Dr Araz Rawshani

Effects of sweeteners: aspartame, fructose, stevia, sucralose, saccharin, acesulfame

Contents

How are we affected by sweeteners in food and drink? About aspartame, fructose, stevia, sucralose and other additives

Fructose (fruit sugar) and glucose (glucose) are naturally found in fruits, vegetables and honey. Man has probably eaten fructose and glucose as long as it exists. However, the intake of fructose and glucose was low until the 19th century, when sugar became cheap and easily accessible.

Man, like other plants and animals, prefers to use glucose as an energy source. The fact is that the body is able to convert most carbohydrates into glucose and thus the body can extract energy from most carbohydrates. The only exception is fibers. We can not break down fiber in the intestine and thus not absorb fiber.

However, man cannot use fructose as an energy source. So we cannot extract any energy from fructose until we convert it into other substances and this is done using enzymes. In the liver, small intestine and kidneys, fructose can be converted into other substances that give us energy (e.g. glucose). Of all the fructose we eat, about half is converted into glucose. The rest will be lactate, fat and glycogen (all of these can also be used as an energy source). However, converting fructose costs energy, which makes fructose a less efficient source of energy than glucose.

Sugar and health: a matter of quantity

The fact that sugar can affect health is nothing new. In 1912, the French doctor Paul Carton suggested that sugar was one of the root causes of human diseases (this is, of course, a sharp exaggeration, especially in 1912 when the majority of all deaths were caused by infections). In the 1960s, Yudkin had more meat on his bones and even then he suggested that sugar was a health hazard. Yudkin actually suggested that sugar was more dangerous than saturated fat. 17

Discussion on sugar as the cause of obesity, diabetes and cardiovascular disease receded in the 21st century. 18 Increasingly, researchers and organisations are sounding the alarm about health hazards associated with sugar and fast carbohydrates. It seems that the excessive intake of sugar and fast carbohydrates is one of the most important explanations for the obesity and diabetes epidemic that has hit the whole world.

Note that sugar itself is not toxic or harmful. The human body is able to cope with sugar just excellently. Rather, sugar becomes harmful because of the large quantities we eat.

The solution to the problem: sweetener?

To get to grips with the problem, they turned to sweeteners. More and more people have begun to realise that sugar (in the quantities we eat) is harmful, which means that companies selling sugar-containing products have to find alternatives to sugar. Of course, this is not an easy task, but despite this, several alternatives to sugar have been found. These options are called “sweetener”. Some sweeteners are completely natural, such as fructose (fruit sugar). Others are artificial (artificial), for example, aspartame.

Many of the sweeteners are low-calorie, which means they do not contain any calories. The companies advertise these products aggressively, claiming that they do not lead to weight gain or other negative effects (because they are not glucose and contain no calories). The question is whether this is true or false. Let’s go through what studies learned about this.

Fructose (fruit sugar) as a sweetener in food and beverages

We start with fructose (fruit sugar), which is a common additive in both food and drink. It has been seen that high doses of fructose lead to animals developing obesity, insulin resistance, type 2 diabetes, blood lipid disorder and high blood pressure (hypertension). 19 People who eat large amounts of fructose and foods with added fructose are fatter than others. 20 People who eat large amounts of fructose. Investigations show that high consumption of fructose leads to overweight and obesity due to fructose stimulates the production of fat and is not as measured by fructose. 22

Regarding fructose as a sweetener/additive we know today fooling: 23

  • There is a relationship between fructose and blood sugar, in that people who eat a lot of fructose tend to have higher blood sugar. People who eat a lot of fructose also appear to have higher triglycerides, higher blood pressure and lower HDL cholesterol (good cholesterol).
  • People who eat a lot of sugar have higher total cholesterol, higher LDL cholesterol, higher triglycerides, lower HDL cholesterol and higher blood pressure. drinking plenty of soft drink (which is usually sweetened with fructose) has a higher risk of developing chronic kidney disease.
  • Fruit juice with added sugar is likely to lead to increased risk of type 2 diabetes.
  • Fruit juice that was 100% pure fruit (no added sugar) is not subject to increased risk of type 2 diabetes.
  • Fruit juice that was 100% pure fruit (no added sugar) is not subject to increased risk of type 2 diabetes.
  • Fructose in excessive amounts can increase the deposition of fat in the liver, which can lead to fatty liver and finally cirrhover.
  • All drinks with added sugar lead to weight gain.
  • Very high intake of fructose likely leads to higher LDL cholesterol.
  • Replacing sugar and starch with Fructose leads to better blood sugar if you have type 2 diabetes.
  • It seems that fructose is particularly unhealthy if at the same time leads to eating more calories than you should.

