to the Food, Drug, and Cosmetic Act) prior to their use in the food supply. Food additives are given an acceptable daily intake (ADI) which is an estimated quantity of the additive per kg of bodyweight that a person can consume daily without any adverse health risks. The ADI is an extremely conservative value (1, 4).
Ingredients which obtain either GRAS or FAP (Food Additive Petitions) approval are designated for specific uses in food (i.e. for use in savory snacks only) and may be used for those purposes only. If the food manufacturer desires to use their ingredient for other purposes, another food additive petition must be filed (5).
Sugar Substitutes
There are two main categories of sugar substitutes. These include intense sweeteners and sugar replacers (2). One trend in the food industry is to combine various substitutes creating a synergistic product which is even sweeter than the individual components (1). Products that indicate that they are "low in sugar," have "no added sugars," or are "sugar-free," most likely contain one or more sugar substitutes. These substitutes should be listed by name under "ingredients" on the food label.
Intense Sweeteners (Nonnutritive Sweeteners)
Intense sweeteners are low or no calorie, non cariogenic (does not cause dental caries) ingredients created in food labs. Although some may actually contain calories, their caloric contribution to the food they are in is negligible because they are so intense that very little quantities are needed to sweeten food. There are four intense sweeteners which have approval as food additives. These include: saccharin, acesulfame-K (also called acesulfame potassium), sucralose, and aspartame (1).
Saccharin was the first original intense sweetener. It is 200-700 times sweeter than sugar, is not metabolized, can be used in baking, and has been given an ADI of 5 mg/kg body weight. In the 1970s saccharin was banned for a brief period of time and then given the warning label: "Use of this product may be hazardous to your health. This product contains saccharin which has been determined to cause cancer in laboratory animals." Studies linking saccharin to cancer were conducted using rats and other small animals. Human studies examining this relationship indicate that saccharin does not lead to cancer (1). Saccharin can be found in cosmetics, pharmaceuticals, chewing gum, candy, beverages, baked goods, cake mixes, and of course those pink packets we use as a tabletop sweetener (1).
Aspartame (Equal, NutraSweet, NutraTaste) ranks as the most widely used sweetener. It is composed of the amino acids phenylalanine and aspartic acid, is 200 times sweeter than sugar, is metabolized in the body like regular food, cannot be used in cooking or baking at high temperatures, and has an ADI of 50 mg per kg bodyweight (the equivalent of 20, 12 oz. diet sodas for a 150 lb adult) (1). Although complaints of headaches, dizziness, and seizures have been reported by some individuals, research indicates that these claims unrelated to aspartame consumption (2). The only known hazard related to aspartame consumption is for those with phenylketonuria, a metabolic disease in which individuals are unable to metabolize phenylalanine (1). It may seem as if aspartame can be found in anything and everything these days but it is actually approved for use in: hot and cold beverages, breakfast cereals, gelatins, puddings, ice cream, regular and frozen yogurt, candy, chewing gum, pharmaceuticals, and of course, tabletop sweetener packets that are blue (1).
Acesulfame-K is approximately 200 times sweeter than sugar, is not metabolized by the human body, can withstand high cooking/baking temperatures, and has an ADI of 15 mg per kg bodyweight. It has been approved for use as a tabletop sweetener and as an additive in chewing gum, desserts, yogurt, sauces, alcoholic beverages, other cold beverages, and confections (1).
Sucralose (marketed as Splenda®) is made from sugar and yet is 600 times sweeter than sugar (1, 2). It has no calories and is not metabolized by the body, can be used in cooking and baking, and has an ADI 15 mg per kg of bodyweight. Sucralose can be found in desserts, confections, beverages, and tabletop sweeteners (1).
Sugar Replacers (Nutritive Sweeteners)
Sugar replacers are lab-synthesized carbohydrates that are often referred to as sugar alcohols (also known as reduced-energy polyols) and have names ending in -ol (with the exception of hydrogenated starch hydrolysates and isomalt). However, they are composed of neither sugar nor alcohol (1, 2).
