How do artificial sweeteners affect insulin resistance in type 2 diabetes patients. What are the potential benefits and risks of using artificial sweeteners for diabetes management. Are artificial sweeteners truly beneficial for weight control and blood sugar regulation in diabetics.

The Role of Artificial Sweeteners in Diabetes Management

Artificial sweeteners have long been promoted as sugar substitutes for people with diabetes and those trying to manage their weight. However, recent research has called into question their effectiveness and safety for these purposes. This article examines the complex relationship between artificial sweeteners and type 2 diabetes, with a focus on how they may impact insulin resistance.

What are artificial sweeteners?

Artificial sweeteners are synthetic sugar substitutes that provide sweetness with few or no calories. The most common types include:

• Sucralose
• Acesulfame potassium (Ace-K)
• Aspartame
• Saccharin

These sweeteners can be hundreds of times sweeter than sugar, allowing them to be used in very small amounts. They were originally developed as a way for people with diabetes to enjoy sweet foods without raising their blood sugar levels.

Effects of Artificial Sweeteners on Blood Sugar and Insulin

Contrary to previous assumptions, artificial sweeteners may not be metabolically inert. Research has shown they can influence several aspects of glucose metabolism:

Glucose Absorption

Do artificial sweeteners affect how the body absorbs glucose? Recent studies indicate they may enhance glucose absorption in the intestinal tract. This could potentially lead to higher blood sugar levels after meals containing artificial sweeteners.

Insulin Secretion

Can artificial sweeteners trigger insulin release? Some research suggests certain sweeteners may stimulate insulin secretion, even in the absence of actual glucose. This “cephalic phase insulin release” could theoretically contribute to insulin resistance over time.

Incretin Hormones

Incretin hormones like GLP-1 play a crucial role in blood sugar regulation. How do artificial sweeteners impact these hormones? Studies have found mixed effects, with some sweeteners potentially altering incretin secretion patterns.

Artificial Sweeteners and the Gut Microbiome

One of the most intriguing areas of research involves the interaction between artificial sweeteners and the gut microbiome. The trillions of bacteria in our intestines play a vital role in metabolism and overall health.

Microbiome Alterations

Can artificial sweeteners change the composition of gut bacteria? Multiple studies have shown that regular consumption of artificial sweeteners can indeed alter the gut microbiome. These changes may have far-reaching metabolic consequences.

Glucose Intolerance

How might microbiome changes affect blood sugar control? Research in both animals and humans suggests that artificial sweetener-induced alterations in gut bacteria can lead to glucose intolerance. This could potentially worsen glycemic control in people with diabetes.

Long-Term Health Impacts of Artificial Sweeteners

While artificial sweeteners were once thought to be a safe alternative to sugar, accumulating evidence points to potential long-term health risks associated with their regular consumption.

Cardiovascular Risk

Do artificial sweeteners affect heart health? Large cohort studies have found associations between high artificial sweetener intake and increased risk of:

• Cardiovascular disease
• Coronary artery disease
• Cerebrovascular events (e.g., stroke)

These findings suggest that artificial sweeteners may not be as heart-healthy as once believed.

Cancer Risk

Is there a link between artificial sweeteners and cancer? While early concerns about cancer risk have largely been dismissed, some recent studies have found associations between high artificial sweetener consumption and certain types of cancer. More research is needed to clarify this potential connection.

All-Cause Mortality

Perhaps most concerning, large population studies have found links between artificial sweetener intake and increased all-cause mortality. This suggests that regular consumption may have broader health impacts beyond specific disease risks.

Artificial Sweeteners and Weight Management

One of the primary reasons people use artificial sweeteners is for weight control. But do they actually help with weight loss or maintenance?

Impact on Body Weight

Are artificial sweeteners effective for weight loss? Contrary to popular belief, meta-analyses of human studies have found that artificial sweeteners have no significant effect on body weight. Some research even suggests they may contribute to weight gain in certain individuals.

Effects on Appetite and Cravings

Do artificial sweeteners influence eating behaviors? Some studies indicate that consuming artificial sweeteners may actually increase appetite and cravings for sweet foods. This could potentially lead to overconsumption of calories from other sources.

