Sugar-free, Artificial Sweeteners and Diabetes

When diagnosed with diabetes one of the first dietary interventions suggested is to limit foods high in simple sugars – biscuits, soft drinks, sweets…

This could represent a drastic change of diet, and patients can be tempted by the “sugar-free” version of those same sugar, no harm, right?

Is not that simple. There is a lot of research on the topic, and it can sometimes be contrasting.
Some studies show a small weight reduction associated with swapping foods containing real sugar with the “sugar-free” equivalent (but no impact on waist circumference or type2 diabetes markers), while others show an increase in BMI and type2 diabetes markers.

Let’s dive into the main sweeteners in “sugar-free” products: aspartame and saccharin.

Aspartame is a white, odourless powder that is two hundred times sweeter than sugar and dissolves easily in water, reason why it is frequently used in sugar-free drinks. Some studies have linked an excessive intake of aspartame to a possible exacerbation of diabetes, headaches, depression, arthritis and other medical conditions.

Saccharin is an artificial sweetener commonly used as a sugar substitute. It is three hundred to five hundred times sweeter than sugar, and it passes directly through the human digestive system without being digested.

While some studies on mice have shown that the intake of saccharin can result in a decrease of insulin resistance and improvement of blood sugar level, others have shown an association between consumption of saccharin and an increased accumulation of body fat (despite decreased caloric intake), increased food intake and weight gain.

Why so many contrasting results in those studies? The individual microbiota is also crucial in understanding each person’s response to the intake of foods containing artificial sweeteners, even more for diabetic patients. It is widely known that excessive intake of foods containing artificial sweeteners can alter the gut microbiota, leading to digestive distress. A healthy and balanced microbiota is vital for the production of Short Chain Fatty Acids (SCFA), which are fibre fermentation by-productions, involved in many body functions, including metabolism and mood regulation. A regular consumption of processed foods, low fibre intake and a diet rich in simple sugar can alter the microbiota balance.

This means that artificial sweeteners are harmful and should be avoided at all costs? The answer is to understand why we want to include these foods in our diet. Even if “sugar-free”, products such as soft drinks, sweets, candies, and condiments should be eaten occasionally and not on a regular basis.

Sugar free options can be a first stepping stone when modifying eating habits featuring many processed foods and sweets, but is important to remember that a diet rich in processed foods (sugar free or not) is associated with weight gain, decreased variety of microbiota, metabolic alterations, and a general decreased overall health.