There was a bit of brief discussion on this topic in a separate thread encouraging people to exercise. It’s not like it hasn’t been discussed before, on threads asking which ones people like the taste of, or complaining doctors and diet books have wildly divergent opinions. A new newspaper article appears every month with positive, puzzling or pessimistic news about a specific non-nutritive sweetener (NNS). Sugar alcohols are often thrown into the discussion too, despite some calories and different effects.
Most people sometimes enjoy at least some sweet tasting foods. Eating large amounts of sugar tends to have consequences over many years. Avoiding sweet stuff altogether may be a better solution if NNS can be harmful in physiologic doses.
I found this new metastudy on sweeteners reassuring, and this newer review of sugar alcohols informative.
1. Which artificial sweeteners or sugar alcohols do you prefer, or avoid?
2. What are your beliefs about these?
3. What advice about these have you received?
The first article compares many common sweeteners, alone and in combination, enjoyed alone, or with added food, or before adding food. It looked at 36 small trials involving 472 people. It did not show any difference between NNS and water in terms of effects on insulin, endocrine and glucose effects. They looked at insulin reaction, glucose, glucagon, gherelin, GLP-1 etc. (but not leptin). They confirmed different reactions with glucose, fructose and sucrose (table sugar is a 50:50 mix of the first two). The study is powerful enough to find every side effect or potential problem, but it’s not like this hasn’t been studied in much detail.
a variety of single NNS (acesulfame potassium, aspartame, cyclamate, saccharin, stevia, and sucralose) and NNS blends (acesulfame potassium + aspartame, acesulfame potassium + sucralose, acesulfame potassium + aspartame + cyclamate, and acesulfame potassium + aspartame + sucralose), along with matched water/unsweetened controls and SSBs sweetened with various caloric sugars (glucose, sucrose, and fructose). In uncoupling interventions, NNS beverages (single or blends) had no effect on postprandial glucose, insulin, GLP-1, GIP, PYY, ghrelin, and glucagon responses similar to water controls (generally, low to moderate confidence), whereas SSBs sweetened with caloric sugars (glucose and sucrose) increased postprandial glucose, insulin, GLP-1, and GIP responses with no differences in postprandial ghrelin and glucagon responses (generally, low to moderate confidence). In coupling and delayed coupling interventions, NNS beverages had no postprandial glucose and endocrine effects similar to controls (generally, low to moderate confidence).
I’m t2 diabetic, and control it predominantly by rigorous low-simple carb diet plus a bit of metformin. Prior to being diagnosed I tended towards the “real food is good; weird science is bad” school of thought, preferring sucrose to fructose to any artificial sweetener, preferring butter to margarine, real high fat foods to “Lite” or “low carb” foods full of thickeners, emulsifiers, etc. IOW, my plan was to make the overall diet healthy through portion control of the less-good-for-you ingredients, not through substituting advanced chemistry for real natural products.
When I got diagnosed I found it simplest to skip any / all sweetness, period. Rather than substitute fake stuff. A decade-plus later I’m quite not as militant about my diet, but still maintain a 5.5 A1C mostly though careful eating despite a badly battle-damaged pancreas.
I now enjoy Coke Zero with it’s aspartame and acelsulfame potassium as sweeteners and also A&W Root Beer zero sugar variety with the same sweeteners. To me at least in those beverages the fake stuff tastes almost identical to the real thing. I never really tried, nor much cared for, the other fake sweeteners in any context. I probably drink 12 floz of that soda per week now and for many years had none at all. Definitely not addicted to the stuff.
I’ve actively avoided sugar alcohols in all their formats.
Here’s the take of a medical chemist blogger I follow on the recent erythritol research. I follow his blog for a bunch of reasons and recommend it highly to the chemical / medicine R&D curious amongst us.
Sugar alcohols tend to be less sweet than glucose, can sometimes cause bloating or diarrhea in doses in the 20-50 gram range, and vary quite a bit from each other. Some have no insulemic or glycemic response, most have some response although quite a bit less than sugar. Since the difference between xylitol, sorbitol, mannitol, maltitol, lactitol, isomalt, erythritol and others can be confusing - plus they have different uses and chemistry - this article gives a good (if academic) introduction to those interested. Specifically, “Table Five” shows their relative effect on insulin release and blood glucose effect relative to sugar.
Monk fruit sweeteners are used in Japan at four times the average rate as in the United States, and have been studied pretty extensively. A recent Cleveland Clinic study pointed out some potential cardiac concerns, surprising many. But it is not clear that these concerns will be verified by further research. Still, this research needs to be done, and until it is there are better alternatives. People like erythritol since we don’t seem to absorb it; I am unsure if insects do, or at what dose, or if this matters.
