HealthCommentary

Exploring Human Potential

Artificial Sweeteners, Obesity, and The Holidays

Mike Magee

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Dr David Ludwig, in a recent editorial comparing natural sugars with artificial sweeteners in the Journal of the American Medical Association, noted that  “Problems occur when sugars—chiefly sucrose and the chemically similar product, high-fructose corn syrup—are refined, concentrated, and consumed in large amounts. Without the protection conferred by an intact, natural food containing fiber and antioxidants, these refined sugars increase blood glucose and insulin levels rapidly after consumption, increasing concentrations of triglycerides,inflammatory mediators, and reactive oxygen radicals. In contrast to whole fruit, intake of refined carbohydrate increases risk for diabetes, cardiovascular disease, and other chronic illness. Sugar-sweetened beverages may have an especially adverse effect on body weight because of the exceptionally low-satiety value of sugars in liquid form.”1,2,3

OK. Sugars, especially heavily processed sugars, separated from their origins and ingested in large quantities (as with soda beverages) are not healthy. How about those artificial sweeteners? According to Dr. Ludwig, they create a whole separate set of problems. “One proposed solution to the problems caused by overconsumption of these fattening, empty calories is artificial sweeteners. Presently, 5 such products have US Food and Drug Administration (FDA) approval…These synthetic substances are hundreds to thousands of times more potent than sucrose and elicit an intense sensation of sweetness in trace concentrations… artificial sweeteners are intended to produce a sweet taste comparable with their sugar-containing counterparts but with fewer calories, thereby promoting weight loss when substituted for calorie-containing products.”1,4

So what’s wrong with that? A number of things according to the experts. First, the body tends to compensate for the loss of natural sweeteners by adding other foods. Second, artificial sweeteners are very powerful and tend to overstimulate sugar receptors in the body dampening the range of foods an individual finds to be satisfying, causing the exclusion of beneficial items like vegetables or fruits with natural sugar levels. Third, and a special issue with diet beverages, sense of sweetness can become dissociated with food, and potentially “disrupt the hormonal and neurobehavioral pathways regulating hunger and satiety”.1,5

While considerable research has cleared these sweeteners of cancer risk, the problems they create may actually be more far reaching. Says Ludwig, “Per capita diet drink intake has increased from less than 1 oz per day in the 1960s to about 4 oz per day this decade. Among regular consumers of diet drinks, intake now totals more than three 8-oz servings per day. If trends in consumption continue, the nation will, in effect, have embarked on a massive, uncontrolled, and inadvertent public health experiment. Although many synthetic chemicals have been added to the food supply in recent years, artificial sweeteners in beverages stand out in their ability to interact with evolutionarily ancient sensorineural pathways…” 1,6,7

There’s a lot we don’t know. I’ll give you that. But common sense suggests a few simple steps as the holiday season rolls around. First, reconnect liquid beverages with food. They are meant to go together. Second, if you want low calorie beverages try water, mineral water, tea, or coffee. Three, maintain a bias toward natural foods where fiber, nutrients and calories co-exist. And fourth, maintain a healthy suspicion for easy fixes that begin with the word “artifical” or end with the word “processed”.

For Health Commentary, I’m Mike Magee

References:
1. Ludwig, DS. Artificially Sweetened Beverages: Reasons For Concern. JAMA. 2009;302(22):2477-2478. http://jama.ama-assn.org/cgi/content/full/302/22/2477

2. Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002;287(18):2414-2423.FREE FULL TEXT. Mann J. Dietary carbohydrate: relationship to cardiovascular disease and disorders of carbohydrate metabolism. Eur J Clin Nutr. 2007;61(suppl 1):S100-S111. FULL TEXT | WEB OF SCIENCE | PUBMED

4. Raben A, Vasilaras TH, Moller AC, Astrup A. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am J Clin Nutr. 2002;76(4):721-729. FREE FULL TEXT

5. Fowler SP, Williams K, Resendez RG, Hunt KJ, Hazuda HP, Stern MP. Fueling the obesity epidemic? artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring). 2008;16(8):1894-1900. FULL TEXT | PUBMED

6. Nettleton JA, Lutsey PL, Wang Y, Lima JA, Michos ED, Jacobs DR Jr. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009;32(4):688-694. FREE FULL TEXT

7. Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr. 2009;89(1):1-14. FREE FULL TEXT

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