September 7, 2019 · 6:11 PM
I enjoy an aspartame-flavored Fresca now and then
“The U.S. Food and Drug Administration (FDA) has reviewed several types of sugar substitutes for safety and approved them for consumption by the general public, including people with diabetes (211). In this report, the term sugar substitutes refers to high-intensity sweeteners, artificial sweeteners, nonnutritive sweeteners, and low-calorie sweeteners. These include saccharin, neotame, acesulfame-K, aspartame, sucralose, advantame, stevia, and luo han guo (or monk fruit). Replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories. These dietary changes could beneficially affect glycemic, weight, and cardiometabolic control. However, an American Heart Association science advisory on the consumption of beverages containing sugar substitutes that was supported by the ADA concluded there is not enough evidence to determine whether sugar substitute use definitively leads to long-term reduction in body weight or cardiometabolic risk factors, including glycemia (212). Using sugar substitutes does not make an unhealthy choice healthy; rather, it makes such a choice less unhealthy. If sugar substitutes are used to replace caloric sweeteners, without caloric compensation, they may be useful in reducing caloric and carbohydrate intake (213), although further research is needed to confirm these concepts (214). Multiple mechanisms have been proposed for potential adverse effects of sugar substitutes, e.g., adversely altering feelings of hunger and fullness, substituting for healthier foods, or reducing awareness of calorie intake (215). As people aim to reduce their intake of SSBs, the use of other alternatives, with a focus on water, is encouraged (212).
Sugar alcohols represent a separate category of sweeteners. Like sugar substitutes, sugar alcohols have been approved by the FDA for consumption by the general public and people with diabetes. Whereas sugar alcohols have fewer calories per gram than sugars, they are not as sweet. Therefore, a higher amount is required to match the degree of sweetness of sugars, generally bringing the calorie content to a level similar to that of sugars (216). Use of sugar alcohols needs to be balanced with their potential to cause gastrointestinal effects in sensitive individuals. Currently, there is little research on the potential benefits of sugar alcohols for people with diabetes (217).”
Source: Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report | Diabetes Care
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November 3, 2016 · 8:24 AM
Overweight and obese women who habitually drank diet beverages lost more weight if they substituted water for the diet beverage. Over the course of 24 weeks on a reduced calorie diet, the water drinkers lost an extra 1.2 kg (2.6 lb) compared to those who continued their diet beverage habit.
Furthermore, the researchers found that the water drinkers had healthier values on insulin levels, HOMA-IR (a measure of insulin resistance), and after-meal blood sugar levels.
It was a small study with only about 30 in each experimental group. Whether similar results would be seen in men is unknown to me.
In the past, I’ve advised dieters it’s OK to drink diet drinks in moderation while trying to weight. I may have to revise my recommendations. On the other hand, if diet drinks help keep you happy and on a successful weight-loss journey, they may be helpful. The diet beverage consumers still lost 7.6 kg (16.7 lb) compared with 8.8 kg (19.4 lb) in the abstainers. But diets don’t work, right?
Steve Parker, M.D.
PS: I haven’t read the full text of the article; just the abstract.
PPS: Steven Novella at Science-Based Medicine blog concludes that low energy sweeteners probably help with weight control.
October 1, 2015 · 5:58 PM
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.
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.
“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.
July 21, 2015 · 2:34 AM
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.
November 3, 2014 · 11:43 PM
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.
August 3, 2012 · 2:00 AM
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.
February 1, 2012 · 4:45 PM
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.