Zero-Calorie Doesn’t Mean Harmless: The Truth About Sugar Alternatives

1. Aspartame: The Popular Classic

Aspartame is one of the most widely used artificial sweeteners, present in thousands of products from diet sodas to sugar-free gum. After consumption, aspartame is rapidly broken down in the digestive tract into its component amino acids and methanol, which are then absorbed and metabolized much like those from natural foods. This efficient metabolism is a key reason for its popularity and acceptance by regulatory agencies worldwide.

However, aspartame has faced considerable controversy, especially in recent years. In 2023, the World Health Organization’s International Agency for Research on Cancer classified aspartame as “possibly carcinogenic to humans,” though other agencies like the FDA have maintained its safety at current intake levels. For those sensitive to aspartame, symptoms may include headaches, dizziness, or digestive upset. Some individuals with phenylketonuria (PKU), a rare genetic disorder, must avoid aspartame entirely due to their inability to metabolize phenylalanine, one of its byproducts.

While ongoing debate continues, it’s crucial to recognize both its widespread presence and the signs of individual intolerance. For more on the controversy, see the WHO’s Q&A on Aspartame.

2. Sucralose: The Heat-Stable Sweetener

Sucralose stands out among artificial sweeteners for its remarkable stability when exposed to heat. This unique property allows it to retain its sweetness even during baking and cooking, making it a favorite for manufacturers of low-calorie desserts, protein bars, and other baked goods. Sucralose is not metabolized by the body and passes through the digestive system largely unchanged, contributing to its “zero-calorie” status.

However, this same resistance to breakdown has raised concerns. Recent research suggests that when sucralose is heated to high temperatures, it can form potentially harmful chlorinated byproducts, although the long-term health implications remain unclear. Some laboratory studies have also questioned its effects on the gut microbiome, suggesting possible disruptions to beneficial bacteria over time.

Consumers with gastrointestinal sensitivities or those who regularly bake with sucralose should be cautious and monitor for symptoms such as bloating or digestive discomfort. For a thorough review of sucralose’s safety and current findings, visit the FDA’s official page on sucralose.

3. Saccharin: The Oldest Synthetic Choice

Saccharin, discovered in 1879, holds the distinction of being the world’s first artificial sweetener. It quickly became popular during sugar shortages in the early 20th century and remains a common ingredient in tabletop sweeteners and diet products. Saccharin’s intensely sweet taste—hundreds of times sweeter than sugar—means only tiny amounts are needed to achieve desired sweetness.

Safety debates have dogged saccharin for decades. In the 1970s, studies linked high doses in lab animals to bladder cancer, leading to warning labels on products in the United States. However, subsequent research and human epidemiological evidence led regulatory agencies like the National Cancer Institute to conclude that saccharin is safe for human consumption at normal levels, and the warnings were removed in 2000.

Despite its safety record, overconsumption can cause side effects. Watch for symptoms such as headaches, digestive upset, or a lingering metallic aftertaste. Those with a known sulfa allergy should exercise particular caution, as saccharin belongs to the sulfonamide class of compounds and may trigger sensitivity reactions in rare cases.

4. Stevia: The Plant-Based Alternative

Stevia has gained popularity as a “natural” sweetener, derived from the leaves of the Stevia rebaudiana plant native to South America. The active compounds, called steviol glycosides, are responsible for stevia’s remarkable sweetness—up to 300 times sweeter than table sugar—allowing for tiny amounts to deliver a powerful punch of flavor without calories. Stevia’s plant origin appeals to those seeking a less processed option compared to synthetic alternatives.

However, not all stevia products are created equal. Some brands mix stevia with other sweeteners or fillers that can affect taste and health impact. For best results, choose products labeled as containing “pure stevia extract” and scrutinize ingredient lists for additives. Look for brands that have undergone third-party testing or certification, which can help ensure quality and purity.

The U.S. Food and Drug Administration recognizes high-purity steviol glycosides as generally safe, but crude stevia extracts and whole stevia leaves have not been approved for use in food products. To learn more about selecting reputable stevia brands, consult the FDA’s official guidance on sweeteners.

5. Acesulfame Potassium: The Hidden Additive

Acesulfame potassium, often abbreviated as Ace-K, is a commonly used artificial sweetener in a wide variety of processed foods and beverages. You’ll find it in everything from diet sodas and flavored waters to sugar-free baked goods and dairy products. Its popularity stems from its high sweetness intensity and stability under heat, making it a versatile ingredient for manufacturers.

Acesulfame potassium is frequently combined with other sweeteners, such as aspartame or sucralose, to mask any potential aftertaste and create a more sugar-like flavor profile. Some experts have raised concerns about the health effects of these combinations, as there’s limited research on the long-term impacts of consuming multiple artificial sweeteners together. Animal studies have suggested possible effects on metabolism and gut health, but human data remains inconclusive.

When scanning ingredient labels, look for “acesulfame potassium,” “Ace-K,” or the food additive code “E950.” Products that list multiple sweeteners may be using Ace-K to boost overall sweetness and improve taste. For more details on its safety and regulatory status, visit the FDA’s acesulfame potassium page.

6. Monk Fruit Extract: The Ancient Sweetener

Monk fruit extract, derived from the small green melon native to southern China, has been used for centuries in traditional medicine. The sweetness comes from unique antioxidants called mogrosides, which not only deliver a sugar-free punch but have also shown potential anti-inflammatory and antioxidant benefits in preliminary research. Some consumers choose monk fruit for its natural origin and potential health-promoting properties.

Taste-wise, monk fruit extract is considerably sweeter than sugar and is often praised for its clean, fruity profile without the bitter aftertaste sometimes found in stevia-based sweeteners. However, flavor can vary by brand and formulation. Many commercially available monk fruit sweeteners are blends, often mixed with erythritol or even added sugars to balance sweetness and texture.

To ensure you’re getting the true benefits, look for products labeled “100% monk fruit extract” and inspect ingredient lists carefully for additives or hidden sugars. The U.S. Food and Drug Administration recognizes monk fruit extract as generally safe for consumption. For more on its properties and regulatory status, see the FDA’s sweeteners guidance.

7. Allulose: The Rare Sugar

Allulose is gaining attention as a “rare sugar” found naturally in small quantities in foods like figs and raisins. It offers the taste and texture of traditional sugar but with only a fraction of the calories—about 0.4 calories per gram compared to sugar’s 4 calories. Unlike most other sweeteners, allulose is absorbed by the body but not metabolized for energy, so it passes out in urine unchanged. This property makes it an appealing option for those seeking low-calorie or diabetic-friendly alternatives.

