As you may or may not be aware, I belong to quite a few diabetes oriented food groups. There seems to be a recurring theme of people championing sugar-free foods, because they've been taught to only count carbs. While counting carbs is a valid way to lose weight, it may not play as great a role in maintaining a diabetic system as one might want to believe.
When I first started the MDF blog back in 2014 after being diagnosed type 2, my motto was DUMP THE CARBS!, and I truly believed that motto was going to save my life. A decade later I've learned that it's not just simple carbs we have to watch. There are the factors of glycemic index and load as well as portion control, and it seems newer studies are showing that replacing simple carbs with artificial sweeteners may not really be all it's cracked up to be.
This week's Weekend Ramble features two articles from 2014 and 2022. Studies are ongoing and there is a ton of information at your Google inspired fingertips, but it's my hope that these two pieces will give my followers a bit of insight and something to think about when they're preaching:
"OMG SUGAR FREE XYZ IS SOOOO GOOD!!!"
Study: Artificial Sweeteners May Trigger Blood Sugar Risks
National Geographic
By Dan Vergano, September 17, 2014
Bacteria in your gut might determine whether saccharin
triggers glucose intolerance.
Sugary sodas have come under fire for contributing to
obesity and diabetes, but new research suggests artificial sweeteners may also
raise blood sugar levels. Photograph by Sam Hodgson, Reuters
There's no such thing as a free lunch, or at least a free
artificially sweetened one, a new study suggests. Saccharin and other
artificial sweeteners may raise blood sugar levels – a condition the sugar
substitutes aim to help prevent – by altering digestive bacteria, Israeli
researchers reported
on Wednesday. (Related: "What
Lives in Your Gut?")
Sugar-free sodas and diet snacks abound with artificial
sweeteners, invented more than a century ago as a cheaper sugar substitute.
Amid an obesity epidemic, the U.S. Food and Drug Administration has to date
approved six artificial sweeteners, which are widely used and roughly 500 times
sweeter than sugar. These additives cut calories from foods and drinks, and are
seen as precluding the elevated blood sugar, or glucose intolerance, that often
precedes diabetes. (See "Sugar:
Why We Can't Resist It.")
But a first-of-its-kind study suggests one reason why diet
sodas and their ilk don't seem to have made much difference in the obesity
crisis. The answer may lie within ourselves, or at least in the bacteria in our
intestines that are exposed to artificial sweeteners, a joint team headed
by Eran Segal and Eran Elinav of
the Weizmann Institute of Science in
Rehovot report in the journal Nature.
"This huge and poorly understood microbial world which
resides within each one of us, starting from birth, has been shown to have a
huge effect on our physiology," Elinav says. Although cautioning that the
findings are preliminary, he says, "our results suggest the consumption of
artificial sweeteners may affect the microbiome in ways that cause glucose
intolerance in some people."
Over decades of study, research results on artificial
sweeteners have been mixed, with some pointing to artificial sweeteners raising
the risk of elevated blood sugar levels, obesity, diabetes, or other ailments,
and other research suggesting lower risks. Many of the people in those studies
already suffered from these conditions to some extent or ate an unhealthy diet,
or both, when they enrolled, which greatly complicated the results.
A 2012 review of the safety of artificial sweeteners by the
American Heart Association (AHA) and American Diabetes Association (ADA)
suggested that "when used judiciously," artificial sweeteners might
help people lose weight.
But the review also concluded that more research was needed
on the panoply of health questions surrounding the additives. The only one that
seems answered is that saccharin doesn't cause bladder cancer, a well-known
fear raised by lab rat studies in the 1970s, which subsequent studies
determined was unfounded, according to the National Cancer Institute.
Epidemic of Caution
In a briefing for reporters, Segal said that the study
authors are "by no means" calling for people to make any changes to
what they eat or drink, but are asking the scientific community to confirm the
new results and reassess artificial sweeteners.
Experts reacted to the study results with a mixture of
caution and interest, noting that the research was conducted largely on mice
and included only seven human volunteers. And they downplayed a direct link
between artificial sweeteners and the obesity epidemic. More than one-third of
U.S. adults are now obese, according to the Centers for Disease Control and
Prevention.
"Artificial sweeteners are associated with overweight
in humans, but the obvious connection is that overweight people use them
more," says New York University nutrition expert Marion Nestle, by email.
"This is the first study I have seen suggesting that the connection is
mediated through the microbiome. I'm not crazy about artificial sweeteners (I
think they taste terrible), but this needs confirmation before taking it too
seriously."
Epidemiologist Judith Wylie-Rosett of the Albert Einstein
College of Medicine in New York agrees. "It would be a disaster if people
with diabetes started drinking sugar-laced drinks because of this one study, so
we need some caution," says Wylie-Rosett, who co-chaired the 2012 AHA/ADA
review of the safety of artificial sweeteners. "It is an interesting
hypothesis at this point."
Of Mice and Men's Guts
In the new study, the team began by adding one of three
FDA-approved artificial sweeteners – saccharin, sucralose, or aspartame – to
the drinking water of mice. The researchers compared these groups of mice with
others that drank only water. Within 11 weeks, the mice drinking sweetened
water had developed glucose intolerance, most notably when saccharin was added
to their diet.
