Sugar substitutes ppt

sugar substitutes

1. sugar substitutes Presented by: Dr. swati verma MDS- I st year

2. Contents Introduction Types of sugar substitutes Classification Ideal requirements Sweet score & USDA Food pyramid Health benefits of AS FDA approved AS –benefits & toxic effects Polyalcohols Natural sweeteners Tooth friendly sweet concept References

3. INTRODUCTION WSRO STATEMENT ,NOV.2011 Sugar (sucrose) being most acceptable sweetening agent in use by mankind is considered as the “Arch Criminal” in dental caries initiation. Dental caries occur when acid-producing bacteria, especially Mutans streptococci, Lactobacilli and Actinomyces species, populate the sticky coating on the surface of tooth. Frequent consumption of fermentable carbohydrates, including sucrose, has a role in the aetiology of dental caries.

4. Sugar substitutes Artificial sweeteners are called as sugar substitutes Added to foods to provide sweetness without adding extra calories 2 kind of sweeteners Nutritive Non-nutritive

5. Types of nutritive sweeteners Sugar sweeteners High fructose corn syrups Glucose Dextrose Lactose Maltose Honey Concentrated fruit juices Reduced energy polyols or sugar alcohols Sorbitol Xylitol Mannitol Hydrogenated starch hydrolysates (HSH)

6. Classification

7. Based on their origin Pramod Yadav et al. sugar substitutes & health . IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) Volume 13, Issue 8 Ver. III (Aug. 2014),

8. Ideal requirements

9. SWEET SCORE SWEETS : FREQUENCY X SCORE Liquid : _ x 5 Solid : _ x 10 Slowly dissolving : _ x 15 Total sweet score: —  Interpretation sweet score   5 or less: excellent   10: good   15 or more: “watch out” zone   Diet Counselling – A Primordial Level of Prevention of Dental Caries. Journal of Dental and Medical Sciences (IOSR-JDMS) Volume 13, Issue 1 Ver. II (Jan. 2014), PP 64-70

10. USdA FOOD PYRAMID

11. Health benefits of AS Weight loss Dental care Diabetes mellitus Cost

12. SACCHARIN Discovered by Remsen & Fahlberg in 1879 Oldest of artificial sweeteners 200-700 times sweeter than sucrose Available in liquid & tablet forms as a tabletop sweetener, has a slightly bitter taste

13. Benefits Calorie free Pharmacologically inert & is stable under moist conditions encountered in food preparations Heat stable

14. Excretes almost without metabolic alteration, 75% - 90% in urine Brand name – Sweet ‘N Low & Sugar Twin

15. Dental aspects Saccharin 0.5% ,when used as a supplement to a cariogenic diet , it significantly reduced both fissure and smooth surface caries in rats, apparently by interfering with the growth of S.mutans .

16. Adverse effects Oral dose of 5-25 gm daily may cause anorexia, nausea & vomiting Bladder cancer FDA , 1972 – Set limits on the use of saccharin (1gm/day for a 155 lb person) Reuber MD, 1977 – experimental group of rats which had 5% saccharin in their diet had higher incidence of bladder cancer than control group of rats. Howe et al, 1977 – conducted a study on hospitalized patients with bladder cancer. Risk of bladder cancer was 60% higher among men who had used saccharin tablets

17. Aspartame Combination of amino acids Aspartic acid & Phenylalanine It is about 180-200 times sweet as sucrose Caloric value of 4 cal/gm Kroger et al (2006)-low calorie sweeteners & other substitutes- a review of safety issue .vol.5

18. ADI- 50 mg/kg/d Effective in enhancing acid fruit flavors & extending sweet taste as in chewing gums Brand names – Nutrasweet , Equal

19. Food containing Aspartame

20. Toxic effects Acute Headache dry mouth dizziness mood change nausea Vomiting thrombocytopenia Chronic Lymphomas Liver dysfunction Whitehouse et al.(2008)the potential toxicity of artificial sweeteners-vol.56.No.6

21. Disadvantages Risk of fetal abnormalities & mental retardation if blood levels of phenylalanine are not carefully maintained below 12mg/100ml, during pregnancy for persons with PKU (FDA, 1981)

22. Acesulfame K 200 times sweeter than sucrose First approved by FDA in 1988 for use as a sweetener in dry food products . Used in yogurt, refrigerated desserts,syrups .

