I’ve just been told by my new g.p. to stop using artificial sweeteners, such as Equal. Just stop. Today. (My blood sugar has me down as “borderline diabetic,” which according to her means that I’ll be a diabetic within a year. Oddly, I’ve been a borderline diabetic for the past decade or more, so this was said to put the fear of God into me. I have no idea if my blood sugar has climbed in the past year, or if this is what she says to anyone with elevated blood sugar levels.)
She also says I must lose weight, which I have no problem with, except she has also recommended that if I must have something sweet, I can have a sugary drink or sugary pastry, etc. This seems odd to me, as the calories in a Pepsi seem to me more than the calories in a Diet Pepsi, but no–“Drink the Pepsi, if you must.” So drinking the sugary option is wiser than the zero-calorie option. “Yes.”
Can you explain this, doctor? It seems contradictory to me.
[Twenty minutes of big words follow]
So i’m following orders, but would like to understand this better. Does anyone know of a study that explains this? I’m not talking about a chemical study per se, which I probably wouldn’t be able to make sense of, not being trained in chemistry, but rather a study that compares results of borderline diabetics in groups that ingest sugar and that ingest artificial sweeteners.
This seems to me a remarkably easy study to run. In all the years that we’ve had artificial sweeteners, and all the years that this contralogical argument has been made (it feels like i’ve been hearing it forever, and ignoring it because it didn’t make sense to me. Calories = weight gain, fewer calories = weight loss) I would think someone would have run a definitive study on the results of two groups that differed only in their uses of sugar and artificial sweeteners. Has there been such a study?
IMNAD, but there is one thing I know that bears on the question. It turns out there are taste receptors in the intestines and when an artificial sweetener comes in, it stimulate the release of insulin and thus may contribute to metabolic disease. But I don’t see how actual sugar is any better. In fact, I use it but only in my morning pot of tea. My doctor certainly never gave that advice.
I can’t answer as to the studies, but my PCP (primary care physician) was explicit in his advice to drink artificially sweetened drinks in preference to sugared drinks (but water, flavored seltzers preferred above all those.) Same with a close interventional radiologist doctor friend of mine who is very much learned in the science of diet, as well (though he is clearly not a dietician or nutritionist.) So I follow their advice. For me, it seems to work in terms of keeping weight off/losing weight, hunger, etc.
Does it not seem strange to you that no study such as I mentioned has been done? You’d suppose that a book called ARTIFICIAL SWEETENERS ARE WORSE THAN SUGAR (or “BETTER”) that was based on such a study would be much read, wouldn’t you? It just seems unthinkable that no such study has ever been done, when it’s so simple and directly answers a question on many people’s minds for decades. Either they are effective at what they do or they’re not, no?
Since there is no definitive study doctors are at liberty to tell patients whatever makes sense to them based on what they’ve read or heard from other doctors. The bottom line is if you asked 10 different doctors what is better for you, sugar or artificial sweeteners, you might get 10 different answers.
As far as weight lose goes, there’s at least one study out there. " A study done in 2005 by the University of Texas Health Science Center at San Antonio showed that, rather than promoting weight loss, the use of diet drinks was a marker for increasing weight gain and obesity. Those who consumed diet soda were more likely to gain weight than those who consumed naturally-sweetened soda.[ Animal studies have convincingly proven that artificial sweeteners cause body weight gain. A sweet taste induces an insulin response, which causes blood sugar to be stored in tissues, but because blood sugar does not increase with artificial sweeteners, there is hypoglycemia and increased food intake. So in the experiment, after a while, rats given artificial sweetener have steadily increased caloric intake, increased body weight, and increased adiposity."
My take is that sugar is needed for human body to function, and humans have evolved over millions of years to consume sugar in its many forms. Artificial sweeteners mimic sugar but don’t provide the energy the body needs. Whether they promote diabetes or not, they don’t provide what your body needs and they don’t help you keep your weight at a healthy level.
On the other hand (and this article more seems to say that it’s complex):
“People who carried the most fat around their midsections — a major risk factor for metabolic disease — had significantly less weight gain when they switched from sugary drinks to diet beverages or water. Among this group, those who drank diet beverages gained about a pound during the study, while those who switched to water lost roughly half a pound. But the people with high levels of belly fat who continued drinking sugary beverages gained an average of 10 pounds.”
and:
" The impact of artificial sweeteners on body weight has also been controversial. Over the years, some observational studies have found that people who consume a lot of diet beverages have a higher obesity risk, suggesting that artificial sweeteners might fuel — rather than prevent — weight gain. But observational studies can show only correlations, not cause and effect. Reverse causality may be a factor, since people who are more likely to use artificial sweeteners may gain weight for a variety of reasons, such as other dietary factors and lack of exercise.
