Written by Kelsey Schaffstall, Dietetic Intern for Hailey Crean Nutrition LLC

What are ‘Artificial Sweeteners’?

Artificial sweeteners, also known as nonnutritive sweeteners (NNS), are sweet-tasting sugar alternatives that contain low to no calories. The FDA currently approves the use of acesulfame-potassium/Ace-K, aspartame (Equal), neotame, adventame, saccharin (Sweet’N Low), sucralose (Splenda), stevia extract, and monk fruit extract (1).  Amongst everyday Americans, these sweeteners are commonly used as a means of weight management without having to sacrifice ‘sweets’.

What the Research Says About Artificial Sweeteners and the Insulin Response

First, here’s some background on blood glucose control. Insulin is a hormone secreted by the pancreas that lowers blood sugar. When a person eats food containing carbohydrates, it’s broken down into glucose and sent to the bloodstream causing blood sugar to rise. In response to high blood sugar insulin is released and acts as a ‘key’, allowing glucose to enter body cells from the bloodstream. The American Diabetes Association (ADA) defines insulin resistance as ‘the body’s inability to respond to and use the insulin it produces’(2).  In other words, as the body becomes insulin resistant, it requires higher levels of insulin to return blood glucose back to normal. When insulin resistance progresses to diabetes, blood sugar can no longer be controlled by the body’s insulin supply and instead must be treated with dietary, lifestyle, and pharmaceutical interventions.

Artificial sweeteners are sugar-free, so they don’t impact your body’s insulin response, right? In theory, yes, this would make sense. However, emerging research is discovering that these sugar alternatives may have a more complex effect on the body than we once thought.

A 2019 review explains the possible mechanisms behind the puzzling effects of NNS in recent studies. First, sweet taste receptors found not only in the mouth, but all throughout the GI tract, may stimulate the secretion of hormones involved in glucose homeostasis, leading to insulin resistance (3).  Second, NNSs may interrupt the body’s learned response to sweet taste, increasing food intake in the long run (3).  In other words, the mouth tastes ‘sweet’ and sends signals to the brain telling the body to prepare for a carbohydrate-rich meal, but those carbohydrates never come. Think of it like a knock at your front door when you’re expecting guests, but when you open it no one is there. Confusing, right? Finally, NNSs may influence gut bacteria in a negative way, promoting weight gain and insulin resistance (3).

A 2017 systematic review examined the long term effects of NNSs and concluded that the existing evidence does not support the use of NNSs for weight management, reporting associations between chronic NNS use, higher BMI, and cardiometabolic risk factors (4).  It’s important to point out here, however, that association does not prove causation. The ADA and the Academy of Nutrition and Dietetics both endorse the safety of NNSs but acknowledge that NNSs are typically associated with the consumption of less nutritious foods, which could play a role in this relationship.

Other studies have focused on the insulin response. A 2020 study of patients with Type 2 Diabetes found an association between the consumption of artificial sweeteners and higher levels of insulin resistance (5).  In the same year, a randomized controlled trial explored the effect of chronic sucralose (Splenda) consumption in healthy adults. Participants consumed either plain water or a sucralose solution (equal to 1-2 diet sodas per day) every day for 10 weeks. The study reported reduced insulin sensitivity and increased A1c from baseline with chronic sucralose consumption despite no significant differences in dietary intake over the intervention period (6).  However, this result was not dose-dependent which warrants future research (6).

Some researchers have taken a deep dive into the gut, examining the microbiome. A 2019 study of adults with obesity found variations in gut bacteria between frequent NNS consumers and those who don’t consume them. The primary finding was decreased fecal butyric acid associated with NNS use (7).  This is especially interesting since butyric acid is believed to have a number of anti-obesogenic effects such as decreased appetite, increased satiety, reduced insulin resistance, and improved lipid profiles (7).

How Should This Impact My Use of Artificial Sweeteners?

Despite it being too early to draw conclusions from this new evidence, what most scientists agree on is that more research needs to be done on this topic. The emerging evidence isn’t to say that artificial sweeteners aren’t safe, just that they may not be as metabolically inactive as we once thought.  For now, it is probably safe to say that artificial sweeteners should be used in moderation, just like table sugar. It’s also possible that limiting your consumption of ‘sweets’, regardless of what sweetener is used, is what could be best for your health in the long run.

 

References

1. Administration UFaD. Additional Information about High-Intensity Sweeteners Permitted for Use in Food in the United States. https://www.fda.gov/food/food-additives-petitions/additional-information-about-high-intensity-sweeteners-permitted-use-food-united-states. Published 2018. Accessed June 10, 2020.
2. Association AD. Common Terms. Resources for students Web site. Accessed June 8, 2020.
3. Liauchonak I, Qorri B, Dawoud F, Riat Y, Szewczuk MR. Non-Nutritive Sweeteners and Their Implications on the Development of Metabolic Syndrome. Nutrients. 2019;11(3).
4. Azad MB, Abou-Setta AM, Chauhan BF, et al. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. CMAJ. 2017;189(28):E929-E939.
5. Mathur K, Agrawal RK, Nagpure S, Deshpande D. Effect of artificial sweeteners on insulin resistance among type-2 diabetes mellitus patients. J Family Med Prim Care. 2020;9(1):69-71.
6. Bueno-Hernandez N, Esquivel-Velazquez M, Alcantara-Suarez R, et al. Chronic sucralose consumption induces elevation of serum insulin in young healthy adults: a randomized, double blind, controlled trial. Nutr J. 2020;19(1):32.
7. Farup PG, Lydersen S, Valeur J. Are Nonnutritive Sweeteners Obesogenic? Associations between Diet, Faecal Microbiota, and Short-Chain Fatty Acids in Morbidly Obese Subjects. J Obes. 2019;2019:4608315.

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