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April 2006

Sugar Substitutes
EALTHHINTS
Texas Cooperative Extension The Texas A&M University System
Editors: Janet M. Pollard, MPH; Mary K. Bielamowicz, PhD, RD, LD, CFCS; Carol A. Rice, PhD, RN

What are Sugar Substitutes?


Vol.10 No. 3

Are they safe? Substances for low-calorie sweetness

S
ugar substitutes, also called artificial sweet-

T
he rise in obesity in America contributes to
disease, disability, and the loss of quality of eners, are substances that are used instead
life. As we strive to promote health and of sucrose (table sugar) to sweeten foods
wellness, there are ever-increasing questions and beverages.1 Sugar substitutes are many times
about how to lose weight – the best type of sweeter than table sugar, and therefore, smaller
exercise and the best diet. amounts are needed to create the same level of
sweetness.1
One question that has come to the forefront is
about sugar substitutes. Can they really help with “According to a survey conducted in 2004 by the
weight loss, and are they safe? Calorie Control Council, a trade organization, 180
million adult Americans use these products.
This issue of HealthHints will look at sugar Consumers often select these foods because they
substitutes and sugar alcohols (polyols) – how want the taste of sweetness without added calo-
they sweeten our foods, their benefits and draw- ries or because they want to reduce the risk of
backs, and, of course, their safety. tooth decay. The dietary options that such prod-
ucts provide may be especially helpful in the
Note: The information in this issue of HealthHints is management of obesity and diabetes mellitus.”2
directed to the general population and does not di-
rectly address the needs of people with diabetes. For
information on using sugar substitutes in a diabetic Did you know?
meal plan, please see Special Food Needs: A Reference Guide Table sugar, also known as sucrose, is a combi-
for County Agents at http://fcsagents.tamu.edu/ nation of glucose and fructose (i.e., a disaccha-
food_and_nutrition/pdf/SFN2002.pdf. ride – composed of 2 simple sugars) derived
from sugar cane and sugar beets that have
INSIDE undergone a rigorous refining process to form
H E A L T H H I N T S ... the crystalline white granules we use today in
Safety & regulation .............................................. 2 cooking and at the table.3 All sugars are carbo-
Sweetness & stability ........................................... 3 hydrates. Once these carbohydrates are broken
Sugar alcohols (polyols) ...................................... 5 down in the body, the sugars are absorbed in
Weight control ...................................................... 6 the bloodstream and go to the liver where they
Sugars are “carbs” ................................................ 7 can be stored as glycogen or used immediately
Making healthy choices ...................................... 7 as glucose for energy by the body and brain.3
References .............................................................. 8
1
The only U.S.-approved sugar substitute that
Safety & Regulation requires a label for safety is aspartame. Products
that contain aspartame must be labeled with a
statement indicating that they contain the amino
How do I know if sugar substitutes are safe? acid phenylalanine. This statement is to protect
individuals with a rare, hereditary, metabolic
condition called phenylketonuria, or PKU