Sugar alcohols can be found in a number of foods including candies, chewing gum, jams/jellies, various diet products, energy bars, baked goods, frozen confections, pharmaceuticals, and hygiene products such as toothpaste and mouthwash (1). Information about sugar alcohols may be voluntarily placed on the "Nutrition Facts" food label. However, manufacturers are not required to indicate the grams of sugar alcohols within a foodstuff unless a specific claim (such as "sugar free" or "no sugar added") is made about sugar alcohols (7). Sugar alcohols are not completely digested or absorbed and therefore provide less calories per gram than table sugar (sucrose) (1). However, incomplete absorption does not come without a drawback. Your intestinal flora (think of that healthy bacteria in your gut) feed on sugar alcohols through fermentation. This process may result in flatulence, bloating, and cramping (1). In addition, sugar alcohols create an osmotic effect in the gut drawing water into your intestines leading to the potential for diarrhea (2). All products containing sorbitol and/or mannitol may carry the following warning on their label: "excess consumption may have a laxative effect." While studies indicate that it takes more than 50 grams of sorbitol or 20 grams of mannitol per day to lead to diarrhea, gastrointestinal symptoms that may result from polyol consumption are different for each individual (1). Some people experience side effects from consuming a few grams of sugar alcohols while others may be able to consume 40 or more without experiencing untoward symptoms.
The good news is that, while doubled over in pain due to the digestive side effects of your sugar-free candy consumption, your blood sugar won't rise quite so rapidly as it may with other carbohydrates. Also, polyols (especially xylitol) may reduce your risk for dental caries (1).
Fat Substitutes
Creating low-fat and fat-free foods that taste good and are more palatable than styrofoam has been a challenge for food manufacturers. However, older versions of fat substitutes combined with newly synthesized substitutes have come close.
Three main categories of fat substitutes include: carbohydrate-based, protein-based, and fat-based substitutes. Food manufacturers often use a combination of fat substitutes in foods to help achieve the desired texture, taste, and function of fat in food (5). If a product indicates that it is reduced-fat or fat-free, you may have to do some detective work to find out which, if any, fat substitutes have been added. Once again, the ingredient list on the food label is your friend as long as you are familiar with the types of substitutes that are used.
Carbohydrate-Based Ingredients
Carbohydrate-based fat replacers help thicken food, provide the mouth feel of fat, and act as bulking agents, moisturizers, and stabilizers (4, 5). Common carbohydrate-based fat replacers include maltodextrins, starches, gums, polydextrose, carrageenan, cellulose, gelatin, gels, and starches (6). The caloric contribution of a carbohydrate-based fat replacer varies from 0 to 4 calories per gram depending on the particular substitute and it's degree of fluid content (4, 5). Carbohydrates such as cellulose and xanthan gum can only be digested by bacteria in the lower intestine and therefore contribute few, if any, calories (5). Because some carbohydrate substitutes are not completely digested and absorbed in the gastrointestinal tract, consumption of large amounts of carbohydrate-based fat substitutes may lead to gas, bloating, cramping and other gastrointestinal symptoms. Carbohydrate-based fat substitutes can be found in lower-fat and fat-free desserts, cheeses, baked goods, salad dressings, sauces, gravies, processed meats, sour cream, yogurt, and pudding (5).
Protein-Based Ingredients
Through a process called microparticulation, proteins are heated and broken down into tiny particles that mimic the creaminess of fat. Protein-based fat substitutes also help stabilize emulsions (such as salad dressings, sauces, and spreads) (4). Soy, whey, and egg whites are familiar protein-based fat replacers. Protein-based fat replacers range in calories from 1 to 4 per gram and can be found in spreads, salad dressings, cheese, butter, mayonnaise, sour cream, refrigerated and frozen desserts, baked goods, yogurt, and cheese (5).
One popular protein-based fat replacer is Simplesse. Simplesse is made from egg whites and/or milk, water, sugar, pectin and citric acid. The egg whites are pulverized into particles smaller than the tongue can detect giving them a creamy mouth feel. It is digested and absorbed just like other dietary sources of protein, contains no fat and adds fewer calories to food than would regular fat (1 to 2 calories per gram vs. 9 calories per gram). Because Simplesse is made from ingredients that are already in the food supply, it is considered safe for consumption. Only those who have an allergy or intolerance of eggs or milk should avoid foods containing Simplesse.
