Sugar: The Good, The Bad, and The Ugly Part 2

Missed Part 1? Find it here.

With the growing obesity epidemic and increasing number of people being diagnosed with diabetes, there has been a push to eliminate sugar from our diets. This has led to increased consumption of non-nutritive sweeteners (NNS). These sweet sugar substitutes are calorie-free, and are therefore thought to be a safe way to prevent the negative consequences of over-consumption of sugar. But is this really the case?

Evidence about the safety and efficacy of NNS is confusing. According to the Food and Drug Administration (FDA), these products are completely safe for human consumption. Anecdotal accounts would suggest otherwise. Opinions on the safety of these products are so polarized, that it is nearly impossible to sift through the data out there to draw unbiased, accurate conclusions. Part of the issue is that companies that stand to benefit from the growing use of NNS fund much of the scientific research conducted. Fewer resources are allocated to determining any potential long-term negative effects of consuming these products.

Despite these barriers, we are learning more about NNS every day. We are finding that just because NNS are calorie-free doesn’t mean that they do not influence insulin and metabolism. One concern is that NNS activate reward centers in the brain the way sugar does, but without causing a release in dopamine. Dopamine plays a major role in desire, addiction, and satiation. In theory, NNS could change our perception of satiation thereby changing our appetite and causing increased calorie intake over time.

Artificial NNS

Saccharin. Also know as Sweet’N Low. It is 300 times sweeter than sugar. Back in the 1960’s concern was raised about the possibility of saccharin increasing the risk of bladder cancer in rats. Subsequently, the FDA has determined that this risk does not exist in humans, and has allowed saccharin back on the market. New research shows that saccharin can stimulate insulin secretion via taste receptor activation alone. In high amounts it can induce glucose intolerance by changing the microflora species in the GI tract.

Aspartame. Also known as NutraSweet. It is 200 times sweeter than sugar, and its sweet taste sensation lasts longer. High intakes can increase irritability and depressive feelings. Animal studies show that intake of aspartame in the perigestational period may predispose offspring to develop obesity and metabolic syndrome, but this has not been shown in human studies. There has been concern about increased risk of brain cancer due to aspartame consumption, but this has not been confirmed by scientific literature. Aspartame is toxic to people with phenylketonuria, due to its breakdown into phenylalanine.

Acesulfame K. Also known as Ace K. It is 200 times sweeter than sugar, and has a bitter after taste, so is generally combined with another NNS (commonly aspartame) in food products. In vitro studies of rat pancreas cells show that acesulfame K induces insulin secretion, though this has not been shown in vivo (in a live animal).

Sucralose. Also known as Splenda. It may be up to 1000 times sweeter than sugar, and is very heat stable, so can be used in baking and cooking. A recent rat study published in the prestigious Nature journal, showed that sucralose could induce glucose intolerance by altering the microflora in the gut. This effect was “contagious” in that transplanting the feces of an affected mouse into an unaffected mouse could induce the same glucose intolerance.

Natural NNS

Xylitol. Xylitol, along with mannitol, sorbitol, maltitol, and erythritol, are all sugar alcohols. These occur naturally, but are now generally made by hydrogenating sugar. Sugar alcohols do cause a small increase in blood sugar with consumption, but this effect is much smaller than with pure sugar. This is the basis for their use as a sugar substitute. Xylitol may increase the body’s innate ability to fight infection and therefore prevent cavities, ear infections, and sinus infections. Sugar alcohols are fermentable carbohydrates, meaning that bacteria in our digestive tract can break them down. This can lead to excessive gas, bloating, and digestive discomfort. Sugar alcohols, including xylitol, should be avoided in patients with irritable bowel syndrome, inflammatory bowel disease, and those who are prone to intestinal upset.

Stevia. This sugar substitute, which is extracted from the leaves of the Stevia rebaudiana plant, is 300 times sweeter than sugar. Stevia has only a miniscule effect on blood sugar, and is becoming a popular sugar substitute. One study suggests that stevia may actually have anti-hyperglycemic effects (preventing high blood sugar) via various mechanisms. Two products containing Stevia have been approved by the FDA: Truvia (stevia with erythritol) and PureVia (stevia with either dextrose or erythritol).

So, what’s the take home message? At present, research indicates that NNS are safe for human consumption. Little is known about the long-term safety metabolic effects of their consumption, however, newer studies are showing that some NNS have the potential to induce glucose intolerance and contribute to obesity and diabetes.

Your naturopathic doctor at Today Integrative Health and Wellness can answer further questions you may have about non-nutritive sweeteners, and make individual recommendations about whether or not she recommends them for your use.