S
ugar substitutes are regulated by the U.S. (pronounced fennel-keet-a-NOOR-ia). Individu-
Food and Drug Administration (FDA). The als with this condition cannot metabolize pheny-
FDA is an agency of the Department of lalanine and must completely restrict this amino
Health and Human Services, which regulates acid from their diets. “Unless the disorder is
food, drugs, medical devices, cosmetics, detected in early infancy and treated with a
biologics, and radiation-emitting products. A law phenylalanine-restricted diet, it results in mental
established in 1958 requires the FDA to approve retardation and other severe, permanent effects.
food additives, including sugar substitutes, Thus, apparently normal individuals cannot
before they can be available for sale in the have the disease without knowing it.”2 New-
United States; however, this legislation does not borns have been screened for phenylketo-
apply to products that are “generally recog- nuria in the U.S. and other industrial-
nized as safe (GRAS).” Such products do ized countries for the past 50 years.2
not require FDA approval before being Therefore, there is no need for
marketed. 1 undue concern in regards to the
safety labeling on aspartame-
There are currently five low-calorie containing products. If you or a
(nonnutritive) sweeteners approved loved one has phenylketonuria,
for use in the U.S. Extensive scientific you would know it.
research has demonstrated the safety of
these five sugar substitutes: Claims of adverse behavioral,
neurological, carcinogenic,
• acesulfame-K (common brand names: allergic, and other adverse effects
SweetOne, Sunette, Sweet & Safe, have been made against sugar
Ace-K), substitutes, particularly aspar-
• aspartame (common brand names: tame. These claims are often
NutraSweet, Equal, others), highly circulated through e-mail
• neotame (common brand names: not and Internet sites, but they have
yet available), not been supported by scientific
• saccharin (common brand names: Sweet ’N research. In fact, numerous studies have been
Low, Sweet ’N Low Brown, Sugar Twin, conducted that have found aspartame to be safe
Necta Sweet, Hermesatas, others), and and these claims to be unfounded. “A controver-
• sucralose (common brand name: Splenda). sial animal cancer study of aspartame conducted
using unusual methodology is currently being
There are three other low-calorie sweeteners reviewed by regulatory authorities in several
used in other countries but not approved as food countries.”2 To date, this is the only outstanding
ingredients in the U.S.: controversy. No other issues about the safety of
acesulfamate, aspartame, neotame, saccharin, or
• alitame, sucralose remain unresolved at the present
• cyclamate, and time.2
• steviol glycosides.
Eating sweeteners is safe as long as you do not
eat too much of them. The Acceptable Daily
Steviol glycosides may be sold as a dietary
Intake (ADI) is the amount of a food additive
supplement in the U.S., but marketing this
that can be safely consumed on a daily basis over
product as a food ingredient in the U.S. is
a person’s lifetime without any adverse effects.4
illegal.2 Both alitame and cyclamate are currently
The ADI is usually set at 1/100 of the maximum
under study by the FDA for potential safety
level at which no adverse effect was observed in
approval in the U.S.
2
animal experiments. These levels are set to The acceptable daily intake for acesulfame-K is
ensure that actual daily intakes do not exceed 15 mg/kg/d.2
the ADI. Recent worldwide evaluation indicates
that intakes of low-calorie sweeteners are below Aspartame
the ADIs for these substances.2 We’ll take a look Aspartame (Equal or NutraSweet) is about 200
at these numbers in the next section. times sweeter than table sugar. Unlike other
artificial sweeteners, aspartame is made from
protein; it leaves no bitter chemical or metallic
aftertaste. Although each gram of aspartame
Sweetness & Stability contains about 4 calories, the amount needed to
sweeten foods is so tiny that the amount of
calories you get is of no consequence.5, 6

Factors contributing to food usages Aspartame, however, is not heat stable, so you
cannot use it in cooking. Additionally, if you

H
ow sweet each sugar substitute is, as store drinks that contain aspartame in heat, they
well as whether or not it stays stable will eventually lose their sweetness. Note: When
when heated, both contribute to what heat causes aspartame to breakdown, the only
types of foods and/or beverages the sweetener result is that the beverage loses its sweetness.
can be used in and whether or not it can be used
in cooking. Sometimes combinations of sweet- Aspartame-containing products that might be
eners will be used to provide just the right used in recipes carry a label stating that the
amount of sweetness, bulk/texture, or both. In product should not be used in cooking or bak-
most cases, the goal is to keep calories low while ing. This is not a health warning; its purpose is
giving the taste closest to sucrose (table sugar) or simply to inform people that aspartame does not
to the expectation of the consumer. maintain its sweetness in heated
conditions.2
The following information shows how
sweet each sugar substitute is com- As noted earlier, some people say
pared to sucrose, how stable it is in that aspartame causes a wide
heat, and the “acceptable daily variety of symptoms. Research
intake” – the estimated amount has been unable to prove this
(usually expressed in milligrams per sensitivity or describe how
kilogram of body weight per day - mg/ these symptoms could be
kg/d) that a person can safely consume triggered in the body.
on an average day over a lifetime with-
out risk. The one true concern about
aspartame is for people with PKU, a
Acesulfame-K genetic disorder. People with this disorder
Acesulfame-K (SweetOne, Sunette, Sweet & cannot metabolize the amino acid phenylala-
Safe, Ace-K) is about 200 times sweeter than nine, which is in aspartame. To help these
table sugar and does not leave an aftertaste. The people avoid it, the FDA requires that warnings
“K” is the chemical symbol for potassium. be included on products that contain aspar-
tame.6 For more information on the safety of
Acesulfame-K (pronounced a-seh-SUHL-faym aspartame (and other sweeteners), see Sugar
K) is not used by the body and remains un- Substitutes: Americans Opt for Sweetness at:
changed in body waste. Thus, it is a noncaloric http://www.fda.gov/fdac/features/1999/
sweetener, meaning it contains zero calories per 699_sugar.html.
gram. It can also be used in diabetes meal plans,
and it does not contribute to tooth decay. The acceptable daily intake for aspartame is 50
Heating acesulfame-K does not change its sweet- mg/kg/d. 2
ening power; rather, it remains stable under
heat. Manufacturers use acesulfame-K in packet
sweeteners, chewing gum, pudding, gelatins and
other foods.5
3
Neotame Saccharin remains stable in heat. It is approved
The FDA has approved the NutraSweet in the U.S. for use as a tabletop sweetener and
Company to start marketing neotame as a sweetener for beverages. It can also be used in
nonnutritive, general-purpose sweetener in medicines, such as cough syrups. Its stability for
foods. This product is the most recent addition some food purposes, however, is limited because
to the nonnutritive (noncaloric) sweeteners its sweet taste is accompanied by bitterness,
approved in the U.S. in 2002. which some people detect more than others.2

