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With a spoonful of sugar...

Switching from Sugar to Sweeteners
Quite the opposite of what we thought, switching from sugar to sweeteners could be a bad, even dangerous, step to take. The Sun newspaper reported on this in July 2019[1], and after reading what they had to say, you might want to re-evaluate whether switching to sweeteners is sensible as sweeteners found in Diet Coke and other soft drinks could damage your gut bacteria. According to scientists from universities in Israel and Singapore[2], six common artificial sweeteners (aspartame, sucralose, saccharin, neotame, advantame and acesulfame potassium-k) turn gut bacteria toxic when even tiny concentrations are exposed to them. Just one mg/ml of artificial sweetener was found to be harmful, yet many so-called ‘sugar-free drinks’ or ‘diet sodas’ contain as much as 180mg.

With a spoonful of sugar...
Picture Credit/Attribution: With a spoonful of sugar… by MlleMiracle is marked with CC BY-NC 2.0.

In laboratory trials, the scientists found that toxins were released when gut bacteria were exposed to each artificial sweetener, and it only took one mg/ml of the artificial sweeteners to turn the bacteria toxic. A can of Diet Coke contains around 180mg of aspartame. The Sun reported it led scientists to conclude that: “This is further evidence that consumption of artificial sweeteners adversely affects gut microbial activity which can cause a wide range of health issues”.

British Soft Drinks Association Director-General Gavin Partington told The Sun: “According to all leading health authorities in the world, including the European Food Safety Authority, low- and no-calorie sweeteners are safe. In March 2017, the UK Government and Public Health England publicly endorsed the use of low-calorie sweeteners as a safe alternative to reduce sugar in food and drink and help people manage their weight.”

Common Artificial Sweeteners[3]
The following artificial sweeteners are allowed for use in the United States and/or European Union.

  • Aspartame. Sold under the brand names NutraSweet, Equal, or Sugar Twin, aspartame is 200 times sweeter than table sugar. It is used as a tabletop sweetener found in a wide variety of foods and beverages, including cereals, yoghurt, frozen and gelatin desserts, sweets, sugar-free gum, juices, diet sodas, and many other products. It is also used in drugs such as vitamin supplements and laxatives. The general consensus is that this sweetener MUST be avoided by those with phenylketonuria (PKU), a rare genetic disorder[4].
  • Acesulfame potassium. Also known as acesulfame K, it is 200 times sweeter than table sugar and suited for cooking and baking. Sold under the brand names Sunett® and Sweet One®. It is generally used in combination with other non-nutritive sweeteners and is frequently found in sugar-free ‘fizzy’ drinks.
  • Advantame. This sweetener is 20,000 times sweeter than table sugar and suited for cooking and baking. Advantame is the newest non-nutritive sweetener approved by the US FDA.
  • Aspartame-acesulfame salt. Sold under the brand name Twinsweet, it’s 350 times sweeter than table sugar.
  • Neotame. Sold under the brand name Newtame, this sweetener is up to 13,000 times sweeter than table sugar and is suited for cooking and baking. It is used in low-calorie foods and beverages, but to a lesser extent than other sweeteners.
  • Neohesperidin. It’s 340 times sweeter than table sugar and suited for cooking, baking, and mixing with acidic foods. It is not approved for use in the United States.
  • Saccharin. The oldest artificial sweetener on the market is sold under the brand names Sweet’N Low, Sweet Twin, or Necta Sweet. Saccharin is up to 700 times sweeter than table sugar.
  • Sucralose. Sucralose, which is 600 times sweeter than table sugar, is suited for cooking, baking, and mixing with acidic foods. It is sold under the brand name Splenda® and Equal Sucralose.

Cyclamate is worth a mention. This sweetener, which is 50 times sweeter than table sugar, was used for cooking and baking until safety concerns led to it being banned in a few countries, including the US (in 1970). However, the European Union considered it safe. The UK banned cyclamate in the late 1960s after being linked to cancer, before being re-evaluated and reinstated in 1996.

Natural Sweeteners
Two ‘natural’ sweetener alternatives to sugar are shown below. They are slightly different to other sweeteners because they are still young in the sugar substitute game in the West and have the least amount of research to support or deny health claims about them.

  • Stevia (Truvia®, Stevia in the Raw®, SweetLeaf® Sweet Drops™, Sun Crystals® and PureVia®) is extracted from the leaves of the stevia plant, which is native to South America. Stevia is considered 200 to 300 sweeter than sugar. It is often blended with another non-nutritive sweetener to reduce bitterness.
  • Luo Han Guo (Monk fruit extract). Monk Fruit in the Raw ® is a natural sweetener made from crushed monk fruit. It has been used as a sweetener in China for almost 1,000 years. It contains no calories and is considered about 10-250 times sweeter than sugar. It is often blended with other non-nutritive sweeteners.

