Sweet trap: how sugar and sweeteners in children's vitamins are harmful to health

Parents want only the best for their children. They often care about the health of their offspring much more than about their own, choosing vitamins, syrups and supplements with great commitment to strengthen their immunity, support brain function and support the developing body. It is an expression of care and love. However, manufacturers and their carefully designed advertising and packaging often mislead parents.

Many, often unknowingly, give their children products that contain mainly... sugar and sweeteners, including artificial ones. These ingredients may interfere with the action of active substances, increase sugar addiction, lower the body's defenses and harm the child. Parental vigilance, the ability to read labels and conscious selection of quality products are the key to effective and safe support for the growing body. In this article, we'll talk about how sugar and other sweeteners in dietary supplements (and other products) can be harmful to your child.

Sugar in children's supplements – what do you need to know?

Nowadays, sugar and sweeteners are present in most ready-to-eat products, including children's ones. Even if parents try hard to eat healthily at home, they cannot control everything their children eat outside the home. And sugar or its substitutes are really everywhere!

Children move a lot, they are constantly growing, their brains are developing. Therefore, they need a lot of nutrients. And they often instinctively reach for sweets to meet the body's energy needs. Why? For various reasons, including bad eating habits among friends, feeding children sweets by grandparents, the tradition of giving out "sweet prizes and gifts" in kindergartens and schools, advertising, etc. As a result, the child's immunity weakens, concentration decreases, and more and more health problems…

In response, parents begin to look for support for their child's health in the form of dietary supplements. However, many of them do not realize that popular children's products are themselves a hidden source of sugar. In fact, they only add fuel to the fire. Excess sugar has a negative impact on the growing body on many levels.

Why do manufacturers add sugar and sweeteners to children's dietary supplements?

There are several strategic reasons for this:

• Taste and attractiveness . Sugar gives supplements a sweet taste that is attractive to children. This makes the products more attractive to children. For many parents, a product that is tasty for the child and does not need convincing to eat seems to be a better choice.

• Masking the taste of active ingredients. Some active ingredients in dietary supplements may have an unpleasant taste or smell. Adding sugar or sweeteners helps mask these flavors, making them easier for children to consume.

• Extension of shelf life . Sugar can help preserve the shelf life of supplements, especially in the form of gummies or liquids. Acts as a preservative.

• Maintaining behavioral patterns (and addictions). If children get used to supplements (or other products) containing sugar from an early age, they may develop a habit of reaching for sweet products, which may influence their future dietary decisions.

Please remember that excess sugar in dietary supplements for children may lead to negative health effects, such as obesity, tooth decay and problems with regulating blood sugar levels. Let's take a closer look at them.

Sugar and obesity in children .

Obesity is a huge problem for Polish children. Recent WHO data indicate that 32% of Polish children aged 7-9 are overweight or obese.  ¹ . In this respect, Poland ranks 8th among European countries. Among teenagers, the results are even worse. Nearly every second person has excess weight (approx. 43%).

Sugar may contribute to childhood obesity through several mechanisms:

• High glycemic index. Products containing a lot of sugar, especially those with added simple sugars, can cause a sharp increase in blood sugar levels. This leads to a quick feeling of hunger when sugar levels drop, which may prompt children to eat more sweet foods.

• No feeling of satiety. Foods high in sugar often provide little fiber and other ingredients that keep you feeling full for longer. Children who eat a lot of sugar may feel hungry faster and reach for more snacks.

• Excess calories. Sugar provides calories but little nutritional value.

• Effects on hormones that regulate appetite. Some research suggests that sugar may affect the hormones leptin and ghrelin, which may result in increased appetite and higher caloric intake.  ^2.3 .

• Fat processing. Excess sugar can lead to excess calories in the body being converted into fat, which increases body weight.

Being overweight is not just an aesthetic problem. Obesity in children increases the risk of health problems such as:  ⁴ :

• hypertension,
• insulin resistance and type 2 diabetes,
• heart diseases,
• mental disorders,
• disorders of the musculoskeletal system,
• fat metabolism disorders,
• non-alcoholic fatty liver disease,
• bronchial asthma,
• cholecystolithiasis,
• hormonal disorders.