Recent regulatory advances have made allulose more accessible to consumers. The U.S. Food and Drug Administration now allows it to be excluded from total and added sugar counts on food labels, a move that highlights its unique metabolic impact. Allulose is considered “generally recognized as safe” (GRAS), but larger quantities can sometimes cause mild digestive symptoms such as bloating or loose stools.

If you’re new to allulose, start with small amounts and monitor for any gastrointestinal discomfort. For comprehensive information on its safety and regulatory standing, visit the FDA’s official page on allulose.

8. Erythritol: The Sugar Alcohol Standout

Erythritol is a sugar alcohol commonly used in low-carb and keto-friendly products for its mild sweetness and ability to mimic the texture of real sugar. Unlike other sugar alcohols, erythritol is mostly absorbed into the bloodstream in the small intestine and then excreted unchanged in the urine, rather than being fermented by gut bacteria. This unique absorption profile means it typically causes fewer digestive problems than xylitol, sorbitol, or maltitol.

Erythritol’s popularity has soared alongside keto diet trends, as it does not raise blood sugar or insulin levels and is virtually calorie-free. However, consuming large amounts in a single sitting can still produce gastrointestinal symptoms, such as bloating, gas, or mild stomach upset. Some people may be more sensitive than others and should introduce erythritol gradually into their diets.

If you’re following a low-carb lifestyle and want to minimize digestive discomfort, pay attention to serving size recommendations on product labels. For more on erythritol’s safety, metabolism, and use in foods, refer to the FDA’s page on erythritol.

9. Xylitol: Dental Health Booster

Xylitol is a sugar alcohol well known for its cavity-fighting reputation. Often found in sugar-free gum, mints, and dental care products, xylitol inhibits the growth of oral bacteria that cause tooth decay and helps neutralize acids in the mouth. Numerous studies support its benefits for oral health, making it a popular ingredient among dentists and consumers alike.

Despite its advantages for humans, xylitol can be extremely toxic to dogs, causing a rapid release of insulin that may lead to dangerously low blood sugar and potentially fatal liver damage. Pet owners should be vigilant about keeping xylitol-containing products out of reach of animals. To learn more, see the FDA’s pet safety alert.

For most people, xylitol is safe in moderate amounts, but excessive consumption may lead to digestive discomfort, such as gas or diarrhea. A daily intake of up to 10-15 grams is generally well tolerated by adults, but it’s best to start with small servings and increase gradually to minimize gastrointestinal side effects.

10. Maltitol: The Sweetener in Sweets

Maltitol is a sugar alcohol frequently used in sugar-free chocolates, candies, and baked goods, thanks to its sugar-like sweetness and creamy texture. It provides about half the calories of regular sugar and closely mimics the mouthfeel that consumers expect from traditional confections. Maltitol’s ability to blend well with fats and other ingredients makes it a go-to choice for manufacturers seeking to replicate the indulgence of real chocolate without the added sugar.

However, maltitol is notorious for its laxative effects when consumed in excess. Because it is only partially absorbed in the small intestine, the remainder is fermented by gut bacteria in the colon, leading to gas, bloating, and sometimes diarrhea. Products containing maltitol often carry a warning about potential laxative effects, especially in Europe and other regions with stricter labeling laws.

To spot maltitol in ingredient lists, look for names like “maltitol syrup,” “E965,” or simply “maltitol.” Always check the nutrition label for serving size recommendations and be mindful of cumulative intake if you’re enjoying multiple sugar-free treats in one day. For further details, see the FDA’s maltitol overview.

11. Sorbitol: The Sugar-Free Gum Ingredient

Sorbitol is a sugar alcohol commonly found in sugar-free gum, mints, and various “diet” or “light” foods. Once consumed, sorbitol is slowly metabolized in the body and absorbed in the small intestine. A significant portion, however, escapes absorption and passes into the colon, where it is fermented by bacteria—a process that can lead to digestive symptoms in sensitive individuals.

People who consume large amounts of sorbitol may notice bloating, abdominal discomfort, or even diarrhea. Those with irritable bowel syndrome (IBS) or other gastrointestinal sensitivities are particularly prone to these effects. Because sorbitol is often present in both foods and medications (like cough syrups and laxatives), it’s important to monitor total daily intake.

To limit sorbitol consumption, check ingredient labels for “sorbitol,” “E420,” or “sugar alcohols.” Opt for products with lower sugar alcohol content, and avoid consuming multiple sorbitol-containing products in a short period. For more on sorbitol’s metabolism and digestive effects, visit the FDA’s sorbitol information page.

12. Mannitol: The Medical Sweetener

Mannitol is a sugar alcohol with unique properties that make it valuable in both food and medicine. While it is used as a sweetener in products like sugar-free candies and chewing gum, mannitol’s primary role is often medicinal—as a diuretic to reduce swelling or pressure in medical emergencies, and as a laxative in certain preparations. Its use is well established in clinical settings, particularly for managing intracranial pressure and acute kidney failure.

Compared to other sugar alcohols like sorbitol or xylitol, mannitol is less sweet and is only partially absorbed in the digestive tract. Much like its counterparts, unabsorbed mannitol can be fermented by gut bacteria, potentially causing bloating, gas, or diarrhea, especially if consumed in large amounts. People with sensitive digestive systems or those with a history of gastrointestinal issues should be cautious with mannitol-containing foods.

To avoid excessive intake, check product labels for “mannitol,” “E421,” or “sugar alcohols.” For more details on mannitol’s medicinal uses and safety profile, see the FDA’s mannitol safety page.

13. Tagatose: The Prebiotic Sweetener

Tagatose is a lesser-known sweetener gaining recognition for its prebiotic effects on gut bacteria. Structurally similar to fructose, tagatose is only partially digested and absorbed in the small intestine; the remainder travels to the colon, where it serves as food for beneficial bacteria. Early research suggests that this process may support a healthier gut microbiome and potentially improve digestive health.

Unlike traditional sugars, tagatose has minimal impact on blood glucose and insulin levels, making it an attractive option for people with diabetes or those seeking low-glycemic alternatives. Its sweetness and mouthfeel closely mimic those of sucrose, allowing it to be used in a wide range of beverages and baked goods.