Sugar Alcohols
A separate category of sugar substitutes are sugar alcohols. The most commonly seen are xylitol, sorbitol, erythritol, maltitol, mannitol, hydrogenated starch hydrolysates (HSH) and isomalt. These are considered nutritive sweeteners because they contain some calories but much less than real sugar. Sugar alcohols may be extracted from fruits and vegetables; however, most are manufactured. They are often used in “sugar-free” or “reduced-sugar products.” Moderate doses of up to 10 to 15 grams/day are generally tolerated. At higher dosages, consuming some sugar alcohols, particularly sorbitol and mannitol, may cause flatulence, stomach pain and diarrhoea.

What does WebMD say about Sucralose?
Sucralose is marketed as Splenda, an artificial sweetener. It differs from other sweeteners, like aspartame (Equal) and saccharin (Sweet’N Low), in that it’s made from real sugar. It has a taste that is generally preferable compared to other artificial sweeteners. Sucralose is chemically changed, and although 600 times sweeter than real sugar, it has almost no calories. It doesn’t leave an aftertaste in your mouth, so sucralose is used in foods like yoghurt, confectionery, ice cream, and soft drinks. In addition to being chemically changed for taste, sucralose is also altered. Most of it passes naturally through your body instead of being stored for later use as energy.

To make sucralose almost calorie-free, some naturally-occurring parts of the sugar molecule, called hydroxyl, are replaced by chlorine. Making the simple swap of sucralose for sugar can help to limit calorie intake. It sweetens foods and drinks without causing your blood sugar levels to rise, which happens with natural sugar – but it does not mean it will help you lose weight.

Sucralose and gut health
Your gastrointestinal tract (GI) or microbiome is home to many helpful bacteria. These bacteria help your body to maintain a healthy immune system. Some studies have shown that Sucralose can change your gut microbiome by lowering the number of good bacteria by half.

Is Sucralose Safe?
Studies in both the US and the UK have found that sweeteners like Splenda don’t cause cancer, which was once a concern. Even though sucralose is considered to be safe, you should try to be mindful when it comes to artificial sweeteners. There are still studies being done on artificial sweeteners and how they affect our health. It is advisable to read the labels of products you regularly eat, drink, or use to see if they contain sucralose or other sweeteners.

Cleveland Clinic on Sugar Substitutes & Non-Nutritive Sweeteners
The US Food and Drug Agency (FDA) has approved eight types of non-nutritive sweeteners[5] for use in food, drinks, oral care products and some medications.

Pros and Cons of sugar substitutes
Benefits of non-nutritive sweeteners include:

  • Weight control: Non-nutritive sweeteners may be useful for people who are trying to lose weight or maintain their current weight. Non-nutritive sweeteners have few or no calories, compared with about 16 calories in one teaspoon (four grams) of sugar. When used as tabletop sweeteners or in cooking or baking, they can provide the sweetness of sugar without the calories.
  • Diabetes control: People with type 2 diabetes may choose to consume foods and beverages containing non-nutritive sweeteners vs those with added sugars, as these sweeteners will affect blood sugars to a much smaller extent.
  • Prevention of tooth decay: Non-nutritive sweeteners do not increase the chances of developing dental cavities, which is why they are used in oral hygiene products, such as mouthwash and toothpaste. Studies have shown that xylitol may help prevent dental cavities.
  • Pleasant taste: These sweeteners provide a sweet taste for those attempting to decrease dietary added sugars that have been associated (directly or indirectly) with overweight/obesity, pre-diabetes, type 2 diabetes, inflammation, and some cancers.

Drawbacks
Drawbacks of sugar substitutes include:

  • Inadequate calorie intake: Growing children need to consume an adequate number of calories every day for proper nutrition. If they consume a lot of low-calorie foods and beverages every day, they might run the risk of not consuming enough calories to sustain normal growth. Even if they are trying to lose weight, children and adults must consume adequate levels of calories based on their height and weight. Consult a nutritionist or dietitian for help with planning meals that are nutritious and meet dietary guidelines.
  • Nutrition issues: Beverages with non-nutritive sweeteners may replace nutritious beverages such as low-fat milk.
  • Stability issues: With a few exceptions, artificial sweeteners undergo chemical changes when exposed to high temperatures, such as those required for cooking and baking. Consumers should read the product label to determine how a non-nutritive sweetener can be used. Even if the sweetener is approved for cooking and baking, the recipe might need to be adjusted to yield the desired results.