You can read more about the factors that contribute to obesity in children and tips on how to prevent it in a separate article .

Sugar and addiction in children.

Sugar can lead to addiction in children by affecting their brains and behavior. This mechanism is most likely based on the fact that when a child eats products containing sugar, it activates the areas of the brain responsible for feeling satisfaction and pleasure. This feeling is strongly rewarded, which makes the child want to experience it again. However, over time, larger doses are needed to feel pleasure  ⁵ .

Additionally, sugar can affect the levels of hormones that regulate appetite, such as leptin and ghrelin. Consuming large amounts of sugar may disrupt these mechanisms, resulting in an increase in appetite for sweet snacks. Children who regularly consume sugar may develop the habit of reaching for sweet foods even if they do not feel physically hungry.

Sugar and behavioral disorders in children.

Sugar consumption can lead to sudden spikes in blood glucose levels. This problem does not only affect diabetics. "Healthy" people may also experience sugar levels that are too high or drop too low, e.g. under the influence of diet  ⁶ .

When glucose spikes, the child may become hyperactive and hyperactive. When glucose drops, you may experience what's called emotional low. May be irritable and moody, as well as tired.

Sudden glucose spikes may cause memory problems and learning problems  ⁷ , sleep disorders  ⁸ and even depression  ⁹ .

Sugar can also affect neurotransmitter levels in the brain. Changes in the levels of these chemicals can affect how you feel and behave  ¹⁰ , for example by making us less satisfied with life or more anxious.

All these mechanisms may contribute to the comprehensive impact of sugar on children's behavior. Therefore, it is important to control their sugar intake and promote healthy eating habits to support their mental and emotional health.

Sugar and tooth decay in children.

This is probably the most well-known and most scientifically proven side effect of eating products with sugar. The process of tooth decay in this case results from the interaction between sugar and bacteria in the oral cavity.

When children eat sweets (including sweetened dietary supplements), sugar enters the mouth. The bacteria present there convert sugar into organic acids, especially lactic acid. These acids attack tooth enamel, leading to the loss of minerals from the tooth surface. If this process takes longer and is not stopped by the child's body (e.g. due to deficiencies of minerals and other nutrients in the child's diet), tooth decay occurs.

Tooth cavities and caries are also caused by the excessive proliferation of harmful bacteria caused by frequent consumption of sugar and refined carbohydrates.  ¹¹ .

Sugar and immunity.

The immune system protects us against harmful microbes. When microbes overcome the first defense barriers (such as the skin, mucous membranes or stomach acid) and reach deeper into the body, white blood cells come into play to absorb the invader. Research from the 1970s conducted at Loma Linda University showed that after consuming sugar, the ability of white blood cells to fight bacteria decreased dramatically and this effect lasted up to 5 hours  ¹² .

Other animal studies have shown that sugar may increase the risk of allergic reactions in the lungs  ¹³ , and also promote the development of inflammation and weaken the immune system  ¹⁴ .

The negative effect of sugar on immunity occurs mainly after consuming large amounts of refined sugar and simple carbohydrates. As a result, there is a sharp increase in glucose levels in the blood. And although glucose is necessary for the proper functioning of the immune system, its increased level leads to completely opposite effects: the body itself begins to produce inflammatory molecules.  ¹⁵ .

The body's immunity also depends on the state of the intestinal microbiota. Its diversity includes, among others: influenced by our diet and the amount of sugar and highly processed products we consume. Scientific studies have shown that high sugar intake reduces the abundance of Bacteroidetes - a type of microbes that strengthen the intestinal wall and mucosal immunity.  ¹⁶ . Sugar can also feed "harmful microbes" that multiply and crowd out the "beneficial" ones. An imbalanced microbiome leads to a weakening of the body's defense forces.

