Editing Sugar substitute (section)

=== Reasons for use ===
Sugar substitutes are used instead of sugar for a number of reasons, including:

==== Dental care ====
Carbohydrates and sugars usually adhere to the [[tooth enamel]], where bacteria feed upon them and quickly multiply.<ref name="riley">{{cite journal | vauthors = Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV | title = Xylitol-containing products for preventing dental caries in children and adults | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD010743 | date = March 2015 | volume = 2015 | pmid = 25809586 | doi = 10.1002/14651858.CD010743.pub2 | pmc = 9345289 }}</ref> The bacteria convert the sugar to acids that decay the teeth. Sugar substitutes, unlike sugar, do not erode teeth as they are not fermented by the [[microflora]] of the [[dental plaque]]. A sweetener that may benefit dental health is [[xylitol]], which tends to prevent bacteria from adhering to the tooth surface, thus preventing plaque formation and eventually [[tooth decay]]. A [[Cochrane (organisation)|Cochrane]] review, however, found only low-quality evidence that xylitol in a variety of dental products actually has any benefit in preventing tooth decay in adults and children.<ref name="riley"/>

==== Dietary concerns ====
Sugar substitutes are a fundamental ingredient in [[diet drink]]s to sweeten them without adding [[calorie]]s. Additionally, [[sugar alcohol]]s such as [[erythritol]], [[xylitol]] and [[sorbitol]] are derived from sugars. In the United States, six high-intensity sugar substitutes have been approved for use: [[aspartame]], [[sucralose]], [[neotame]], [[acesulfame potassium]] (Ace-K), [[saccharin]] and [[advantame]].<ref name="his-fda"/> [[Food additive]]s must be approved by the FDA,<ref name="his-fda"/> and sweeteners must be proven as safe via submission by a manufacturer of a [[generally recognized as safe|GRAS]] document.<ref name="GRAS">{{cite web |date=14 July 2014 |title=Generally Recognized as Safe (GRAS) |url=https://www.fda.gov/Food/IngredientsPackagingLabeling/GRAS/default.htm |url-status=live |archive-url=https://web.archive.org/web/20140905135135/http://www.fda.gov/Food/IngredientsPackagingLabeling/GRAS/default.htm |archive-date=5 September 2014 |access-date=17 September 2014 |publisher=U.S. [[Food and Drug Administration]]}}</ref> The conclusions about GRAS are based on a detailed review of a large body of information, including rigorous toxicological and clinical studies.<ref name="GRAS"/> GRAS notices exist for two plant-based, high-intensity sweeteners: steviol glycosides obtained from stevia leaves (''[[Stevia rebaudiana]]'') and [[extract]]s from ''[[Siraitia grosvenorii]]'', also called ''luo han guo'' or monk fruit.<ref name="his-fda"/>

===== Glucose metabolism =====
*[[Diabetes mellitus]] – People with diabetes limit [[refined sugar]] intake to regulate their blood sugar levels. Many artificial sweeteners allow sweet-tasting food without increasing blood glucose. Others do release energy but are metabolized more slowly, preventing spikes in blood glucose. A concern, however, is that [[overconsumption]] of foods and beverages made more appealing with sugar substitutes may increase risk of developing diabetes.<ref name="bmj">{{cite journal | vauthors = Imamura F, O'Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, Forouhi NG | title = Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction | journal = BMJ | volume = 351 | pages = h3576 | date = July 2015 | pmid = 26199070 | pmc = 4510779 | doi = 10.1136/bmj.h3576 }}</ref> A 2014 systematic review showed that a 330ml/day (an amount little less than the standard U.S can size) consumption of artificially sweetened beverages lead to increased risks of type 2 diabetes.<ref name="Lohner-2017">{{cite journal | vauthors = Lohner S, Toews I, Meerpohl JJ | title = Health outcomes of non-nutritive sweeteners: analysis of the research landscape | journal = Nutrition Journal | volume = 16 | issue = 1 | pages = 55 | date = September 2017 | pmid = 28886707 | pmc = 5591507 | doi = 10.1186/s12937-017-0278-x | doi-access = free }}</ref> A 2015 [[meta-analysis]] of numerous [[clinical research|clinical studies]] showed that habitual consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice increased the risk of developing diabetes, although with inconsistent results and generally low quality of evidence.<ref name=bmj/> A 2016 review described the relationship between non-nutritive sweeteners as inconclusive.<ref name="Lohner-2017"/> A 2020 Cochrane systematic review compared several non-nutritive sweeteners to sugar, placebo and a nutritive low-calorie sweetener ([[tagatose]]), but the results were unclear for effects on HbA1c, body weight and adverse events.<ref name="Lohner-2020">{{Cite journal |last1=Lohner |first1=Szimonetta |last2=Kuellenberg de Gaudry |first2=Daniela |last3=Toews |first3=Ingrid |last4=Ferenci |first4=Tamas |last5=Meerpohl |first5=Joerg J |date=2020-05-25 |editor-last=Cochrane Metabolic and Endocrine Disorders Group |title=Non-nutritive sweeteners for diabetes mellitus |journal=Cochrane Database of Systematic Reviews |language=en |volume=2020 |issue=5 |pages=CD012885 |doi=10.1002/14651858.CD012885.pub2 |pmc=7387865 |pmid=32449201}}</ref> The studies included were mainly of very low certainty and did not report on health-related quality of life, diabetes complications, all-cause mortality or socioeconomic effects.<ref name="Lohner-2020"/>
*[[Reactive hypoglycemia]] – Individuals with reactive hypoglycemia will produce an excess of insulin after quickly absorbing glucose into the bloodstream. This causes their blood glucose levels to fall below the amount needed for proper body and brain function. As a result, like diabetics, they must avoid intake of [[Glycemic|high-glycemic]] foods like white bread, and often use artificial sweeteners for sweetness without blood glucose.

==== Cost and shelf life ====
Many sugar substitutes are cheaper than sugar in the final food formulation. Sugar substitutes are often lower in total cost because of their long [[shelf life]] and high sweetening intensity. This allows sugar substitutes to be used in products that will not perish after a short period of time.<ref>{{cite book | vauthors = Coultate T | date = 2009 | title = Food: The chemistry of its components | location = Cambridge, UK | publisher = The Royal Society of Chemistry }}</ref>