Low Carb Dietitian
  • Home
  • Book
  • About Me
  • Blog
  • Contact
  • Research
  • Links
  • My Diet Doctor articles

Sugar Substitutes: Help or Hindrance for Diabetes and Weight Control?

11/11/2014

12 Comments

 
Picture
The Artificial Sweetener Study

I'm sure that by now most of you have heard about the recent study about artificial sweeteners purportedly increasing the risk of diabetes and obesity due to changes in gut bacteria. Bill Lagakos wrote a fantastic blog post about the study, including the questionable way some of the results were reported. I definitely recommend reading Bill's article (as well as his book and blog, if you're not already doing so). But as a brief synopsis, the paper discusses the adverse metabolic effects experienced by mice, and potentially some humans, in response to changes in their intestinal microbiome after consuming saccharin (and by inference other artificial sweeteners). The human study looked at saccharin's effects on 7 people who didn't regularly consume artificial sweeteners. Just over half of these subjects exhibited changes in their gut microbiota and apparently declines in glucose tolerance, according to daily glucose tolerance tests (GTTs), although this is an area where the data was oddly reported. However, the initial bacterial composition of the "responders" likely differed from the 3 participants whose bacteria and GTT results did not change.

Sugar Substitutes: Yes or No?

The use of sugar substitutes -- particularly artificial sweeteners -- is one of the more controversial issues within the low-carb, whole-foods community. From what I've read online, as well as having talked to people about this quite a bit, intake seems to range from drinking several Diet Cokes and using Splenda in multiple cups of coffee every day to only using "natural" sweeteners like stevia in small amounts or avoiding sweeteners altogether. Since the study above came out and was widely circulated on social media, I've seen many arguments about the risks vs. benefits of using sugar substitutes, and some of them have gotten pretty heated. I can relate to the first line of Bill's post: "I didn't want to blog about the artificial sweetener study." The truth is that I'm ambivalent about the use of sugar substitutes and can understand the points being made by both sides.

I have a long history of artificial sweetener use, beginning at around age 12, when I started using them in an attempt to prevent further weight gain after putting on several pounds following puberty. I'm turning 48 next week, and although I can't quantify with any degree of accuracy how much artificial sweetener I've consumed over the course of the past 36 years, I'm fairly sure it was a lot more than the average person. I started with saccharin-sweetened Shasta and Tab, progressed to Equal (aspartame) once it became available, then Splenda (sucralose), acesulfame potassium, sugar alcohols, and stevia within the past few years. A couple of times I took a brief break  (including the few months I went "full Paleo" about 3 years ago) but always went back to using them. My weight stayed the same, and I didn't notice any difference in my appetite or intake whether I consumed them or not. However, research and anecdotal reports suggest that some people have a different experience.

Looking at Both Sides of the Argument

Obviously, I can't say whether changes occurred in my own microbiota as a result of fairly heavy long-term sugar substitute use, but I do know that in my case, they haven't caused weight gain and, if anything, have likely helped me remain thin for the past 30+ years. Consuming sugar-free beverages and desserts allows me to treat myself to something sweet (an innate preference in humans) without ingesting empty calories or experiencing unstable blood sugar levels. I think they can play a supportive role in weight loss and diabetes for the many people who tolerate them. In terms of which types are best to use, every sweetener has its advantages and drawbacks, including "natural" ones (which are often highly processed, just like artificial sweeteners), so it's up to each person to make a choice from among the growing list of available products. I just finished trying out some of the newer sugar substitutes (monk fruit and Just Like Sugar, which is inulin based) so I can include my own thoughts in the "Sugar Substitutes" section of the book I'm currently writing. They aren't bad, although not nearly as sweet as saccharin tablets, which is still my favorite after all these years, particularly in Hot Cocoa Tea. (It's very simple and quick: Pour boiling water over a rooibos or other herbal tea bag, steep a few minutes, then add 1 Tbsp cocoa powder, 1 Tbsp cream or half-and-half, and sugar substitute to taste. Voila --a  delicious, hot, chocolatey beverage with antioxidants galore!)

On the other hand, some people have legitimate adverse reactions to certain sugar substitutes, find that their sweet taste triggers cravings for sugar and other high-carbohydrate foods, or have trouble losing weight when consuming them. Others may simply not want to eat anything sweet other than fruit. In these cases, it makes sense to avoid them. But trying to discourage everyone else from using sugar substitutes doesn't sit well with me. Since the studies on them aren't definitive in terms of risk and we know that high sugar intake does increase the likelihood of developing  diabetes and obesity, I'll go on record as saying that sugar substitutes are the better choice for many. Should they be considered a health food? No, and I certainly don't recommend overdoing them; this is one of the many nutrition areas where I believe the term "in moderation" applies. But if they can help overweight people or those with diabetes maintain low intakes of sugar without feeling deprived -- and experience better health as a consequence -- I think their use can be justified.