If you are interested in the impact of sugar on health, we also recommend taking a look at this article and the text version and recordings of meetings conducted by Magda Kumorek based on the book "Słodziutki. Biography of Sugar.

Are sweeteners better for children than sugar?

Therefore, is replacing sugar with another sweetener a good solution? Will it help avoid all these potential side effects? The store offer includes sweeteners without calories, without fructose (or based on fructose only), with various consistencies, tastes and smells. Manufacturers of dietary supplements also offer a lot of alternatives to classic sugar in their syrups, lollipops and vitamins. Let's check.

What sugar substitutes can be found in dietary supplements for children?

In dietary supplements you can find various artificial sugar substitutes that are used as sweeteners. Here are some examples of popular artificial sweeteners used in dietary supplements:

• Aspartame. Aspartame is one of the most popular artificial sweeteners. It is much sweeter than sugar and virtually calorie-free. It is used in many supplements, including children's vitamins and minerals. However, the International Agency for Research on Cancer (IARC) has classified aspartame as probably carcinogenic to humans. Did this cause aspartame products to be withdrawn from sale? NO. The WHO has not made such recommendations or advised consumers against consuming aspartame  ¹⁷ , because the evidence on which it was named a possible carcinogen is “limited” and doses are important (the more aspartame, the greater the danger). But is it worth giving your children something that can potentially cause cancer? Every parent should consider this question.

• Saccharin. This is another popular artificial sweetener that is 350 times sweeter than sugar and calorie-free. Many studies have confirmed that it can cause cancer in animals  ^18,19 , although it is officially considered safe for humans.

• Sodium cyclamate (E952). It is a sweetener with an intense flavor, 30-50 times sweeter than sugar. It is relatively stable at high temperatures, which means it can be used in various products, including dietary supplements, e.g. in the form of jellies. Sodium cyclamate is banned in the United States, Sweden, France, the Netherlands, the United Kingdom and Norway due to research suggesting it may be carcinogenic. In turn, experts from the European Food Safety Authority (EFSA) claim that sodium cyclamate is safe for human health. Therefore it is allowed in the European Union  ^{20, 21} .

• Acesulfame potassium (or acesulfame K). Acesulfame potassium is a calorie-free sweetener with an intense sweet taste. There is no solid research on its long-term effects on human health. Some studies suggest it may cause cancer. Acesulfame K is not digested by the human body, it is excreted unchanged. However, its effects while passing through the digestive system remain an object of research for now.

• Sucralose. It is a very popular and highly stable, calorie-free sweetener. Studies show it can cause cancer  ²² . Some human studies suggest that it may impair glucose tolerance in the body and cause intestinal dysbiosis  ²³ .

Compared to artificial sweeteners, sweeteners of more natural origin used by dietary supplement manufacturers (but not only them) seem to many parents to be a better choice. Is this really the case? Let's look at the most commonly used substances:

• Glucose-fructose syrup. Probably every parent has heard about its negative impact on children's health caused by its high fructose content. In excess, fructose not only impairs glucose tolerance in the body, but also stimulates appetite, disturbs satiety regulation, causes excess weight and can influence behavior by stimulating neurotransmitters in the brain (e.g. dopamine).  ²⁴ .

• Glucose syrup. Due to the bad reputation of syrup containing fructose, many manufacturers replaced it with glucose syrup. However, this option seems to be even more dangerous than sugar. Sugar has a glycemic index of 61. This is an indicator that shows how much of a spike in blood glucose can be expected after consuming it. Glucose syrup has a glycemic index of 100! This means a huge spike in blood glucose after consuming it, especially in the form of a dietary supplement that is devoid of fiber or other substances that could slow down the release of glucose.

• Stevia. It is a natural sweetener obtained from the leaves of a plant called Stevia rebaudiana. It is much sweeter than sugar, but is low in calories. It has a rather specific taste, which is why manufacturers are often forced to mask it with various additives to encourage children to eat products with stevia. The European Food Safety Authority (EFSA) declared in 2010 that stevia is safe  ²⁵ . However, for some people, consuming large amounts of stevia may cause digestive problems such as bloating, diarrhea, or stomach discomfort.