How safe are sugar substitutes?
FDA-approved sugar substitutes are considered safe in the amounts that people typically eat or drink. The FDA has set an acceptable daily intake (ADI) level for each non-nutritive sweetener approved for general use in the US (including pregnant and lactating women). The ADI is the maximum amount of sweetener that can be consumed each day over a lifetime without causing health risks. It is virtually impossible for the average consumer to exceed the ADI based on normal consumption levels for low-calorie foods and beverages.

As mentioned several times in this paper, there is an exception regarding the use of aspartame (NutraSweet). There is a warning for people who have been diagnosed with phenylketonuria (PKU), a disorder in which the body lacks the enzyme that breaks down an amino acid called phenylalanine. Unless the person avoids certain foods that contain phenylalanine, it can accumulate in the body and cause damage to the brain and central nervous system. Because aspartame changes to phenylalanine and aspartic acid when it enters the digestive tract, people with PKU should avoid foods and beverages that contain aspartame.

Despite being considered safe by the FDA, and evidence to support at least a short-term benefit for weight management, there are questionable health disadvantages associated with non-nutritive sweeteners. In general, they offer no nutritional advantage. Dietary recommendations for their consumption are inconsistent across different health organisations and are often inconclusive. Taking a cautious approach may be prudent until there is more research in this area. You can’t go wrong by following the recommendations offered in the 2015 Dietary Guidelines scientific committee[6] to “reduce added sugars in the diet and replace with healthy options, such as substituting water for sugar-sweetened soda, instead of non-nutritive sweeteners.” The American Heart Association suggests: “For those who consume sugar-sweetened beverages regularly, a low-calorie or non-nutritive-sweetened beverage may serve as a short-term replacement strategy, but overall, people are encouraged to decrease both sweetened and non-nutritive-sweetened beverages and use other alternatives, with an emphasis on water intake.”

Gut Microbiota[7]
Gut microbiota, or the population of microorganisms living in the human intestine, play many important roles in the human body, including the regulation of digestion. Diet and other bodily conditions can affect the function and composition of gut microbiota. Because artificial sweeteners are not digested by the body (hence their lack of calories), they come into direct contact with microbes in the intestines.

Many people consider artificial sweeteners a good diet option for weight loss and controlling blood glucose levels. However, a study by a team from the National Human Genome Research Institute suggests that artificial sweeteners have the opposite effect on many people. The study’s authors demonstrate that artificial sweeteners can induce dysbiosis and glucose intolerance in healthy human subjects and suggest that it may be necessary to develop new nutritional strategies tailored to the individual and to variations in the gut microbiota. You can read an abstract online[8].

Risk of Developing Diabetes
In the case of artificial sweeteners, the shift in gut bacteria seems to make it far likelier that a person will develop diabetes. In the study, those whose gut bacteria had changed showed poorer blood sugar control just five days after consuming the artificial sweetener. In another study out of Europe, researchers found that chronic consumption of artificial sweeteners increased their risk of type 2 diabetes, regardless of other risk factors[9].

The NHS: The Truth about Artificial Sweeteners[10]
Artificial sweeteners are low-calorie or calorie-free chemical substances that are used to replace sugar to sweeten foods and drinks. They’re found in thousands of products, from drinks, desserts and ready meals, to cakes, chewing gum and toothpaste. Sweeteners approved for use in the UK include:

  • acesulfame K
  • aspartame
  • saccharin
  • sorbitol
  • sucralose
  • stevia
  • xylitol

A picture containing invertebrate, coelenterate Description automatically generated
Picture Credit/Attribution: Escherichia coli – is one of the many species of bacteria present in the human gut.
Credit: Rocky Mountain Laboratories, NIAID, NIH, Public domain, via Wikimedia Commons.
File URL: https://upload.wikimedia.org/wikipedia/commons/3/32/EscherichiaColi_NIAID.jpg

Both Cancer Research UK and the US National Cancer Institute have said sweeteners do not cause cancer.  “Large studies looking at people have now provided strong evidence that artificial sweeteners are safe for humans,” states Cancer Research UK.

All sweeteners in the EU undergo a rigorous safety assessment by the European Food Safety Authority (EFSA) before being used in food and drink. As part of the evaluation process, the EFSA sets an acceptable daily intake (ADI), which is the maximum amount considered safe to consume each day over the course of your lifetime. You do not need to keep track of how much sweetener you consume each day, as our eating habits are factored in when specifying where sweeteners can be used.

Are sweeteners healthy?
Sweeteners may be safe, but are they healthy? Food manufacturers claim sweeteners help prevent tooth decay, control blood sugar levels and reduce our calorie intake.