23. ADI- 15 mg/kg/d Brand names – Sunett & Sweet one

24. Advantages Calorie free No evidence of carcinogenicity, mutagenicity , cytotoxicity & teratogenicity Excellent shelf life so it is used in candies,canned food and alcoholic beverages Disadvantages Headache

25. Sucralose Discovered in 1976 Non- nutritive, non caloric derivative of sucrose 6oo times sweeter than sucrose Sold under the trade name SPLENDA Widely used throughout the world in tea, coffee, carbonated & non- carbonated beverages, chewing gums etc. ADI- 5 mg/kg/d

26. Advantages Non- cariogenic Nutritive value is zero calories Disadvantages Diarrhoea Dizziness Stomach pain

27. NEOTAME Newest of the low calorie sweeteners 8000 times sweeter than sucrose ADI- 2 mg/kg/d Found in baked foods , soft drinks, chewing gum, frosting, frozen desserts, jams, jellies, gelatins , puddings, processed fruits, toppings, and syrups. TOXIC EFFECTS Headache Hepatotoxicity at high doses

28. Polyalcohols

29. Sorbitol Occurs naturally in cherries, plums , pears , apples . Prepared from glucose by high pressure hydrogenation or by electrolytic reduction. 1 gm sorbitol yields 4 calories Recommended intake by Food & Agricultural organization ( WHO) 150mg/kg/day oxidoreductase Sorbitol fructose

30. Advantage Can be used by only 5-10% of bacteria in plaque – less acid production ( Kalfas et al, 1990) Disadvantage Too much sorbitol consumption ( >20-30gm) can cause diarrhoea . It act as a laxative because of osmotic transfer of water into the bowel.

31. Xylitol Obtained commercially from birch trees. Naturally in fruits and vegetables (strawberries, raspberries, plums), oats, certain mushrooms. Commonly used by diabetic patients. High dosage causes diarrhoea . The recommended dose for dental caries prevention is 6–10 g/d.

32. A study conducted in Turku, Finland, evaluated the effectiveness of xylitol on dental plaque reduction in 1970 . xylitol has been widely researched and globally accepted as a natural sweetener approved by the US Food and Drug Administration (FDA) and the American Academy of Pediatric Dentistry.

33. Guideline on Xylitol Use in Caries Prevention.by AAPD (2011)

34. Nayak et al.(2014)The effect of xylitol on dental caries and oral flora. Clinical, Cosmetic and Investigational Dentistry

35. MECHANISM OF ACTION

36. Oral health benefits Decreases incidence of caries by ng salivary flow Reducing Cariogenic bacteria Plaque level Xerostomia Gingival inflammation Erosion

37. Milgrom et al .studied the effect of habitual consumption of xylitol gummy bear snacks (11.7 g/d) in reducing cariogenic microorganisms in school-going children. And found significant reduction in S. mutans and S. sobrinus . Murthykumar reported in 2013 that xylitol in milk demonstrated a beneficial anticaries effect and is well accepted by both children and adults. Shikhar kumar et al (2013) concluded that Children consuming the sugar-free ( xylitol ) chewing gum showed a marked increase in the pH of saliva.

38. Lactilol Sugar alcohol used as a replacement bulk sweetener for low calorie foods 40% as sweet as sucrose Provides 2.4 cal/g Used in sugar-free candies, cookies (biscuits), chocolate, and ice cream

39. Advantages Highly stable, can be used in baking Promotes colon health as a prebiotic Laxative and is used to prevent or treat constipation Disadvantages Cramping, flatulence & diarrhoea

40. High fructose corn syrup(HFCS) Mixture of glucose & fructose Produced from corn syrup 2 most common types HFCS 42 = 42% fructose, 58% glucose HFCS 55 = 55% fructose, 45% glucose

41. ROLE OF HFCS Baked goods – give a brown crust, enhances flavour in fruit fillings Yogurt – enhances flavor, controls moisture . Sauces & condiments – enhances flavor & balance Canned & frozen fruit – Protect the firm texture of canned fruit, reduces freezer burns on frozen fruits Beverages – Provide greater stability than sucrose in acidic carbonated sodas .