Fat-Based Ingredients
Fats which are modified to contribute fewer calories can be used to replace real fat in foods while closely mimicking the sensory properties such as taste, texture, and the mouth feel of real fat (5). Fat-based fat substitutes include caprenin, salatrim, monoglycerides, diglycerides and olestra (6). The calorie range of fat-based fat substitutes is from 0 to 9 calories per gram and they can be found in chocolate, confections, margarine, chocolate coatings, spreads, sour cream, salted snacks (potato chips, Doritos, tortilla chips), and cheese (5).
Olestra is probably the most widespread and well researched fat-based fat substitute (6). It is a sucrose polyester made from sugar and long-chain fatty acids that have been combined to produce a bulky molecule which passes through the digestive system unabsorbed providing no fat or calories to food. Although Olestra is not digested by the body, it tastes like fat since it contains fat, is heat-stable, and can be used to fry foods. Foods containing Olestra (often marketed under the brand name Olean) include salty and spicy snacks (6).
Because it is not digested, vitamins A, D, E, and K as well as some fat soluble phytochemicals are not available for absorption with olestra present. When the FDA approved the use of the olestra in 1995 it required that the fat-soluble vitamins A, D, E and K be added to foods containing olestra. Because olestra is not absorbed, it may cause gastrointestinal distress including diarrhea, gas, cramping, and bloating (5, 6). All products containing olestra must carry a label warning that reads: "This product contains Olestra may cause abdominal cramping and loose stools. Olestra inhibits the absorption of some vitamins and other nutrients. Vitamins A, D, E, and K have been added."
No Help in the Battle of the Bulge Although it seems logical to believe that sugar and fat substitutes may help us fight the battle against obesity, or at least manage it, sweeteners and fat substitutes have been around for a number of years and our nation as a whole is only getting heavier (1, 3, 5). In addition, studies examining alterations in overall calorie intake per day or over a longer period of time created by the consumption of decreased calorie foods containing sugar and/or fat substitutes are inconclusive (1, 5).
In summary, fat and sugar substitutes may play a role in our diet but they are not a panacea for those of us trying to lose or maintain weight, control diabetes, or decrease our risk for cardiovascular disease. New food products that are low in calories may be enticing but they are far from magical. Instead, the age-old advice of exercising, increasing your activities of daily living, decreasing stress, and eating a diet high in fruits, vegetables, and whole grains, with moderate amounts of fish, low-fat meats and dairy, still applies.
So next time you decide to sit at home and have your fat and sugar free groceries delivered to you at the click of a mouse, why not get up and actually go to the grocery store or farmer's market and walk around the aisles? You may find that there are a number of naturally low-fat and low-sugar items out there that help meet your dietary needs.
References
Position of The American Dietetic Association: Use of nutritive and nonnutritive sweeteners. J Am Diet Assoc 98(5):580-587; 1988
McNutt K. What clients should know about sugar replacers. J Am Diet Assoc 10(4):466-468; 2000.
Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The spread of the obesity epidemic in the United States, 1991-1998. JAMA 282(16):1519-1522; 1999.
Finn SC. Fat: can't live with it, can't live without it. J Women's Health 7(108):1211-1214; 1998.
International Food Information Council Foundation Review. Uses and nutritional impact of fat reduction ingredients. Sept. 1997.
Position of the American Dietetic Association: fat replacements. J Am Diet Assoc 91(10):1285-1288; 1991.
Warshaw HS; Powers MA. A search for answers about foods with polyols (sugar alcohols). The Diabetes Educator 25(3):307-321; 1999.
Author Biography
With degrees in both Exercise and Sport Science as well as Nutrition Science, Marie Spano, MS, RD, works at the Centers for Disease Control and Prevention and is a freelance writer on various nutrition topics. You can reach Marie at (404) 639-2534 or mspano@cdc.gov.
