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Emerging research casts a shadow on the health benefits of artificial sweeteners, commonly used as sugar substitutes in diet products. A recent study, featured in Nature Metabolism, indicates that non-caloric sweeteners, such as those found in diet soda, may paradoxically stimulate hunger. The study specifies that sucralose, a widely used artificial sweetener, can disrupt hypothalamic mechanisms responsible for appetite control. These findings suggest that regular consumption of artificial sweeteners could potentially impact appetite regulation and metabolic responses over extended periods.
Concerns Mount Over Sugar Alternatives
This research reinforces growing unease about sugar substitutes. Earlier in August, Cleveland Clinic researchers discovered a potential connection between erythritol, a sugar alcohol present in numerous baked goods and sweets, and an elevated risk of cardiovascular incidents, including stroke and heart attack.
Erythritol and Cardiovascular Risks
The study, published in Arteriosclerosis, Thrombosis, and Vascular Biology, revealed that erythritol exhibited a blood-clotting effect, unlike glucose from conventional sugar. Erythritol, a low-calorie sweetener, naturally occurs in certain fruits but is added to processed foods in much greater concentrations. It differs in composition from other sugar substitutes like aspartame or sucralose.
While acknowledging the limited scale of the study and the absence of definitive proof of causation, researchers emphasize the significance of these findings. Artificial sweeteners and low-calorie sugar substitutes are frequently promoted as healthier alternatives, particularly for individuals at higher risk of heart disease. Their popularity also stems from their suitability for ketogenic diets. This latest research complements previous studies from the same clinic, published in Nature Medicine the previous year, linking erythritol to cardiovascular risks.
Adding to the discourse, the World Health Organization (WHO) issued guidance in 2023 advising against the use of sugar substitutes for long-term weight management, citing a lack of effectiveness.
Dr. Stanley Hazen, lead author of the erythritol study and Chair of Cardiovascular and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute, stated in a news release: “Many medical organizations and physicians routinely advise individuals with heightened cardiovascular risk – those with obesity, diabetes, or metabolic syndrome – to consume foods containing sugar substitutes instead of sugar.”
He further emphasized, “These results highlight the critical need for comprehensive, long-term clinical investigations to thoroughly evaluate the cardiovascular safety of erythritol and other sugar alternatives.”
The Centers for Disease Control and Prevention (CDC) recommends a balanced approach to sugar substitutes, similar to that advised for regular sugar: moderation. However, low-calorie or zero-calorie sweetener options present distinct health profiles compared to traditional sugar. The diversity in forms of artificial sweeteners and sugar substitutes complicates the assessment of their overall health benefit-risk profile.
Here’s a detailed overview of what you should know.
Types of Alternative Sweeteners
To comprehend the debate between sugar and its alternatives, understanding the categories of alternative sweeteners is essential. They broadly fall into three categories, each with unique applications, advantages, and disadvantages.
Artificial Sweeteners
Artificial sweeteners represent the common understanding of sugar alternatives, including brands like Splenda (sucralose), Sweet’N Low (saccharin), Equal (aspartame), and Sweet One (acesulfame K). Neotame, another option, uses a less prevalent sweetener also called neotame.
These sweeteners exhibit sweetness levels 200 to 700 times greater than table sugar (sucrose) while containing zero calories, hence the designation “non-nutritive sweeteners.” Aspartame is a minor exception, containing negligible calories due to the minute quantities needed for intense sweetness.
Sugar Alcohols
Sugar alcohols, a type of carbohydrate, occur naturally in plants but can also be manufactured. They are primarily derived from sugars and starches through industrial chemical processes.
While containing fewer calories per gram than sugar, they are not calorie-free. Common sugar alcohols found on food labels include sorbitol, erythritol, maltitol, and xylitol, frequently used in sugar-free gum, protein bars, low-calorie ice cream, and various processed, especially diet-oriented, foods. They also feature in dental products like toothpaste and mouthwash.
Despite the name, sugar alcohols do not contain ethanol and do not cause intoxication. Their nomenclature reflects a chemical structure resembling both sugar and alcohol.
Novel Sweeteners
Novel sweeteners encompass newer sugar alternatives that defy easy categorization. Stevia, particularly stevia extract, exemplifies this category. As a plant-derived sweetener, stevia has virtually no calories and a distinct chemical structure diverging from both artificial non-nutritive sweeteners and sugar alcohols.
Other novel sweeteners include monk fruit extract (a zero-calorie sweetener from a Chinese fruit) and tagatose (an artificial sweetener less sweet than table sugar).
The Food and Drug Administration (FDA) classifies all these sugar alternatives as “high-intensity sweeteners,” each presenting a mix of benefits and drawbacks.
Benefits of Sugar Alternatives
Sugar alternatives are among the most intensely evaluated food additives. FDA authorization is mandatory for consumption in the US. Currently, the FDA considers numerous sugar alternatives safe for consumption, with research suggesting potential health advantages, especially for specific applications like managing diabetes.