EFSA[11] has approved the health claims made about xylitol, sorbitol and sucralose, among others, concerning oral health and controlling blood sugar levels.

It has been suggested that using artificial sweeteners may stimulate appetite and, therefore, may play a role in weight gain and obesity. But research into sweeteners and appetite stimulation is inconsistent. Also, there’s little evidence from longer-term studies to show that sweeteners cause weight gain.

Mayo Clinic: Artificial Sweeteners and other Sugar Substitutes
If you’re trying to reduce the sugar and calories in your diet, like many others in the same situation, you may turn to artificial sweeteners or other sugar substitutes. Artificial sweeteners and other sugar substitutes are found in various food and beverages marketed as “sugar-free” or “diet,” including soft drinks and baked goods.

Understanding artificial sweeteners and other sugar substitutes
Sugar substitutes are sweeteners used instead of regular table sugar (sucrose). Artificial sweeteners are just one type of sugar substitute.

Some manufacturers call their sweeteners “natural” even though they’re processed or refined. Stevia preparations are one example. And some artificial sweeteners are derived from naturally occurring substances — sucralose comes from sugar.

Natural sweeteners
Natural sweeteners are sugar substitutes that are often promoted as healthier options than sugar or other sugar substitutes. But even these “natural sweeteners” often undergo processing and refining. Natural sweeteners that the US FDA recognises as generally safe include:

  • Fruit juices and nectars
  • Honey
  • Molasses
  • Maple syrup

Artificial sweeteners
Artificial sweeteners are synthetic sugar substitutes. But they may be derived from naturally occurring substances, such as herbs or sugar itself. Artificial sweeteners are also known as intense sweeteners because they are many times sweeter than sugar. Artificial sweeteners can be attractive alternatives to sugar because they add virtually no calories to your diet. Also, you need only a fraction of artificial sweetener compared with the amount of sugar you would normally use for sweetness.

Uses for artificial sweeteners
Artificial sweeteners are widely used in processed foods, including:

  • Soft drinks, powdered drink mixes and other beverages
  • Baked goods
  • Confectionery
  • Puddings
  • Canned foods
  • Jams and jellies
  • Dairy products

Artificial sweeteners are also popular for home use. Some are used in baking or cooking as a sugar alternative. However, some recipes may need modification – it’s best to check the labels on artificial sweeteners for appropriate home use. Some artificial sweeteners may leave an aftertaste. A different artificial sweetener or a combination may be better.

Possible health benefits of artificial sweeteners
Artificial sweeteners don’t contribute to tooth decay and cavities. Artificial sweeteners may also help with:

  • Weight control. Artificial sweeteners have virtually no calories. In contrast, a teaspoon of sugar has about 16 calories — so a can of sweetened cola with ten teaspoons of added sugar has about 160 calories. If you’re trying to lose weight or prevent weight gain, products sweetened with artificial sweeteners may be an attractive option, although their effectiveness for long-term weight loss is by no means clear.
  • Diabetes. Artificial sweeteners aren’t carbohydrates. So unlike sugar, artificial sweeteners generally don’t raise blood sugar levels. Ask your doctor or dietitian before using any sugar substitutes if you have diabetes.

Possible health concerns with artificial sweeteners
Artificial sweeteners have been scrutinised in detail for decades. Critics of artificial sweeteners say they cause various health problems, including cancer. That’s largely because of studies dating to the 1970s linked artificial sweetener saccharin to bladder cancer in laboratory rats. Because of those studies, saccharin once carried a label warning that it may be hazardous to your health. But according to the National Cancer Institute and other health agencies, there’s no sound scientific evidence that any artificial sweeteners approved for use in the US cause cancer or other serious health problems. Numerous studies confirm that artificial sweeteners are generally safe in limited quantities, even for pregnant women. As a result, the warning label for saccharin was dropped.

Artificial sweeteners are regulated by the US Food and Drug Administration (FDA) as food additives. They must be reviewed and approved by the FDA before being made available for sale. Sometimes the FDA declares a substance “generally recognised as safe” (GRAS). Substances receive this designation if they meet either of these criteria:

  • Qualified professionals deem the substance safe for its intended use based on scientific data. Stevia preparations are an example of this type of GRAS designation.
  • The substances have such a lengthy history of common use in food that they’re considered generally safe.

The FDA has established an ‘acceptable daily intake’ (ADI) for each artificial sweetener. ADI is the maximum amount considered safe to consume each day over the course of a lifetime. ADIs are set at very conservative levels.

Novel sweeteners
Novel sweeteners are hard to fit into a particular category because of what they’re made from and how they’re made. Stevia is an example. The FDA has approved highly refined stevia preparations as novel sweeteners but hasn’t approved whole-leaf stevia or crude stevia extracts for this use.

