Everyone knows better than to eat sugar. The body of evidence against fast-acting carbohydrates, and sugar in particular, has been growing for decades and is by now vast. Many believe that artificial sweeteners are a healthier alternative, especially for those with some form of diabetes or a family history of diabetes that worries them. After all – even the website for the American Diabetes Association (a US organization that promotes diabetes research and advocates on behalf of diabetics) recommends sweeteners as alternatives to sugar.1
But a growing body of evidence associates the consumption of artificial sweeteners with health risks similar to those associated with carbohydrate consumption.
What’s The Evidence?
A paper from the Center for Research in Epidemiology and Population Health described a study performed by six French scientists, who tracked consumption of sugar-sweetened beverages (SSBs), artificially-sweetened beverages (ASBs), and one-hundred percent fruit juice by 61,118 women for fourteen years beginning in 1993, among whom 1369 cases of type two diabetes were later diagnosed.2
Unsurprisingly, the women in the top twenty-five percent of sugar-sweetened beverage consumers were found to be at thirty-four percent higher risk of developing type two diabetes than non-consumers. But the risk for women in the top twenty-five percent of ASB drinkers increased more than twice as much, and all the women who regularly consumed either SSBs or ASBs were found to be at increased risk. Interestingly, there was no increase in risk associated with the consumption of 100% fruit juice.
The study demonstrated a strong correlation between diabetes and the consumption of artificial sweeteners, but it did not prove that the one causes, or may cause the other. It lacked randomized trials, and the authors did not investigate the cause of the increased risk to drinkers of artificially-sweetened beverages.
Can The Body Tell The Difference Between Sweetener and Sugar..?
However, in 2007, the National Institute On Aging published a study demonstrating that endocrine cells in the gut, which produce regulatory effects on appetite, insulin secretion, gastric emptying, and gut motility by the release of two incretin-class hormones called glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are stimulated by both glucose, and the artificial sweetener sucralose, through the same biochemical mechanisms present in the taste cells of the tongue.3
It referred to another study which demonstrated that glucose, taken intravenously, provokes no GLP-1 response at all.4 The authors of the NIH study concluded that the ability of the human gut to ‘taste’ sweetness was the previously unknown mechanism by which carbohydrates provoked an incretin response in the human gut, and speculated that methods of altering the release of GLP-1 could become “important treatments” for diabetes and obesity. These ‘taste’ receptors may also be the missing link between consumption of artificial sweeteners and incidence of type two diabetes evidenced by the French study.
Do Sweeteners Cause Glucose Intolerance?
An article published by a team of seventeen Israeli scientists put forth another possibility.5 Their study demonstrated clearly that common artificial sweeteners, added to the diets of mice, changed the composition of the animals’ gut flora and altered the metabolic processes of microorganisms present in their digestive tracts. This induced glucose intolerance in the mice themselves, which could be alleviated by treatment with antibiotics, and replicated in mice raised in sterile environments by inoculating them with gut flora from mice that had been fed sweeteners, or with bacteria cultivated in the presence of sweeteners.
This went on to demonstrate similar effects in otherwise healthy human subjects. Because glucose intolerance is the characteristic symptom of a pre-diabetic state, alteration of the intestinal microbiome is another plausible cause of diabetes-spectrum pathologies.
The unfortunate take-away from mounting evidence of the ill-effects of carbohydrates, especially sugars, and artificial sweeteners is that the ideal diet would include nothing sweet at all. If you can manage that without too much grief, you probably should. But the most you can say about scientific knowledge in any field is that it hasn’t been disproven yet, and the only dietary idea that’s lasted long enough to be called a law applies to every aspect of life – everything in moderation.
If you want something sweet now and then, remember that the French study associated no increased risk of diabetes with fruit juice consumption, and that chimps, genetically our closest non-human relatives, eat figs like crazy, as most primates do with one kind of fruit or another. 6, 7, 8
Whole foods are widely recommended, and have nutritional profiles much broader than their carb content; much broader on average than refined and processed foods. Go for treats that occur naturally. They may well have health benefits that no one has ever thought of.
- https://www.ncbi.nlm.nih.gov/pubmed/11078452/ This study assessed insulin secretion and sensitivity in members of a family that carries a genetic beta-cell defect which results in a heritable form of type 1 diabetes called monogenic diabetes, or MODY.