Neotame is a soluble, crystalline white powder Saccharin is the oldest of the approved
that is about 8,000 times sweeter than table nonnutritive sweeteners. Like aspartame, saccha-
sugar. Neotame is also heat-stable, unlike rin has been surrounded with controversy over
NutraSweet’s other sweetener, aspartame. its safety since its discovery in 1878.2 Questions
have lingered about whether saccharin may
Neotame can be used as a tabletop sweetener cause cancer in humans since studies in rats
and in baked goods, nonalcoholic beverages verify increases in bladder cancer. Controversy
such as soft drinks, chewing gum, confections over high dosages of saccharin given to rats in
and frostings, frozen desserts, gelatins and these studies, as well as varying physiologic
puddings, jams and jellies, processed fruits and differences between animals (rats) and humans
fruit juices, toppings and syrups. In fact, it is continue, even today.
approved for use in all foods and beverages.
However, after hundreds of studies and reviews
Although researchers have looked at possible by the FDA, saccharin has been approved as safe
links to cancer, birth defects, and nerve damage, for human consumption in the U.S. The Ameri-
they have found no concerns about nerve toxins can Cancer Society, American Medical Associa-
or behavioral effects in people from eating tion, and American Dietetic Association agree
neotame.7, 8, 9 that saccharin is acceptable.10

The acceptable daily intake for neotame is 18 In the year 2000, saccharin was delisted from the
mg/p/d (that is, 18 milligrams per person per Report on Carcinogens, stating: “Saccharine will
day).2 be delisted from the report on carcinogens,
because the rodent cancer data are not sufficient
to meet the current criteria to list this chemical
as reasonably anticipated to be a human carcino-
gen. This is based on the perception that the
observed bladder tumors in rats arise by mecha-
nism not relevant to humans, and the lack of
data in humans suggesting a carcinogenic haz-
ard.”11