However, because tagatose is incompletely absorbed, excessive intake can lead to gastrointestinal symptoms such as gas, bloating, and diarrhea—especially in those with sensitive digestive systems. Individuals with hereditary fructose intolerance or certain metabolic disorders should avoid tagatose, as their bodies may not process it safely. For more about its health effects and regulatory details, visit the FDA GRAS Notice Inventory.

14. Neotame: The Potent Enhancer

Neotame is an artificial sweetener renowned for its extraordinary potency—up to 7,000 to 13,000 times sweeter than table sugar. This potency allows food manufacturers to use it in minute quantities, significantly reducing calorie content while maintaining a sugar-like flavor profile in products. Neotame is heat-stable, making it suitable for both processed foods and baked goods, and it is often used in beverages, dairy products, and other low- or no-calorie foods.

A major advantage of neotame over aspartame is that it’s safe for people with phenylketonuria (PKU), as it is metabolized differently and does not produce significant amounts of phenylalanine. Its taste profile is clean and pleasant, with little to no aftertaste, making it an appealing option for both food manufacturers and consumers seeking alternatives.

Regulatory agencies, including the FDA and EFSA, have approved neotame as safe for general use in foods and beverages. Its ultra-high sweetness and regulatory endorsement have made it a staple in the world of processed “diet” foods.

15. Advantame: The Newcomer

Advantame is one of the newest high-intensity sweeteners approved for use in the food supply. It is derived from aspartame and vanillin, but is far sweeter—reportedly more than 20,000 times sweeter than table sugar. This potent sweetness allows manufacturers to use only tiny quantities, making it a cost-effective option for large-scale food production.

One of advantame’s standout features is its remarkable stability at high temperatures. This makes it especially suitable for baked goods, processed foods, and even hot beverages, where other sweeteners might degrade or lose their flavor profile. You’ll increasingly find advantame in “diet” sodas, flavored waters, and foods marketed as low-calorie or sugar-free.

Safety data for advantame is robust, with both the FDA and international agencies like the Food Standards Australia New Zealand reviewing and approving its use. Extensive studies have not found evidence of carcinogenicity or adverse health effects at approved consumption levels, but as with all new sweeteners, continued monitoring is important.

16. Isomalt: The Candy-Maker’s Choice

Isomalt is a sugar alcohol prized by confectioners for its ability to replicate the glossy, crystalline texture of traditional hard candies while providing fewer calories. You’ll commonly find isomalt in sugar-free lollipops, cough drops, and decorative cake toppers thanks to its stability and resistance to humidity. Unlike regular sugar, isomalt doesn’t brown or caramelize as easily, giving candies a clean and attractive finish.

Compared to maltitol, isomalt is less sweet—about half as sweet as sucrose—so it’s often paired with intense sweeteners to achieve the desired flavor. Both isomalt and maltitol can cause digestive discomfort if consumed in large quantities, but isomalt is generally considered less likely to cause a dramatic laxative effect. Still, moderation is key, especially for those with sensitive digestive systems.

From a dental perspective, isomalt does not promote tooth decay, as oral bacteria cannot readily ferment it to form acids. This makes isomalt-based candies a better choice for dental health compared to traditional sugary treats. For more about its properties and safety, visit the FDA’s isomalt overview.

17. Lactitol: The Dairy-Derived Sweetener

Lactitol is a sugar alcohol made by hydrogenating lactose, the natural sugar found in milk. Its mild sweetness and sugar-like texture make it a popular choice in reduced-calorie confections, such as diabetic-friendly chocolates, baked goods, and ice cream. Because lactitol has a minimal impact on blood glucose, it’s often used in products targeted at people with diabetes or those seeking to manage their sugar intake.

Despite its appealing qualities, lactitol is only partially absorbed in the digestive tract. The unabsorbed portion is fermented by gut bacteria, which can lead to gastrointestinal symptoms like gas, bloating, and diarrhea—especially when consumed in large amounts. People with lactose intolerance may also experience heightened sensitivity, since lactitol is derived from milk sugars.

To minimize discomfort, check product labels for serving size recommendations and consider starting with small portions to gauge your tolerance. As with other sugar alcohols, moderation is vital for digestive comfort. For more on lactitol’s production, safety, and use in diabetic sweets, see the FDA’s lactitol information.

18. Aspartame Sensitivity: Uncommon but Real

While aspartame is considered safe for the vast majority of people, a small number of individuals may experience adverse reactions after consuming it. Reported symptoms include headaches, dizziness, mood changes, and in rare cases, allergic-like responses such as hives or swelling. Though these reactions are uncommon, they can cause significant discomfort and should not be overlooked.

A special population that must strictly avoid aspartame is individuals with phenylketonuria (PKU), a rare genetic disorder. People with PKU cannot metabolize phenylalanine, a breakdown product of aspartame, which can accumulate to dangerous levels and cause serious neurological damage. All products containing aspartame must carry a warning for those with PKU, as required by the FDA.

If you notice unexplained symptoms after consuming aspartame-containing foods or beverages, it’s wise to consult a healthcare professional. They can help assess whether you have a sensitivity or if other underlying issues may be involved. For persistent or severe reactions, discontinuing aspartame and seeking medical advice is strongly recommended.

19. Sugar Alcohols and Bloating

Sugar alcohols such as sorbitol, xylitol, and maltitol are notorious for causing bloating and digestive discomfort in some people. This is primarily due to their osmotic effects in the gut: because they are not fully absorbed in the small intestine, sugar alcohols draw water into the colon, leading to feelings of fullness, bloating, and sometimes diarrhea. The unabsorbed portion is also fermented by gut bacteria, which produces gas and can further contribute to discomfort.

Interestingly, this digestive response is similar to what some people experience after consuming high-fiber foods, such as beans or bran. Both fiber and sugar alcohols are only partially broken down in the digestive tract and can cause similar symptoms, especially when introduced rapidly or in large amounts.

To minimize symptoms, start with small servings of sugar alcohol-containing foods and increase your intake gradually to allow your digestive system to adapt. Drink plenty of water, and avoid consuming several products with sugar alcohols in a short period. For additional insight on sugar alcohol digestion, visit the Mayo Clinic’s resource on sugar alcohols.

20. Impact on Gut Microbiome

Emerging research shows that some sugar alternatives can have noticeable effects on the gut microbiome—the community of trillions of bacteria living in our digestive tract. Certain sweeteners, including sucralose and some sugar alcohols, have been found to alter the composition of gut bacteria, potentially influencing inflammation, metabolism, and even immune function. Animal and human studies have linked high sucralose intake to reductions in beneficial bacterial populations and increases in less desirable strains, though the long-term significance of these changes is still being studied.

