Diet therapy


Public awareness of sugars within our diet has slowly increased in recent years. Whilst fat has borne the majority of blame for its implication in development of excess body weight, sugar has escaped relatively lightly.

Low fat foods have resulted in increased contribution of sugar to ensure suitable taste and mouth feel for consumers. Total energy, in addition to macronutrient content should play a larger role in assisting food choices. Sweeteners have been used by the food industry for years to enable changes in composition and processing of certain foods.

Quite apart from natural sweeteners such as sugars, syrups and honey sweeteners used in the food industry can be classified into 2 groups, energy providing (nutritive) and those which do not (non-nutritive).

Nutritive sweeteners Non-nutritive sweeteners
Isomalt (Palatinit) Cyclamate, Saccharin
Oligofructose (Raftilose, Actilight, Orafti) Alitame (Aclame)
Sorbitol Stevia (Equal Stevia, Natvia)
Mannitol Aspartame (NutraSweet)
Xylitol Sucralose (Splenda)


Isomalt is a sugar substitute which has half the energy value of sugar, it has only a small impact on blood sugar levels and does not promote tooth decay. However it is a sugar alcohol and can cause gastric upset such as flatulence and diarrhoea if consumed in large amounts. Therefore it should not be consumed in quantities greater than 50g for adults and 25g for children. If combined with Sucralose it has approximately the same sweetness as sugar.


Oligofructose is available in liquid and powder form and contains the natural sugars of glucose, fructose and sucrose. Oligofructose is more soluble than sucrose.

Nutritive sweeteners

Nutritive sweeteners such as sorbitol provide similar amounts of energy to sucrose, unless eaten in excess (>15g) which results in slowed absorption resulting in malabsorption and diarrhoea. Mannitol and xylitol do have a lower caloric content and Glycaemic response, however as they are not soluble in water they often are combined with fat, resulting in an increased energy consumption regardless.

Artificial sweeteners

Artificial sweeteners have been investigated primarily in relation to carcinogenicity; however epidemiological studies indicate that no measurable increase in risk of bladder cancer has been noted in individuals who have used these non-nutritive sweeteners.

Cyclamate and Alitame (Aclame) are still being investigated for Food and Drug Administration (FDA) in the states, however the remaining non-nutritive sweeteners (see table) have been approved for use. Safe amounts for daily consumption over a lifetime have been defined with average consumption in individuals with diabetes falling well below the acceptable daily intake. As Saccharin and cyclamate has been found to cross the placenta, these sweeteners are not recommended for pregnant women and are also not suitable for children under the age of two years.

Stevia herb

Stevia, is a natural, non nutritive sweetener that is extracted from the Stevia herb. It is 250-300 times sweeter than table sugar with no impact on blood sugar levels.


Asparatame (e.g. Equal®, NutraSweet®) contain the proteins aspartic acid and phenylalanine.  People with Phenylketonuria (PKU), an inherited disorder that increases the levels of phenylalanine in the blood, are advised to avoid this type of sweetener.

Use in the family setting could assist both parents and children, at risk of overweight, in reducing total energy intake. However the major focus should still be the promotion of a healthy lifestyle via appropriate food choices and regular exercise.

About the author View all

Lea Stening

Lea is one of New Zealand’s leading paediatric dietitians and also specialises in Sports Nutrition. She has specialised in Paediatric Nutrition for 31 years and in 1985 was the first paediatric dietitian to enter private practice in New Zealand. Lea helps families through her private consultations, public lectures, newspaper and magazine articles as well as television and radio interviews. Read more »

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