Artificial Sweeteners and Taste Perception

An often-overlooked aspect of artificial sweetener use is how it may affect our perception of sweetness and our relationship with food.

Altered Taste Response

Can artificial sweeteners change how we perceive sweetness? Research has shown that early and frequent exposure to intense artificial sweeteners can suppress the taste response to natural sugars. This may lead to a preference for highly sweetened foods and beverages.

Food Reward Pathways

Do artificial sweeteners affect the brain’s reward system? Some studies suggest that artificial sweeteners may not fully activate the food reward pathways in the brain, potentially leading to continued cravings and dissatisfaction.

Reconsidering the Role of Artificial Sweeteners in Diabetes Treatment

Given the complex and sometimes contradictory evidence surrounding artificial sweeteners, their role in diabetes management needs careful reconsideration.

Individualized Approach

Should artificial sweeteners be recommended for all people with diabetes? The evidence suggests that a one-size-fits-all approach is not appropriate. Healthcare providers should consider each patient’s individual circumstances, preferences, and metabolic responses when making recommendations about artificial sweetener use.

Monitoring and Guidance

How can the effects of artificial sweeteners be tracked in diabetes patients? Long-term monitoring of blood glucose levels, weight changes, and even gut microbiome composition may be necessary to fully understand the impact of artificial sweeteners on individual patients. This data can then inform personalized guidance on their use.

Alternative Approaches

What other strategies can help manage sweet cravings in diabetes? Instead of relying solely on artificial sweeteners, healthcare providers might consider recommending:

• Gradual reduction of overall sweetener intake
• Use of natural, low-glycemic sweeteners in moderation
• Mindful eating practices to enhance satisfaction with smaller amounts of sweetness

Future Directions in Artificial Sweetener Research

While much has been learned about the effects of artificial sweeteners, many questions remain unanswered. Future research should focus on several key areas:

Long-Term Studies

What are the truly long-term effects of artificial sweetener consumption? Most current studies are relatively short-term or observational. Rigorous, long-term clinical trials are needed to fully understand the chronic effects of artificial sweeteners on metabolism, gut health, and overall disease risk.

Mechanism of Action

How exactly do artificial sweeteners influence glucose metabolism and insulin sensitivity? More detailed research into the molecular mechanisms by which these compounds affect the body could lead to better understanding of their risks and potential benefits.

Personalized Response

Why do some individuals seem to respond differently to artificial sweeteners? Investigating genetic, microbiome, and other factors that influence individual responses could help develop more targeted recommendations for their use.

Novel Sweeteners

Can new types of sweeteners offer the benefits without the drawbacks? Research into novel sweetening compounds or combinations that don’t have the negative effects associated with current artificial sweeteners could provide better options for people with diabetes.

In conclusion, the relationship between artificial sweeteners and type 2 diabetes is complex and multifaceted. While these compounds may offer some benefits in terms of calorie and sugar reduction, emerging research suggests they may also have unintended metabolic consequences. Healthcare providers and patients should approach the use of artificial sweeteners with caution, considering individual factors and staying informed about the latest scientific evidence. As research continues to evolve, our understanding of how best to incorporate (or limit) artificial sweeteners in diabetes management will undoubtedly improve.

Is the Use of Artificial Sweeteners Beneficial for Patients with Diabetes Mellitus? The Advantages and Disadvantages of Artificial Sweeteners

Review

. 2022 Oct 22;14(21):4446.

doi: 10.3390/nu14214446.

Katsumi Iizuka 
¹

Affiliations

Affiliation

• ¹ Department of Clinical Nutrition, Fujita Health University, Toyoake 470-1192, Japan.

• PMID:

  36364710

• PMCID:

  PMC9655943

• DOI:

  10.3390/nu14214446

Free PMC article

Review

Katsumi Iizuka.

Nutrients.

2022.

Free PMC article

. 2022 Oct 22;14(21):4446.

doi: 10.3390/nu14214446.

