DEAR DOCTOR K:

I want to cut down on sugar in my diet. Are artificial sweeteners the answer?

DEAR READER:

You're wise to reduce the amount of sugar you consume. Sugar, particularly added sugar in foods and beverages, leads to weight gain -- and excess weight increases your risk of heart disease, diabetes, high blood pressure and other health problems.

Sugar comes in many forms, including honey, brown rice syrup, corn syrup and molasses. You want to limit all of them.

Artificial sweeteners are sugar-free and typically lower in calories than sugar. All of the sweeteners on the market are considered safe. Earlier reports linking saccharin and aspartame to cancer have been disproved.

So artificial sweeteners might seem like a healthier option than sugar. But that idea is controversial.

Dr. Michelle Hauser, certified chef, nutrition educator and clinical fellow in medicine at Harvard Medical School, explains it this way: On the one hand, artificial sweeteners such as aspartame (NutraSweet, Equal), saccharin (Sweet'N Low) and sucralose (Splenda) can reduce the number of calories in your diet. Obviously, that makes it easier for you to achieve or maintain a healthy weight.

But artificial sweeteners are generally hundreds -- or even thousands -- of times sweeter than sugar. There is some evidence that they may make you crave sweets even more. I don't regard that evidence as solid, but it is plausible.

You can cut down on sugar without replacing it with artificial sweeteners. Here are some tips:

-- Don't eliminate all sugary foods at once. You'll only crave sweets more.
-- Keep sugary foods away. Don't tempt yourself by keeping candy, cookies and soda in your house. Stock your fruit bowl instead.
-- Retrain your taste buds. Eat a healthy diet made up of more satisfying foods -- whole grains, fruits, vegetables, healthy oils and lean protein.
-- Sweeten foods yourself. Start with unsweetened iced tea, plain yogurt and unflavored oatmeal. Add your own sweetener in the smallest amounts to be satisfying. It may surprise you to see how little sugar you need to add.
-- Watch for hidden sugars. Read food labels to find out how much sugar is in the foods you buy. Avoid products that list sugar as the first ingredient or that contain several different types of sugar.

Many of my patients try to achieve or maintain a healthy weight by avoiding fats but ignore the importance of sugar. They've heard that, ounce for ounce, fat has more calories than sugar. That's true, but there are healthy fats and unhealthy fats. It's important to make that distinction. The unhealthy fats to avoid are saturated and trans fats. You can check for them on the Nutrition Facts label of packaged foods. The fats you need for health are monounsaturated and polyunsaturated fats: Don't avoid those.

In contrast, generally avoiding foods rich in sugar is always a healthy choice.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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