Tag Archive for: artificial sweeteners

Artificial Sweeteners—Still Your Choice

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The use of artificial sweeteners is always a contentious topic in the health field. Some people hate them, other people love them. I use them occasionally, but when it comes to benefits versus harms, I stick to the research. In this case, it’s what wasn’t stated in the headlines about the study that is important, but we can make a decision based only on what we read. This was an abstract of a presentation at a conference, so some details may have been left out that were included in the study.

The Rest of the Story

The authors established an increased risk of diabetes with artificially sweetened drinks and saccharin in any form, but there were no statistically significant diabetes symptoms linked with total intake of artificial sweeteners, sucralose, or aspartame in all foods. That means that artificial sweeteners used in other foods didn’t raise the risk of diabetes, such as added to coffee, used in ice cream or other dairy products, or used in baking. You have to wonder why it had no apparent impact.

It may be that the specific food delivery system has some impact on why it does or does not have an effect. One possibility is that if the sweetener reaches the gut bacteria, it’s modified in some way so that it doesn’t impact blood sugar or blood sugar release.

It seems odd that they used markers of diabetes as their criteria rather than physician diagnosis. They looked for fasting glucose of 126 mg/dl or more; oral glucose tolerance test 2-hour glucose of 200 mg/dl or more; hemoglobin A1C of 6.5% or more; or use of diabetes medications. The last one makes sense, because you don’t get the meds unless you have a diagnosis, but still, odd language.

FFQ—Again!

Even though the food frequency questionnaire is still a good assessment tool when used with interviews, I checked the validation studies. The correlations with food diaries and interviews for the food frequency questionnaire developed specifically for the CARDIA study were no better than 0.5, indicating a moderate positive relationship—maybe it did, maybe it didn’t. That’s much worse than other correlations used in large studies. Also, the first two nutritional assessments couldn’t have assessed sucralose because it wasn’t available until after they took place; I don’t know why sucralose was included when it wasn’t available for almost half the follow-up period.

The Bottom Line

The debate on artificial sweeteners will go on, because people love them or hate them. Based on the results of this observational study, nothing of worth has really been added to the knowledge base. The researchers called for more research to examine how artificial sweeteners impact glucose metabolism. We don’t know that it does from anything done in this study, but that doesn’t mean well-designed studies shouldn’t be done in the future. Until then, it’s up to you whether to use artificially sweetened drinks or not. Maybe a better idea is to give up the mega-burger and fries instead.

What are you prepared to do today?

        Dr. Chet

Reference:  Cur Devel in Nutr  https://doi.org/10.1016/j.cdnut.2025.107034

Artificial Sweeteners—Again

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“I’ll have the jumbo mega-burger with extra cheese, a large order of fries, and a diet cola.” Have you ever heard that when you’re standing in line? Have you maybe ordered that yourself? That’s what I thought of when I read the health headlines about the dangers of artificial sweeteners contributing to the development of diabetes.

The Coronary Artery Risk Development in Young Adults (CARDIA) study began in the early 1980s by recruiting and tracking young adults to determine which factors are associated with the development of heart disease. Nutrition was one of the primary factors that was tracked using a food frequency questionnaire with dietician interview. They tested the subjects at the beginning of the study, at year 7 of follow-up, and year 20 of follow-up.

After tracking the subjects for almost 25 years, they found that 14.8% of subjects developed metabolic changes that indicated diabetes. Comparing the highest quintile of artificially sweetened drink use with the lowest quintile, there was a 129% increased risk for developing diabetic symptoms in the highest quintile. The use of saccharin was also associated with 120% increased risk of developing diabetes.

Is there more to this study that wasn’t highlighted in the headlines? I’ll cover that in Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

Reference:  Cur Devel in Nutr  https://doi.org/10.1016/j.cdnut.2025.107034

The Actual Effects of Sucralose

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Continuing the examination of the study on diet drinks and appetite, let’s get into the details of the study. The MRI portion of the study is difficult to interpret for the layperson. The researchers seemed to think that based on the brain response, obese women would be more susceptible to overeating after consuming a drink with sucralose than sucrose. Did they eat more? More important, did their blood values vary abnormally?

Blood Response to Sucralose

To me, the most significant finding was that there were no abnormal physical responses to sucralose. A prior study suggested that sucralose raises blood insulin in anticipation of sugar following a drink sweetened with artificial sweeteners, but that didn’t happen in this study. There were no differences in blood sugar, insulin, glucagon-like peptide-1, or other measures in response to sucralose that differed from drinking water (the placebo). That in and of itself is a significant finding.