42. Toxic effects Fat deposits in liver Narrowing of blood vessel Triggers asthma, food allergies and damages immune system Accelerates the ageing process Mercury poisoning as HFCS contains mercury. Dr.mercola - Bad to the Last Drop: Refiners Squeeze Dangerous Additives from Corn

43. Natural sweeteners

44. Stevioside Found in leaves of stevia rebaudiana . Calorie free, non- cariogenic 300 times sweeter than sucrose Brand name – pure via, truvia

45. Miraculin Shrub grown in West Africa produces berries that have property of causing sour substances to taste sweet Active ingredient ( miraculin )is a glycoprotein with a molecular weight of about 44,000

46. Effective in sweetening citrus fruits,berries,yogurt etc. Trade name- miralin miracle fruit drops

47. Licorice (ammoniated glycyrrhizin) Derived from licorice root( glycyrrhiza glabra ) 50 times as sweet as sucrose Used as expectorant & pharmaceutical vehicles Reduce the solubility of enamel & prevent fall in pH during incubation of saliva-glucose mixtures

48. Monellin Red berries growing in grape like cluster. Serendipity berries 3000 times sweeter than sucrose Loses its sweetness within about a day, if left standing at room temperature

49. Tooth friendly sweet concept Started in switzerland in 1989. To provide consumers with easy guidance to toothfriendly products, the Toothfriendly (" Happy Tooth ") label was created. Lollipops mints chewing gums Pastilles

50. Tooth friendly bubble gum concept was presented by BENEO with palatinose . These chewing gums are derived from sugar beet low glycemic response which is approved by EHA. Reduced stickiness

51. References Pediatric dentistry priciples & practice- MS muthu 2 nd edition Cariology –Ernst newburn ,1 st edition Textbook of pediatric dentistry- Nikhil marwah -2 nd edition Roshan NM, Sakeenabi M. Practical problems in use of sugar substitutes in preventive dentistry. JISPPD 2011;1(1): 1-8 Bray GA et al. Consumption of high fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004;79:537-43 Kroger M. Low calorie sweetners & other sugar substitutes: A review of safety issues. Comprehensive reviews in food science & food safety 2006(5): 35-47

52. AAPD. Policy on the use of xylitol in caries prevention. Reference manual; 34(6): 45-47 Whitehouse et al. The Potential Toxicity of Artificial Sweeteners. American Association of Occupational Health Nurses Journal. 2008; 56(6),251-259. Raben Anne et al. Sucrose compared with artificial sweeteners. The Americal journal of Clinical Nutrition. 2002; 76,721–729.

53. Matsukubo and Takazoe : Sucrose substitutes and their role in caries prevention, International Dental Journal (2006) Vol. 56/No.3. Pramod Yadav et al. sugar substitutes & health . IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) Volume 13, Issue 8 Ver. III (Aug. 2014). Oku T et al. Digestion, absorption, fermentation & metabolism of sugar substitutes. Pure Appl Chem , 2002; 74(7): 1253-61 Guideline on Xylitol Use in Caries Prevention.by AAPD (2011)

54. Kumar, et al.: Effects of xylitol on salivary and dental plaque pH in children. JISPPD OCT-DEC 2013 ,vol.31.issue 4 . Nayak et al.(2014)The effect of xylitol on dental caries and oral flora. Clinical, Cosmetic and Investigational Dentistry Diet Counselling – A Primordial Level of Prevention of Dental Caries. Journal of Dental and Medical Sciences (IOSR-JDMS) Volume 13, Issue 1 Ver. II (Jan. 2014), PP 64-70