Growing up in the wilds of Eastern Kentucky, I was never a stranger to diabetes. Known colloquially as "the sugars" (or, occasionally, having a "sugar foot") in Appalachian communities, Type 2 diabetes runs rampant throughout towns and, in recent years, has reached an almost epidemic-level of crisis.
Depressed economic conditions, lack of nutritional education and limited access to fresh, healthy food have ensured for decades that diabetes diet management has revolved around one key component: artificial sweeteners.
Sugar substitutes—which are defined as synthetic or natural food additives containing, typically, zero calories—have been around for centuries; even the Ancient Romans attempted to use lead acetate (aka "sugar of lead") in their food as a form of sweetener. (Spoiler alert: this resulted in widespread lead poisoning and, ultimately, death.)
Sugar substitutes ...have been around for centuries; even the Ancient Romans attempted to use lead acetate in their food as a form of sweetener.
After my grandfather was diagnosed with Type 2 diabetes, cloying, NutraSweet-tinged hard candies began dotting bowls around his house, eliciting a pang of disappointment if I accidentally bit into one instead of its full-sugar counterparts. Years later, the depth of my understanding about artificial sweeteners—and their impact on the body—grew by leaps and bounds when my first serious boyfriend was diagnosed with Type 1 (or "juvenile") diabetes. Almost overnight, all the full-sugar Coca-Cola went out the window and was replaced with its diet counterpart.
Whether or not artificial sweeteners do more harm than good, however, remains a topic of debate with frequent tectonic-sized shifts in opinion. The argument has become particularly concentrated around diet soda, which takes the prize for the largest share of the "sugar free" consumables market. The quest to find an artificial sweetener that functions as a serviceable sugar replacement without major side effects has been—and continues to be—a wild struggle for scientists and researchers since the popularization of "diet" soda in the mid-20th century.
The first diet soda was created in 1904 by hospital administrator Hyman Kirsch, who began experimenting with sugar-free drinks in order to give diabetic patients at his Queens, New York sanatorium a means by which to enjoy fizzy drinks without the blood sugar spike. Eyeing an opening in the market—and a whole new sales route targeting women watching their figure—Kirsch took his operation to the masses in 1952, calling the ginger ale-like soda "No-Cal" in ham-fisted messages about its "waistline-friendly" lack of sugar. Kirsch used the chemical compound calcium cyclamate as a replacement for sugar, which clocks in at sweetness levels 30 to 50 times that of table sugar but fails to impact insulin levels.
The arrogance of believing that humans are capable of building culinary Frankensteins better ... than what nature has been producing for eons seems almost blasphemous.
No-Cal was a wild success, with actresses like Kim Novak shilling for the soda and a roster of seven flavors crafted to suit a variety of tastes. Over the course of the 1950s, a wave of cyclamate-sweetened, no calorie sodas burst forth from the test tubes of beverage companies across the country, including Diet Rite (which remains on shelves today with a different chemical makeup) and a ginger ale from Canada Dry called Glamor (now discontinued). The drinks—often first intended for use by diabetics—found a wide-ranging reach as "healthy" alternatives to highly caloric, sugary counterparts. No-Cal was treated not unlike the magical weight loss elixirs or diet pills of the day: "Drink this and let science do all the heavy lifting for you," ads cooed out to consumers.
Ultimately, though, No-Cal’s stew of synthetics proved too good to be true. By the 1960s, Coca-Cola and Pepsi both leapt in the diet soda game, pushing out the small batch trailblazer with offerings like TAB (1963) and Patio Diet Cola (which was quickly rebranded as Diet Pepsi by 1964). The death knell, though, for No-Cal arrived in 1969, when the Food and Drug Administration banned the use of cyclamates, citing research that the sweetener caused bladder cancer in lab rats.
There’s something inherently mad scientist about attempting to replace an ingredient that’s naturally occurring with a synthetic material concocted by piecing together neutrons. This is particularly true when it comes to food and beverages. The arrogance of believing that humans are capable of building culinary Frankensteins better—and better for you—than what nature has been producing for eons seems almost blasphemous. It’s almost impossible to imagine that, if introduced today, audiences would be as receptive to chemical laden diet soda as they were in the 1950s, when advances in food science and technology were synonymous with test tube tinkering.
So much remains unknown or disputed about various artificial sweeteners that it’s practically impossible to keep up with the latest findings. The ban on cyclamates still stands in the United States, even as multiple studies have indicated it likely doesn’t have direct links to bladder cancer after all. Following a short dalliance with saccharin as a standalone artificial sweetener (which was also briefly banned by the FDA as a carcinogen, then overturned), soft drink manufacturers stumbled upon the sugar alternative now practically synonymous with diet soda: aspartame.
Though sugar has long been maligned as a kind of culinary devil ... it’s hard to say that sugar replacements are any better.
Aspartame has been one of the most hotly contested synthetic ingredients in the history of the FDA, with a number of interest groups firmly convinced that an improper relationship between the sweetener’s creator—the G.D. Searle Company—and the FDA ensured that it was ramrodded through the approval process in the 1970s. (The company was eventually purchased by Monsanto.) From dedicated conspiracy theorists to widely circulated internet chain letters, claims have been made for decades that aspartame can cause brain tumors, intense migraines and everything in-between. Despite holey research and one-off anecdotes forming a wobbly platform for these accusations, public perception about aspartame skews decidedly negative. At best, its very best, aspartame is net zero for one’s health.
In response to an ever-increasing national wave of skepticism about synthetic food additives, soda companies have started actively looking for natural artificial sweeteners to replace or supplement the standby synthetic options. One of the most popular and promising is stevia, a plant-derived sweetener used across Central and South America for centuries which currently accounts for 40 percent of Japan’s sugar substitute market. Initially banned in the United States for potential carcinogenic properties in 1991, stevia derivatives crafted by Coca-Cola and Pepsi, respectively, were approved for use as a food additive in 2008.
Today, Coca-Cola Life (essentially, stevia-sweetened Coke) and Pepsi’s SoBe Lifewater both incorporate a Stevia-derived natural sugar alternative, but the FDA has yet to approve the use of whole-leaf stevia. "The FDA has not permitted the use of … crude stevia extracts because these substances have not been approved for use as a food additive," an FDA report outlines. "[Our] concerns are control of blood sugar and effects on the reproductive, cardiovascular and renal systems."
Perhaps more encouraging still are mogrosides, calorie-free sweeteners derived from the monk plant. A small, bright green Chinese melon, mogrosides have long been associated with a number of positive health properties across Southeast Asia, like fighting inflammation. While it has yet to be approved as a food additive by the FDA, Splenda briefly marketed a monk fruit extract-based sweetener known as Nectresse until late 2014, but it was pulled after disappointing sales and a pending false advertising lawsuit. (Nectresse claimed to be "100% Natural," but the sweetener’s primary ingredient was a synthetic sugar alcohol.)
Though sugar has long been maligned as a kind of culinary devil—with films like 2014’s Fed Up further bolstering this position—it’s hard to say that sugar replacements are any better. In some cases, one could argue that they’re even worse.
What’s next for sweetener alternatives doesn’t need to be another attempt at manufacturing something that allows people to feel like they’re, essentially, cheating the caloric system. Perhaps, what this country needs next is a national cultural referendum on why many are still drinking soda in the first place—and, with that, a deep hard look into the importance of moderation.