Eating Response to Sucralose

The average buffet intake two hours after consuming the drinks was about 900 calories regardless of whether the subjects had the drinks with sucrose, sucralose, or plain water.

It should be noted that the food intake varied by +/- 450 calories. When analyzed by weight class and gender, obese women ate about 100 calories more after the sucralose drink, but that’s still fewer calories than if they’d consumed a 300-calorie sugar drink. The subjects served as their own controls, meaning they were tested under each drink condition.

In this case, seeing the raw data for every subject might have helped. The subjects were tested in random order but by the third exposure to the same buffet items, they might have decided to eat more or less of their favorite snack foods.

More

The NPR science writer chose the title “Diet soda may prompt food cravings, especially in women and people with obesity.” In a television courtroom drama, they’d call that “assuming facts not in evidence.” Here’s why that title was particularly misleading: there was no diet soda used in this study. The drinks weren’t soda and they weren’t carbonated—they were more like Kool-Aid. It’s tempting to extend the idea to diet soda, but that wouldn’t take into account the effect of carbonation.

There was also no measure of food cravings. People were offered food and they ate it or they didn’t, so the headline was doubly misleading.

The Bottom Line

The study did contribute to the knowledge about artificial sweeteners, especially as they impact blood sugar and insulin. If you use sucralose, there’s no reason to stop. If you don’t, you have to decide for yourself whether you want to use it or not. Artificial sweeteners can be part of a weight loss effort, but the only way they help is if you don’t eat more to make up for the calories you’re not getting when using them. “I’m getting a diet soda, so I’ll get the large fries”—if that’s how you’re thinking, you’re missing the whole point of diet drinks. If you can maintain or decrease your caloric intake of all other foods and drinks but substitute sucralose for sugar, then you’ll be ahead of the game.

What are you prepared to do today?

        Dr. Chet

References:
1. Allison Aubrey YOUR HEALTH NPR. Diet soda may prompt food cravings, especially in women and people with obesity. October 7, 2021.
2. JAMA Network Open. 2021;4(9): doi:10.1001/jamanetworkopen.2021.26313

Does Diet Soda Increase Appetite?

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“Diet soda may prompt food cravings.” If you regularly drink diet soda with non-nutritive sweeteners such as sucralose, that headline would give you pause. Could drinking drinks with artificial sweeteners cause you to compensate later for being cheated out of calories? That’s what researchers attempted to find out in a very complex study conducted at the University of Southern California.

When I say complex, here’s what I mean. The researchers used an MRI to perform brain scans in response to photographs of different types of foods and non-foods. The 74 subjects were all tested under three conditions: after drinking 300 mL (1.25 cup) of water, 75 grams of sucrose (sugar) mixed in 300 mL water, or 300 mL of a sucralose drink matched for sweetness to the sucrose drink. Blood was tested before and after drinking the fluid at regular intervals up to two hours afterward. Then the subjects were allowed to eat as much as they wanted at a snack buffet with high-fat, high-sugar choices as well as healthy choices.

The researchers found differences in the way men and women responded to the drinks as well as the way normal, overweight, and obese subjects responded, both in the brain scans and in how much they ate at the buffet: obese women responded by eating more at the snack buffet than men or other weight classifications.

Is it time to stop drinking diet soda? A little more information from the study would be helpful before you clean out the fridge and go buy a case of Coke.

What are you prepared to do today?

        Dr. Chet

References:
1. Allison Aubrey YOUR HEALTH NPR. Diet soda may prompt food cravings, especially in women and people with obesity. October 7, 2021.
2. JAMA Network Open. 2021;4(9): doi:10.1001/jamanetworkopen.2021.26313

Artificial Sweeteners and Your Digestive System

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Before I address the concerns of the study on artificial sweeteners I talked about on Tuesday, be assured that I’m bringing you the facts as I interpret them. If you don’t use artificial sweeteners, I’m not trying to convert you, but I’m not going to let slide inflammatory headlines that only seek to raise fear where none should exist. The problem with the artificial sweeteners study is that it didn’t use a systems approach.

Bench Science

What the researchers did would be considered bench science. It’s basic in its approach: create a medium where the bacteria will grow, throw in various quantities of the artificial sweeteners, and see what happens. That’s a good first step in any type of research to see an impact on an entire organism. The same is true for examining the effect of the artificial sweeteners on the bacteria in the cancer cell medium. They established that chronic exposure to artificial sweeteners cause two probiotics to become pathogenic.