• Honey. It is rich in antioxidants and has soothing antibacterial properties. At the same time, it is worth remembering that it contains 30 to 40% fructose and, depending on the type, its glycemic index may range from 30 to 70. Honey is quite rarely used in dietary supplements. Due to its consistency, it may be less practical, which is why manufacturers most often combine it with other sweeteners.

• Agave syrup. It is a natural sweetener obtained from the agave plant. It is less sweet than sugar. The glycemic index of agave syrup is relatively low and is usually around 15-30. Agave syrup raises blood sugar levels slower than some other sweeteners, but it contains a lot of fructose (we talked about the negative effects of its consumption when talking about fructose syrup). Agave syrup is also often combined by dietary supplement manufacturers with other sweeteners.

• Polyols (erythritol, xylitol, sorbitol, maltitol, etc.) . These sweeteners have gained popularity due to their very low calorie content and low glycemic index. Our body does not digest them, they pass intact to the large intestine, where they can cause unpleasant symptoms: gas, flatulence, diarrhea. In February 2023, the world learned that one of these sweeteners - erythritol - showed in research that it may contribute to heart attack and stroke.  ²⁶ . The study itself and its conclusions have been criticized because cardiovascular disease typically develops over decades, and the impact of erythritol consumption was assessed over a 3-year period. Therefore, it is not known exactly whether the sweetener was the main culprit  ²⁷ . However, the absolute safety of this type of sweetener has been questioned.

To sum up, each of the sugar alternatives has its own underwater stones: some are known, while others will only be discovered after some time. And while some sweeteners are often considered healthier sugar substitutes, evidence suggests they are not a better choice, especially for children.

A sweetener is always a sweetener. And replacing one with the other may solve one issue but cause another problem instead.

Here are some things to keep in mind:

• Sweeteners shape children's taste preferences. People who consume a lot of sweeteners may develop a higher tolerance to sweetness, which may result in a greater craving for sweet foods and drinks, as well as an addiction to the sweet taste.

• Sweeteners stimulate the appetite for unhealthy foods. Sweeteners make children more likely to reach for sweets and other highly processed and unhealthy products that stimulate the reward system in the brain in the same way as, for example, sugar.

• Sweeteners affect the intestinal microbiota . Sweeteners can disturb the balance of intestinal microorganisms, resulting in long-term health consequences. A diverse gut microbiota is important for immune function, digestion and mental health.

• There are no long-term studies on the effects of sweeteners on human health. Some of the studies carried out today indicate that sweeteners may contribute to the development of cancer, metabolic syndrome, diabetes, behavioral disorders, heart diseases, etc. What will future discoveries of scientists bring? It is unknown.

How much sugar can a child eat?

WHO recommends that children aged 4-6 years consume no more than 35 grams of added sugar per day, and those aged 7 to 10 years consume no more than 42 grams of sugar. For teenagers and adults, the recommended daily limit is a maximum of 50 grams of sugar (or 10% of daily caloric intake). Even better, according to WHO, if the consumption of added sugar in all people is less than half the amounts mentioned above. So in the case of children it is a maximum of 20 grams of sugar (approx. 4 teaspoons)  ²⁸ . For comparison, a glass of lemonade can contain up to 18 grams of sugar.

What does it look like in practice? According to the Central Statistical Office, Polish children eat up to 19 teaspoons of sugar a day!  ²⁹ This applies not only to loose sugar itself, but also to other sweeteners: fructose, glucose, lactose, galactose, maltose, dextrose. It is also available in the form of syrups: fructose, glucose-fructose, glucose, maple, cane, date, rice, malt, corn, agave, honey, caramel, molasses.