Randomized clinical trials, which are more reliable, have generally shown that diet sweeteners help prevent weight gain. A clinical trial published in the New England Journal of Medicine found that when children who consumed sugary beverages were assigned to drink artificially sweetened beverages, they had less weight gain and fat accumulation after 18 months than children who continued drinking sugary beverages."
and:
" Another clinical trial led by researchers at the University of North Carolina at Chapel Hill found that overweight and obese adults who were instructed to give up sugary beverages for water or low-calorie sweetened beverages for six months lost an average of 2 percent to 2.5 percent of their body weight. But the group that switched to water showed significant improvements in their blood sugar levels, a risk factor for diabetes, while the group that used low-calorie sweeteners did not."
So, it isn’t simple or straightforward. But that study does go with my PCP’s advice of water is best overall, then artificially sweetened drinks, then sugar drinks, at least in terms of weight gain if not blood sugar levels.
The first part of what you mention is what I sarcastically think of as the “I’ll have two double bacon cheeseburgers, extra large fries, and a Diet Coke” type dieting, with the dieter then wondering why they don’t lose weight.
On the second point, it’s true that humans gain no caloric benefit from artificial sweeteners. The bacteria in our, gut, however, may be able to metabolize them, depending on (generic) your particular gut flora. It’s not very well researched, but it seems more likely than not that the sorts of bacteria that like eating sugar alcohols and such are also the sorts of gut bacteria that may promote making you feel hungrier. This is another possible mechanism that can explain a harmful effect of artificial sweeteners.
It depends on how you define “needed.” Glucose is needed by our cells to generate ATP. That much is true. What isn’t needed is the oral intake of glucose or other sugars (including complex carbohydrates like starch). Our livers are more than capable of creating all the glucose our bodies need to function from other substances, and we would theoretically get by just fine even with a carb intake as low as zero. In practice the only reason we can’t test that is because we do need other vitamins, minerals, specific amino acids, and fats, and it’s not possible to consume all those necessary nutrients while also eating a zero carb diet because the foods that contain those other nutrients will have at least a few carbs.
This is the part that kills me. Decades of study, and no one can come up with any more solid than “I think this might possibly be the key but unfortunately no one has studied it yet. Maybe in another century or two…”
This sort of study is very difficult and time consuming. To control all the confounding variables, you would basically have to have a large number of people in a 24 hour a day controlled setting, for an extended period of time. That’s an expensive proposition, and for something like this where medications aren’t involved, there’s unlikely to be a financial payoff regardless of what the results show.
and lots of others I can’t think of right now. (List in no order.)
Some don’t have calories (at all I think), others in a form we don’t digest, and some in a form we only digest slowly.
Thaumatin apparently is even a protein.
Sugar alcohols(those ending in -ol), for example, are digested slowly and don’t affect blood sugar (much). They may be trouble if you can’t digest fructose I think.
I think there is no “the authoritative study” because it’s too complex. I’m sure there’s studies on individual sweeteners, as well as the workings of the groups of sweeteners.
Aspartame, for example, is probably one of the best studied one, since it’s always cited as “THE artificial sweetener” (or poison, depending on source).
Saccharine is probably the oldest, with well over a hundred years now.
Also, of course - is there money in doing such a study? Aspartame has long lost its patent. Saccharine too.
So anyone doing a study either is doing it merely “for science!”, which is a noble goal that probably won’t get any funding, or to prove a point, which makes the result usually less reliable.
As for the doctor, unfortunately doctors are people too, and some buy into the “artificial means evil” hype.
I don’t think they’re evil. My objections are gustatory, not based on scientific, moral, or ethical grounds. I think they all, without exception, taste nasty .
Heh, yeah, most taste weird. Funnily, the one I despise most is Sucralose - BECAUSE it tastes like sugar. You even get that sugary aftertaste
I prefer the “unholy trinity”, Aspartame, Acesulfam, Cyclamate. They cancel each other out mostly, and I’ve grown to like the weird side-taste they have.
Although for chewing gum you can’t beat Xylitol. “Cooling” taste, and even fights caries and might prevent ear infections. (Though that’s probably more because of the chewing motion.)
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