Tagatose is also considered a novel sweetener because of its chemical structure. It is a low-carbohydrate sweetener similar to fructose that occurs naturally but is manufactured from the lactose in dairy products. The FDA categorises tagatose as a GRAS substance[12].

Sugar alcohols
Sugar alcohols (polyols) are carbohydrates that occur naturally in certain fruits and vegetables — although they can also be manufactured. Despite their name, sugar alcohols aren’t alcoholic because they don’t contain ethanol, an essential element found in alcoholic beverages.

Sugar alcohols aren’t considered intense sweeteners because they aren’t sweeter than sugar. Some are less sweet than sugar. As with artificial sweeteners, the FDA regulates the use of sugar alcohols. Sugar alcohols contain calories. But they’re lower in calories than sugar, making them an attractive option.

Sugar alcohols generally aren’t used when you prepare food at home. But they’re in many processed foods and other products, including chocolate, chewing gum and toothpaste. Sugar alcohols add sweetness, bulk and texture to food, as well as helping food to stay moist.

Sugar alcohols are often combined with artificial sweeteners to enhance sweetness. Food labels may use the general term “sugar alcohol” or list the specific name, such as sorbitol.

Possible health benefits of sugar alcohol
Like artificial sweeteners, sugar alcohols don’t contribute to tooth decay and cavities and may also help with:

  • Weight control. Sugar alcohols contribute calories to your diet — but fewer calories than regular sugar. Sugar alcohols may help weight-control efforts.
  • Diabetes. Unlike artificial sweeteners, sugar alcohols are carbohydrates and can raise blood sugar levels. But your body doesn’t completely absorb sugar alcohols, so their effect on blood sugar is smaller than other sugars. Talk to your doctor or dietitian for guidance because sugar alcohols vary in their impact on blood sugar.

Possible health concerns with sugar alcohol
When eaten in large amounts, sugar alcohols can have a laxative effect, causing bloating, intestinal flatulence and diarrhoea. Product labels may carry a warning about this potential laxative effect.

Possible health benefits of natural sweeteners
Natural sugar substitutes may seem healthier than sugar. But their vitamin and mineral content isn’t significantly different. For example, honey and sugar are nutritionally similar, and your body processes both into glucose and fructose. It’s perfectly acceptable to choose a natural sweetener based on its taste rather than its health claims -just try to use any added sweetener sparingly.

Possible health concerns with natural sweeteners
Natural sweeteners are generally safe. But there’s no health advantage to consuming any particular type of added sugar. Consuming too much-added sugar, even natural sweeteners, can lead to health problems, such as tooth decay, weight gain, poor nutrition and increased triglycerides. Honey can contain small amounts of bacterial spores that can produce botulism toxins. Honey shouldn’t be given to children younger than one-year-old.

Remember that processed foods, which often contain sugar substitutes, generally don’t offer the same health benefits as whole foods, such as fruits and vegetables.

Healthline: The Aspartame Controversy
Aspartame is one of the most popular artificial sweeteners available on the market. The chances are high that you or someone you know has consumed an aspartame-containing diet soda within the past 24 hours. In 2010, one-fifth of all Americans drank a diet soda (’fizzy’ drink) on any given day, according to the Centers for Disease Control and Prevention.

While sweeteners remain popular, they have been the subject of intense controversy in recent years. Many opponents have claimed that aspartame is actually bad for your health. There are also claims about long-term repercussions of aspartame consumption. Unfortunately, while extensive tests have been conducted on aspartame, there’s no consensus as to whether aspartame is “bad” for you.

What is aspartame?
Aspartame is sold under the brand names NutraSweet and Equal. It’s also used widely in packaged products — especially those labelled as “diet” foods. The ingredients of aspartame are aspartic acid and phenylalanine. Both are naturally occurring amino acids. Your body produces aspartic acid, and phenylalanine is an essential amino acid that you get from food. When your body processes aspartame, part of it is broken down into methanol. Consumption of fruit, fruit juice, fermented beverages, and some vegetables also contain or result in methanol production.

As of 2014, aspartame was the largest source of methanol in the American diet. Methanol is toxic in large quantities, yet smaller amounts may also be concerning when combined with free methanol because of enhanced absorption.

Free methanol is present in some foods and is also created when aspartame is heated. Free methanol consumed regularly may be a problem because it breaks down into formaldehyde, a known carcinogen and neurotoxin in the body. However, the Food Standards Agency in the United Kingdom states that even in children who are high consumers of aspartame, the maximum intake level of methanol is not reached. They also say that since eating fruits and vegetables enhances health, methanol intake from these sources is not a high priority for research.