For a handout and more information on the


safety of saccharin (and other sweeteners), see
the following publication from The University of
Arizona Cooperative Extension: Sugar Substitutes
– Are They Safe? at http://ag.arizona.edu/pubs/
health/az1229.pdf.
Saccharin
Saccharin (Sweet ’N Low, Sweet ’N Low Brown, Saccharin has become a popular sugar substitute
Sugar Twin, Necta Sweet, or Hermesatas) is for people suffering from diabetes, obesity, or
about 300 times sweeter than table sugar. Sac- gout. Saccharin may also help to maintain good
charin does not convert to glucose. It is readily dental health since it does not contribute to the
absorbed and is excreted unchanged by the development of cavities.
kidneys. Therefore, saccharin contains zero
calories per gram. This is an alternative sweet- Note: “Sodium saccharin” – the most common
ener to consider for people with diabetes. form of saccharin used to sweeten foods – may
increase the sodium content in the diet. Be sure
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to read food labels carefully.
In other countries, the ADI for saccharin is set
between 2.5–5.0 mg/kg/d. No ADI is currently Sugar Alcohols (Polyols)
set by the FDA in the United States. Saccharin is
permitted by the FDA under an interim regula-
tion that specifies the amount of saccharin
Another sweet alternative
permitted in beverages, processed foods, and
tabletop sweeteners.2
Sugar alcohols, also called polyols, are another
Sucralose category of sugar-free sweeteners. Sugar alcohols
Sucralose (Splenda) is about 600 times sweeter are carbohydrates, but they are not sugars, nor
than sugar or sucrose and is the only are they alcohols. Since “polyol” is not a very
nonnutritive sweetener made from sugar, so it consumer-friendly word, scientists call them
tastes like sugar. Better yet, your body doesn’t sugar alcohols because their chemical structure
metabolize it as sugar. This means that sucralose partly resembles sugar and partly resembles
gives you the sweet taste of sugar without carbo- alcohol.12
hydrates or calories.
Unlike the low-calorie sugar substitutes (men-
More than 100 scientific studies conducted over tioned in the previous section), which are used
20 years have shown that sucralose is safe, and only in tiny amounts to sweeten foods, sugar
the FDA has authorized the use of it in foods. alcohols provide the “bulk” of sugar without as
Research has also shown that sucralose does not many calories.13 They are used cup-for-cup
raise blood sugar in people with diabetes. (volume-for-volume) in the same amount as
sugar is used.12 Sugar alcohols deliver the taste
Sucralose is heat stable. You can use sucralose- and texture of sugar with about half the calories.
containing products, such as Splenda, just as They vary in sweetness from about half as sweet
you would sugar when you cook and bake. as sugar to equally as sweet, and they are some-
Splenda stays sweet regardless of how long the times combined with low-calorie sweeteners to
cooking time or how create the desired level of sweetness.14
high the cooking tem-
perature. You can use The most familiar sugar alcohols used in the U.S.
Splenda the same way are:
you would use sugar.
Substitute 1 cup of • sorbitol,
Splenda for 1 cup of • manitol, and
sugar.5 • xylitol.

Note: “Splenda Sugar Blend” is a mix of pure Other sugar alcohols permitted for use in food in
sugar (sucrose) and the Splenda brand sweet- the U.S. are:
ener (sucralose). It is used in half the amount,
substituting 1/2 cup Splenda Sugar Blend for 1 • isomalt,
cup sugar. • erythritol,
• lactito,
The acceptable daily intake for sucralose is 5 mg/ • maltitol, and
kg/d. 2
• hydrogenated starch hydrolysates (HSH)
(aka: polyglycitol, polyglucitol).2, 14

Sugar alcohols have been used in foods around


the world for many years.12 In fact, some sugar
alcohols, such as sorbitol and xylitol, occur
naturally in certain fruits and other foods.2 The
World Health Organization has carefully re-
viewed them and concluded that they are safe
for human consumption. The FDA classifies
some sugar alcohols as GRAS (generally recog-
5
nized as safe), while others are approved food
additives.12 Weight Control
Sugar alcohols have three potential benefits over
sugar as a food ingredient: Can alternative sweeteners help?