Author

Katsumi Iizuka 
¹

Affiliation

• ¹ Department of Clinical Nutrition, Fujita Health University, Toyoake 470-1192, Japan.

• PMID:

  36364710

• PMCID:

  PMC9655943

• DOI:

  10.3390/nu14214446

Abstract

Artificial sweeteners have been developed as substitutes for sugar. Sucralose, acesulfame K (ACE K), aspartame, and saccharin are artificial sweeteners. Previously, artificial sweeteners were thought to be effective in treating obesity and diabetes. Human meta-analyses have reported that artificial sweeteners have no effect on body weight or glycemic control. However, recent studies have shown that artificial sweeteners affect glucose absorption in the intestinal tract as well as insulin and incretin secretion in humans and animals. Moreover, artificial sweeteners alter the composition of the microbiota and worsen the glycemic control owing to changes in the gut microbiota. The early intake of ACE K was also shown to suppress the taste response to sugar. Furthermore, a large cohort study showed that high artificial sweetener intake was associated with all-cause mortality, cardiovascular risk, coronary artery disease risk, cerebrovascular risk, and cancer risk. The role of artificial sweeteners in the treatment of diabetes and obesity should be reconsidered, and the replacement of sugar with artificial sweeteners in patients will require the long-term tracking of not only intake but also changes in blood glucose and weight as well as future guidance based on gut bacteria data. To utilize the beneficial properties of artificial sweeteners in treatment, further studies are needed.

Keywords:

acesulfame K; aspartame; microbiota; saccharin; sucralose.

Conflict of interest statement

The author declares no conflict of interest.

Figures

Figure 1

The sweet taste receptors T1R2/T1R3,…

Figure 1

The sweet taste receptors T1R2/T1R3, artificial sweeteners, and metabolism.

Figure 1

The sweet taste receptors T1R2/T1R3, artificial sweeteners, and metabolism.

Figure 2

Artificial sweeteners have advantages and…

Figure 2

Artificial sweeteners have advantages and disadvantages. Artificial sweeteners (sucralose, saccharin, aspartame, and acesulfam…

Figure 2

Artificial sweeteners have advantages and disadvantages. Artificial sweeteners (sucralose, saccharin, aspartame, and acesulfam K) present advantages (non-caloric; a flavor enhancer; a GLP-2 stimulant) and disadvantages (increased mortality, cerebrovascular risk, cardiovascular risk, hyperglycemia, increased plasma HDL levels with impaired antioxidant functions, impaired FGF21 secretion).

Figure 3

Questioning the intake of artificial…

Figure 3

Questioning the intake of artificial sweeteners may be an important issue in nutritional…

Figure 3

Questioning the intake of artificial sweeteners may be an important issue in nutritional guidance in the near future.

See this image and copyright information in PMC

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References

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Publication types

MeSH terms

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Grant support

• 20K11645/Japan Society for the Promotion of Science

Artificial Sweeteners :: Diabetes Education Online

Home » Living With Diabetes » Diet And Nutrition » Understanding Carbohydrates » Demystifying Sugar » Artificial Sweeteners

• Understanding Fats & Oils »
• «
  Demystifying Sugar

Artificial sweeteners do not raise blood sugar levels.

When used instead of sugar, artificial sweeteners help you keep within your carbohydrate goals when planning meals.

Artificial sweeteners, or non-nutritive sweeteners offer the sweet taste of sugar, but have no carbohydrates or calories. Artificial sweeteners do not raise blood sugar levels. So when used instead of sugar, artificial sweeteners can help you keep within your carbohydrate goals when planning meals. And because artificial sweeteners have no calories, choosing foods made with artificial sweeteners may lower your calorie intake.