In contrast, stevia appears to have a milder effect on the gut microbiome. Preliminary data suggest that it does not significantly disrupt bacterial diversity, though further research is needed to establish its full impact. Sensitivity to gut changes can vary widely; while some people may notice symptoms like bloating, gas, or altered bowel habits, others may have no issues at all.

If you experience new or persistent digestive changes after introducing a new sweetener, consider keeping a food diary and consult a healthcare provider if symptoms persist. For more on how artificial sweeteners interact with gut health, read the NIH review on sweeteners and the gut microbiome.

21. Appetite Regulation Disruption

One of the lesser-known impacts of sugar alternatives is their potential to disrupt normal appetite regulation. When the brain senses sweetness but receives few or no calories, it may trigger further food-seeking behavior in an attempt to find the energy it expected. This mismatch can interfere with satiety signals and lead to increased hunger or cravings, especially for high-calorie foods.

Several studies support this theory, showing that the regular use of zero-calorie sweeteners may not always result in reduced calorie intake as intended. For example, research published in reviews by the NIH highlights how some individuals may compensate for the lack of calories in artificially sweetened foods by consuming more later in the day. However, responses can vary, and not everyone experiences these effects.

To avoid unintentional overeating, practice mindful eating by paying close attention to hunger and fullness cues rather than relying solely on calorie counts or sweetness. Focusing on whole, nutrient-dense foods and being aware of how sugar alternatives affect your own appetite can help you make balanced, sustainable choices.

22. Insulin Response Confusion

Artificial sweeteners are often chosen to help manage blood sugar, but some research has revealed a surprising effect: certain sweeteners may trigger a small insulin response even in the absence of real sugar. This phenomenon, sometimes called the “cephalic phase insulin response,” suggests that the mere taste of sweetness on the tongue can prompt the body to release insulin in anticipation of incoming glucose.

While most sugar alternatives do not raise blood glucose levels the way traditional sugars do, some—such as sucralose and aspartame—have been shown in limited studies to cause a modest rise in insulin in certain individuals. However, responses vary widely and the clinical significance of these findings remains debated. For most people, these effects are minimal and unlikely to impact metabolic health, but those with insulin resistance or diabetes may want to monitor their own reactions.

If you have diabetes or are closely managing your blood sugar, consider testing your levels after trying new sweeteners to see how your body responds. For a closer look at the science, review the NIH discussion of artificial sweeteners and insulin response.

23. Long-Term Metabolic Effects

The long-term metabolic effects of artificial sweeteners remain a topic of active investigation and debate. While they are marketed as tools for weight management and diabetes prevention, some large population studies have found unexpected links between frequent consumption of sugar alternatives and increased risk of weight gain, metabolic syndrome, and type 2 diabetes. Researchers theorize that disruptions in appetite regulation, altered gut microbiome, and changes in insulin response may all play a role in these outcomes.

For example, data from the JAMA Network and other cohort studies suggest that artificial sweetener use does not consistently result in long-term weight loss and may even be associated with higher body mass index (BMI) in some populations. However, such studies are observational and cannot conclusively prove cause and effect—a critical nuance when interpreting these findings.

Given these uncertainties, it’s wise to periodically review your overall dietary patterns, focusing on whole foods, balanced meals, and moderation in all forms of sweeteners. Continued research will help clarify these risks, but mindful, varied eating remains a sound approach for long-term metabolic health.

24. Blood Pressure and Heart Health

Emerging research is raising concerns about the potential cardiovascular risks associated with some artificial sweeteners. Cohort studies have suggested that high intake of certain sugar substitutes, especially in diet beverages, may be linked to increased risk of hypertension, stroke, and heart disease. One French study published in The BMJ observed a higher incidence of cardiovascular events in people who consumed larger amounts of artificial sweeteners compared to non-users.

The mechanisms behind these associations are still being explored. Possible explanations include effects on the gut microbiome, blood vessel function, and metabolic health, as well as the tendency for people to compensate with unhealthy habits elsewhere in their diet. While the absolute risk increase appears modest, the findings highlight the importance of moderation and ongoing monitoring of your health.

Be alert for warning signs such as persistent high blood pressure, chest discomfort, or unexplained palpitations if you frequently use artificial sweeteners. If you have a history of heart disease or hypertension, it may be wise to discuss your sweetener intake with your healthcare provider. Ongoing research will help further clarify the links between sugar alternatives and heart health.

25. Kidneys: Processing and Elimination

Many artificial and alternative sweeteners are eliminated from the body through renal clearance, meaning the kidneys filter them out of the bloodstream and expel them in urine. This process is similar to how the body handles substances like caffeine and certain medications. For most healthy individuals, the kidneys efficiently manage the removal of these compounds without adverse effects. Erythritol, for example, is largely absorbed but not metabolized, and is excreted unchanged via the urine.

However, people with chronic kidney disease or reduced kidney function should be mindful of their intake. While most non-nutritive sweeteners are considered safe at standard consumption levels, reduced clearance can potentially lead to higher circulating levels of these substances. There is limited evidence on the long-term impact of sweetener accumulation in those with advanced kidney disease, so caution is warranted.

If you have kidney issues, consult your nephrologist or dietitian before making significant dietary changes involving artificial sweeteners. For more information about sweeteners and kidney health, visit the National Kidney Foundation’s resource on sweeteners.

26. Children and Sugar Alternatives

Children are uniquely sensitive to the effects of sugar substitutes due to their smaller size, developing organs, and higher relative intake per body weight. Many “kid-friendly” foods and flavored drinks—such as yogurts, juices, and snack bars—now contain artificial or natural zero-calorie sweeteners to reduce sugar content. However, there is limited long-term safety data on the effects of regular sweetener consumption during childhood and adolescence.

Some pediatric experts caution that excessive intake may influence taste preferences, potentially fostering a lifelong preference for intensely sweet foods. There are also concerns about digestive upsets, such as bloating or diarrhea, especially with sugar alcohols. To screen for excessive intake, parents should review ingredient labels for sweeteners like sucralose, acesulfame potassium, stevia, or sugar alcohols, and be mindful of the number of artificially sweetened products their child consumes daily.

