Category Archives: Sugar Substitutes

Do Artificial Sweeteners Cause Diabetes and Overweight?

Would aspartame or stevia be healthier than those sugar cubes?

Would aspartame or stevia be healthier than those sugar cubes?

We don’t know with certainty yet. But a recent study suggests that non-caloric artificial sweeteners do indeed cause overweight and type 2 diabetes in at least some folks. The study at hand is very small, so I wouldn’t bet the farm on it. I’m not even changing any of my recommendations at this point.

exercise for weight loss and management, dumbbells

Too many diet sodas?

The proposed mechanism for adverse metallic effects is that the sweeteners alter the mix of germs that live in our intestines. That alteration in turn causes  the overweight and obesity. See MedPageToday for the complicated details. The first part of the article is about mice; humans are at the end.

Some quotes:

“Our results from short- and long-term human non-caloric sweetener consumer cohorts suggest that human individuals feature a personalized response to non-caloric sweeteners, possibly stemming from differences in their microbiota composition and function,” the researchers wrote.

The researchers further suggested that these individualized nutritional responses may be driven by personalized functional differences in the micro biome [intestinal germs or bacteria].


Diabetes researcher Robert Rizza, MD, of the Mayo Clinic in Rochester, Minn., who was not involved with the research, called the findings “fascinating.”

He noted that earlier research suggests people who eat large amounts of artificial sweeteners have higher incidences of obesity and diabetes. The new research, he said, suggests there may be a causal link.

“This was a very thorough and carefully done study, and I think the message to people who use artificial sweeteners is they need to use them in moderation,” he said. “Drinking 17 diet sodas a day is probably a bad idea, but one or two may be OK.”

I won’t argue with that last sentence!

Finally, be aware the several clinical studies show no linkage between human consumption of non-caloric artificial sweeteners and overweight, obesity, and T2 diabetes.

Steve Parker, M.D.


Filed under Causes of Diabetes, Overweight and Obesity, Sugar Substitutes

A New Artificial Sweetener: Advantame

Lumps of Diabetes

Sugar or advantame?

The U.S. Food and Drug Administration this last spring approved a new artificial sweetener called advantame. The press release calls it a high-intensity sweetener, which is a new term for me. Advantame joins five other artificial sweeteners:  saccharin (e.g., Sweet’N Low), aspartame (Equal and others), acesulfame potassium (Sweet One and others), sucralose (Splenda), and neotame (Newtame).

From the FDA:

High-intensity sweeteners, such as advantame, may be used in place of sugar for a number of reasons, including that they do not contribute calories or only contribute a few calories to the diet. High-intensity sweeteners also generally will not raise blood sugar levels.

Advantame is a free-flowing, water soluble, white crystalline powder that is stable even at higher temperatures, and can be used as a tabletop sweetener as well as in cooking applications. Advantame has been approved for use as a general-purpose sweetener and flavor enhancer and can be used in baked goods, non-alcoholic beverages (including soft drinks), chewing gum, confections and frostings, frozen desserts, gelatins and puddings, jams and jellies, processed fruits and fruit juices, toppings, and syrups.

I haven’t seen it in stores yet.

Steve Parker, M.D.


Filed under Sugar Substitutes

Is Any Non-Caloric Sweetener Really Natural?

Are noncaloric sweeteners any better than an teaspoon of sugar in your coffee? Is honey better?

Are noncaloric sweeteners any better than an teaspoon of sugar in your coffee? Is honey healthier since it’s “natural”?

Daniel Engber has an article at the online New York Times on the quest for natural no-calorie sweeteners. Some quotes:

As badly as stevia needs the soft-drink companies, the soft-drink companies may need stevia even more. While sweetened carbonated beverages still make up around one-fifth of all the liquids we consume, the volume sold has dropped, per capita, every year since 1998. We’re more afraid of sugar than we’ve ever been. What yesterday were seen as “empty calories” have today been designated “toxic.” Doctors warn that cans of soda put fat into your liver, weaken your response to insulin and increase your risk of heart disease and diabetes. The panic over sugar has grown so pervasive that other dietary boogeymen — salt and fat and gluten — seem like harmless flunkies in comparison. (In 2012, when the market-research firm Mintel asked consumers which ingredients or foods they were trying to avoid, sugar and added sugar topped the list, by a wide margin.)