Could Bitter Be Better?

Now, after my defense of artificial sweeteners, I'm going to share something that may surprise you. As of this past weekend, I've taken another break from them. I decided to do this after one of my colleagues made a point about Americans disliking the taste of many bitter vegetables prized for their health benefits by practitioners of Ayurveda. Instead of indulging in bitter foods like coffee and chocolate in their natural state, we add sweeteners to mask the flavor. I thought about this, realized how true it is., and did a little research into bitter and astringent foods. I'm one of those rare people who actually enjoys eating unsweetened chocolate (I keep bars of 100% cocoa Ghiradelli chocolate and unsweetened Bakers chocolate in my pantry at all times), and although I typically sweeten my coffee, I also like it with just cream or half-and-half. So I'm interested to see how embracing bitter, unsweetened foods and beverages goes. This is an experiment, and I may go back to using sugar substitutes (given my past history, I'd say that's pretty likely). But I don't think the use or avoidance of them will have much of an impact on my health given that I eat a very healthy, balanced low-carb diet, exercise regularly, get enough sleep, etc. And by the way, unsweetened hot cocoa tea is a lot better than I thought it would be.

References:
  1. Suez J, et al. Artificial sweeteners induce glucose tolerance by altering the gut microbiota. Nature 2014 Oct 9;514(7521): 181-6 
  2. Lavin JH. Lavin JH. The effect of sucrose- and aspartame-sweetened drinks on energy intake, hunger and food choice of female, moderately restrained eaters. Int J Obes 1997 Jan;21(1):37-4
  3. Saha P, et al. Highlighting the anti-carcinogenic potential of an ayurvedic medicinal plant, Swertia Chirata Asian Pac J Cancer Prev. 2010;11(6):1445-9.

12 Comments
Linda Brandon link
11/11/2014 11:07:09 am

Thank you so much for this article, Franziska. I eat LCHF but have felt guilty using Swerve and Ez-Sweetz in a lot of the things I eat. I am still wondering if this is a factor in me not being able to shed about 10 pounds I have gained this year. Not sure what I'm missing, but I've wanted to try to wean myself off the sweeteners. I do feel I'm addicted to the sweet taste. I'll be interested in hearing more about your feelings on going 'bitter'. Looking forward to reading your new book when it comes out.

Reply
Franziska Spritzler link
11/11/2014 11:36:12 am

Thanks so much for your comments and words of support, Linda! Please don't feel guilty for using sugar substitutes. I know it's hard not to when you hear people talking about "clean eating," though. Whether or not they are affecting your weight is hard to say. I like the idea of weaning off them and seeing if it makes any difference in your weight and if you miss them or find that you're okay without them. I'm sure I'll write a follow-up post on my "bitter" experience :)

And thanks for the interest in my book! It's actually going to be a low-carb book just for women, and the title is "The Low Carb Dietitian's Guide to Health and Beauty." Stay tuned for further details :)

Reply
Dan Brown link
11/11/2014 09:32:32 pm

It is a tough choice for me too. And the gut biome aspect is yet another aspect of it; but in the comments section of the original article (abstract only available w/o purchase or subscription) published in Nature, Brenda Hijmans writes, in part, "While alterations of the microbiome may have an important role in the metabolic effects of NAS, it cannot be neglected that these substances travel into the circulation and will interact with the same sweet taste receptors (T1R1/T1R3) as natural sugars, located throughout the body. Binding of artificial sweeteners to the sweet taste receptor in the intestines increases glucose absorption by upregulation of glucose transporter expression^2^. Also, studies in rats indicate that the ability of sweet tastes to signal calories may be disturbed by artificial sweetener use, through weakening of predictive relationships between sweetness and energetic value^3^."

So, it seems clear to me that nothing is clear at all, yet, about the effects of NAS. "upregulation" and "disturb" and "weakening" are just a few of the uncertainties that remain. And the "inherent" trait in both humans and rats (apparently) for something sweet is confirmed; or is it? Keep us posted on your "bitter is better" experiment. I especially like the "paleo" or "ancestral" aspect of it.

Oh, and then there's the complication that both Hijmans (in Nature) and Richard K. Bernstein (in the Diabetes in Control precis) point out that the NAS used in the study(commercial saccharin) is 95% glucose and 5% saccharin. So many confounders!

Reply
Franziska Spritzler link
11/11/2014 09:46:18 pm

Thanks so much for your insightful remarks, as well as the quote from the Comments section of the original paper, Dan. I completely agree that there's still so much we don't know about the potential short- and long-term effects of artificial sweeteners. Yes, using Sweet 'n Low and similar NAS made with dextrose is another thing that makes me scratch my head. Why not use pure saccharin, sucralose, or aspartame instead?

