Question:

In products that use Equal/Nutrasweet as their sweetener, there is a sugar alcohol content. What other sugar substitutes have sugar alcohol amounts?

Answer: No, that's not quite right. Equal/Nutrasweet is a protein-derived sugar, and has no sugar alcohol content. I'm guessing you got the mistaken impression from looking at the label of a "sugar-free" food like dietetic cake, cookies, or candy. Those products use sweetening alternatives to sugar like xylitol, sorbitol, maltitol, or lactitol. While they're derived from the alcohol molecule, they're 100 percent alcohol-free.

Such sugar-free sweeteners are as different from alcohol as a drinking glass is from a handful of sand. Alcohol-free sugars have been used safely for many years to sweeten calorie-controlled foods, especially commercially baked goods and candy. While you may think of sugars as natural sweeteners derived from sugar cane or fruits, there are ways through chemistry to create other sugars.

Sucrose, or white cane sugar, is the staple against which all other sweeteners are compared. Xylitol, the sweetest of the alcohol-derived sugars, has about the same sweetness as sucrose. The other alcohol-derived sugars range from 0.4 to 0.8 times as sweet as table sugar.

While table sugar (sucrose) and fruit sugar (fructose) contain 15 calories per teaspoon, the alcohol-derived sweeteners contain about half the calories. But don't be fooled: Cake and cookies that use these sweeteners still may be high in calories from the flour and oil.

The biggest "plus" of such sweeteners is that they allow diabetics to enjoy cookies or cake in moderation without causing huge spikes in the blood sugar. They also can help prevent cavities, since they're not converted to acids by bacteria in the mouth.

Chewing sugar-free (xylitol or sorbitol sweeteners) gums like Trident or Carefree may cut your risk of cavities by increasing saliva flow across your teeth.

People who eat too much food or candy sweetened with an alcohol-derived sweetener may experience gas, bloating, or a diarrhea laxative effect. That's because they're slowly or only partially absorbed from the digestive tract. The more you eat, the more gas, bloating, or diarrhea you'll get. Equal/Nutrasweet, saccharin, Splenda, and Truvia won't cause this problem.

Less drug advertising won't

lower costs, help patients

Q: Don't you think all those commercials that air continually about Viagra, Cialis, Lunesta, Boniva, and the like are getting to be too much? Couldn't they spend less on advertising and make the drugs cheaper?

A: Yes, I think they could spend far less on advertising. But it would be naive to believe less drug advertising would help the patient.

Drug companies used to market their products only to health-care providers. Beginning in the late 1990s, drug companies began saturating the media with direct-to-consumer (DTC) advertising especially on TV. The Congressional Budget Office states that DTC spending totaled $4.7 billion in 2008. While the industry's PR/lobbying group called "PhRMA" promoted the adoption of "self-enacted" guidelines on selling their products to health-care providers - including the elimination of inexpensive pens, sticky notepads, and mugs as "gifts" - it has quietly redistributed its massive sales budgets into DTC advertising. This has not reduced the cost of drugs to patients; rather, DTC has become a potent means of influencing the prescribing of a specific product. The intent of DTC advertising is to use the patient to "create a dialogue" that will lead to a new prescription. It's nothing illegal. But it is using the patient to influence a doctor's prescribing habits. Many pharmaceutical representatives tell me that if their companies did not adopt the 2009 PhRMA ethics code, the government was going to do it for them. That argument is ludicrous. One need only add up the millions of dollars given to Congress through lobbying to appreciate the enormous clout the drug industry enjoys in Washington. Who came out the winner on the Medicare prescription drug plan that Congress enacted? And don't get me started on the tobacco industry!

Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H.," Box 767787, Atlanta, Ga. 30076. Due to the large volume of mail received, personal replies are not possible.