To see whether the mice's intestinal bacteria contributed to
the problem, the team then used antibiotics to wipe out the mice's intestinal
bugs and found they could return the mice's blood sugar levels to normal.
Finally, they fed fecal samples from
glucose-intolerant mice to normal mice, transferring the unhealthy mice's gut
bugs. The normal mice that got these fecal samples then developed glucose
intolerance within six days.
Analysis of mouse gut bacteria after the experiments found a
proliferation of the bugs involved in digesting carbohydrates in the
glucose-intolerant mice. (Carbohydrates are found in breads, cereals, and other
foods in the human diet.)
"I think this is surprising," Elinav says. He
calls it "counterintuitive" that artificial sweeteners, which are not
meant to be absorbed by the digestive tract, end up apparently altering its
performance.
To see if the effect extends to humans, the team first
looked at 381 people in a nutritional study headed by Segal. They found links
between artificial sweetener use, symptoms of obesity and elevated blood sugar,
and the kinds of altered gut bacteria seen in the mice.
In particular, the study noted a 20-fold increase in the
numbers of Bacteroides fragilis bacteria, linked to inflammation in
the gut.
Finally, as a proof of concept, the team enrolled five adult
men and two adult women who didn't use artificial sweeteners in a one-week
experiment. In the experiment, the volunteers ate the FDA's recommended
allowance of saccharin, about 120 milligrams daily; they had their blood sugar
levels checked every five minutes and underwent a daily glucose tolerance test.
Sweetener made from stevia plants, here in a research
greenhouse at Michigan State University, has gained popularity as an
alternative to artificial varieties. Photograph by Kevin J. Miyazaki,
Redux
"Notably, even in this short-term seven-day exposure
period, most individuals (4 out of 7) developed significantly poorer glycemic
[blood sugar] responses," says the study. Normal mice fed fecal samples
from the four human volunteers with glucose intolerance developed the same
condition.
Along with a historical shift toward processed foods over
the past century, the move toward artificial sweeteners "coincides with
the dramatic increase in the obesity and diabetes epidemic," the study
concludes. "Our findings suggest that [artificial sweeteners] may have
directly contributed to enhancing the exact epidemic they themselves were
intended to fight."
Microbiome Mystery
"This study reinforces the idea that what we eat
directly influences our gut microbiota, which, in turn, is intimately linked to
many facets of our health," says Stanford University microbiologist Justin
Sonnenburg. He called for closer examination of the results, pointing to the
uncertainty over the mechanism behind the changes in the gut bacteria seen in
the study. (Related: "The
Quantified Microbiome Self.")
For starters, when people eat artificially sweetened foods,
only milligrams of the sweetener ends up in their gut, compared to most of the
sugar eaten in normally sweetened foods, notes Stanford University's
Christopher Gardner, another co-chair of the 2012 AHA/ADA artificial sweetener
safety review. If the gut bacteria are eating artificial sweeteners, then very
small amounts of the material seem to have a disproportionately large effect on
the community of microbes, he says.
The missing piece in the study is a mechanism for the
artificial sweeteners to directly spur a population boom in some gut bacteria
and a population bust in others.
The researchers acknowledged that they don't understand how
artificial sweeteners would stimulate the growth of potentially harmful
intestinal bacteria. It's possible, but untested, that the sweeteners may
change conditions in the gut in some way that spurs the growth of the microbes,
even if the microbes are not eating the additives.
Elinav says the results also point to the very individual
nature of how people respond to changes in diet, noting the three out of seven
people whose blood sugar remained unaffected in the last part of the study.
"Eventually, we may be moving toward an era of
personalized nutrition," he says, where individuals' diets are tuned to
their digestive tract's tendencies. (Related: "Discovering
My Microbiome.")
Personalized nutrition, like personalized medicine, is a hot
topic among health experts, says Wylie-Rosett, but there are fairness issues to
consider: "We want to see we don't move toward an era of diet haves and
have-nots. Obesity, unfortunately, has a larger effect on the have-nots."
------------------------------------------------------------------------
Spate of new research points to the potential harms of artificial sweeteners
Recent studies suggest that consuming too many artificial sweeteners could elevate blood sugar levels and raise one's risk of heart disease or stroke.
Sept. 8, 2022
By Aria Bendix (Breaking
health reporter for NBC News Digital)
New research adds to mounting evidence that artificial
sweeteners may be harmful to your health.
A study published
Wednesday in the BMJ (British Medical Journal), which involved more than 100,000 adults in France, found
a potential link between consumption of artificial sweeteners and heart
disease.
The results showed that participants who consumed large
amounts of aspartame — found in the tabletop sweeteners Equal and NutraSweet as
well as cereals, yogurt, candy and diet soda — had a higher risk of stroke than
people who didn’t consume the sweetener.
Similarly, people who consumed high quantities of sucralose
— found in Splenda as well as baked goods, ice cream, canned fruit, flavored
yogurt and syrups — and acesulfame potassium, often used in
"sugar-free" soda, had a higher risk of coronary heart disease.