The American Academy of Pediatrics advises prioritizing whole fruits, water, and minimally processed snacks over artificially sweetened foods. If you have concerns about your child’s diet, discuss them with your pediatrician or a registered dietitian to ensure a balanced and safe approach to sugar alternatives.

27. Pregnancy and Lactation Considerations

Pregnant and breastfeeding individuals often have questions about the safety of sugar alternatives, given the importance of nutrition during these critical periods. Most major health organizations, including the CDC and ACOG, consider moderate consumption of approved non-nutritive sweeteners such as aspartame, sucralose, and stevia to be safe during pregnancy and lactation. However, some sweeteners—like saccharin—are generally recommended in limited amounts due to their ability to cross the placenta and potential for accumulation in fetal tissues.

These recommendations are similar to those for caffeine, which should also be consumed in moderation during pregnancy. Because every pregnancy and lactation journey is unique, individual sensitivities, allergies, and medical history should always be considered. It’s wise to avoid excessive intake and to prioritize whole, nutrient-rich foods over processed options with added sweeteners.

If you have concerns about a specific sweetener or are unsure about your intake, consult with your OB-GYN or a registered dietitian. They can help tailor dietary advice to your unique needs and provide the most current safety guidance for you and your baby.

28. Allergic Reactions and Intolerances

Although rare, allergic reactions and intolerances to sugar alternatives do occur. Most sweeteners are considered non-allergenic for the general population, but case reports have documented adverse responses, particularly to compounds like saccharin (a sulfonamide derivative) or stevia extracts. Symptoms of an allergy may include hives, itching, swelling, difficulty breathing, or gastrointestinal distress shortly after consumption.

For example, individuals with a sulfa allergy may react to saccharin, and there have been isolated reports of stevia-induced allergic reactions, especially in people with ragweed or related plant allergies. Intolerances, which are more common, typically manifest as headaches, bloating, or digestive upset rather than immune-mediated symptoms.

If you experience sudden swelling of the lips, tongue, or throat, trouble breathing, or severe abdominal pain after ingesting a sweetener, seek urgent medical care immediately, as these may indicate a life-threatening allergic reaction called anaphylaxis. If you suspect you have a food intolerance or allergy to a sugar substitute, consult an allergist for proper diagnosis and personalized management. For more information on food allergies, visit the Food Allergy Research & Education (FARE) website.

29. Headaches and Migraines

Some artificial sweeteners, notably aspartame and sucralose, have been implicated as potential headache and migraine triggers in sensitive individuals. While large-scale studies remain inconclusive, numerous case reports and patient surveys describe headaches developing within hours of consuming these sweeteners, especially in people with a prior history of migraines. The mechanism is not fully understood but may involve changes in brain neurotransmitters or blood vessel reactivity.

A review published by the American Migraine Foundation highlights both anecdotal and clinical observations of aspartame-induced migraines. Sucralose has also been reported in isolated cases to provoke similar reactions, though less frequently than aspartame. Symptoms can include mild tension-type headaches, cluster-like episodes, or classic migraine attacks with aura, nausea, and light sensitivity.

If you suspect a link between sweetener intake and headaches, keep a detailed symptom diary noting what you eat and when symptoms arise. This record can help you and your healthcare provider identify patterns and make informed dietary changes. If headaches are severe or persistent, consult a neurologist or headache specialist for personalized guidance.

30. Mood and Mental Health

The potential effects of artificial sweeteners on mood and mental health are the subject of growing scientific interest. Some studies have suggested a possible link between high artificial sweetener intake—particularly aspartame—and increased risk of mood disturbances, such as depression or anxiety, though results remain mixed and causation has not been firmly established. A review in the NIH literature notes both animal and human findings of altered mood after exposure to certain sweeteners, especially in susceptible individuals.

Unlike natural sugars, which can provide a quick energy boost and may temporarily elevate mood, some artificial sweeteners may affect neurotransmitter levels or interact with the gut-brain axis, influencing emotional regulation in subtle ways. However, these effects appear to be highly individualized, with most people experiencing no noticeable mood changes.

If you suspect a connection between sweetener use and shifts in mood, consider tracking your intake alongside any changes in mental health. Share this information with a healthcare provider or mental health professional, especially if symptoms are persistent or worsening. Awareness and individualized observation remain the best strategies as research continues to evolve.

31. Cancer Risk: Myths and Evidence

Concerns about artificial sweeteners and cancer have circulated for decades, driven by early animal studies and recurring public debate. However, large-scale epidemiological studies in humans have not found a consistent association between the consumption of approved sweeteners—such as aspartame, saccharin, or sucralose—and increased risk of cancer. Comprehensive reviews by organizations like the National Cancer Institute and the European Food Safety Authority (EFSA) have repeatedly concluded that these sweeteners are safe for human use within established daily intake limits.

Despite this reassuring evidence, fear persists—often fueled by headlines or outdated information. For instance, the World Health Organization’s 2023 statement that aspartame is “possibly carcinogenic” was based on limited and inconclusive data. Most regulatory agencies maintain that moderate use poses no meaningful risk.

If you’re concerned about cancer risk, refer to reputable sources like the National Cancer Institute and EFSA for up-to-date, evidence-based guidance. Continue to follow intake recommendations and focus on overall healthy dietary patterns, as lifestyle factors play a far greater role in cancer prevention than artificial sweetener consumption alone.

32. Dental Health: Fact vs. Fiction

Unlike sucrose (table sugar), most sugar alternatives do not promote tooth decay because oral bacteria cannot efficiently metabolize them to produce acid. This makes sweeteners like aspartame, sucralose, stevia, and sugar alcohols a safer choice for dental health, particularly in products such as sugar-free gum and mints. Xylitol stands out among these for its additional dental benefits: it not only fails to feed cavity-causing bacteria but also actively inhibits their growth and helps reduce plaque formation.

Numerous studies, including those cited by the American Dental Association, support the use of xylitol-containing products to lower the risk of cavities and promote better oral hygiene. However, sugar alternatives are not a substitute for regular brushing, flossing, and dental checkups.

To optimize dental health, choose sugar-free candies and gums, especially those with xylitol, and maintain consistent oral hygiene practices. Remember to check ingredient labels, as some “sugar-free” products may still contain fermentable carbohydrates. A balanced approach—combining wise sweetener choices with daily oral care—remains the best strategy for healthy teeth and gums.