Does this mean that you have to completely cut your child off sugar, its substitutes and all sweets? No, but moderation is key. In addition, it is also worth choosing naturally sweet products, e.g. fruit, and using tricks that will help reduce the negative impact of the sugar they contain on blood glucose levels. Namely, eat sweet fruit, sweets or drinks after:

• vegetables or other products rich in dietary fiber,
• meals rich in protein and fat.

In other words, the concept of dessert, i.e. eating sweets after a savory main course, has its justification in science, because this order helps reduce blood sugar spikes. And if, after eating sweets, you go for at least a 15-minute walk with your child or start cleaning the apartment together, this will further reduce the rapid increase in glucose levels.

Bibliography:

1. Obesity in children - they will not grow out of it on their own, Website of the Ministry of Health and the National Health Fund, March 21, 2023, patient.gov.pl.
2. Bharath K Mani, Kripa Shankar, Jeffrey M Zigman, Ghrelin's Relationship to Blood Glucose, Endocrinology, Volume 160, Issue 5, May 2019, Pages 1247–1261, https://doi.org/10.1210/en.2019-00074.
3. Vasselli JR. The role of dietary components in leptin resistance. Adv Nutr. 2012 Sep 1;3(5):736-8. doi: 10.3945/an.112.002659. PMID: 22983859; PMCID: PMC3648762.
4.  Obesity in children…, op.cit.
5. Héloïse Hamelin, Ghislaine Poizat, Cédrick Florian, Miron Bartosz Kursa, Elsa Pittaras, Jacques Callebert, Claire Rampon, Mohammed Taouis, Adam Hamed, Sylvie Granon, Prolonged Consumption of Sweetened Beverages Lastingly Deteriorate Cognitive Functions and Reward Processing in Mice, Cerebral Cortex, Volume 32, Issue 7, 1 April 2022, Pages 1365–1378.
6. Schwartz NS, Clutter WE, Shah SD, Cryer PE. Glycemic thresholds for activation of glucose counterregulatory systems are higher than the threshold for symptoms. J Clin Invest. 1987;79(3):777–781. doi:10.1172/JCI112884.
7. Messier C, Desrochers A & Gagnon M (1999) Effect of glucose, glucose regulation, and word imagery value on human memory. Behavioral Neuroscience 113, 431–438.
8. Mehrdad M, Azarian M, Sharafkhaneh A, Alavi A, Zare R, Hassanzadeh Rad A, Dalili S. Association Between Poor Sleep Quality and Glycemic Control in Adult Patients with Diabetes Referred to Endocrinology Clinic of Guilan: A Cross-sectional Study. Int J Endocrinol Metab. 2021 Dec 5;20(1):e118077. doi: 10.5812/ijem.118077. PMID: 35432555; PMCID: PMC8994826.
9. Knüppel A, Shipley MJ, Llewellyn CH, Brunner EJ. Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Sci Rep. 2017;7(1):6287. Published 2017 Jul 27. doi:10.1038/s41598-017-05649-7.
10. Angela Jacques, Nicholas Chaaya, Kate Beecher, Syed Aoun Ali, Arnauld Belmer, Selena Bartlett,The impact of sugar consumption on stress driven, emotional and addictive behaviors, Neuroscience & Biobehavioral Reviews, Volume 103, 2019, Pages 178-199, ISSN 0149 -7634.
11. Sheiham A, James WP. Diet and Dental Caries: The Pivotal Role of Free Sugars Reemphasized. J Dent Res. 2015 Oct;94(10):1341-7.
12. Sanchez, A., Reeser, J. L., Lau, H. S., Yahiku, P. Y., Willard, R. E., McMillan, P. J., … & Register, U. D. (1973). Role of sugars in human neutrophilic phagocytosis. The American journal of clinical nutrition, 26(11), 1180-1184.
13. Kierstein, S., Krytska, K., Kierstein, G., Hortobágyi, L., Zhu, X., & Haczku, A. (2008). Sugar consumption increases susceptibility to allergic airway inflammation and activates the innate immune system in the lung. Journal of Allergy and Clinical Immunology, 121(2), S196.