Dr Alan Gaby, MD, reported in Alternative Medicine Review in 2007 that aspartame found in commercial products or heated beverages may be a seizure trigger and should be evaluated in cases of difficult seizure management.

Aspartame approvals
Several regulatory agencies and health-related organisations have weighed in favourably on aspartame. It’s gained approval from the following:

  • US Food and Drug Administration (FDA)
  • United Nations Food and Agriculture Organization
  • World Health Organization
  • American Heart Association
  • American Dietetic Association

In 2013, the European Food Safety Authority (EFSA) concluded a review of more than 600 datasets from aspartame studies. It found no reason to remove aspartame from the market. The review reported no safety concerns associated with normal or increased intake.

At the same time, artificial sweeteners have a long history of controversy. Aspartame was developed when the FDA banned the artificial sweeteners cyclamate (Sucaryl) and saccharin (Sweet’N Low). Lab tests showed that massive doses of these two compounds caused cancer and other disorders in laboratory animals.

While aspartame is approved by the FDA, the consumer advocate organisation Center for Science in the Public Interest has cited numerous studies that suggest problems with the sweetener, including a study by the Harvard School of Public Health[13]. In 2000, the National Institutes of Health decided saccharin could be removed from the list of cancer-causing substances. Though cyclamate is available in more than 50 countries, it’s not sold in the United States.

Healthline: Artificial Sweeteners: Good or Bad?[14]
Artificial sweeteners are often the topic of heated debate. On the one hand, they’re claimed to increase your cancer risk and harm your blood sugar and gut health. On the other hand, most health authorities consider them safe, and many people use them to reduce their sugar intake and lose weight. Healthline[15] reviewed the evidence on artificial sweeteners and their health effects:

What are artificial sweeteners?
Artificial sweeteners, or sugar substitutes, are chemicals added to some foods and beverages to make them taste sweet. People often refer to them as “intense sweeteners” because they provide a taste similar to that of table sugar but up to several thousand times sweeter. Although some sweeteners contain calories, the amount needed to sweeten products is so small that almost no calories are consumed.

How do artificial sweeteners work?
The surface of your tongue is covered by many taste buds, each containing several taste receptors that detect different flavours[16]. When you eat, your taste receptors encounter food molecules. A perfect fit between a receptor and molecule sends a signal to your brain, allowing you to identify the taste. For example, the sugar molecule fits perfectly into your taste receptor for sweetness, allowing your brain to recognise the sweet taste.

Artificial sweetener molecules are similar enough to sugar molecules to fit on the sweetness receptor scale. But, generally, they are too different from sugar for your body to break them down into calories. This is how they provide a sweet taste without the added calories. Only a small number of artificial sweeteners have a structure that your body can break down into calories. As only very small amounts of artificial sweeteners are needed to make foods taste sweet, virtually no calories are consumed. One recent study had people with obesity and excess weight drink either a quarter gallon (1 litre) of regular soda, diet soda, water, or semi-skimmed milk each day. By the end of the six-month study, those drinking the diet soda weighed 17–21% less, had 24–31% less belly fat, 32% lower cholesterol levels, and 10–15% lower blood pressure, compared with those drinking regular soda. In fact, drinking water offered the same benefits as drinking diet soda. Although interesting, more studies are needed before strong conclusions can be made[17].

Artificial sweeteners may disrupt the balance of gut bacteria in some people, which could increase the risk of disease. However, more studies are needed to confirm this effect.

Since the 1970s, the debate about whether there is a link between artificial sweeteners and cancer risk has raged. It was ignited when animal studies found an increased risk of bladder cancer in mice fed extremely high amounts of saccharin and cyclamate[18]. However, mice metabolise saccharin differently than humans. Since then, more than 30 human studies have found no link between artificial sweeteners and the risk of developing cancer. One such study followed 9,000 participants for 13 years and analysed their artificial sweetener intake. After accounting for other factors, the researchers found no link between artificial sweeteners and the risk of developing various types of cancer[19].

Furthermore, a recent review of studies published over 11 years did not find a link between cancer risk and artificial sweetener consumption[20]. This topic has also been evaluated by US and European regulatory authorities. Both agreed that artificial sweeteners, when consumed in recommended amounts, do not increase cancer risk[21]. A notable exception is cyclamate, which was banned for use in the United States after the original mouse-bladder-cancer study was published in 1970. Since then, extensive studies in animals have failed to show a cancer link. However, cyclamate has never been re-approved for use in the United States.

Artificial sweeteners and dental health
Dental cavities — also known as caries or tooth decay — occur when the bacteria in your mouth ferment sugar. Acid is produced, which can damage tooth enamel. Unlike sugars, artificial sweeteners do not react with the bacteria in your mouth. This means they do not form acids or cause tooth decay[22].

