Artificial sweetener: Friend or foe?

June 16, 2024, 3:25 PM IST Lalit Kapoor in FIVE PILLARS OF HEALTH: A Blueprint for Wellbeing, India, TOI

“These findings (2008 San Antonio Heart Study) raise the question of whether artificial sweetener use might be fueling—rather than fighting—our escalating obesity epidemic.”

                         Dr. Sharon Fowler 

In last week’s blog, we learned about the harmful effects of sugar so a natural question that comes to mind is why not use artificial sweeteners. In today’s blog, we will explore this subject.

The use of substitute sweeteners has expanded rapidly in the last half-century. There is a lot of confusion about the benefits and harms of artificial and low-calorie sweeteners. Many people, especially those who are overweight or diabetic, consume them thinking they are helping themselves. I hope this post will debunk that myth.

History

The story of artificial sweeteners begins in 1879 when saccharin was inadvertently discovered. Its popularity grew during the sugar shortages of the world wars. Saccharin led to further research, and in 1951, cyclamate was approved as a food additive. The combination of cyclamate and saccharin became America’s most popular sugar substitute and “Sweet’N Low” was created in 1957. Initially popular for its low cost, its low-caloric value soon became the primary interest during the automobile boom, leading to the start of obesity. Diet sodas emerged, and Sweet’N Low gained popularity.

Health concerns were ignored until the Pure Food and Drug Act forced the FDA to temporarily ban saccharin after links to cancer were documented. In 1977, a Canadian study highlighted bladder cancer in lab rats exposed to saccharin, leading to its ban in Canada. Aspartame, discovered in 1965, became controversial after a 1977 FDA investigation found it caused deaths in infant mice.

Stevia, used as a sweetener in South America for centuries, and in Japan since 1970, was approved by the FDA in 2008. Truvia and Purevia, derivatives of Stevia, were developed by Coca-Cola and Pepsi, respectively. The world’s most commonly used sweetener, sucralose (Splenda), was discovered in 1976 and approved by the FDA in 1998. Erythritol, introduced in the US in 2001, is a sugar alcohol found in natural fruits but usually made synthetically or from corn.

Current Status

Despite health concerns, aspartame continues to be a frequently used food additive since 1983. All sweeteners sold in the US have gone through testing and been found to be harmless, otherwise, they would not be approved. However, this does not mean they are truly harmless, as studies can be structured to achieve desired results.

Science

Our bodies evolved to sense the desirability of food with the tip of the tongue. Sweet food signaled to eat as much as possible until full, a behavior that led to the concept of appetizers. Hunger is more related to our circadian rhythm and the Ghrelin hormone, which is released based on the circadian rhythm. However, even when not hungry, tasting sugary or fatty food triggers an immediate appetite.

When you taste an artificial sweetener, the body believes the food is desirable and wants to eat more. However, artificial sweeteners don’t lead to satiation, resulting in overeating.

There is growing evidence that non-caloric sweeteners lead to obesity and increase the risk of diabetes.

Food companies argue and present many studies that have concluded otherwise or shown mixed results, but we know how these studies have a way of achieving results depending on who is funding them.

A 2016 study titled “Effects of Artificially Sweetened Beverages on Weight Outcomes: A Systemic Review of Reviews” found that review results depended on who was sponsoring the study.

Diet alternatives to most beverages have filled the market in the last five decades. However, most independent research points out that all non-caloric sweeteners, whether artificial or natural, are unhealthy. Some sweeteners are toxic and may cause cancer or other serious diseases. Some people seek unprocessed versions like stevia, monkfruit and agave, thinking they are safer, but even these can lead to overeating and obesity.

The issue isn’t necessarily with the substance itself; it’s about how our body reacts to it. Sweetness triggers bodily responses, including the release of hormones and mechanisms related to satiety.

When our tongue senses a sweet taste, the brain signals the pancreas to release insulin. Insulin’s role is to help glucose enter muscle cells. However, if there is no glucose present, this insulin is not utilized, leading to an increase in insulin levels in the blood. A higher insulin level indicates an abundance of glucose in the blood. When the liver receives this message, two reactions occur:

1. The liver stops burning fat, assuming there is enough glucose available for energy.

2. The liver converts any fructose into fat. If the fructose consumed is in a refined form, it is absorbed rapidly, overwhelming the liver. In this situation, the newly formed fat may not be sent to the subcutaneous fat cells under the skin for storage but instead spill over into the following areas:

1. The fat spills over into the liver itself, causing fatty liver, which can lead to a condition called Non-Alcoholic Fatty Liver Disease (NAFLD).

2. The fat deposits onto vital organs as visceral fat.

3. The fat deposits between muscle cells (intramyocellular lipids), blocking insulin receptors. This causes insulin resistance, which is the primary cause of type-2 diabetes.

In addition, the body’s satiety mechanism is fooled leading to increased food consumption and weight gain. Most independent studies support this finding.

This is no longer a debated fact; what remains debated is the precise mechanism by which this happens. Evidence from two large studies on this subject includes:

1. A survey by the American Cancer Society of 78,694 women found that those using artificial sweeteners were more likely to gain weight.

2. Dr. Sharon Fowler’s 2008 San Antonio Heart Study, which studied 5,158 adults over an eight year period, found that diet beverages substantially increased the risk of obesity by 47 percent.

Conflicting reports often generate confusion within nutritional science. One study might show a benefit, while another shows the opposite. Generally, the deciding factor is who funded the study. Researchers reviewed seventeen studies on sugar-sweetened drinks and weight gain. Studies sponsored by food companies often showed no relationship between sugar-sweetened drinks and weight gain, while independently funded studies showed a strong relationship.

Conclusion:

When in doubt, I advise against all highly processed products and products that don’t look like food. My recommendations for sweeteners are dates, date syrup, date sugar, raisins, blackstrap molasses, jaggery, and raw honey, in that order. They should only be used in moderation. If you are seriously ill, jaggery and honey should also be avoided.

To Read this article on Times of India click here