Look for manufactured foods and sweeteners for the table that contain one of these 5 sugar substitutes approved by the United States Food and Drug Administration:

• Aspartame (Brand Name: Equal)
• Sucralose (Brand Name: Splenda)
• Acesulfame-K (Brand Name: Sweet One)
• Saccharin (Brand Name: Sweet and Low, Sugar Twin)
• Neotame

A note to household chefs

Aspartame loses sweetness when cooked. Sucralose, acesulfame-K and saccharin can be used for baking. Look for special baking recipes for artificial sweeteners, as direct substitution for sugar might not give you the result you want. Or, try a combination of artificial sweetener and sugar in recipes to get your desired result while lowering the overall carbohydrate amount. Keep in mind that some artificial sweeteners can be sweeter than equal amounts of natural sugar. A little bit goes a long way.

What is Stevia?

This naturally sweet herb has been used in other countries for centuries. It is not FDA approved for use as a sweetener, but it can be purchased as a “dietary supplement” in many health food stores. Stevia comes in powder, liquid and tablet form. It doesn’t provide calories or impact blood glucose.

Are Artificial Sweeteners Safe?

The FDA has completed careful testing of all the artificial sweeteners. Artificial sweeteners have been shown to be safe to eat. Despite rumors of cancer causing effects of artificial sweeteners, research does not support that risk. All artificial sweeteners may be used by people with diabetes.

Food For Thought

Some foods made with artificial sweeteners may have more calories or fat than the original sugar-sweetened product. This may be the case with desserts and baked goods. Read food labels to compare products for serving sizes, calories and fat. Choosing a smaller portion of a sugar-sweetened product may be lower in calories than the artificially sweetened version!

View a printer-friendly Guide to Sweeteners.

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Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about  Understanding Carbohydrates, take our self assessment quiz when you have completed this section.  The quiz is multiple choice. Please choose the single best answer to each question. At the end of the quiz, your score will display. If your score is over 70% correct, you are doing very well. If your score is less than 70%, you can return to this section and review the information.

• Understanding Fats & Oils »
• «
  Demystifying Sugar

Artificial Sweeteners and Diabetes » HOREV Medical Center

Beware of the latest “diet” fad: artificial sweeteners fortified with vitamins and minerals

By Dr. according to them, nearly 40% of American adults more than 18% of teenagers and nearly 14% of children are now not only overweight but obese, and processed foods and sugar-sweetened beverages are clearly driving factors.

Unfortunately, many people mistakenly think that artificially sweetened foods are a healthy choice that cuts down on calories. This is not true at all.

Over the years, a growing body of research has shown that artificial sweeteners increase the risk of obesity and type 2 diabetes, perhaps even more so than sugar. A recent example is an animal study presented at the 2018 San Diego Experimental Biology Conference.

It examines how various sweeteners affect the use and storage of food in the body, and how they affect vascular function. Sugar and artificial sweeteners have been found to cause disturbances, albeit in different ways.

After a diet high in artificial sweeteners (aspartame or acesulfame potassium) or sugars (glucose or fructose) for three weeks, adverse effects were noted in all groups. All had increased blood lipids (fats), but the artificial sweeteners also accumulated in the animals’ blood, further damaging the lining of the blood vessels.

Newest fad: nutrient-fortified artificial sweeteners

Despite this evidence, the artificial sweetener market continues to thrive. Merisant launched a new calorie-free sweetener called Sugarly Sweet exclusively on Amazon at the end of January 2019, as well as a brand new line of vitamin and mineral fortified artificial sweeteners, according to Food Navigator.

Fortified sweeteners are sold under the Equal Plus brand and are available in three varieties: vitamin C and zinc, vitamins B3, B5 and B12, or vitamins C and E. The products are advertised as a “good source” of these nutrients, one sachet of which provides 10 percent of the recommended daily allowance for added vitamins and minerals.

Metabolic Effects of Zero Calorie Sweeteners

It is important to understand that while artificial sweeteners have no (or very few) calories, they are still metabolically active. As explained in the 2016 paper, Metabolic Effects of Non-Caloric Sweeteners, many studies have linked them to an increased risk of obesity, insulin resistance, type 2 diabetes, and metabolic syndrome. The article presents three mechanisms by which artificial sweeteners contribute to metabolic dysfunction:

1. They disrupt the conditioning that promotes glucose control and energy homeostasis.
2. They disrupt the gut microbiota and cause glucose intolerance
3. They interact with the sweet taste receptors expressed in the digestive system that are involved in glucose absorption and trigger insulin secretion.