T
1 Sugar alcohols do not promote the develop- he average American eats the equivalent
ment of tooth decay. “The bacteria in dental of 20 teaspoons of sugar a day....”10
plaque, which produces substantial amounts About 60 percent of that consumption is
of decay-promoting acid from sugars and from nutritive corn sweeteners in sodas and
starches, produces little or no acid from these other sweetened beverages. The other 40 percent
substances [sugar alcohols].”2 is from table sugar and small amounts of other
nutritive (calorie containing) sweeteners, such as
2 Sugar alcohols produce a lower glycemic honey and molasses.10
response than most sugars do. “Thus, these
use may be advantageous for people with Humans naturally have an appetite for sweet
diabetes.”2 things. Unfortunately, sugary foods consumed in
large quantities can add up to a surplus of
3 Most sugar alcohols have fewer calories than calories, which can contribute to weight gain.10
sugar. Sugar has 4 calories per gram (16
calories per teaspoon). Most commonly used To lose weight, we must decrease the total
sugar alcohols have fewer calories, as can be calories, especially from foods with lots of calo-
seen below: ries from sugars and fats, and increase our
physical activity to expend the extra calories.
sorbitol 2.6 cal/g Many health-conscious consumers seek out
mannitol 1.6 cal/g alternative low-calorie sweeteners (like sugar
xylitol 2.4 cal/g substitutes and sugar alcohols) to help lower
erythritol 0.2 cal/g their daily calorie count without having to give
isomalt 2.0 cal/g up their favorite foods.10
lactitol 2.0 cal/g
maltitol 2.1 cal/g So, can alternative sweeteners such as sugar
HSH 3.0 cal/g.2 substitutes and sugar alcohols help with weight
loss? The answer to that question has not come
“Most polyols [sugar alcohols] are incompletely without some controversy. If we use alternative
digested and poorly absorbed; this is the pri- sweeteners correctly – in place of other sugar-
mary reason why their caloric values are lower sweetened foods – we can potentially lower our
than that of sugar.”2 One disadvantage to sugar weight. The problem is, we don’t always use
alcohols, however, is that this incomplete ab- these alternatively sweetened foods correctly.
sorption may cause negative gastrointestinal
effects (a laxative effect) in some people, such as
gas production, softer stools, and even diarrhea.
There are large differences in tolerance among
people consuming sugar alcohols. Some indi-
viduals who wish to consume these products
will need to start with small amounts and build
up a tolerance over a few days until their body
can adapt to larger amounts.2

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I can remember when I first got a box of re-
duced-calorie chocolate cookies that used a sugar
Sugars are “Carbs”:
substitute. They were delicious, and I ate half the Read Labels Carefully
box “guilt-free.” I suppose you see the problem
here. If I am replacing 2 cookies made with table Sugars and sugar alcohols are types of carbo-
sugar with half a box of cookies made with a hydrates (“carbs”). Sugar alcohols are not
sugar substitute, I may have reduced my sugar completely digested. So, if you eat foods that
intake, but I still got a half-a-box worth of contain large amounts of sugar alcohols, your
calories from the other ingredients in the cook- blood glucose may rise less than with other
ies. Calories count! We can’t just assume that a carbohydrates, which may help in a diabetic
box that says sugar-free or fat-free, for that meal plan. Note, however, that the term “low
matter, means we aren’t getting any of the carb food,” “net carbs,” and “low impact
calories. We may also be replacing nutritious carbs” are not approved label claims and are
foods in our diet with foods that provide no not a good way to choose foods.16
nutritional value. It is important to read labels
and keep our intake of these products in mod- Read food labels. If a food has more than 10
eration for health and weight control. grams of sugar alcohol, half the grams can be
subtracted from the “total carbohydrate” value
“’Successful’ weight reduction – losing weight listed on the package. For example:
and keeping it off – involves many factors, such
as eating habits (including a balanced diet, eaten If total carbohydrates = 26g
in moderation), exercise and long-term Total sugar alcohol = 22g (half this amount = 11g)
commitment....The majority of those who use Thus, 26–11 = 15g carbs to count.16
low-calorie sweeteners to lose or maintain weight
do not rely solely on these products.”15 “Health “Even if a food is ‘low’ in carbohydrates, it may
professionals agree that the key to losing weight not be low in calories or a healthy food. Use
is to burn more calories than are consumed, common sense to meet your carbohydrate
either by increasing physical activity or consum- goals, and do not lose track of the bigger
ing fewer calories – preferably both.”15 Low- picture. Take steps to build good eating habits
calorie sweeteners can be incorporated into this and keep active.”16
plan, if desired.