33. Effects on Weight Loss Efforts

Sugar alternatives are often marketed as tools to support weight loss by reducing calorie intake from sweetened foods and beverages. Many diet plans—including low-carb, keto, and diabetic diets—incorporate non-nutritive sweeteners as a way to satisfy cravings without derailing progress. However, research into their actual effects on weight loss yields mixed results.

Some randomized controlled trials show modest benefits, with participants consuming artificially sweetened products experiencing slight reductions in body weight compared to those using sugar. For instance, a 2019 NIH review notes that short-term substitution can help with calorie control, but long-term studies are less conclusive. Factors such as appetite compensation, dietary habits, and psychological cues can influence individual outcomes.

Realistically, sugar alternatives are not a magic solution. They can be a helpful tool when combined with mindful eating, portion control, and a balanced diet rich in whole foods. For sustainable weight management, focus on overall lifestyle changes rather than relying solely on sugar substitutes. Set realistic expectations and consult with a nutrition professional for personalized guidance.

34. Influence on Taste Preferences

High-intensity sweeteners, such as sucralose, aspartame, and stevia, deliver sweetness hundreds of times greater than that of natural sugars. Regular consumption of these potent sweeteners may gradually alter your taste sensitivity, making naturally sweet foods like fruit or dairy seem less flavorful by comparison. This phenomenon can create a preference for more intensely sweetened foods and drinks—a trend noted in both children and adults who frequently consume sugar substitutes.

Unlike natural sugars, which deliver both sweetness and energy, artificial sweeteners provide only the taste, potentially desensitizing the palate over time. Some researchers suggest that this shift in taste sensitivity could make it harder to enjoy foods with subtle or moderate sweetness and may increase cravings for highly sweetened products.

To help “reset” your palate, try gradually reducing your intake of all sweetened foods and focusing on whole, unprocessed options. Allow your taste buds time to adjust to more natural flavors, and experiment with using spices like cinnamon or vanilla to enhance perceived sweetness. For more tips, see the Harvard T.H. Chan School of Public Health’s advice on artificial sweeteners.

35. Environmental Impact

Beyond personal health, the environmental impact of sugar alternatives is an increasingly important consideration. The production of synthetic sweeteners like aspartame, sucralose, and saccharin requires energy-intensive chemical processes and generates manufacturing waste, which can contribute to pollution if not managed responsibly. Studies have also found residues of artificial sweeteners in waterways, as many of these compounds are not fully broken down in wastewater treatment plants, raising concerns about their effects on aquatic ecosystems.

By contrast, plant-based sweeteners such as stevia and monk fruit may have a lower environmental footprint if sourced sustainably, though large-scale agriculture and extraction processes can still lead to land use change and resource consumption. Organic or fair-trade certification may help ensure more eco-friendly production practices for these natural options.

To reduce your environmental impact, choose sweeteners from companies that prioritize responsible sourcing and invest in sustainable practices. Limit the use of single-serve packets and opt for bulk or concentrated products to cut down on packaging waste. For further information on sweeteners and sustainability, visit the Environmental Working Group’s analysis of sweetener pollution.

36. Labeling Loopholes

Navigating the world of processed foods can be tricky, especially when it comes to spotting hidden sugar alternatives. Manufacturers often use multiple sweeteners in a single product, which may be listed under names unfamiliar to most consumers. Terms like “sugar alcohols,” “natural flavors,” or obscure chemical names (such as “acesulfame potassium” or “E950”) can easily go unnoticed on ingredient lists. Some products labeled as “no sugar added” or “diet” may still contain several types of artificial, plant-based, or sugar alcohol sweeteners.

Packaging can also be misleading, with health claims or front-of-package buzzwords masking the true sweetener content. The FDA requires disclosure of specific ingredients but does not mandate clear front-label warnings for all sugar alternatives. Learning to decode ingredient lists is key: look for terms like “sucralose,” “sorbitol,” “erythritol,” “stevia extract,” or “monk fruit concentrate.” Multiple sweeteners may be used to mimic the taste of sugar while masking any aftertaste.

For practical guidance on reading food labels and understanding what’s really inside, see the FDA’s Nutrition Facts Label resource. Being a savvy label reader empowers you to make informed choices about the sweeteners in your diet.

37. Regulatory Approvals and Bans

The safety and regulation of sugar alternatives are overseen by agencies such as the U.S. Food and Drug Administration (FDA), the European Food Safety Authority (EFSA), and other international health organizations. These agencies conduct thorough safety evaluations before approving sweeteners for use in food products, setting acceptable daily intake (ADI) levels based on scientific evidence. Most widely used sweeteners—including aspartame, sucralose, stevia, and acesulfame potassium—are approved in the U.S. and Europe, although regulations can differ by country.

Occasionally, new research prompts bans, warnings, or changes in recommended intake. For example, the World Health Organization’s 2023 classification of aspartame as “possibly carcinogenic” sparked debate but did not result in outright bans, and most agencies maintained their stance on its safety when consumed within established limits. Certain sweeteners, such as cyclamate, remain banned in the U.S. but are approved elsewhere.

To stay up to date, consult the FDA’s High-Intensity Sweeteners page or the EFSA’s sweetener safety resource. Monitoring regulatory updates ensures you’re informed about any new findings, warnings, or policy changes regarding sugar alternatives worldwide.

38. Combination Products: When Sweeteners Mix

Many processed foods and beverages now contain blends of multiple sugar alternatives, designed to enhance taste, mask aftertastes, and mimic the complex sweetness profile of real sugar. Manufacturers often combine high-intensity sweeteners like sucralose or aspartame with sugar alcohols such as erythritol or xylitol to achieve synergy, where the combined sweetness exceeds the sum of the individual components. These blends can also help reduce the off-notes of certain sweeteners and improve texture in baked goods and confections.

While the synergy effect allows for lower quantities of each sweetener, it can also complicate the body’s digestive response. Some people may notice increased sensitivity or more pronounced gastrointestinal symptoms when consuming products with multiple sugar substitutes. Children and those with digestive disorders should be especially cautious.

To identify combination products, carefully review ingredient lists for several sweetener names—such as “acesulfame potassium, sucralose, erythritol, and stevia extract”—or check for terms like “proprietary blend.” For more on the science and labeling of sweetener blends, visit the FDA’s high-intensity sweeteners resource. Being aware of what’s in your foods can help you make informed choices and monitor for any adverse reactions.

