There has been a lot of negative publicity going around about diet sodas and artificial sweeteners recently. A controlled, clinical trial from the Washington University School of Medicine and a series of epidemiological studies are seeking to change the public’s and health care community’s take on the safety and efficacy of these calorie-free additives.
The Washington study looked at one sweetener in particular, sucralose. In this small study of 17 obese, healthy participants, subjects were given either 60 mL of 2mmol/L sucralose or water and then asked to consume a 75 g glucose meal. The amount of sucralose provided mimicked the amount in a can of diet soda. Blood glucose levels were collected prior to beginning the study and for 5 hours after consuming the glucose. The researchers measured glucose, insulin, c-peptide, glucagon and a variety of incretin-based hormones.
Peak glucose concentration, insulin and C-peptide (a byproduct of insulin production) concentration were higher after sucralose than after water. In addition, insulin clearance rates were lower after sucralose. The concentration of the incretins was not significantly different with sucralose than water.
The findings indicate that sucralose may have a negative effect on insulin sensitivity in people who have never used artificial sweeteners before. Whether this effect is clinically (real-world) significant is unknown as is whether the results translate to other populations. It is also unknown whether the findings for sucralose can be applied to other artificial sweeteners.
The study from Washington University School of Medicine, mentioned above, that was published in Diabetes Care used a research model to test if and how sucralose might change the body’s hormonal responses compared to a known inert substance, water. Population-based studies (these studies do not test interventions), on the other hand, compare weight outcomes of people who drink diet sodas to those who do not. Several studies have found a correlation between the increasing intake of diet sodas and weight gain, a seemingly paradoxical outcome.
Even people who believe the rumors that artificial sweeteners cause cancer, generally agree with the supposition that they are metabolically inert and that products made with them provide fewer calories than their high sugar cousins. Artificial sweeteners are often touted as a weight loss aid, but there are rumblings in the scientific literature that this might not be the case.
You might start to shake your head and ask how this could possibly be true. After all we know that the non-nutritive sweeteners are just that –non-nutritive -meaning they don’t contain any appreciable calories. Even sucralose, which has about 1 calorie per packet, would require the use of massive quantities per day to truly contribute to excessive calorie intake.
Scientists have postulated a number of possibilities to explain this possible incongruity including a change in hormonal homeostasis as demonstrated by the study above. Others include that the sweet taste of artificial sweeteners may stimulate people to eat more calorie-containing foods.
Given the limitations of population-based studies, the size of the Washington study, its confinement to one population and the question of its relevance to the real world, much more research needs to be done before health authorities issue a proclamation to reduce or eliminate artificial sweeteners in the diet.
Still it is difficult to know what to believe since a new study comes out almost every day. When you have diabetes, foods with artificial sweeteners can make the diet more palatable. And some sweeteners such as saccharine have been around since the 1880s (although it didn’t gain widespread appeal until after World War I) without being linked to any serious health outbreaks.
Each person needs to weight the impact artificial sweeteners have on making his diet and glucose control manageable against the possible long-term negative consequences of their continued use. Sometimes this is a difficult decision to make on your. Discussing your options with your diabetes educator and/or heath care provider may help you decide what course of action is best for you.
–UPDATE: The following sweeteners, aspartame, saccharin, acesulfame-K, sucralose, rebiana and monk fruit extract have been found safe to use for the general public, including people with diabetes and pregnant women. The American Diabetes Association concurs with this assessment.–