Fructose must not be confused as an additive to foods and beverages, with fructose contained in fruit. Indeed, there are no studies that show that fruit is unhealthy. Read more about Fructose (fruit sugar).

Other sweeteners: aspartame, sucralose, stevia, acesulfame

Over the years, many attempts have been made to find alternatives to sugar and fructose. Some of the options are artificial, and others are natural. Among these sweeteners we find aspartame, sucralose, stevia, acesulfame and others. Today, these sweeteners can be found everywhere in grocery stores and restaurants. They are often marketed as “healthy alternatives” to sugar (fructose and glucose) because they contain no calories. Many of these sweeteners are many times sweeter than sugar, so you only need small amounts of them. But the question is how these sweeteners affect our blood sugar, insulin, body weight and the risk of becoming overweight, fatty or getting diabetes.

In fact, there is no evidence that calorie-free sweeteners lead to weight loss in the long term. 24. In fact, there are studies that suggest that sweeteners can have the opposite effect and instead disrupt the metabolism. 25 This means that you who want to lose weight have no benefit from products containing low-calorie sweeteners, such as aspartame, stevia, acesulfame, sucralose, saccharin, etc.

The giant study NHANES (one of the greatest epidemiological studies of our time) examined the relationship between the intake of table sugar, fructose, aspartame, saccharin and the risk of becoming overweight or developing type 2 diabetes. People in NHANES who rarely ate sweeteners were narrower than people who often ate sweeteners, and this was also true of calorie-free sweeteners.

Studies also show that aspartame can actually have a negative impact on the turnover of glucose in the body. 26 This applies to both fasting blood sugar, insulin sensitivity and glucose tolerance. Several studies have reported that artificial sweeteners have a negative impact on our blood sugar and metabolism. 27

Intestinal flora that brew between sweeteners and metabolism

In a study in the prestigious journal Nature, Suez describes with colleagues how sweeteners can cause glucose intolerance (something related to type 2 diabetes) through changes in our intestinal flora. Suez used common sweeteners and analyzed how these affected the intestinal flora and the body’s ability to handle glucose. This suggests that the harmful effect of sweeteners may be through our intestinal flora. 28

Azad and colleagues merged results from 7 clinical studies investigating how sweeteners such as aspartame, sucralose and stevia affect risk factors for cardiovascular disease. These studies showed that sweeteners did not cause weight loss and instead a slight increase in BMI was observed. It could not be observed that there would be any benefits of sweeteners.29

In a study published in the reputable medical journal New England Journal of Medicine, Ebbelinge and colleagues showed that overweight and obese people who regularly drank soft drinks could lose weight if they chose soft drinks with artificial sweeteners. After 1 year, those who drank soda with sweeteners had lost 1.9 kg more than those allowed to drink optional but after 2 years there was no difference between the groups! Again, anyone who wants to lose weight has no significant benefit from products with sweeteners. 30

Tey and colleagues examined how aspartame, monk fruit, stevia and sucrose in drink affected the body’s metabolism (blood sugar, insulin levels) and the total energy intake (calories). This study is very interesting because it showed that when you gave the participants received (for breakfast) drinks with calorie-free sweeteners, they ate fewer calories for breakfast but instead they ate more calories for lunch, which meant that their total calorie intake was the same as those who ate drinks with sugar for breakfast. In other words, participants who ate sweeteners could not reduce their calorie intake. In addition, there was no difference in either blood sugar or insulin levels. 31

Evans and colleagues examined whether it was beneficial to replace a part of glucose or sucrose with fructose for people with type 1 or type 2 diabetes. They found that replacing glucose/sucrose with fructose had a less pronounced increase in blood sugar after meals, especially in people with type 1 and type 2 diabetes. In addition, insulin levels in the blood were lower, compared to the same amount of glucose/sucrose. Therefore, for people with diabetes, there is an advantage in replacing glucose with fructose. 32

Concluding on sweeteners

  • Sugar and fast carbohydrates are unhealthy unless intake is severely restricted.
  • Sweeteners do no benefit and can be harmful as soon as possible.

Concluding on sugar, overweight and diabetes

  • People with excess weight and obesity can lose weight by eating diets with a reduced amount of carbohydrates (LCHF).
  • People with type 2 diabetes can get large improvements in blood sugar and lose weight by eating less sugar and fast carbohydrates. LCHF is a diet that works well for people with type 2 diabetes.
  • More and more people with type 1 diabetes advocate low carbohydrate diet, but for this group there is not enough data to recommend it generally. More studies are needed to show that low-carbohydrate diet is safe for people with type 1 diabetes.
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