Category: Nutrition

The Scoop on Artificial Sweeteners

Discussing diet and nutrition is a big part of patient care at Attune Health.

One questions we get asked frequently is, “Are artificial sweeteners healthy?”

This is a loaded question, but Attune Health nutritionist and research associate Natalie Fortune breaks it down for us. The short answer is that they are in a category labeled Generally Recognized as Safe, or GRAS. GRAS means that the American Food and Drug Administration has declared that a chemical or substance added to food is considered safe because of experts’ research findings.

Artificial sweeteners entered the market in the 1950s, shortly after in 1968 Cyclamate, an artificial sweetener, was banned as high doses were linked with bladder cancer in rats [1]. Other artificial sweeteners have not shown results like cyclamate. There are many different types of artificial sweeteners, so it is important to assess them separately as they all cause different interactions in our bodies.

In 2004, the American Dietetic Association, now the Academy of Nutrition and Dietetics put forth their position on non-nutritive sweeteners [2]. Here are some of the main takeaways:

  • Artificial sweeteners have the potential to increase the palatability of nutrient-dense foods/beverages, therefore, sweeteners can promote diet healthfulness buy assisting in the consumption of “healthy” foods that would not normally be consumed.
  • Nutritive sweeteners increase risk of dental caries.
  • An intake below the Acceptable Daily Intake of artificial sweeteners is thought to be safe to consume.

It seems that artificial sweeteners are generally “safe” when consumed in acceptable daily limits. Artificial sweeteners are thought to not affect blood glucose levels and are recommended to be consumed in moderation, especially for individuals with diabetes.  However, there are some adverse effects, specifically gastrointestinal discomfort that come along with the consumption of artificial sweeteners. As a consumer it is difficult to make decisions about artificial sweeteners, as there is an abundance of conflicting information available. So, the question is, is it worth it? If you can consume a healthy diet without artificial sweeteners, is that better?

Dr. Mark Hyman, the medical director at Cleveland Clinic’s Center for Functional Medicine has said that “any sweetener can make you hungry, lower your metabolism, create gas, and store belly fat.”

As always it is important to take all the scientific information that is available and make an evidence-based decision about your health with the impute of your physician.

Here’s a primer on some of the more popular artificial sweeteners:

 

Sugar Alcohols

When you are reading an ingredient list and come across an ingredient that the has the last two letters as “ol” chances are it is a sugar alcohol. Xylitol, Sorbitol, and Mannitol are common sugar alcohols and are sometimes found in diabetic or sugar free candy and most gums. Xylitol has the same sweetness as regular sugar and sorbitol and mannitol are slightly less sweet. Sugar alcohols are created by hydrogenation of natural sugars (maltose, lactose, palatinose, glucose, xylose) [3]. There are side effects associated with consuming sugar alcohol, and they are usually dose dependent. Meaning, the more you consume the more likely you are to experience adverse symptoms and the more severe the symptoms may become. Symptoms include: watery stool, diarrhea, cramping, gas, nausea, and borborgymi [4] (that rumbling sound your stomach makes when fluid and gas are moving in the gastrointestinal tract).

 

Saccharin

Sweet’n Low and Sweet Twin are examples of Saccharin. Saccharin is about 200-700 times sweeter than sugar. The acceptable daily intake for saccharin is 15 mg/kg body weight/day. Saccharin has been proposed to be a risk factor for developing diseases such as Ulcerative Colitis and Crohn’s Disease [5]. Though saccharin has been determined to be one of the most thoroughly studied and best known man-made chemicals [6]. Furthermore, on April 6, 2001 saccharin was delisted as a known cause of cancer.

Saccharin use should still be taken with caution for pregnant women. Though there is no evidence that saccharin increases the risk of birth defects , it should be noted that saccharin crosses the placenta and is eliminated much more slowly in the fetus than in the adult [7].

 

Sucralose

Splenda is a common example of sucralose. Sucralose is 600 times sweeter than sugar. The acceptable daily intake for sucralose is 5 mg/kg body weight/day. When consumed at the acceptable daily intake sucralose was shown to increase the risk of developing tissue inflammation, through disrupting the gut microbiota in mice [8]. However, sucralose has been shown to lower blood glucose in the presence of carbohydrates in healthy individuals [9]. There results were not carried through for newly diagnosed individuals with type-2 diabetes [9].

 

Aspartame

Equal and Nutrasweet are examples of Aspartame. Aspartame is about 160-220 time sweeter than sugar. The acceptable daily intake for aspartame is 50 mg/kg body weight/day. A randomized clinical trial that utilized a comprehensive battery of psychological tests, biochemistry, and state of the art metabonomics there was no evidence of any acute adverse responses to aspartame [10]. The association between aspartame and headaches is limited, though a review found that large doses of aspartame (900-3000 mg/kg bodyweight/day) were reported to trigger or exacerbate headaches in individuals susceptible to migraines [11]. The association between mood and aspartame use has also shown conflicting results, where one study was actually stopped when the consumption of 30 mg/kg body weight/day was found to have a severity of adverse reactions in depressed patients [12]. While other studies have shown no difference in mood when taking aspartame compared to sucrose [13, 14].