"Artificial sweeteners may not be a safe alternative to
sugar," said Mathilde Touvier, the study’s author and a research director
at the French National Institute for Health and Medical Research.
Last month, a smaller study found
that consuming non-nutritive sweetener — sugar substitutes that contain few
calories or nutrients — could alter a person's gut microbes and potentially
elevate blood sugar levels. High blood sugar can increase one's risk of
diabetes, heart disease or stroke.
Prior to that, a June lab study found
that artificial sweeteners prompted gut bacteria to invade cells in the
intestine wall, which could ultimately raise one's risk of infection or organ
failure.
Other previous research has linked artificial sweeteners
to obesity,
high blood pressure, diabetes and increased
cancer risk as well.
"The more data that comes out showing these adverse
health effects, the less we're going to want to encourage people to switch from
added sugars to non-nutritive sweeteners," said Dr. Katie Page, an
associate professor of medicine at the University of Southern California.
But the healthiest course of action, Page said, isn't to opt
for regular sugar instead.
"We really need to encourage people to eat sugar in
more moderation and try to decrease sugar consumption," she said.
"And the way to do that isn’t to consume more non-nutritive
sweeteners."
Some sweeteners thought of as natural aren't preferable
either, Page said.
"I definitely would not switch to agave," she
said. "I know people think that’s healthy, but it actually has a very high
fructose content."
An emerging link between sweeteners and heart disease
As a category, artificial sweeteners are low- or no-calorie
additives often found in soft drinks and other highly processed foods like
yogurt, granola bars, cereal or microwaveable meals. They're also sold as
tabletop sweeteners like Equal, Splenda, Sweet ‘N Low and Truvia.
The sweeteners were originally billed as a healthier
replacement for sugar, which is known to promote
obesity and diabetes and can increase one's risk of heart disease if
consumed in excess.
Touvier said her study is the first to directly assess how
overall dietary consumption of artificial sweeteners impacts one’s risk of
heart disease. Previous studies mostly looked at how artificially sweetened
beverages impact heart disease risk.
Her team defined a large amount of sweetener as around 77
milligrams per day, on average, which is a little less than two packets of
tabletop sweetener.
More than half of the participants' artificial sweetener
consumption came from soft drinks, while 30% came from tabletop sweeteners.
Another 8% came from sweetened dairy products like yogurt or cottage cheese
with fruit topping.
Sucralose is the most commonly
consumed artificial sweetener worldwide, Page said, whereas
"aspartame has kind of gotten out of favor, so people aren’t consuming it
as much."
She said sodas are the biggest source of artificial
sweeteners in our food supply, though "a lot of the non-nutritive
sweeteners people are consuming are coming from foods that you might think of
as healthy."
Two prime examples: flavored yogurts and sports drinks.
The best alternative to sugary food, Page said, is naturally
sweet fruit. If water isn't a satisfying substitute for soft drinks or juice,
she suggested carbonated water without artificial sweeteners.
Sweeteners could disrupt your metabolism and elevate blood
sugar
A growing body of research suggests that artificial
sweetener may disrupt the body's ability to properly metabolize glucose, which
can be a risk factor for diabetes and cardiovascular health issues.
For the study published last month, Israeli researchers
asked 120 people to consume four artificial sweeteners — aspartame, saccharin,
stevia and sucralose — for two weeks. Participants consumed six sachets of
sweetener per day, which is within the Food and Drug Administration’s
acceptable intake.
The researchers observed changes in the makeup and function
of participants' gut microbes, which help break down food and ward off
disease-causing bacteria. The changes were not seen in people who did not
consume artificial sweeteners.
"All four sweeteners changed the microbiome, each in
their unique way," said Eran Elinav, the study's author and a microbiome
researcher at the Weizmann Institute of Science.
Two sweeteners in particular, sucralose and saccharin (found
in Sweet ‘N Low), altered some people's ability to process glucose.
"It changed the way the bugs in their gut are
functioning and that, in turn, led to increases in their glucose levels, which
is of course not a good thing," Page said.
The researchers even transferred samples of gut microbes
from the study participants with significant metabolism changes into mice. The
mice, too, developed blood sugar alterations, Elinav said.
"That's pretty good evidence suggesting that
[artificial sweeteners] have some type of effect on metabolism and on the gut
microbiome," Page said.
Page said her team is now studying how artificial sweeteners
affect children's risk of metabolic conditions like diabetes.
"There's been very, very few studies in children and
there's data showing that the increases in non-nutritive sweetener consumption
are even higher among children and adolescents," she said.
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Just so you all know that I actually practice what I preach (for the most part), I have decided to limit my artificial sweetener intake as much as possible. To that end, I am leaving Splenda out of my coffee... huge change for me... and not easy. BUT... as I have stated before... I wanna live, and after having researched the topic I can no longer justify what I was doing to my system. My next labs are in December... We shall see. :-)
Have a great week, everyone, and thank you for your support!
Blessed be… and happy cooking!
Chef Michael R