September 2023

Too Sweet or Not To Sweet, Part I

Rarely does the same topic make one side of the STEPS REAL News newsletter, but this is too sweet a topic to be ignored. According to the June 2023 Nutrition Action newsletter, a March 2023 article in Natural Medicine reported that the artificial sweetener (AS), erythritol, might elevate the risk of major adverse cardiac events like heart attack, strokes or death. See more on other artificial sweeteners here here and here. Like all science, which is fluid, just a year before, in a March 2022 article in JAMA Network Open, a meta-analysis of 17 studies showed that “over the moderate term, LNCSBs [AS] are a viable alternative to water as a replacement strategy in adults with overweight or obesity who are at risk for or have diabetes.” What gives?

As Nutrition Action reviewed the more current study, and a Medscape commentary from March 2022 also argued, there’s more to these scares than meets the eye. For one thing, the fact that subjects who used AS probably had higher rates of excess weight and, very likely, elevated risks for diabetes and heart disease negates some of the alarm: those who needed to control weight were more likely to consume AS. Too, our bodies produce erythritol as a component of the antioxidant system. Therefore, excess erythritol as found in the blood of those who consumed AS might be a marker of poorer kidney function not a cause. Besides some methodological concerns, such as timing of blood measurements and disease onset, there are other ways to interpret the data that are not as alarming as they appear.

Overall, “Randomized trials show that switching to low-cal drinks reduces body weight by about a kilogram, and BMI by 0.3 points. It also reduces body fat by about half a percent.” So maybe AS can help some people some of the time, as Lincoln might have said, just not all the time….

Too Sweet or Not To Sweet, Part 2

Artificial sweeteners (AS) have always made news from their inception to today. The saccharine scares of the 1960s meet aspartame and sucralose (aka Splenda) of the 1990s meet erythritol in the 2020s attesting to the controversies surrounding super-sweet non- or low-calorie chemistry products for mass consumption. Promoted as viable additives to foods and beverages that will help you prevent or even lose weight have catapulted their popularity in modern Western diets. But do they perform, safely, as promoted? That is the question.

A 2014 study (in Nature) found that consumption of AS “drives the development of glucose intolerance through inductions of compositional and functional alterations to the intestinal microbiota” of the gut. Like others that have suggested as much, most are done on lab animals. Furthermore, a more recent study has affirmed that sucralose “may increase food cravings and appetite.” This was done on humans using functional MRI to “observe the unconscious brain reactions to plain water vs. water flavored with either sucrose (table sugar) or …sucralose.” Blood tests were done to capture changes in glucose, insulin and some hunger hormones in addition to measuring total calories consumed during a buffet meal after the drinks were consumed. It turns out that women, especially those with obesity, had more brain activity in appetite centers and that hormones like leptin which “signal fullness” fell after drinking the AS beverage. These results suggest that AS interfered with signals that help regulate appetite. Not surprisingly, women but not men ate more after drinking the AS beverage. Ultimately these results suggest “different people may have different neural and metabolic reactions to sweeteners in these beverages.”                                                                                                              

Tufts Nutrition Letter Dec. 2022

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