Research also shows that sucralose is less likely to cause tooth decay than sugar. For this reason, the Food and Drug Administration (FDA) allows products containing sucralose to claim that they reduce tooth decay[23]. The European Food Safety Authority (EFSA) states that all artificial sweeteners, when consumed in place of sugar, neutralise acid and help prevent and decrease the likelihood of tooth decay[24].

Aspartame, headaches, depression, and seizures
Some artificial sweeteners may cause unpleasant symptoms, such as headaches, depression, and seizures in some individuals. Most studies find no link between aspartame and headaches, with two noting that some people are more sensitive than others[25]. This individual variability may also apply to aspartame’s effects on depression. For instance, people with mood disorders may be more likely to experience depressive symptoms in response to aspartame consumption[26].

Finally, artificial sweeteners do not increase seizure risk for most people. However, one study reported increased brain activity in children with absence seizures[27]. Artificial sweeteners are unlikely to cause headaches, depression, or seizures. However, some individuals could be more sensitive to these effects than others.

Safety and side effects
Artificial sweeteners are generally considered safe for human consumption. They are carefully tested and regulated by US and international authorities to ensure they are safe to eat and drink, but some people should avoid consuming them. For example, individuals with the rare metabolic disorder phenylketonuria (PKU) cannot metabolise the amino acid phenylalanine, which is found in aspartame. Thus, those with PKU should avoid aspartame altogether. Some people are allergic to sulfonamides — the class of compounds to which saccharin belongs. For them, saccharin may lead to breathing difficulties, rashes, or diarrhoea. Additionally, growing evidence indicates certain artificial sweeteners like sucralose reduce insulin sensitivity and affect gut bacteria[28].

­­Conclusions

  • Artificial sweeteners are generally considered safe but should be avoided by people who have phenylketonuria or who are allergic to sulfonamides.
  • Overall, the use of artificial sweeteners poses few risks and may even have benefits for weight loss, blood sugar control, and dental health.
  • These sweeteners are especially beneficial if you use them to decrease the amount of added sugar in your diet.
  • Some people may feel bad or experience negative effects after consuming artificial sweeteners, even though they are safe and well-tolerated by most people.
  • A person experiences the same sweet taste as sugar when they consume sweeteners, but the body receives fewer calories than it might otherwise expect. If the body unlearns the association between sweet tastes and calories, the reversal means that high-calorie foods will no longer trigger feelings of fullness, and can lead to overeating[29].
  • Besides its benefits, animal studies have convincingly proven that artificial sweeteners cause weight gain, brain tumours, bladder cancer and many other health hazards. Some health-related side effects, including carcinogenicity, are also noted in humans. Many studies have been carried out on these substances with conclusions ranging from “safe under all conditions” to “unsafe at any dose”[30].
  • There are many artificial sweeteners currently on the market, and many of them are even added to ‘healthier’ food options like yoghurt, vitamins, and breakfast cereal. The worst of the bad culprits include aspartame (found in Equal and NutraSweet), sucralose (found in Splenda), and saccharin (found in Sweet ‘N Low). Many people who cut artificial sugars out of their diets report improving many health problems such as migraines, depression, IBS, weight gain, and more[31].
  • The likelihood of negative effects can vary by individual and depend on the type of artificial sweetener consumed. If you’d like to avoid artificial sweeteners, you might use natural sweeteners instead.

Sources and Further Reading

Caution: No advice is implied or given in articles published by us. This guide is for general interest only – and should never be used as a substitute for obtaining advice from your doctor or other qualified clinician/medical practitioner. The facts are believed to be correct as at the date of publication, but there may be certain errors and omissions for which we cannot be responsible. Claims about the effectiveness or dangers of certain sweeteners shown in this paper are claims attributed to the organisations concerned and not by us. The hyperlinks in this paper were current at the date of publication.

 

