Alyssa Salz | Registered Dietitian Nutritionist
Sugar substitutes are often a go-to for people looking to cut calories and carbohydrates in their diets to be ‘healthier.’ However, they have often been wrought with controversy on their safety. Sugar substitutes have been deemed safe by the FDA and many research studies have been conducted to prove their safety; however safe does not necessarily equal healthy.
Many people use sugar substitutes because they still want a sweet taste but do not want the calories and sugar that comes from table sugar or other sweeteners such as maple syrup or honey. Often it is thought that fewer calories and less sugar would translate to lost pounds, avoidance of weight gain, or even a reduced risk for health problems but new research is revealing that may not be the case!
We all know that added sugars are not good for our health. Research has proven that too much sugar in the diet adds empty calories which leads to weight gain, increases risk for disease, and adds no nutritional value to the diet whatsoever. Added sugars are abundant in regular sodas, candies, and sweets but also are hidden in many food items such as yogurt, salad dressings, condiments, and bread.
Products with non-nutritive sweeteners are an alternative that many individuals and the food industry use to cut back on added sugars. Artificial sweeteners are widely popular with about 40% of Americans consuming them. These sweeteners are also hidden in a lot of foods, even ones that are not labeled light or diet. Sucralose, or Splenda, is the most popular sugar substitute and is part of a $3 billion industry. It is 400-700 times sweeter than table sugar. Other substitutes, including saccharin and aspartame, are also commonly used and can be hundreds to thousands of times sweeter than table sugar. Published studies find mixed results on how these artificial sweeteners impact our health and bodies.
When looking at research studies examining the effect of artificial sweeteners on our health there are a lot of things to consider…
- Who was the study funded by?
- Were the subjects of the study in a controlled environment?
- Was it an animal study that would not necessarily translate to humans?
- How big was the sample size?
- Was the length of the study long enough to reveal patterns?
- Were subjects instructed to make other lifestyle changes that could have made an impact on the results?
Researchers have determined that research on artificial sweeteners overall has been poor quality and that more research is needed but some important trends are being discovered which should concern anyone that frequently consumes sugar substitutes.
The goal of losing weight with the use of sugar substitutes may be counter-intuitive. Newer studies are highlighting this fallacy. Just because something is zero-calorie does not mean that it will lead to weight loss. For example, one study from 2015 () revealed that a higher intake of diet soda was associated with increased abdominal obesity compared to those that drank less or no diet soda at all.
Another long-term study of more than 750 people over 65 years’ old who used high amounts of low-calorie sweeteners (described as the equivalent of 3 or more diet sodas per day), had more weight gain and increased rates of type 2 diabetes and heart disease. Some studies have found that sugar substitutes are associated with a greater risk of type 2 diabetes, metabolic syndrome, increased blood pressure, and heart disease. It is unclear if the increased risk is related to the artificial sugars or if it due to the lifestyles and/or body composition of those reaching for diet soda and other foods sweetened with zero-calorie, sugar-free sweeteners.
There are many hypotheses as to why artificial sweeteners in our foods may be associated with increased weight and health issues. When choosing to drink a diet soda, do people justify eating more food or do they allow themselves to splurge on less nutritious foods? Does the magnified sweetness of artificially sweetened foods increase our desire for sweet foods? Do sugar substitutes alter our taste perception? Or do sugar substitutes disrupt our ability to estimate the number of calories we consume? It is hard to say what exactly is at play but with nearly 40% of American adults battling obesity eliminating products with these sweeteners may be a good strategy to improve our health.
Common beliefs about sugar substitutes include that they are “free” and are processed in the body just as water would be. But new research from the University of Illinois and another featured in Cell Metabolism is turning this belief upside down.
In the study from the University of Illinois, researcher Y. Papino had 17 obese individuals drink a calorie-free beverage sweetened with sucralose (often sold as the brand-name Splenda) and then monitored how their bodies reacted to an oral glucose tolerance test. The researchers then repeated the procedure with plain water. Since many people believe that drinking a beverage with sweeteners is the same as drinking plain water, the thought process would lead you to believe that the results would be the same. However, the researchers found that the participants who received the beverage with sucralose were more insulin resistant than those who drank plain water.
The researcher followed up with additional experiments to determine if the sweet receptors in our digestive tract may stimulate change in blood glucose levels. In a recent experiment they asked participants to spit out the sucralose-sweetened drink to determine if just having the sweet taste would trigger a different response on the glucose test. In this experiment, insulin levels didn’t rise as much as when the drink was swallowed but levels still did rise. Even though the research sample size was small the results prove that more research is needed and caution should be taken with the use of sugar substitutes.
Another new study released in 2020 in Cell Metabolism that received a lot of attention in the press also found that the use of sucralose (Splenda) may cause changes in our body's blood sugar response. In this study researchers broke participants into 3 groups. The first group received a drink sweetened with table sugar, the second group received a drink sweetened with the equivalent of 2 packets of Splenda, and the last group had a drink with a mix of sucralose and maltodextrin (a simple sugar). After 7 weeks the individuals who were given the drink sweetened with artificial sweeteners and simple sugars became glucose intolerant with higher blood glucose and an increased risk for diabetes. The researchers found that the individuals receiving the other 2 beverages had a normal metabolic response and did not show an increased risk for disease.
Again, more research is needed on both of these topics regarding sugar substitutes but the results bring about more questions about the impact these sweeteners have on our overall health. Does simply tasting something sweet impact our body’s metabolism? Does mixing carbohydrates with sugar substitutes confuse our body’s response and decrease our ability to metabolize sugar making us more insulin resistant?
Many researchers are starting to believe that when our body detects something sweet (and remember artificial-sweetened foods are significantly sweeter than natural sweeteners) the body thinks it’s about to metabolize sugar and releases insulin. When this process happens and there is no glucose or sugar for our body to metabolize (as in when we consume non-nutritive sweeteners), the body may adapt over time leading to an increase in insulin resistance.
Health authorities suggest that sugar substitutes are safe to eat even though there are some studies suggesting concerns. Many of these organizations seem to have changed their tune when discussing artificial sweeteners of late. For instance, the American Diabetes Association states on their website regarding artificial sweeteners: “At this time there is no clear evidence that using sugar substitutes help with blood sugar, weight, or cardiometabolic health in the long run.” A welcome change from the past when health organizations would recommend individuals drink beverages with artificial sweeteners to improve their health.
At Seattle Sutton's Healthy Eating we are proud that our meals have been free of sugar substitutes and any artificial ingredients since we began in 1985. We believe in the natural sweetness of fruits but also in not depriving yourself of a treat now and then. We also think that eating something that is over 400 times as sweet as table sugar may only increase our sweet tooth which is counterintuitive to our goal to improving the health of our customers. We are interested to see what the continued research on sugar substitutes reveals but commit to our original mission to be free of sugar substitutes in all of our meals.