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Blog author, Solai Buchanan is an experienced Registered Dietitian and Certified Diabetes Educator with an MS from Columbia Teachers College. She specializes in treating heart disease, diabetes, hypertension, high cholesterol, polycystic ovarian syndrome,and other chronic diseases. She is a provider at a full-service cardiology practice accepting most insurance and staffed with a primary care MD, pediatrician, and cardiologist. Call: 718.894.7907. NYCC is lead by Interventional Cardiologist Sanjeev Palta, MD, FSCAI, FACC. He trained at Cornell-Columbia Presbyterian Hospital and the State University Hospital of Brooklyn. He currently is an Attending Cardiologist at New York Methodist Hospital and Maimonides Medical Center. He is also an Assistant Clinical Professor in the Department of Medicine at Mount Sinai Medical Center. Having performed over 2000 invasive cardiac procedures Dr. Palta’s patients know they are in trusted hands.

Thursday, May 30, 2019

NOT ALL ARTIFICIAL SWEETENERS CREATED EQUAL

Artificial sweeteners, also referred to as “sugar-free”, “low-calorie”, and "calorie-free" sweeteners are substances that taste sweet but add little or no calories to foods and beverages.  Some available  that contain almost no calories in the amounts consumed include aspartame (Equal, NutraSweet), saccharin (Sweet n Low), stevia leaf extract (rebaudioside A, with brands including PurVia, Truvia), monk fruit, and sucralose (Splenda).  Sugar-alcohols such as xylitol, sorbitol have about ½ half the calories of sugars.

While there is solid evidence that intake of full-calorie sweeteners including  table sugar, syrup, fruit juice concentrate, corn syrup, and many others  increases risk of weight gain, insulin resistance and diabetes, fatty liver, heart disease, systemic inflammation, and many other chronic conditions, the role of sugar-free sweeteners on weight and health continues to be a subject of much debate.  Many large observational studies have found associations between sugar-free sweetener intake and weight gain.  At the same time experimental trials have mostly found slight reductions in weight with the use of sugar-free sweeteners.    

A recent study suggests there may be significant differences in how the body responds to the different products.  A randomized controlled trial compared how intake of four different sugar-free sweeteners impacted bodyweight and found bodyweight responded differently depending on which sweetener was consumed.  For the study, 154 adults aged 18-60, who were overweight/obese but otherwise generally healthy and weight stable, were assigned to one of five experimental treatments.   Participants were randomized to drink 5-7 cups (amount varied depending on baseline bodyweight) of a beverage sweetened with one of four sugar-free sweeteners: saccharin (Sweet n’ Low), aspartame (Equal), rebaudioside A (stevia), and sucralose (Splenda), or sucrose (sugar) daily for 12-weeks. Researchers found that those consuming the drinks sweetened with sugar (containing 400-560 calories) gained the most weight, on average 4.1 lbs.  Those consuming Sweet n’ Low gained an average of 2.6 lbs. while those consuming Splenda, Equal, and stevia did not experience significant weight change.  Compared to the other treatments, the Sweet n’ Low consumers reported greater hunger.  Those in the Splenda treatment showed a significant decrease in energy intake and a trend toward weight loss though the amount of change was not statistically significant. 

What to do:  While small, this study suggests that the bodyweight impact of sugar-free sweeteners may differ depending on which sweetener is consumed and that Sweet n’ Low may potentially promote weight gain.  Particularly for diabetics and regular consumers of sweetened drinks, substituting “diet drinks” that contain sugar-free sweeteners rather than caloric sweeteners appears beneficial and outweighs the potential risks of sugar-free sweeteners. Still, in general, it is not known what impact additives and artificial ingredients have on our physiology.  There is some evidence that sugar-free sweeteners increase the appetite for sweet foods and beverages.  Most products containing sugar-free sweeteners contain a mixture of different artificial sweeteners.  While the FDA has approved the available artificial sweeteners as likely safe, some health groups suggest stevia, monk fruit, and sugar alcohols (which contain about ½ the calories of real sugars) are preferable to Equal, Sweet n’ Low, and Splenda because of potential risks of increased rates of cancer at high doses though any increased risk is likely very slight.  Also, there is some evidence that high doses of Equal can worsen mood in vulnerable individuals.    Your best bet is to develop the healthy habit of quenching thirst with beverages that do not taste sweet.     Aim for naturally calorie-free beverages like unsweetened teas, seltzer, water infused with lemon, mint, or cut-up fruit, and just plain water. 

Information adapted from articles available at:

Source:
KA Higgins, RD Mattes.   A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity, The American Journal of Clinical Nutrition, Volume 109, Issue 5, May 2019, Pages 1288-1301, https://doi.org/10.1093/ajcn/nqy381

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