No Calories Doesn’t Mean No Health Effects

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Sugar alternatives may not be as harmless as commonly believed. Marie La Fauci/Getty Images
  • Researchers conducted a randomized controlled trial to investigate the effects of artificial sweeteners such as aspartame, saccharin, stevia, and sucralose on human metabolism and the gut microbiome.
  • They found that these non-nutritive sweeteners can induce individual and specific changes in glycemic response by altering the gut microbiome.
  • This finding challenges the popular notion that sugar substitutes have no effect on the human body and highlights the need for further clinical studies.

After eating foods containing carbohydrates, blood sugar (blood sugar) rises as we digest the food. This spike in blood sugar after meals is known as the glycemic response.

Non-nutritive sweeteners (NSNs), such as aspartame, saccharin, stevia, and sucralose, contain little or no carbohydrate and have therefore been presumed by scientists not to trigger a glycemic response. This belief that NNS are biologically inert, coupled with their sweetness, has made them very popular sugar substitutes, especially for managing diabetes and weight gain.

In a study published in 2014, Dr. Eran Elinav, an immunologist and microbiome researcher at the Weizmann Institute of Science in Israel and the Division of Microbiome and Cancer, DKFZ, Heidelberg, Germany, and his team challenged the idea that NNS are biologically inert. The study established that non-caloric artificial sweeteners induce glucose intolerance in mice by altering their gut microbiota.

Now, a new study published by Dr Elinav and his team in the journal Cell shows that NNS have a similar effect on humans.

“We need to raise awareness that non-nutritive sweeteners are not inert to the human body as we originally thought.”
— Dr. Eran Elinav

“This is a very strong and rigorous study and the results are important and timely,” Dr. Michael Goranprofessor of pediatrics at the Keck School of Medicine at the University of Southern California and program director for diabetes and obesity at the Saban Research Institute at Children’s Hospital Los Angeles, who was not involved in this study, said Medical News Today. Dr. Goran is also the author of sugar resistant.

“Non-nutritive sweeteners are rapidly proliferating in the food supply and across all demographics, including children and pregnant women, but their full and long-term impact on human health has not been thoroughly studied” , did he declare.

The researchers recruited into the study only healthy volunteers who did not consume any NNS in their daily diet. A total of 120 people passed the rigorous screening test, and the researchers randomly assigned them to one of six supplementation groups: aspartame, saccharin, stevia, sucralose, glucose (to control for potential glucose interference in the formulations standard NNS) and no supplement (the second control group).

All sweeteners were given in commercially available packets containing a mixture of glucose and at doses below the acceptable daily intake recommended by the FDA.

To study the effect of NNS on glycemic response, participants wore a continuous glucose monitor throughout the clinical trial and performed glucose tolerance tests on predetermined days. The glucose tolerance test measures the body’s ability to absorb and use glucose (sugar).

The researchers found that the groups consuming saccharin and sucralose had a “significantly elevated” glycemic response when exposed to NNS. No significant effects on glucose tolerance were observed in the aspartame, stevia, glucose and no supplement groups.

These results suggest that short-term consumption of saccharin and sucralose at doses below the acceptable daily intake may impact glycemic responses in healthy individuals.

Based on the results of studies in animal models, the researchers hypothesized that NNS may affect human metabolism by altering the gut microbiome. To test their hypothesis, the researchers analyzed participants’ stool microbiome samples before and after consuming NNS.

They found that the four NNS tested altered the bacteria in the gut and the molecules they secrete. Similarly, the four NNS “had a distinct impact” on the oral microbiome.

Such microbiome changes did not occur in control groups. These results suggest that NNS are not inert to the human microbiome.

“[The study is] a first step to confirm what many have suspected for some time now; that artificial sweeteners have a measurable impact on metabolism and health. The results provide a valid mechanism of action for the downstream effects on glycemic control of sweeteners, through interaction with the gut microbiome.
Professor Tim Spectorco-founder of personalized nutrition company ZOE and research fellow at King’s College London

To determine if the changes in the microbiome were indeed the cause of the altered blood sugar responses, the researchers transplanted gut bacteria from the study participants into germ-free mice, mice that had been raised under completely sterile conditions and did not did not have their own microbiome.

Collectively, these mice showed glycemic responses that mirrored those of their human microbiome donors.

These results suggest that human microbiome responses to NNS are highly personalized and may lead to glycemic alterations in some, but not all, consumers depending on their microbiomes and the NNS they consume.

The idea that the human gut microbiota can react to certain food additives and trigger metabolic changes is not new. Previous studies have suggested that food emulsifiers, food preservativesand dyes promote metabolic changes by altering the microbiome.

More recently, researchers have discovered that a new low-calorie sweetener promotes the growth of beneficial gut bacteria, which impacts overall health.

Asked about the limitations of the study, Dr. Elinav noted that the clinical trial included only healthy, non-overweight, normoglycemic people, and participants received only one formulation of NNS.

“Our findings call for further randomized, non-industry-funded interventional studies in at-risk populations, such as prediabetics and diabetics. Other SNNs[s]formulations and doses need to be explored further,” Dr. Elinav said.

“Furthermore, the impacts of NNS should be compared in future controlled trials between high carbohydrate consumers and [carbohydrate]-restrictive diets for their potential differential effects on human metabolic physiology. A longer exposure period than used in our study may be required to fully assess the potential health ramifications induced by the altered microbiome when consuming different NNS.[s],” he added.

Dr. Goran, who was not involved in the study, suggested that other sweeteners, including monk fruit sweetener and allulose, are becoming increasingly popular and should also be considered.

“We also need studies in children because their microbiome is still developing and therefore the impact of these compounds could be different and affect longer-term outcomes,” he said.

“In addition, this article contains very detailed information on microbiome outcomes and glycemic responses, but other outcomes of interest include overall effects on appetite regulation as well as cognitive effects, as there are evidence suggesting adverse effects on both of these outcomes,” he added.

Professor Spector, who was also not involved in the study, pointed out that additives or colorings in these sweeteners may also cause these effects.

“As the authors have stated in this article, it is likely that emulsifiers, additives and artificial colors may affect the human microbiome and therefore the metabolic response, but it is not yet clear whether this is it a glycemic response or something else,” he said. DTM.

Dr. Goran suggests avoiding all sweeteners “until we have stronger evidence that they are safe.”

“None of [the non-nutritive sweeteners] will solve [the] craving for sweets and there are studies suggesting that habitual consumption of sweeteners increases overall daily calorie and sugar consumption.
— Dr. Michael Goran

Professor Spector echoed similar thoughts:

“The results of the study imply that the response is variable between individuals, but all sweeteners seem to have some sort of impact, so none of them seem better than the others and I would personally avoid them.”

Although the results of this study raise concerns about the effects of NNS on human health, Dr Elinav warned that “sugar consumption is still a very serious and well-proven risk for obesity, diabetes and their implications. for health, and our results do not support or promote the consumption of sugar in any form.

“[We] strongly believe that sugar consumption should be minimized and avoided whenever possible,” he added.

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