  1. See: https://www.thesun.co.uk/fabulous/7397437/diet-drinks-six-artificial-sweeteners-drinks-toxic-gut-bacteria/
  2. In a study published in Molecules, a peer-reviewed open access scientific journal that focuses on all aspects of chemistry and materials science. It was established in March 1996 and is published monthly by MDPI. The study looked at the relative toxicity of the sweeteners and ten sports supplements containing them.
  3. Sources: https://www.healthline.com/nutrition/sucralose-good-or-bad, https://www.webmd.com/food-recipes/features/truth-artificial-sweeteners, https://www.webmd.com/drugs/2/drug-7215/aspartame-bulk/details/list-interaction-medication, https://www.nhs.uk/live-well/eat-well/food-types/are-sweeteners-safe/, and https://my.clevelandclinic.org/health/articles/15166-sugar-substitutes–non-nutritive-sweeteners
  4. The NHS says that PKU is an inherited disorder that increases the levels of a substance called phenylalanine in the blood. Phenylalanine is a building block of proteins (an amino acid ) that is obtained through the diet. It is found in all proteins and in some artificial sweeteners. The main treatment for PKU is a low-protein diet that completely avoids high-protein foods (such as meat, eggs and dairy products) and controls the intake of many other foods, such as potatoes and cereals. In addition, people with PKU must take an amino acid supplement to ensure they’re getting all the nutrients required for normal growth and good health. Source: https://www.nhs.uk/conditions/phenylketonuria/ © Crown Copyright acknowledged.
  5. Non-nutritive sweeteners are substances used instead of sugars (i.e., sucrose, corn syrup, honey, agave nectar) to sweeten foods, beverages and other products, such as oral care products and certain medications. Non-nutritive sweeteners (also called sugar substitutes or artificial sweeteners) contain few or no calories or nutrients. They may be derived from plants or herbs, or even sugar itself. They have a greater intensity of sweetness compared with sugar, so smaller quantities are needed for flavoring foods and beverages. Some artificial sweeteners are not metabolized, meaning that they pass through the digestive tract essentially unchanged. Source: Cleveland Clinic at: https://my.clevelandclinic.org/health/articles/15166-sugar-substitutes–non-nutritive-sweeteners
  6. See: https://academic.oup.com/advances/article/7/3/438/4616725
  7. Source: https://www.genome.gov/27559347/exploring-harmful-interactions-between-artificial-sweeteners-and-gut-microbiota
  8. The absract is at: https://www.nature.com/articles/nature13793
  9. Source: https://getwellbe.com/side-effects-of-artificial-sweeteners/
  10. Source: https://www.nhs.uk/live-well/eat-well/food-types/are-sweeteners-safe/ © Crown Copyright acknowledged
  11. See: https://www.efsa.europa.eu/en/efsajournal/pub/2076
  12. GRAS means “Generally Recognised As Safe”
  13. See: https://www.health.harvard.edu/blog/sweeteners-time-to-rethink-your-choices-2019022215967, https://www.nbcnews.com/healthmain/harvard-hospital-admits-it-promoted-weak-science-aspartame-1c6663411 and https://www.health.harvard.edu/blog/artificial-sweeteners-sugar-free-but-at-what-cost-201207165030
  14. Source: https://www.healthline.com/nutrition/artificial-sweeteners-good-or-bad
  15. Ibid
  16. Source: https://www.ncbi.nlm.nih.gov/books/NBK279408/
  17. Source: https://pubmed.ncbi.nlm.nih.gov/22205311/ The consumption of sucrose-sweetened soft drinks (SSSDs) has been associated with obesity, the metabolic syndrome, and cardiovascular disorders in observational and short-term intervention studies. Too few long-term intervention studies in humans have examined the effects of soft drinks.
  18. Source: https://pubmed.ncbi.nlm.nih.gov/5411626/ Cyclamate is no longer sold in the US.
  19. Source: https://pubmed.ncbi.nlm.nih.gov/17043096/
  20. Source: https://pubmed.ncbi.nlm.nih.gov/26202345/
  21. See: https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/j.1541-4337.2006.tb00081.x
  22. Source: https://pubmed.ncbi.nlm.nih.gov/11887514/
  23. Sources: https://pubmed.ncbi.nlm.nih.gov/11887514/ and https://pubmed.ncbi.nlm.nih.gov/16572525/
  24. See: https://www.efsa.europa.eu/en/efsajournal/pub/2229
  25. Sources: https://pubmed.ncbi.nlm.nih.gov/25786106/, https://pubmed.ncbi.nlm.nih.gov/2347957/, https://pubmed.ncbi.nlm.nih.gov/3657889/, https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2524.1988.hed2801010.x and https://pubmed.ncbi.nlm.nih.gov/7936222/
  26. Source: https://pubmed.ncbi.nlm.nih.gov/8373935/
  27. Sources: https://pubmed.ncbi.nlm.nih.gov/7506878/, https://pubmed.ncbi.nlm.nih.gov/7614911/, and https://pubmed.ncbi.nlm.nih.gov/1579221/
  28. Sources: https://pubmed.ncbi.nlm.nih.gov/30535090/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363527/
  29. Source: https://www.medicalnewstoday.com/articles/322266#health-risks
  30. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198517/
  31. Source: https://drkavitarao.com/hidden-dangers-artificial-sweeteners/

 


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