39. Marketing Claims vs. Scientific Reality

The world of sugar alternatives is filled with bold marketing claims—”guilt-free,” “natural,” “diabetic-friendly,” “zero-calorie”—designed to appeal to health-conscious consumers. While these buzzwords sound reassuring, they often oversimplify or exaggerate the actual health benefits of these products. For example, products labeled as “natural” may still contain additives or be highly processed, and “diabetic-friendly” does not always mean they are free from blood sugar effects.

Scientific research frequently paints a more nuanced picture, showing that artificial and plant-based sweeteners have both advantages and drawbacks depending on the individual and the context of use. Some claims, such as “supports weight loss” or “good for gut health,” may be based on preliminary findings or limited studies, rather than robust, long-term evidence.

To verify product benefits, look beyond the packaging—read ingredient lists, check for reputable third-party certifications, and consult credible sources like the Harvard T.H. Chan School of Public Health. Being a critical consumer means questioning claims and seeking out research-backed information to make truly informed dietary decisions.

40. Psychological Impact: The ‘Health Halo’

The “health halo” effect is a psychological phenomenon where foods labeled as “sugar-free,” “diet,” or “zero-calorie” are automatically perceived as healthier choices—even if they are highly processed or lacking in nutrients. This bias can lead people to overconsume these products, believing they are making virtuous decisions, much like the surge in low-fat processed snacks in previous decades. Research shows that health halos can undermine mindful eating and portion control, sometimes resulting in higher overall calorie intake or less attention to nutritional balance.

A study published by the NIH found that consumers often underestimate calories and other less-desirable nutrients in foods marketed with “healthy” buzzwords. Much like low-fat or “all natural” claims, the sugar-free label does not guarantee that the product is actually good for you.

To avoid falling for the health halo, practice mindful eating: assess the full nutritional profile, read ingredient lists, and consider how a product fits into your broader diet. Remember, a balanced approach—focusing on whole, minimally processed foods—remains the most reliable strategy for long-term wellness.

41. Sweeteners and Food Cravings

The relationship between sugar alternatives and food cravings is complex, involving the brain’s reward pathways. When sweet taste is detected on the tongue, the brain anticipates a caloric reward, which may not materialize with zero-calorie sweeteners. Animal studies, and some human research, suggest that this disconnect can sometimes heighten cravings for sweet or high-calorie foods rather than satisfy them. A review from the NIH highlights that individuals who regularly consume artificial sweeteners may experience more persistent or intense cravings for sugary treats.

However, responses vary; for some, sugar substitutes help reduce overall sugar intake and make dietary changes more sustainable, while others find their cravings remain or intensify. Factors such as eating patterns, psychological cues, and individual brain chemistry all play significant roles.

To better manage cravings, pair sweeteners with balanced meals that include protein and fiber, which can help promote satiety. Monitor your personal response to different sweeteners, and try to reduce reliance on highly sweetened foods over time. Mindful eating habits and occasional indulgence in naturally sweet whole foods can help recalibrate your palate and support long-term success.

42. Sweeteners in Alcoholic Beverages

The trend toward “skinny” cocktails and low-calorie alcoholic beverages has fueled the widespread use of sugar alternatives in the bar and beverage industry. Many premixed drinks, hard seltzers, and cocktail mixers now feature artificial or plant-based sweeteners such as sucralose, stevia, or erythritol to deliver sweetness without the added calories of traditional sugary mixers. This appeals to calorie-conscious consumers who want to enjoy cocktails without derailing their health goals.

Compared to classic mixers like tonic water, juice, or regular soda—which can add significant sugar and calories—these alternative options can help reduce overall intake. However, it’s important to remember that alcohol itself provides calories, and consuming multiple low-sugar drinks can still add up quickly. Additionally, some people may find that sweetener-laden beverages affect their taste preferences or digestive comfort.

To track intake, read ingredient lists on mixers and ready-to-drink cocktails, and be aware of serving sizes. For more on alcohol and calorie content, see the CDC’s guide to alcohol and calories. As with all sweetened products, moderation and mindful consumption are key to balancing enjoyment and health.

43. Sweeteners and Athletic Performance

Sugar alternatives have become increasingly common in sports nutrition products such as low-calorie energy drinks, protein powders, and electrolyte mixes. These sweeteners help reduce the calorie and sugar load in products marketed to athletes and fitness enthusiasts. However, they serve a distinctly different role compared to glucose or other fast-acting carbohydrates, which provide immediate energy for muscles during high-intensity exercise or endurance events.

Sports products sweetened with artificial or plant-based alternatives may be suitable for hydration, flavor, and calorie control, but they do not offer the rapid fuel needed for optimal athletic performance during strenuous activity. For athletes engaged in intense or prolonged exercise, glucose or maltodextrin-based products are typically recommended to maintain blood sugar and energy levels.

When selecting sports drinks or supplements, consider your training goals and the timing of your carbohydrate needs. Be aware that some people may experience digestive discomfort from sugar alcohols or certain sweeteners during exercise. To learn more about the role of carbohydrates and sweeteners in sports nutrition, visit the NCAA’s resource on fueling the athlete. Choose products that align with your performance needs and personal tolerance.

44. Sweeteners in Medications

Sugar alternatives are widely used in pharmaceuticals, including chewable tablets, syrups, lozenges, and liquid medications, to improve taste and encourage adherence, especially among children and those sensitive to bitterness. Sweeteners such as sorbitol, aspartame, sucralose, and xylitol help mask unpleasant flavors without contributing to tooth decay or spiking blood sugar, making them a preferred choice for diabetic or pediatric formulations.

However, individuals with sensitivities or allergies may experience gastrointestinal symptoms or adverse reactions to certain sweeteners in medications. For example, sorbitol and mannitol, commonly used in cough syrups and laxatives, can cause bloating or diarrhea at higher doses. Alternatives may be available, such as unsweetened or naturally flavored formulations, which can be requested through your healthcare provider or pharmacist.

Label reading is critical: check both the “inactive ingredients” section and the fine print for terms like “sorbitol,” “aspartame,” “saccharin,” or “sugar alcohols.” If you have known sensitivities, alert your healthcare provider and pharmacist so they can help you select compatible products. For more on excipients in medications, visit the FDA’s Inactive Ingredients Database.

45. Travel and Hidden Sweeteners

Traveling abroad can introduce new challenges for those monitoring their intake of sugar alternatives. International foods and beverages may contain sweeteners that differ from those commonly used in your home country, such as cyclamate (banned in the U.S. but permitted in parts of Europe and Asia) or unique blends of sugar alcohols and high-intensity sweeteners. Labeling standards and regulatory requirements for disclosing sweetener content also vary widely from country to country.

