Ever wondered whether diet soda is a healthier option than the real thing? It is widely accepted that reducing sugar consumption is beneficial for our health, but what about their replacements? Consumption of artificial sweeteners has increased dramatically nowadays, but should we be in favour of, or avoiding these?
Science is still controversial, but some studies propose that artificial sweeteners may not be the perfect solution for weight management and glucose intolerance. And the composition of our gut microbiome could be also affected by them. Let's take a closer look at the evidence.
What are artificial sweeteners and where are they found?
Artificial sweeteners are synthetic substitutes for sugar that are widely used to reduce calories in our diet while maintaining a sweet taste.
They are classified as food additives and considered by the European Food Safety Authority (EFSA) to be safe for use in doses that do not exceed the Acceptable Daily Intake (ADI).
They can be classified into 2 groups:
- Non-nutritive sweeteners (NNSs): are zero or low-calorie alternatives to nutritive sweeteners, such as table sugar. They have a sweet intensity but provide almost no calories since our digestive system cannot fully absorb them.
- Low-calorie sweeteners: typically polyols or sugar alcohols, are low digestible carbohydrates with a lower caloric content relative to sugar.
Today, these substitutes are gaining in popularity, especially for being promoted as healthy alternatives. Only a tiny amount needs to be consumed to achieve the same satiating effects as sugar, which is why they became very popular in all sorts of diets and nutritional treatments for body weight control.
And they can be found everywhere! From ready-made meals and zero-calorie drinks to toothpaste, chewing gums, and even some vitamin supplements.
Artificial sweeteners and health
Although nonnutritive sweeteners (NNSs) are considered safe and well-tolerated by the general population, their effects on certain aspects of our metabolism are still controversial. How they affect our natural glucose metabolism, how they interact with sweet taste receptors in our mouths, and how they alter the gut microbiome, are questions that are still not fully understood.
This creates mixed messages for us as consumers, making it difficult to choose the right food on a daily basis.
For example, there is evidence raising the concern that the consumption of artificial sweeteners might contribute to the development of metabolic disorders that can potentially lead to obesity, type 2 diabetes, and cardiovascular disease.
One interesting hypothesis that has been proposed to explain these changes in glucose metabolism is that consuming sweet-tasting but noncaloric or reduced-calorie food and beverages interferes with learned responses that normally contribute to glucose and energy balance.
After consuming sweet tastes, normal responses, such as the release of insulin or the activation of brain regions sensitive to energy or reward, are activated to maintain normal blood sugar levels in our bodies. But, it is proposed that the consumption of artificial sweeteners can potentially alter or reduce the ability of sweet tastes to signal the post-ingestive caloric consequences of eating sweet-tasting foods. By reducing the ability to compensate for energy provided by caloric sweeteners in the diet, they might be able to increase appetite and stimulate food intake. This can explain why excessive consumption of high-intensity sweeteners can alter body weight regulation and have negative effects on our health.
Moreover, a considerable number of animal studies indicated that chronic exposure to artificial sweeteners causes adverse health effects, alterations in the composition of the gut microbiome, neurobehavioral effects, induction of kidney injury, and cancer.
Although the existing clinical data are still inconsistent, it is important to be aware of these potential effects to make informed decisions.
Artificial Sweeteners and Gut microbiome
Even though some sweeteners such as sorbitol, mannitol, and xylitol are frequently associated with gastrointestinal disturbances, such as bloating or diarrhea, most non-caloric artificial sweeteners are considered metabolically "inert" because they are excreted unchanged from our bodies. But, this lack of metabolism, does not necessarily mean that these compounds have zero interaction with the gut microbiome.
Some studies indicate that saccharin, sucralose, and stevia may affect the gut microbiota composition. Preliminary observations showed alterations in metabolic pathways linked to glucose tolerance and dysbiosis in humans, after saccharin consumption.
Other effects have been observed after polyols consumption. In patients with inflammatory bowel disease, they can induce dose-dependent flatulence, while in healthy individuals can potentially modify the population of bifidobacteria.
Despite the fact that we know too little about the health effects of artificial sweeteners, we can suspect that their impact on our metabolism just like many other foods is highly individual. Some studies show alterations in glucose metabolism, while others don’t; and the same applies to changes in the microbiome. This is still a new area of research, and we await more rigorous studies on humans to learn more.
Our stance on the matter: Re-educating your sugary palate
Cutting back on sugar or its replacements isn't always easy. But instead of looking for alternatives to satiate our sugar cravings, there is a need to transition to a more mindful way of eating. Choose to eat real food whenever possible.
Occasional consumption of artificial sweeteners probably won't do any harm, but that doesn't necessarily mean they are beneficial to your health.
Since science is still controversial in this regard, we advise against consuming these products in excess. Rather, we encourage the consumption of water and the use of natural alternatives (like fruit!) to satisfy your sweet tooth.
- Non-nutritive artificial sweeteners are considerably sweeter than sugar while providing only small amounts of calories.
- Artificial sweeteners are food additives that can be found in a vast number of foods and beverage products, but also in pharmaceutical products such as vitamins.
- Regulatory bodies such as the FDA consider the consumption of most common artificial sweeteners safe and tolerable.
- Some studies indicate that artificial sweeteners can negatively impact glucose metabolism and potentially change the composition of the gut microbiome. This topic is an active area of research.
- Most studies have been conducted in animals, and therefore further research on the effects of sweeteners on the composition of the human gut microbiome is necessary.
Author: Cecilia Clausen (Clinical Dietitian)