Making Healthy Choices


Want a Guide to Effective Weight Loss
for Your Clientele or Yourself? Keep it moderate – keep it healthy

Here’s a great resource:

T
he choice to use sugar substitutes is a
personal one. The FDA has approved five
Winning by Losing: A Guide to Effective sugar substitutes to choose from. You may
Weight Control choose some of these to try to control weight or
as part of a diabetic meal plan. You can also
http://caloriecontrol.org/winweigh_print.html control these factors without sugar substitutes –
the choice is yours. Mostly, you want to have a
balanced diet – burning more calories than you
consume. Use sugar substitutes and all foods
that don’t have nutritional value in moderation.
If we fill up on foods with little or no nutritional
value, we may deprive our bodies of the nutri-
tional elements we need to stay healthy. When
using sugar substitutes, use them as part of – not
a substitute for – a healthy meal plan and active
lifestyle.
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References
1. National Cancer Institute (2006). Artificial sweeteners and cancer: Questions and answers. Re-
trieved April 4, 2006. From http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners.

2. Kroger, M; Meister, K; and Kava, R. Low-calorie sweeteners and other sugar substitutes: A review
of the safety issues. In Comprehensive Reviews in Food Science and Food Safety 2006; 5:35-47.

3. Greeley, A. (2001). U. S. Food and Drug Administration: Not only sugar is sweet. Retrieved April 4,
2006. From http://www.fda.gov/bbs/topics/CONSUMER/CON00133.html.

4. American Dietetic Association (2006). Use of nutritive and nonnutritive sweeteners. Retrieved
March 24, 2006. From http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/
advocacy_adap0598_ENU_HTML.htm.

5. Mayo Clinic (2004). Sugar substitutes: Sweet taste without all the calories. Retrieved April 4, 2006.
From http://mayoclinic.com/health/diabetes-diet/NU00592.

6. American Dietetic Association (2003). Straight answers about aspartame. Retrieved April 24, 2006.
From http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_1030_ENU_HTML.htm.

7. Sweeteners Holdings, Inc. (2002). Neotame: FAQs. Retrieved April 24, 2006. From http://
www.neotame.com/faq.asp.

8. United States Food and Drug Administration (2002). FDA approves new nonnutritive sweetener
neotame. Retrieved April 24, 2006. From http://www.fda.gov/bbs/topics/ANSWERS/2002/
ANS01156.html.

9. United States Food and Drug Administration. FDA approves new sugar substitute. Food Chemical
News, July 15, 2002, p.17. Retrieved April 24, 2006. From http://www.foodchemicalnews.com/
ejournals/search/SearchQuery.asp?Idx=applications%5C7&request=July+15%2C+2002&stemming
=True&phonic=False&natlang=False&maxfiles=500&sort=DATE&sort_type=0&chkShowAbstract
=0&perpage=25&startat=1&onpage=1.

10. Henkel, J (2004). Sugar substitutes: Americans opt for sweetness and lite. In FDA Consumer
Magazine, Nov–Dec 1999 (rev. 2004). Retrieved January 9, 2006. From http://www.fda.gov/fdac/
features/1999/699_sugar.html.

11. National Institutes of Health (2000). Report on Carcinogens, 11th ed. Summary actions on the
nomination of saccharin for delisting from the report on carcinogens. Retrieved April 4, 2006. From
http://ntp.niehs.nih.gov/ntp/roc/eleventh/append/appb.pdf.

12. Calorie Control Council (2003). Polyols in sugar-free and reduced calorie foods and beverages:
Questions and answers about polyols or sugar replacers. Retrieved March 24, 2006. From http://
www.caloriecontrol.org/polyol_qa_brochure.pdf.

13. Calorie Control Council (2004). FAQs. Retrieved March 24, 2006. From http://caloriecontrol.org/
faqs.html.

14. American Dietetic Association (2006). Polyols: Sweet benefits. Retrieved March 24, 2006. From
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_1035_ENU_HTML.htm.

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15. Calorie Control Council (2004). Benefits of using low-calorie sweeteners. Retrieved March 24,
2006. From http://caloriecontrol.org/benefit.html.

16. Diabetes Care and Education Dietetic Practice Group (2004). The truth about carbs. Retrieved
April 24, 2006. From http://www.dce.org/publications/files/truth_carbs.pdf.

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Texas Cooperative Extension
Attn: Janet M. Pollard
2251 TAMU
College Station, Texas 77843-2251

Extension programs serve people of all ages regardless of socioeconomic level, race, color, sex, religion, disability, or national origin.
The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating
A member of The Texas A&M University System and its statewide Agriculture Program
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