In addition to the sweet taste buds on your tongue, there are also those in your gut that release signaling molecules into your bloodstream in response to sweet tastes, thereby forcing your pancreas to release insulin in preparation for the spike in glucose (that would happen if you ate sugar).

Artificial sweeteners are toxic to gut bacteria

Artificial sweeteners also have significantly different effects on the gut microbiome than sugar. While sugar is bad because it feeds health-damaging microbes, artificial sweeteners are even worse because they are toxic to gut bacteria in principle.

In a 2008 study, sucralose (Splenda) reduced gut bacteria by as much as 50 percent, specifically targeting those with important health benefits. Just seven small sachets of Splenda may be enough to negatively impact the gut microbiome.

In addition to the myriad side effects associated with disruptions to the gut microbiome, sucralose has also been associated with a wide range of other health effects. A selection of studies is provided in the article “Studies Reveal Shocking Side Effects of Splenda”, where you will also find a long list of studies demonstrating that artificial sweeteners cause weight gain and metabolic disturbances.

More recent studies have confirmed and expanded on these findings, showing that all currently approved artificial sweeteners disrupt the gut microbiome. An animal study published in the journal Molecules in October 2018 found that aspartame, sucralose, saccharin, neotame, advantame, and acesulfame potassium-K cause DNA damage and interfere with the normal and healthy activity of gut bacteria.

While all six types of artificial sweeteners have been found to have toxic effects on intestinal bacteria , there are individual differences in the type and amount of damage they produce:

• and genotoxic effects, meaning it is toxic to cells and damages the genetic information in the cell (which can cause mutations).
• Neotame caused a metabolic disorder in mice and also increased several fatty acids, lipids and cholesterol. Some gut genes are also decreased in number with this sweetener.
• Aspartame and acesulfame potassium-K – the latter commonly found in sports supplements cause DNA damage

Artificial sweeteners can cause muscle breakdown

that in addition to harming blood vessels and increasing the risk of obesity and type 2 diabetes, artificial sweeteners also cause muscle breakdown.

As lead author and Ph.D. Brian Gofman, assistant professor of biomedical engineering at Marquette University and the Medical College of Wisconsin, explained, “[Artificial] sweeteners trick the body.

And when your body isn’t getting the energy it needs because it needs some sugar to function properly, it potentially finds a source elsewhere.” Muscle is one such alternative source.

The neuroscience of food awards and how artificial sweeteners trick your body into eating more

An article published in the Yale Journal of Biology and Medicine in 2010 focused specifically on the neurobiology of sugar cravings and the effects of artificial sweeteners in the context of the neurobiology of reward food. As explained in this article:

“Food reward consists of two branches: sensory and post-ingestion… with mechanical satiety.

For moderately concentrated nutrients, rats have learned to prefer food associated with regular feeding, rather than “sham feeding”, in which incoming food flows out of the body through the gastric fistula.

However, the rats showed no preference if highly concentrated nutrients were used. The hypothalamus mediated reward after food ingestion. The hypothalamus secretes a variety of neuropeptides to regulate energy, osmotic balance, and feeding behavior…A growing body of evidence suggests that artificial sweeteners do not activate food reward pathways in the way that natural sweeteners do.”

“Diet” drinks are associated with an increased risk of stroke and heart attack

In related news, a recent observational study from the American Heart Association (AHA) found that, compared to drinking one or fewer “diet” drinks per week , two or more artificially sweetened drinks a day increase the risk of stroke, heart attack and early death in women over 50 by 23, 29 and 16 percent, respectively.

The risk is especially high for women with no history of heart disease, those who are obese and/or African American women. The study included more than 81,700 women from the Women’s Health Initiative Observational Study, a longitudinal health study of nearly 93,680 postmenopausal women aged 50 to 79.

The median follow-up was close to 12 years. According to the authors:

“Most of the participants (64.1 percent) were infrequent users (never or

In a multivariate analysis, those who consumed more PPIs compared to those who never or rarely … had a significantly greater likelihood of all endpoints (except hemorrhagic stroke) after multiple tests were performed.