14. Yu, S., Zhang, G., & Jin, L. H. (2018). A high-sugar diet affects cellular and humoral immune responses in Drosophila. Experimental cell research, 368(2), 215-224.
15. Shomali N, Mahmoudi J, Mahmoodpoor ​​A, Zamiri RE, Akbari M, Xu H, Shotorbani SS. Harmful effects of high amounts of glucose on the immune system: An updated review. Biotechnol Appl Biochem. 2021 Apr;68(2):404-410. doi: 10.1002/bab.1938. Epub 2020 Jun 8. PMID: 32395846.
16. Satokari R. High Intake of Sugar and the Balance between Pro- and Anti-Inflammatory Gut Bacteria. Nutrients. 2020 May 8;12(5):1348. doi: 10.3390/nu12051348. PMID: 32397233; PMCID: PMC7284805.
17. Aspartame hazard and risk assessment results released, July 14, 2023, who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released.
18. Reuber M.D. Carcinogenicity of saccharin. Environ Health Perspective. 1978 Aug;25:173-200. doi: 10.1289/ehp.7825173. PMID: 363408; PMCID: PMC1637197.
19. Saccharin, Center for Science in the Public Interest, February 3, 2022, https://www.cspinet.org/article/saccharin.
20. Cyclamate in food poses a danger to our health, Question for written answer E-001008/2020 to the Commission, Rule 138, Susanna Ceccardi (ID), Gianna Gancia (ID), Anna Bonfrisco (ID), Elena Lizzi (ID), 19/02/2020, https://www.europarl.europa.eu/.
21. CANCER. Carcinogens in the Food Chain, MJ Prival, in Encyclopedia of Food Sciences and Nutrition (Second Edition), 2003.
22. MS, MP, ET, LF, FM, ML, LB, MM, F B. Sucralose administered in feed, beginning prenatally through lifespan, induces hematopoietic neoplasias in male Swiss mice. Int J Occup Environ Health. 2016 Jan;22(1):7-17. doi: 10.1080/10773525.2015.1106075. Epub 2016 Jan 29. PMID: 27078173; PMCID: PMC4894270.
23. Méndez-García LA, Bueno-Hernández N, Cid-Soto MA, De León KL, Mendoza-Martínez VM, Espinosa-Flores AJ, Carrero-Aguirre M, Esquivel-Velázquez M, León-Hernández M, Viurcos-Sanabria R, Ruíz -Barranco A, Cota-Arce JM, Álvarez-Lee A, De León-Nava MA, Meléndez G, Escobedo G. Ten-Week Sucralose Consumption Induces Gut Dysbiosis and Altered Glucose and Insulin Levels in Healthy Young Adults. Microorganisms. 2022 Feb 14;10(2):434. doi: 10.3390/microorganisms10020434. PMID: 35208888; PMCID: PMC8880058.
24. Meyers AM, Mourra D, Beeler JA. High fructose corn syrup induces metabolic dysregulation and altered dopamine signaling in the absence of obesity. PLoS One. 2017 Dec 29;12(12):e0190206. doi: 10.1371/journal.pone.0190206. PMID: 29287121; PMCID: PMC5747444.
25. Scientific Opinion on the safety of steviol glycosides for the proposed uses as a food additive. EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS). April 14, 2010, https://efsa.onlinelibrary.wiley.com/doi/10.2903/j.efsa.2010.1537
26. Witkowski, M., Nemet, I., Alamri, H. et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med 29, 710–718 (2023). https://doi.org/10.1038/s41591-023-02223-9.
27. Which low-calorie sweeteners are safe—and which aren't? Center for Science in the Public Interest, March 2023, cspinet.org.
28. Guideline: sugars intake for adults and children, Guidelines Review Committee, Nutrition and Food Safety, SEARO Regional Office for the South East Asia (RGO), WHO South-East Asia, who.int.
29. Children in Poland eat 19 teaspoons of sugar a day! District Sanitary and Epidemiological Station in Staszów, gov.pl, accessed September 19, 2023.