 

Stevia

A Sweet Leaf, Truvia, PureVia are examples of stevia. Stevia is about 300 times sweeter than sugar. The acceptable daily intake for stevia is 4 mg/kg body weight/day. Stevia is also called Rebaudioside A or rebiana sometimes. Stevia is usually separated from artificial sweeteners as it comes from a plant, the stevia leaf. It is important to note that whole stevia, stevia leaf and crude stevia are still not GRAS, and they are only approved as supplements. Randomized trials have not found safety concerns regarding the consumption of stevia [15]. However, rat studies have highlighted the possibility that stevia extracts may decrease fertility in male rats [16]. Unfortunately, there is a shortage of human studies evaluating all possible negative effects of stevia. Furthermore, there are no studies assessing the relationship between stevia and fertility in humans.

 

Acesulfame-K and Neotame

Sunette, Equal Spoonful, Sweet One are examples of Acesulfame-K. Acesulfame-K is about 200 times sweeter than sugar. The acceptable daily intake for Acesulfame-K is 15 mg/kg body weight/day. Newtame is about 8000 times sweeter than sugar. The acceptable daily intake for newtame is 0.3 mg/kg body weight/day.

 

References:

  1. Price JM, Biava CG, Oser BL, Vogin EE, Steinfeld J, Ley HL. Bladder tumors in rats fed cyclohexylamine or high doses of a mixture of cyclamate and saccharin. Science 1970;167(3921):1131-2
  2. American Dietetic A. Position of the American Dietetic Association: use of nutritive and nonnutritive sweeteners. J Am Diet Assoc 2004;104(2):255-75 doi: 10.1016/j.jada.2003.12.001[published Online First: Epub Date]|.
  3. Tsuneyuki Oku SN. Digestion, absorption, fermentation, and metabolism of functional sugar substitutes and their available energy. Pure Appl. Chem 2002;74:1253–61
  4. Payne AN, Chassard C, Lacroix C. Gut microbial adaptation to dietary consumption of fructose, artificial sweeteners and sugar alcohols: implications for host-microbe interactions contributing to obesity. Obes Rev 2012;13(9):799-809 doi: 10.1111/j.1467-789X.2012.01009.x[published Online First: Epub Date]|.
  5. Qin XF. Impaired inactivation of digestive proteases by deconjugated bilirubin: the possible mechanism for inflammatory bowel disease. Med Hypotheses 2002;59(2):159-63
  6. Saccharin and its salts. IARC Monogr Eval Carcinog Risks Hum 1999;73:517-624
  7. Cohen-Addad N, Chatterjee M, Bekersky I, Blumenthal HP. In utero-exposure to saccharin: a threat? Cancer Lett 1986;32(2):151-4
  8. Bian X, Chi L, Gao B, Tu P, Ru H, Lu K. Gut Microbiome Response to Sucralose and Its Potential Role in Inducing Liver Inflammation in Mice. Front Physiol 2017;8:487 doi: 10.3389/fphys.2017.00487[published Online First: Epub Date]|.
  9. Temizkan S, Deyneli O, Yasar M, et al. Sucralose enhances GLP-1 release and lowers blood glucose in the presence of carbohydrate in healthy subjects but not in patients with type 2 diabetes. Eur J Clin Nutr 2015;69(2):162-6 doi: 10.1038/ejcn.2014.208[published Online First: Epub Date]|.
  10. Sathyapalan T, Thatcher NJ, Hammersley R, et al. Aspartame sensitivity? A double blind randomised crossover study. PLoS One 2015;10(3):e0116212 doi: 10.1371/journal.pone.0116212[published Online First: Epub Date]|.
  11. Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain 2009;25(5):446-52 doi: 10.1097/AJP.0b013e31819a6f65[published Online First: Epub Date]|.
  12. Walton RG, Hudak R, Green-Waite RJ. Adverse reactions to aspartame: double-blind challenge in patients from a vulnerable population. Biol Psychiatry 1993;34(1-2):13-7
  13. Reid M, Hammersley R, Hill AJ, Skidmore P. Long-term dietary compensation for added sugar: effects of supplementary sucrose drinks over a 4-week period. Br J Nutr 2007;97(1):193-203 doi: 10.1017/S0007114507252705[published Online First: Epub Date]|.
  14. Reid M, Hammersley R, Duffy M. Effects of sucrose drinks on macronutrient intake, body weight, and mood state in overweight women over 4 weeks. Appetite 2010;55(1):130-6 doi: 10.1016/j.appet.2010.05.001[published Online First: Epub Date]|.
  15. Wheeler A, Boileau AC, Winkler PC, et al. Pharmacokinetics of rebaudioside A and stevioside after single oral doses in healthy men. Food Chem Toxicol 2008;46 Suppl 7:S54-60 doi: 10.1016/j.fct.2008.04.041[published Online First: Epub Date]|.
  16. Melis MS. Effects of chronic administration of Stevia rebaudiana on fertility in rats. J Ethnopharmacol 1999;67(2):157-61