Adjusted models showed that hazard ratios … were 1.23 for all strokes; 1.31 for ischemic stroke; 1.29 for coronary heart disease; and 1.16 for all causes of death.

In women with no history of cardiovascular disease or diabetes, high PPI intake was associated with a more than twofold increased risk of ischemic stroke with small artery occlusion… High PPI intake was associated with a significant increase in risk development of ischemic stroke in women with a body mass index ≥30 …”

In the accompanying editorial article, “Artificial sweeteners. Real Risks,” Hannah Gardener, Assistant Scientist in the Department of Neurology at the University of Miami, and Dr. Mitchell Elkind suggest drinking pure water instead of non-caloric sweetened drinks as the safest and healthiest low-calorie drink.

If you want a taste, just squeeze a fresh lemon or lime into mineral water. In cases where a little sweetener is needed in cooking, baking or drinks, choose consciously.

Healthy Sugar Substitutes

Two of the best sugar substitutes are stevia and Lo Han Guo (also spelled Lo Han Guo). Stevia, a very sweet herb derived from the leaves of the stevia plant in South America, is sold as a supplement. It is completely safe in its natural form and can be used to sweeten most foods and drinks.

Lo Han Guo is similar to stevia, but this is my personal favorite. I use Lakanto brand vanilla flavor and it is a real delicacy. The Li Han fruit has been used as a sweetener for centuries and is about 200 times sweeter than sugar.

A third option is to use pure glucose, also known as dextrose. Glucose has 70 percent the sweetness of sucrose, so you’ll need a little more for the same sweetness, which is why it’s a bit more expensive than regular sugar.

However, it is healthy because it contains no fructose at all. Unlike fructose, glucose can be used directly in every cell in your body, and as such is much safer than sugar.

Source

Artificial sweeteners are bad! Scientifically proven

Artificial sweeteners increase risk of type 2 diabetes | Article

22nd of May 2017

Kotikovich Yu.S.

Keywords:

glucose,

artificial sweeteners,

type 2 diabetes,

sucralose

Specialties:

En dokrinologiya

Summary

By changing the body’s susceptibility to glucose

In a new small study, scientists from the University of Adelaide, Australia, have shown that the use of artificial sweeteners changes the body’s sensitivity to glucose and increases the risk of developing type 2 diabetes. The results of this work were presented by experts at the annual meeting of the European Association for the Study of Diabetes (EASD), held in Lisbon, Portugal.

Previous studies have shown that high artificial sweetener habits can significantly increase the risk of type 2 diabetes. However, the biological mechanisms underlying the identified relationship remained unknown. In this study, led by Dr. Richard Young, researchers assessed the effect of sweeteners on the body’s response to glucose intake. To do this, they analyzed the condition of 27 healthy participants who received daily placebo or artificial sweeteners (sucralose or acesulfame-K) in an amount equivalent to their content in 1.5 liters of diet soft drink. Participants took the drugs in the form of capsules 3 times a day for 2 weeks. At the end of the study, they assessed the body’s response to glucose, analyzing the degree of its absorption and concentration in the blood plasma, as well as measuring the level of insulin and peptides.

It turned out that the use of artificial sweeteners significantly changed the indicators of the body’s response to the introduction of glucose. The researchers evaluated the results using a method known as area under curve (AUC) analysis. This indicator increased for the level of glucose absorption and decreased for the concentration of the GLP-1 peptide, which inhibits the increase in glucose concentration after a meal. In participants who took placebo, the researchers did not notice any changes in carbohydrate metabolism.

As emphasized by the authors of the work, the data obtained indicate that the use of artificial sweeteners after 2 weeks leads to an increase in the level of glucose absorption, manifested by an increase in the concentration of glucose in the blood plasma. This supports the concept that artificial sweeteners may impair glycemic control, which may contribute to the development of type 2 diabetes.

• Diabetologia (2017) Small study suggests consuming large amounts of artificial sweeteners may increase the risk of developing type 2 diabetes.