Artificial sweeteners may be a healthy choice

Robin Wulffson MD's picture
artificial sweeteners, weight loss, diabetes, safety, compensation
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Artificial sweeteners are popular among individuals who want to lose weight and/or reduce their sugar consumption. However, much controversy surrounds their use as well as whether they actually aid one in controlling caloric intake.

On July 9, the American Diabetes Association (ADA) and the American Heart Association (AHA) issued a joint statement on artificial sweeteners. The statement was published online in both the journals Circulation and Diabetes Care. The ADA and AHA gave cautious approval of six artificial sweeteners.

The six artificial sweeteners evaluated in the report were: Acesulfame-K (Sweet One); Aspartame (Equal, NutraSweet); Neotame (Neotame); Saccharin (Sweet/M Low); Sucralose (Splenda); and Plant-based sweeteners such as Stevia (Truvia, PureVia, Sweet Leaf). The researchers gave a cautious recommendation for the use of the foregoing nonnutritive sweeteners to help people maintain a healthy body weight and for diabetics to aid glucose control. They issued a caveat, however, that sweeteners will be beneficial only as long as individuals do not consume additional calories later as compensation. Furthermore, the statement cautioned that scientific evidence is limited and inconclusive about whether this strategy is effective in the long term for reducing calorie and added-sugars consumption.

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The statement reiterates that limiting glucose consumption is an important strategy for achieving optimal nutrition, healthy weight, and glycemic control. It notes that some data exists, which suggests that nonnutritive sweeteners may be used in a structured diet to replace sources of added sugars and that this substitution may result in modest energy-intake reductions, weight loss, and beneficial effects on related metabolic parameters.

All six of the artificial sweeteners have Food and Drug Administration (FDA) approval; however, concern has been raised about their overall safety. The statement does not address safety issues; rather, it is limited to the question of whether artificial sweeteners result in a reduction of sugar intake. The statement notes that for the artificial sweeteners to successfully contribute to reductions in calories from added sugars or other sources, they must also avoid causing compensatory energy intake immediately or later in the day. The authors wrote: “If choosing a diet soft drink over a regular calorie soft drink leads to a decrease of 100 kcal per 8-oz serving, but later in the day causes an alteration in appetite or hunger that results in an additional 50, 100, or 200 kcal of intake, the initial “calorie saving” effect would be altered or reversed. Or, if choosing a diet soft drink enables an individual to simultaneously justify eating a 150 calorie snack, the calorie savings from the NNS would also be negated.

The researchers noted that when individuals use artificial sweeteners there is compensation; the key is to what degree. They note that if there is only partial compensation, then the balance is still in favor of fewer calories; however, individuals could also completely compensate or even overcompensate. Thus, the sweeteners have to be used smartly to be successful. An interesting finding was that compensation appeared to be less of a problem when the sweeteners were consumed in beverages rather than food. They found that individuals were generally unaware of the lack of calories in a diet soda; therefore, they do not tend to eat more. However, if the consume a low-calorie food product, they do tend to eat more as compensation. Thus, they concluded that artificial sweeteners are more beneficial when consumed in beverages rather than solid foods.

Take home message:
This report should be helpful to anyone who uses artificial sweeteners to aid them in controlling their weight. The fact that artificial sweeteners are more beneficial in beverages is also helpful information. Although safety issues have been raised about these substances, they are currently subject to controversy. The best choice for a weight loss program would be to reduce sugar consumption and limit it to complex carbohydrates (i.e., an apple or orange) rather than a sugary soft drink. Complex carbohydrates are metabolized slowly; however, the intake of refined sugar results in a spike in blood sugar.

Reference: ADA/AHA

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