I don’t and never have used erythritol myself. I eat few foods with sugar alcohols, although don’t actively avoid them nor take them in any significant dose. There are a few sugar alcohols (mostly maltitol) in my preferred protein bar, very low amounts, but I don’t eat these very often. Since they still have glucose and insulin responses, sugar alcohols may mean diabetics need more testing.
Just to clarify, the first study looked at a bunch of different artificial sweeteners. It found no difference between them and water in terms of hormonal responses like insulin release, or resulting blood glucose. It did not matter if the artificial sweetener was in a drink, enjoyed with food, or enjoyed before a meal.
The first study doesn’t seem to distinguish much between chemically-formulated non-nutritive sweeteners (NNS) and NNS derived from plants (stevia, monk fruit). Maybe that’s not a valid distinction regarding a survey of studies like this, especially if there is little to no difference among them with regard to effects on body chemistry. For those who don’t like “artificial sweeteners” it might be good to remember that not all NNS are artificial.
Anyway, thanks for bringing up these surveys of research data. There are people who take it as proven that NNS are bad for you, as bad or worse than sugar if in different ways.
This is my fault, because I thought the term artificial sweeteners might be better understood than a weird acronym like NNS in a thread title. But the article uses it correctly.
I tend to avoid artificial sweeteners, sugar alcohols, mainly because of taste (artificial sweeteners) and IBS (sugar alcohols). I also don’t like the taste of stevia, and I don’t remember if I’ve tried monk fruit.
They aren’t for me, and I generally prefer to have foods which have identifiable ingredients. I would rather reduce the amount of sugar I eat, rather than keep eating sweet things. I have also noticed that if I have something sweeter than usual in the morning, I tend to eat more sweet items during the day.
Due to IBS and other digestive issues, I met with a nutrionist, and we determined that I really have to avoid sugar alcohols.
The studies cited in the OP are interesting but address a very narrow group of questions: the use of NNS on short term glycemic and endocrine responses, and their potential utility for those with diabetes, where harms reduction is an important consideration.
More broadly though one should consider their potential impact on avoiding obesity and the complications thereof, inclusive but not limited to diabetes, in the first place. The data there is … complicated, but suggestive.
My perspective is very biased, looking at the lens of these products being used in childhood, from prenatal exposures, through teen years. Hard quality data there is even harder to come by, but is also suggestive of potential harms.
It also gets caught up with the perspective of the general harms of “ultra-processed foods” as a significant factor in obesity risks. Even more broadly, with the overall pattern of our diets. In general a diet heavy on the ulta sweet as a matter of routine is unlikely to be most in keeping with healthy habits, be the sweet sugar, high fructose, or NNS.
I’d rather encourage avoiding entraining tastes, from prenatal on, to extreme sweet as a matter of common exposure, keeping those experiences in the realm of special treat occasions. On those occasions have real food (of course almost all food is “processed” to some degree) that is sweet naturally.
One time I had a cold and consumed about a half bag of Ricola cough drops sweetened with sorbitol and I farted nearly continuously the following day. So I’d suggest avoiding large amounts of sorbitol, unless you’re into that sort of thing.
For every proponent of the idea that artificial sweeteners promote obesity, there seems to be a counter-argument.
Humans are infinitely capable of taking useful things and abusing them to their detriment.
I’m reminded of Allan Sherman’s “Little Butterball”:
They told me to diet
I promised I’d try it
Yet somehow my weight would not budge
Each Metrecal cookie
To me tasted ooky,
So I covered them with hot fudge
Sucralose is my jam. Before that, all artificially sweetened drinks were crap. I still do enjoy a Diet Coke from McDonald’s but that’s the only way I’ll enjoy a regular “diet” pop. The new artificially sweetened “zero sugar” drinks are much better tasting (even though Coke Zero doesn’t use sucralose anymore). Actually, Pepsi Zero is too sweet. I make Kool Aid with sucralose, and on occasion will get a plain iced tea and add sucralose. I also use maple syrup that is basically flavored sucralose syrup. Once or twice a year if I get a Starbucks drink, I use their sugarfree syrup which I guess is Ace-K.
My belief is that pure liquid sugar in the form of drinks or syrups is pretty bad for me as a T2 diabetic, and generally bad as “empty calories”. I’m grateful for all of the “sugarfree” options out there. Also, when you spill your drink it’s not sticky!!!
I’ve never had any gastric issues from sugar substitutes but I’ve known from the start to avoid certain ones in large quantities. I don’t eat sugar free candies or goodies, I just eat less of the “real” ones.
I typically only drink diet sodas. To me, normal table sugar tastes like dirt. I mean that literally; a spoonful of sugar literally tastes like a spoonful of sand or dirt, followed by a sweet aftertaste. Drinking a non-diet soda also has a strange “dirty” taste to me.