However, that’s where it ends. Trying to explain an increase in the obesity and diabetic epidemics because of how artificial sweeteners may impact a couple of gut bacteria doesn’t make any sense. It’s stretching things way too far with no evidence that what they’re describing happens at all. In effect, they’re trying to explain a health issue by looking at potential causes. Fine, good start—but now there’s a whole lot of animal and human clinical research that has to take place in order to prove whether it’s true, because what happens in a lab is often not what happens in a human.

Bench science has its place for sure, but it has serious limitations. In our headline-a-minute world, everyone is too eager to claim credit for something that hasn’t been proved.

The Digestive System

The human body is made up of various systems; the digestive system is one of them, but it doesn’t begin and end with the epithelial cells of the intestine. Food (including artificial sweetener) starts in the mouth with its salivary glands, goes down the esophagus, enters the stomach with its specialized fluids, travels the 20 to 30 feet of small intestine where more unique fluids do their jobs, and then the 10 to 15 feet of large intestine before it exits the body. The digestive system doesn’t act alone; it requires input from other organs and systems along the way: the pancreas, the liver, and so on. Every one of those could have an impact on the metabolism and elimination of artificial sweeteners and could impact how bacteria behave in the digestive system.

I could write a book on this subject, but let me just point out one thing that should be obvious: they tested two probiotic lines. Two. As of the last count, there are at least 6,500 different microbes that coexist within our digestive system. There are also trillions of them, each with a role to play, and we still don’t know what each and every one does. As I said, it’s complicated.

The Bottom Line

This study illustrates where good research begins: in bench science. There’s a lot more science that has to happen before we become alarmed about whether or not artificial sweeteners directly impact our microbiome, but their approach does raise a question that I’ll talk about next week: a systems approach to Aging with a Vengeance. We look at pain or other conditions as something that stands alone, but in reality, we may need a systems approach to deal with it.

What are you prepared to do today?

        Dr. Chet

Reference: Int. J. Mol. Sci. 2021, 22, 5228. https://doi.org/10.3390/ ijms22105228

Are Artificial Sweeteners Toxic to the Microbiome?

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If you use artificial sweeteners and you saw the words “danger,” “artificial sweeteners,” and “serious health issues” all in the same headline, you’d probably be concerned. The headline recently appeared in my newsfeed, and because many of us use artificial sweeteners, I had to check it out. Here’s what researchers found in a study published in the International Journal of Molecular Sciences.

The researchers examined the impact of three artificial sweeteners (aspartame, sucralose, and saccharin) on two strains of probiotics and one form of tissue from the digestive system. First, they tested whether the artificial sweeteners at various concentrations impacted the growth of the bacteria in a typical medium. They didn’t (with the exception of saccharin at the highest concentration.)

Then they tested whether the sweeteners affected the ability of the bacteria to produce a biofilm, something that’s important to our intestinal health. They didn’t.

Finally, they examined whether exposure to artificial sweeteners would cause changes in the bacteria to make them pathogenic; that can happen, for example, with E. coli. Using cell lines drawn from an established line of colon cancer in this experiment, they demonstrated that the bacteria could potentially become pathogenic and enter the cell walls of the epithelium. That means they could theoretically enter the bloodstream and impact our health.

That sounds pretty bad, right? It certainly seems to merit the use of the words “artificial sweeteners,” “dangers,” and “serious health issues” in a headline. But is it of any real concern to you and me? I’ll let you know in Saturday’s memo as we talk about an important topic related to Aging with a Vengeance.

What are you prepared to do today?

        Dr. Chet

Reference: Int. J. Mol. Sci. 2021, 22, 5228. https://doi.org/10.3390/ ijms22105228

Sugar vs. Sweetener Research: Meaningless in the Real World

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I’m in a slight disadvantage in evaluating this study; I was able to read only the convention-session abstract and the press release. There were no recordings of the presentation that I could find, so there are details I don’t know. I have questions about the process, not the results, so here are my thoughts.

The In-Vitro Study

If you’re not familiar with the lingo, time to learn. In vitro is Latin, meaning literally “in glass.” An in-vitro study is conducted in a Petri dish, a test tube, or some location outside of an entire animal or human.

In this study, researchers exposed endothelial cells from the rats’ arteries to sugars and artificial sweeteners. We know there were changes in proteins; what we didn’t know is whether the change in protein genes that were activated in response to the artificial sweeteners mimicked a pattern we might see in a rat that’s diabetic. That’s an important question.

