Ask Tufts Experts: Comparing Sugar Substitutes…Prunes and BLood Thinners

Q: Which is safer, saccharin or stevia?

A: Judith C. Thalheimer, RDN, LDN, managing editor of Tufts Health & Nutrition Letter, answers: “A table in our September 2019 Special Supplement, Sugar Substitutes: Helpful or Harmful, indicated that a safe intake limit for Stevia® is considered to be around nine packets a day, while it would take more than 45 packets of saccharin (Sweet’N Low®, Sweet Twin®, Necta Sweet®) to pass the daily safe intake limit. This does not, however, necessarily mean that saccharin is a better choice than Stevia®. (Confusing, I know.) In general, these numbers reflect the state of research on these two sugar substitutes.

“Saccharin has been used in foods since the early 1900s. It is an artificial (man-made) sweetener. Based on decades of research, the Food and Drug Administration (FDA) has set an Acceptable Daily Intake (ADI) level for saccharin. The ADI is the maximum amount of a food additive that can be safely consumed on a daily basis over a person’s lifetime without any adverse effects. The ADI and the amount equivalent to it will vary depending on a person’s weight and the high-
intensity sweetener (those 45 packets are actually for a person who weighs around 130 pounds). No one is suggesting that consuming 45 packets of saccharin a day is a good idea! Anyone consuming high levels of saccharin cannot possibly be following a healthy dietary pattern. The ADI simply makes clear that research indicates saccharin is safe. [In the early 1970s, studies linked saccharin to bladder cancer in rats, and a warning label was added to all products containing saccharin. Since then, more than 30 follow-up studies have determined that the results in rats don’t apply to humans. The warning label was removed in 2000.]

“Stevia® is a chemical extracted from the stevia plant and relatively new to the sugar-substitute market. The FDA has only approved steviol glycoside extracts for human consumption; leaves and crude extracts from these plants are not considered safe to consume. Because they are natural, steviol glycosides are in the FDAs GRAS (Generally Recognized as Safe) category and do not have an ADI like saccharin. It is quite possible that more than nine packets a day would be safe to consume, but there is not yet data to prove safety beyond that level. Again, such high levels of sugar substitute intake most likely indicate less-than-desirable dietary intake.

“Getting one’s sweet fix from fruits and sweet veggies like carrots, sweet potatoes, and bell peppers (and the occasional square of dark chocolate) with very limited intake of sweet beverages and highly processed foods likely to have added sugar, saccharin, or Stevia®, is the healthy way to go.”

Q: Are prunes high in vitamin K? I am on blood thinners and was told I need to limit vitamin K intake.

A: Helen Rasmussen, PhD, RD, senior research dietitian in the Metabolic Research Unit at the Jean Mayer USDA Human Nutrition Research Center on Aging, answers:

“Green vegetables (and especially dark leafy greens) are excellent sources of vitamin K, and the most common targets of restrictions for patients on blood thinners. According to the USDA FoodData Central database, one cup of raw spinach contains 145 micrograms (mcg) of vitamin K, and just half a cup of boiled collard greens contains 530 mcg. One prune contains less than six mcg, and a cup of prune juice contains just under nine micrograms.

“A couple of prunes would seem unlikely to represent a concern with regard to dietary vitamin K for those on blood thinners, but remember that portion and context are important: One cup of pitted prunes contains 104 mcg of vitamin K, and prunes eaten on the same day as other high vitamin K foods (like leafy greens) will add to the cumulative total intake. Patients are often on blood thinners because of cardiovascular problems, so a diet rich in heart-healthy foods like vegetables and fruits is important. Be sure to discuss diet with your cardiologist if you feel too restricted or have fears about the intake of any nutrient or food, and ask for a referral to a registered dietitian if you feel you need more help building a healthy dietary pattern that works with your medical conditions, your medications, and your personal preferences.”

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