Still enjoying the unsweetened life for now and plan to write a follow-up most about my experience in a few months or so :)

Reply
Dan Brown link
11/12/2014 05:00:13 am

Oh, yeah, and congratulations on your book deal. That is very exciting indeed.
Dan

Franziska Spritzler link
11/12/2014 05:02:41 am

Thanks, Dan! Not a book deal, though. I'm self-publishing so I can write it exactly the way I want to. I wouldn't do it any other way!

Reply
Eddie Mitchell link
11/14/2014 02:21:55 am

"The Low Carb Dietitian's Guide to Health and Beauty." Well you are certainly well qualified to talk about both subjects. A great dietitian with the looks of a movie star!

OK today's grovel over, a great post as always. Check out this video, backs up what we have been saying for a long time.

http://www.youtube.com/watch?v=7WNqUbDbVqE#t=22

The very best to you and yours.

Kind regards Eddie

Reply
Franziska Spritzler link
11/14/2014 09:03:11 pm

Thanks so much for the nice compliments and feedback on my post, Eddie. Appreciate your support very much. Yes, Catalyst definitely did a great piece on low carb diets. Exciting times ahead!

Kind regards to you and Jan,

Franziska

Reply
Nell McVeigh
11/22/2014 01:19:23 am

I love a bitter taste, escarole, radicchio black coffee etc. and sour too. Never have been a big fan of a sweet taste. I have found lately though since going Keto the every once in a while I like a little sweet at the end of a meal. I have a small piece of choco perfection and that seems to do the trick!

Reply
Franziska Spritzler link
11/22/2014 10:51:34 pm

Thanks for your comments and feedback, Nell! I'm still not missing the sweet taste, and I'm definitely experiencing a heightened sensitivity to the natural sweetness in nuts, seeds, and fruits. Love it!

Reply
Nanette Wise
12/12/2014 06:45:56 am

Hi, I am new to your blog, but I'm enjoying (and learning) a lot. I am 49 and post hysterectomy surgery in 2010. I am starting a Keto lifestyle change because I have gained so much since my surgery. Has there been any research done on women in my similiar situation. I am hoping this change makes a difference in how I look and feel.

Reply
Franziska Spritzler link
12/12/2014 07:08:22 am

Welcome, Nanette, and thanks for your kind words. I'm sorry to hear you've experienced significant weight gain since your surgery. In women who have had a total hysterectomy with removal of both ovaries, I've found that weight gain is common as a result of being thrown into immediate menopause and placed on HRT, and there's research supporting this: http://www.ncbi.nlm.nih.gov/pubmed/23007036.

But even women who only have their uterus removed sometimes experience weight gain as well, particularly once they're in their 40s.
http://www.ncbi.nlm.nih.gov/pubmed/19445617

Ketogenic diets and low-carb diets in general can be beneficial for women struggling with weight gain and insulin in perimenopause or menopause, but please read my blog post from today regarding the importance of including plants and fiber rather than simply keeping carbs as low as possible.

I wish you the best of luck in losing weight and feeling your best.

Franziska

Reply

Your comment will be posted after it is approved.


Leave a Reply.

    Author 

    Franziska Spritzler, RD, CDE

    Categories

    All
    Academy Of Nutrition And Dietetics
    American Diabetes Association
    Answers.com Articles
    Authority Nutrition Articles
    Bone-health
    Bpa
    Calories
    Cardiovascular Disease
    Dairy
    Diabetes
    Dietetic Associations
    Fiber
    High Fat
    Hyperinsulinemia
    Inflammation
    Insulin Resistance
    Introduction
    Ketogenic Diets
    Low Carb
    Muscle Mass
    Net Carbs
    Paleo
    PCOS
    Primal
    Protein
    Quick Low Carb Treats
    Quick Low-Carb Treats
    Recommended Reading
    Restaurants
    Reviews
    Saturated Fat
    Seafood
    Sugar Addiction
    Thanksgiving
    Thyroid
    Veganism
    Weight Management
    Weston A. Price Foundation

    Archives

    July 2019
    March 2019
    January 2019
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    June 2016
    May 2016
    April 2016
    March 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    June 2013
    May 2013
    April 2013
    March 2013
    February 2013
    January 2013
    November 2012
    October 2012
    August 2012
    July 2012
    June 2012
    May 2012
    March 2012
    January 2012
    December 2011
    November 2011
    October 2011
    September 2011
    August 2011
    July 2011

    RSS Feed

  • Home
  • Book
  • About Me
  • Blog
  • Contact
  • Research
  • Links
  • My Diet Doctor articles