DEAR DR. ROACH: I have questions regarding sugar substitutes. I have come to the overwhelming conclusion that sugar is a poison to the human body. However, I have never read any information regarding the safety of sugar substitutes. My questions are: Are they harmless to our bodies; are some safer than others; and do any benefits exist in using some over others? — J.R.K.B.

ANSWER: While I think the term “poison” is too strong, I agree that excess sugar is unhealthy and contributes to both Type 2 diabetes and to obesity. Natural sugars, such as from whole fruits, appear to be treated differently in the body from added sugars, such as those in soft drinks, sports drinks and energy drinks.

Your question is about sugar substitutes, and there are many. There’s no way to comprehensively cover them all, but let me talk about the different types.

Artificial sweeteners include aspartame (Equal, NutraSweet), saccharin (Sweet’N Low), sucralose (Splenda) and others. Most experts agree that these are safe in reasonable doses, but some people may have unpleasant reactions to any of them. Aspartame and saccharin have been linked to cancer in laboratory animals, but never in humans.

The natural sweetener Stevia also is generally well-tolerated and safe.

Sugar alcohols, such as sorbitol, xylitol and mannitol, raise blood sugars somewhat and often cause cramping, gas and diarrhea if taken in large quantities or by people sensitive to their effects.

So, while all are generally safe, any can cause side effects. I don’t recommend any of them above the others, though I have seen reactions to sugar alcohols most frequently.

DEAR DR. ROACH: Why are so many people reluctant to wear a hearing aid? It seems as though there is a stigma associated with it when there isn’t a stigma associated with wearing glasses, and both are common as we age. — M.A.

ANSWER: I also am concerned that many older people with hearing loss refuse a hearing aid (or even to be evaluated for one). This is an important issue, since a hearing aid can improve quality of life as well as safety, not to mention the hearing of those around a person who is hard of hearing if he or she listens to music or the television at loud volumes.

I suspect that glasses, often worn by younger people, aren’t associated with aging as much as hearing loss is, which is far more common in the elderly. We seem to be afraid of aging, or at least of appearing to age. I regret this, since it focuses on what can be lost with aging, and not what is gained.

DEAR DR. ROACH: I keep getting little black splinters under my fingernails that disappear on their own. I also have little black splinters under both of my big toenails that have not disappeared and have been there for a while. What is this? — D.F.

ANSWER: These sounds like splinter hemorrhages. The most common cause of these is trauma to the nail bed, but some dermatologic conditions can cause this as well, such as psoriasis and lichen planus. However, the most worrisome (but unusual) condition is infective endocarditis, an infection of the heart valves. Any fever or fatigue should be promptly evaluated by an internist.

TO READERS: Many headache questions reach me on a regular basis. For a general explanation of headaches and their treatment, consider the booklet on that topic. It presents a comprehensive view. To order a copy, write: Dr. Roach — No. 901, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four days for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

(c) 2014 North America Syndicate Inc.

All Rights Reserved