It would have been more meaningful if they examined a pattern of protein responses that occurred in the endothelial cells of rodents that already had diabetes. Just because something is activated in response to a stimulus, in this case sugars or artificial sweeteners, that doesn’t necessarily mean it’s a bad thing. It just means it happened.

The In-Vivo Study

In vivo is also Latin and means within a live animal or human. I have several issues with the rodent part of the study. First they gave high levels of sugar to the rats as well as high levels of artificial sweeteners. It would seem to me that it would be beneficial to get an estimate of what humans actually consume on a daily basis, dose it down to the appropriate amount for a rat, and start with that. Then you can compare your test results to a “normal” level. Next you can begin increasing the amount to see when the negative effects begin.

Second they used the DR/BB rat; DR stands for diabetes resistant and BB stands for biobreeding. This type of rodent is often used for research on type 1 diabetes because although it’s diabetes resistant, it has an underdeveloped immune system. It will respond to environmental insults differently than normal rats. Excess levels of sugar and artificial sweeteners may create an insult to the immune system to cause type 1 diabetes in this breed of rat.

The reason for doing the study was to see if artificial sweeteners may be contributing to the obesity and diabetes epidemic—type 2 diabetes, not type 1. Using this breed of rat seems like it would muddy the results. The changes they found in the blood of these rats fed excessive amounts sugar and artificial sweeteners would have been expected. The question is whether this is related directly to the research hypothesis or not. In my opinion, no.

To make this study pertinent to humans, we would need a similar pattern found in humans. Perhaps people under excessive stress and whose immune systems were compromised might show some relationship. But we’re not talking about susceptibility to type 1 diabetes. We’re talking about type 2 diabetes, and although they share a name, they’re vastly different diseases.

What we have is a study in test tubes on protein genes that are activated in response to artificial sweeteners and a second study on rodents with some dysfunction in over 200 different protein genes in response to sugar and artificial sweeteners. We may have people who use excessive amounts of artificial sweeteners everyday. We may have specific but as yet unknown gene patterns that may make people more susceptible to type 2 diabetes, but we haven’t identified what those genetic patterns are at this point or even if they exist at all.

The Bottom Line

So what does this study mean? This basic research shows that there may be a pattern to protein synthesis that’s different in high-sugar versus artificial-sweetener intake. But that does not resemble in any way what the authors of the study suggested in the press release. This study is relatively meaningless in the real world. Maybe we’ll know more about how all this impacts humans in another 5–10 maybe even 20 years. But as of today, it’s just provocative headlines. And we get far too many of those already.

Use artificial sweeteners or do not; that’s your choice. But don’t change based on this study. Use the old adage: everything in moderation including moderation.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

What They Got Right in the Sugar and Artificial Sweetener Research

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Whether it’s a new form of treatment, a new medication, or even examining a phytonutrient for potential benefits, it all starts with basic research. That’s what the study I began talking about Tuesday is all about: basic research. I like it because this is the way all research has to begin. This is where test-tube studies are appropriate.

In this case they used epithelial cells from the vascular system of the rodents, exposed them to high amounts of sugars and artificial sweeteners, and then looked at specific changes in proteins that are involved in various types of cell action. In other words, they were looking for dysfunction in the way the genes for the proteins responded after exposure to the sugars and artificial sweeteners.

Were there differences? Yes. The important thing that they discovered was that the proteins inside these epithelial cells responded differently when exposed to sugar than when exposed to artificial sweeteners.

The question is this: was any of this meaningful in the real world? I’ll let you know what I think on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

The Answer to the Sugar Conundrum

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Whether you have prediabetes, type 2 diabetes, or are just concerned about the calories in the sugary treats this holiday season, what should you do? Go without and feel deprived, or indulge and pay some sort of price? Let’s take a look by beginning with a few questions.

Why do you want to reduce your sugar intake? Do you want to reduce your caloric intake? Is it because you know you have prediabetes or type 2 diabetes? Are you concerned about gaining weight over the holiday season? Once you know why you want to avoid sugar, you can start . . .

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Sugar Alternatives

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Dealing with our sweet tooth this week, let’s look at sugar alternatives that may give us better choices if we don’t want to use artificial sweeteners.

Sugar alcohols are one alternative; xylitol, sorbitol, and other sugar alcohols are often used in candies and other treats. They can be a reasonable alternative to regular sugar, but there are a few things you need to know. First, they have a pronounced aftertaste; it feels like a cool sensation. Second, they’re not calorie free but . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.