Processed foods, drinks, and even medications purchased overseas may list unfamiliar additive codes (like E950 for acesulfame potassium or E954 for saccharin) instead of brand names or common U.S. terminology. It’s wise to familiarize yourself with the international names and codes for the sweeteners you are sensitive to before you travel.

When dining out or purchasing foods in markets, don’t hesitate to ask about ingredients, especially if you have allergies or intolerances. Learn key phrases in the local language or carry a translated ingredient card to help communicate your needs. For more on international food labeling, see the FDA’s Food Labeling Guide. Being proactive can help you avoid unwanted exposure and enjoy a safer culinary experience abroad.

46. Sweeteners and Aging

Older adults may experience unique effects from sugar alternatives compared to younger populations. With age, changes in kidney function, digestive efficiency, and overall metabolism can alter how the body processes artificial and plant-based sweeteners. Some older adults are also more likely to be managing chronic conditions—such as diabetes, hypertension, or kidney disease—that influence dietary choices and tolerance for certain additives.

Research suggests that, while most non-nutritive sweeteners remain safe within recommended intake levels, older adults can be more susceptible to gastrointestinal side effects, especially from sugar alcohols like sorbitol or mannitol. Additionally, medication regimens common in this age group can interact with sweeteners, potentially impacting absorption or elimination.

Safe intake for older adults involves starting with modest amounts, monitoring for digestive changes, and choosing sweeteners that are both well-tolerated and approved by regulatory agencies like the National Institute on Aging. It’s also a good idea to discuss dietary changes with a healthcare provider or dietitian, ensuring that sweetener use supports overall nutrition, hydration, and health goals in the context of aging.

47. Sweeteners and Diabetes Management

Sugar alternatives offer several advantages for people with diabetes, allowing them to enjoy sweet flavors without rapid spikes in blood glucose. Most non-nutritive sweeteners—such as aspartame, sucralose, stevia, and monk fruit extract—have minimal to no effect on blood sugar or insulin levels when used in moderation. Sugar alcohols like erythritol and xylitol also have a much lower glycemic impact than sucrose, though some, like maltitol, may still cause mild increases in blood glucose.

However, there are caveats to consider. Some studies suggest that frequent use of artificial sweeteners could potentially affect insulin sensitivity or appetite regulation over time, though findings are mixed and more research is needed. Additionally, consuming large amounts of sugar alcohols can cause digestive upset, which may complicate diabetes management for those with sensitive gastrointestinal systems.

The American Diabetes Association recommends using sweeteners as part of an overall balanced diet and monitoring individual blood sugar responses, especially when trying new products. Keeping a food diary and testing blood glucose can help determine which sweeteners are best tolerated and most effective for maintaining stable blood sugar levels.

48. The Placebo Effect: Perceived Sweetness

Our expectations play a powerful role in how we experience taste and satisfaction, especially when it comes to sweeteners. Studies have shown that when people believe they’re consuming sugar—even if it’s a zero-calorie substitute—they may report similar levels of satiety or enjoyment. This placebo effect is shaped by labeling, branding, and previous experiences with sweet flavors, all of which can influence how satisfied we feel after eating or drinking a sweetened product.

Research published in the NIH literature demonstrates that perceived sweetness can sometimes override the actual caloric or nutritional content, affecting appetite, cravings, and even insulin response. This highlights the importance of mindful eating—being fully present and attentive to the flavors, textures, and internal cues of hunger and fullness.

To harness the placebo effect for healthier choices, try savoring foods slowly, focusing on natural flavors, and setting positive expectations before eating. This approach can help maximize satisfaction with fewer added sweeteners and support more balanced eating habits over time.

49. Global Perspectives: Sweetener Use Worldwide

Sugar alternative consumption varies significantly across the globe, influenced by local regulations, market trends, and cultural preferences. In the United States and much of Europe, aspartame, sucralose, and stevia dominate the market, while Japan has a long history of using stevia and rare sugars like allulose in both foods and beverages. Some countries, such as China and Brazil, have embraced monk fruit and other plant-based sweeteners due to local agricultural resources and traditional practices.

Regulatory disparities are also common. For example, cyclamate is banned in the U.S. but widely used in parts of Asia and South America, while the European Union has more stringent labeling and additive approval processes than many other regions. These differences reflect both scientific assessments and cultural attitudes toward additives and food safety.

Cultural preferences shape not only which sweeteners are used, but also the types of products in which they appear—from diet sodas and candies to teas and savory sauces. For more on how countries regulate and use sweeteners, see the FAO’s global food additives overview. Understanding these perspectives can inform smarter choices at home and while traveling.

50. Practical Strategies for Safe Sweetener Use

Navigating the world of sugar alternatives is easiest with a balanced, mindful approach. Begin by evaluating your overall diet and identifying where sweeteners are most frequently consumed—such as in beverages, breakfast foods, or packaged snacks. Where possible, substitute highly sweetened products with naturally sweet alternatives like fruit, or reduce the total amount of added sweeteners by gradually tapering use. This adjustment allows your palate to adapt to less intense sweetness over time.

When you do choose to use sugar substitutes, rotate between different types to avoid overexposure to any single compound, and pay attention to ingredient lists to spot hidden blends. Monitor for any digestive or allergic symptoms, especially when trying new products or traveling abroad. Children, pregnant individuals, and those with chronic health conditions should consult healthcare professionals before making significant changes to sweetener intake.

Staying informed is key—resources like the Harvard T.H. Chan School of Public Health and American Diabetes Association provide evidence-based guidance. By combining moderation, variety, and awareness, you can enjoy sweetness safely and support your long-term health.

Conclusion

Awareness is your strongest tool when navigating the complex world of sugar alternatives. While these sweeteners can be helpful for reducing sugar intake, they are not risk-free—and individual responses vary. It is urgent to monitor your intake by reading ingredient labels, paying attention to symptoms, and staying informed about regulatory updates. Practical steps such as keeping a food diary, rotating sweetener types, and consulting with healthcare professionals can help tailor choices to your unique needs. Remember, moderation and mindfulness are key to safe and healthy consumption. For more personalized advice, seek guidance from a registered dietitian or trusted health organization, and continue to educate yourself using reputable resources as new research emerges.

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