Potential Support for Short-Term Weight Loss or Maintenance
For individuals aiming to reduce calorie intake for weight management while retaining sweet tastes, sugar substitutes offer an initial strategy. They deliver desired sweetness without added calories.
However, recent studies have questioned this paradigm, suggesting inconsistent effectiveness of alternative sweeteners for weight loss. (See below for drawbacks). Yet, for those mindful of overall dietary intake, low-calorie or zero-calorie sweeteners might facilitate weight reduction.
In 2023, the WHO stated that non-sugar sweeteners like aspartame, sucralose, and stevia are not recommended for long-term weight control, excluding low-calorie sugars or sugar alcohols from this recommendation.
Weight-loss efforts must include awareness to prevent calorie compensation elsewhere. Switching to diet sweet tea might inadvertently lead to higher calorie consumption through increased food intake.
Read more: Can Diet Sodas Cause Cancer? Understanding the WHO’s Aspartame Classification
Blood Sugar Control Assistance
Sugar substitutes can aid individuals with diabetes in managing sweet cravings without the blood sugar spikes associated with regular sugar.
A joint 2012 statement from the American Heart Association and American Diabetes Association acknowledged that non-nutritive sweeteners, used judiciously, can help reduce sugar and overall calorie consumption. However, benefits diminish if compensatory sugar intake from other sources occurs.
Individuals with diabetes should consult their physicians for personalized advice on suitable sugar substitutes or sweeteners, considering their health history.
Improved Oral Health
A definitive benefit of sugar alternatives lies in dental health. Cavities arise from bacterial fermentation of sugar, producing enamel-eroding acid. Sugar substitutes, lacking sugar, disrupt this process and prevent tooth decay.
Read more: Can Prebiotic Soda Harm Your Teeth? Expert Insights
Sugar Alternative Drawbacks
Despite their advantages, non-nutritive sweeteners, sugar alcohols, and novel sweeteners present potential downsides. The perceived “calorie-free” nature masks certain less desirable aspects.
Potential Disruption of Gut Health
Studies indicate that certain artificial sweeteners (saccharin and sucralose) and stevia can alter gut microbiota composition. Reduced beneficial bacteria or impaired growth can create gut imbalance, potentially triggering symptoms like cramping, gas, and bloating.
A 2019 study review suggests variable effects, with some sweeteners exhibiting negative impacts while sugar alcohols might have positive effects. Animal studies have also shown adverse gut bacteria changes post-artificial sweetener consumption, though further human research is needed to determine long-term effects of sugar alternatives on gut health.
Possible Digestive Upsets
Irrespective of gut microbiome disruption, sweeteners are associated with digestive discomfort. Anecdotal evidence of cramps following aspartame consumption dates back decades.
While more research is warranted, current studies suggest digestive symptoms might stem from gut bacteria changes or altered digestive tract motility due to alternative sweeteners.
For now, monitoring individual responses to different sweeteners and avoiding those causing digestive distress is advisable.
Potential Increase in Sweet Cravings
Despite minimal or zero calories, alternative sweeteners might not diminish sugar cravings. Sweet food desire appears independent of sweetness origin. Sweet cravings can arise even without calories, possibly due to the taste-calorie disconnect confusing the body and disrupting appetite regulation.
An animal study showed rats preferring saccharin-sweetened water over intravenous cocaine in a significant majority (94%). Similar preferences were noted with sugar-sweetened water, indicating general sweetness, not specifically artificial sweeteners, may be highly addictive.
Association with Long-Term Weight Gain
Counterintuitively, research suggests frequent consumption of artificial sweeteners, despite low calories, may contribute to weight gain over time. One study linked artificially sweetened soda consumption to increased waist circumference over nine years.
Another study found a larger BMI increase among non-nutritive sweetener users than non-users after eight years, except for regular exercisers.
Possible explanations include metabolic alterations induced by alternative sweeteners or compensatory behaviors, such as overeating due to perceived calorie savings.
The Takeaway
Current scientific consensus emphasizes limited knowledge about the long-term impacts of sugar alternatives—artificial sweeteners, sugar alcohols, or novel sweeteners—preventing definitive pronouncements on their long-term superiority over sugar.
Moderation applies to both sugar and sugar alternatives. Informed food choices, guided by individual health status, medical conditions, and personal responses to sugar or alternative sweeteners, remain critical. Food should be enjoyable within these considerations.
Avoiding sugar alcohols if experiencing laxative effects or limiting table sugar due to headaches or diabetes are examples of personalized adjustments. Given emerging cardiovascular risk research regarding certain sugar substitutes, consulting a doctor about sweetener choices is advisable, especially for consumers of diet, low-calorie, or sugar-free products.
For those concerned about harmful effects from either sugar or alternatives, prioritizing whole foods is generally beneficial. Choose whole fruit over juice, fresh lemonade over diet mixes, and homemade granola over store-bought options.
Ultimately, prioritize choices aligning with health needs and personal satisfaction.