Some consumers also wonder if the natural sweeteners aren’t simply different flavors of the products they’ve been trying to avoid. At the beginning of July, just as PepsiCo got approval for Reb-D and Coca-Cola said it would be working on Reb-X, a 58-year-old woman living in Hawaii filed suit against Big Stevia. In March she bought a box of Truvia at Walmart because she thought it was a natural product. Now she’s convinced it’s no such thing. Her complaint declared that “Reb-A is not the natural crude preparation of stevia,” and that its manufacture is not “similar to making tea,” as Cargill’s packaging suggests. Rather, it’s “a highly chemically processed and purified form of stevia-leaf extract.”

Hers was not the only attack on Cargill’s natural sweetener. In ongoing negotiations to settle a similar suit, Cargill has offered to remove the phrase “similar to making tea” from the packaging and/or add an asterisk to the product’s tagline, “Nature’s Calorie-Free Sweetener,” directing people to a website F.A.Q. That page would explain that Truvia contains very little stevia, by weight, and that its main ingredient — erythritol — comes from yeast that may be fed with genetically modified corn sugar. “As with almost all finished food products,” the F.A.Q. would say, “the journey from field to table involves some processing.”


But what’s “natural” mean anyway?

It’s a question that has bedeviled beverage-makers, too. In the fall of 2012, a German food company surveyed 4,000 people in eight European countries, to find out how they understood the “natural” claim. Almost three-quarters said they thought that natural products were more healthful and that they’d pay a premium to get them. More than half argued that natural products have a better taste. But the respondents weren’t sure what degree or form of processing would be enough to strip a product of its natural status. Some drew a line between sea salt (natural) and table salt (artificial). Others did the same for dried pasta and powdered milk, though both are made by dehydration.

 Read the whole enchilada.

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Filed under Sugar Substitutes

AHA and ADA Position Paper On Non-Nutritive Sweeteners

The American Heart Association and American Diabetes Association just published a review paper on nonnutritive sweeteners, also known as low-calorie sweeteners, artificial sweeteners, noncaloric sweeteners, and intense sweeteners.  I quote from the conclusion section:

At this time, there are insufficient data to determine conclusively whether the use of NNS to displace caloric sweeteners in beverages and foods reduces added sugars or carbohydrate intakes, or benefits appetite, energy balance, body weight, or cardiometabolic risk factors.

With regard to nonnutritive sweeteners and glycemic response [in diabetics], 4 randomized trials that varied from 1 to 16 weeks in duration found no significant difference between the effects of nonnutritive sweeteners and various comparisons (sucrose, starch, or placebo) on standard measures of glycemic response (i.e., plasma glucose and insulin, HbA1c, C-peptide) and, in general, did not detect clinically relevant effects.

You’re welcome to read the entire document.



Filed under Sugar Substitutes

What About Sugar Alcohols?

Dietitian Brenna at Eating Simple recently posted an article on artificial sweeteners exclusive of sugar alcohols.  Now she’s reviewed sugar alcohols.  Many who have a sweet tooth, including myself, use sugar substitutes such as sugar alcohols.  Sometimes they affect blood sugar levels, although not as much as sugar.

Dr. Maria Collazo-Clavell at the Mayo Clinic wrote about use of artificial sweeteners by people with diabetes.  Like Brenna, she notes that sugar alcohols can raise blood sugar levels in people with diabetes.  The Mayo Clinic has another article on sugar substitutes.

Steve Parker, M.D.


Filed under Sugar Substitutes