Do Artificial Sweeteners Cause Diabetes?

Nutrition confusion strikes again! A few weeks ago the media headlines blared that saturated fat is now actually good for us (this one is still being debated) and just last week we were told that artificial sweeteners can increase our risk of diabetes! Yikes – my job as a nutritionist is getting tough. Many health minded people have been preaching the evils of artificial sweeteners for years because they are, well … artificial and are probably not healthy for the body. But is it actually possible that something that contains NO calories and NO sugar may actually cause diabetes? For those of you who like the blue, pink or yellow stuff, read on to get my take on this new study. Should you cut out artificial sweeteners?

Hot debate
Artificial sweeteners have been around for years. To name a few –  saccharin,  aspartame, acesulfame potassium and sucralose. These non-nutritive sweeteners are frequently used by people who are looking to cut down on calories and/or sugar. Despite having been approved as safe for human consumption, the pros and cons of artificial sweeteners have been a hotly debated topic for years. With regards to body weight, there have been a few studies in the past few years suggesting a link between these sweeteners and weight gain (one suggested mechanism is that the sweet taste tricks the body to store more fat.) … yet the next week another study comes out dismissing this link.    pic credit 

The new study
Last Wednesday, a study came out in the journal Nature that suggested that for some people, consuming artificial sweeteners may lead to type 2 diabetes just as much as eating sugar. The mechanism has to do with one of my favorite subjects – the gut microbiome. These little bugs (aka bacteria) that live in your intestine digest food and may play a role in health. This study suggests that differences in gut bacteria may explain why some people can handle artificial sweeteners without a problem while in other people it may lead to diabetes. Sounds kind of strange – right? But I’ve been attending conferences on the gut microbiome for the past 2 years and the research is fascinating. Did you know that 70% of your immune system comes from your gut? They are also linking gut bugs to heart disease, So it’s not surprising that there MAY be a link between artificial sweeteners and blood sugar. But the key word is MAY … 

Criticism
 While this is interesting research, there is still some criticism with the study. The media loves to grab attention getting headlines! Even the authors of the study noted that their work needs to be repeated before we can be sure that artificial sweeteners really trigger diabetes. One critic, Haley Curtis Stevens, Ph. D. and President of the Calorie Control Council, points out that “the study suffers from small sample sizes, unrealistic sweetener applications and doses, and a dependence largely on rodent research. Findings should be interpreted with caution”.

Here are some other noted problems with the study as noted by the Calorie Control Council*:
– Consumption Levels — The study was conducted under circumstances not applicable to real life, with consumption levels at many times the typical intake
– Sample Size — With its small sample size in both the mice and human research, the study findings may not be applicable to all populations
– Study Period — The human trial was conducted over too short a period, with results inappropriately extrapolated and generalizations made despite the lack of confirmation from larger, longer studies with a more diverse population
– Lack of Evidence — In the mice study, subjects in the low-calorie sweetener groups did not gain weight, yet researchers concluded that the observed changes in microbiota or blood glucose response were related to obesity
– Lack of a Control Group — In the human study, there was no control group, which affects the generalizability of the results.

Other experts agree with the study and feel this study should be given some serious thought. I’d recommend that you read Dr. Sharma’s article on What We Can Learn From the Sweetener and Gut Bug Study

My opinion
As a registered dietitian, I make my recommendations on evidenced based science – and not from just one study. I feel that more studies are needed before I would feel comfortable telling my clients to avoid artificial sweeteners due to risk of developing diabetes. That being said, I’m not a fan of artificial non-nutritive sweeteners! I encourage moderate portions of the real thing. But the key word here is moderation. Many Americans seem to have a difficult time when it comes to moderation. The average intake of added sugar is 22 teaspoons a day! Too much added sugar can cause heart disease, obesity and increase risk of diabetes. So what’s a person to do?

Here are my recommendations:

1. Don’t start to load up on real sugar(s). Do you best to cut down on ALL added sugars – even the supposed healthier “natural” ones (like honey, agave, etc.). Tips to help you:
– Sweeten plain yogurt with fresh fruit
– Add fruit slices to your water or plain seltzer to jazz it
– Read labels for sugar in the ingredient list

2. Keep in mind if you are at risk for developing diabetes, losing weight and exercising are the 2 most important things you can do.

3. If you choose to continue to consume artificial sweeteners to cut back on calories or sugar, at least consume them in moderation. My concern is for those people who have multiple servings a day. These sweeteners can appear in many products so make sure you read the ingredient list closely on food labels. For example, many “naturally flavored” waters contain sucralose.

4. Try stevia, a natural sweetener

Bottom line, this was an interesting study. Be prepared to hear more about the gut microbiome in the coming years. I do believe we will learn a lot more about how different foods affect the microbiome, which in turn affects our health. The fewer chemicals we ingest, the better!