Are Artificial Sweeteners Killing You?
Sleepless nights and endless study sessions were the norm at medical school.
There was one particular companion that many students relied on to keep their energy levels up: caffeine.
This usually came in the form of an energy drink or coffee and my personal choice was a cold can of red bull. I thought they were my secret weapon to conquer the long nights and demanding schedule.
But, as I started to have these energy drinks regularly, I noticed something.
I found myself hungry more often, and my cravings veered toward unhealthy, junk food. It was as if my body was constantly searching for an energy boost, and it turned to sugary and salty snacks as its saviour.
While I loved the taste of Red Bull, I couldn't ignore the fact that it seemed to wreak havoc on my eating habits.
I needed to a change so I decided to shift gears. I swapped out the regular Red Bull for its sugar-free counterpart.
This decision was both out of concern for my dietary habits and a desire to avoid the excessive sugar content in the original version.
I didn’t like it at first. I missed the familiar sweetness, but I knew it was a necessary step for my health.
The adjustments didn't stop there - like most Brits I also enjoy a cup of tea. I’d have just a half teaspoon of sugar with it. When I tried using sweeteners as a sugar substitute, it just didn't taste the same.
Despite this, I went on a journey to find healthier alternatives in my diet and throughout my time at medical school, it taught me the importance of listening to my body and making conscious choices about what I put into it.
It was a lesson in balance, reminding me that even in the midst of a difficult academic pursuit, self-care should always remain a priority.
And while those enormous Red Bull cans may have given me a temporary boost, they also served as a reminder that the true source of lasting energy and vitality lies in making thoughtful choices for our well-being.
Speaking of which. You’ve probably had them before.
Those tiny little packets that promise sweetness without the guilt or calories of sugar.
But as you tear open that colourful packet and pour it into your coffee or sprinkle it on your cereal, certain questions may linger in your mind.
Do they cause cancer?
Are they worse than actual sugar?
Do they impact your gut health?
And are they actually safe?
In this article, we're diving deep into the world of artificial sweeteners to uncover the truth about their safety and health effects.
First things first, what is an artificial sweetener?
They’re food additives that gives a sweet taste to food or drink but with little or no calories when compared to sugar.
The story of artificial sweeteners begins with the accidental discovery of saccharin by Constantin Fahlberg, a chemist at Johns Hopkins University in 1879.
Fahlberg noticed an unusually sweet taste on his hand after working in the lab one day. He realised that the sweet sensation came from a compound he had synthesised from coal tar derivatives. This compound turned out to be saccharin, which is about 300 times sweeter than sucrose or sugar.
Saccharin quickly gained popularity and was used as an alternative to sugar, especially during sugar shortages in World War I.
The term artificial can actually be a bit misleading because not all of them are actually artificially derived. An umbrella term like sugar substitutes is probably more appropriate.
Sugar substitutes are either nutritive or non nutritive.
Nutritive sweeteners include sugar alcohols like xylitol or sorbitol. Non-nutritive sweeteners are either artificial like sucralose, or plant-derived sweeteners like stevia.
Non-nutritive sweeteners all possess different chemical structures and have different effects on the body but generally, they are comparable in their ability to activate your taste receptors.
How do non-nutritive sweeteners work?
They work by interacting with our taste receptors and the brain's signalling pathways in ways that mimic the perception of sweetness without providing the calories that sugar does.
Let’s go over the science briefly.
Our perception of sweetness begins on the tongue with specialised taste receptors known as sweet taste receptors.
These receptors are proteins found on the surface of taste bud cells.
Non-nutritive sweeteners are chemically designed to resemble the structure of sugar molecules. So when you consume foods or drinks containing these sweeteners, their molecules bind to the sweet taste receptors in the taste buds.
Once these receptors are activated, they send signals through the nervous system to the brain's gustatory cortex, the area responsible for processing taste.
In addition to the gustatory cortex, sweet taste signals also reach reward centres in the brain, such as the ventral tegmental area (VTA) and the nucleus accumbens.
These areas are associated with pleasure and reinforcement. The activation of these reward centres leads to the release of neurotransmitters, particularly dopamine.
Dopamine is a neurotransmitter associated with feelings of pleasure and reward.
I’ve done a video on dopamine so check that out.
The Dopamine Detox Lie
The release of dopamine and other neurotransmitters reinforces the perception of sweetness, even though the sweeteners themselves do not provide calories or the energy that sugar would.
Also unlike sugar, non-nutritive sweeteners do not provide significant calories because they are not metabolised for energy in the same way sugar is.
Before we go onto the benefits and risks of using non-nutritive sweeteners.
Why do we need to consider replacing sugar with these sweeteners?
Is sugar that bad for you? Picture this:
You're munching on your favourite processed snack, and it tastes amazing.
But here's the catch – it's loaded with added sugar.
That sugar isn't just there for taste; it's a calorie powerhouse.
So, when you consume foods packed with added sugar, you're also piling on extra calories. And guess what?
Consuming too many calories can lead to weight gain over time.
I’ve done a video on calorie counting, linked below.
The Truth About Calories
Adults should have no more than 30g of free sugars a day and at the moment, the current average intake is around double that.
Sugar is often "hidden" in many processed foods and drinks, making it easy to underestimate the number of calories we consume.
Sweetened drinks, sugary snacks, and even savoury things like salad dressings can contain substantial amounts of added sugars, contributing to a higher calorie intake than expected.
Sugar has a way of making your brain light up like a Christmas tree.
When you eat something sweet like a doughnut, your brain releases dopamine, a feel-good neurotransmitter. That can set off a cycle of craving and indulgence.
You might find yourself reaching for more sugary treats, which can lead to unhealthy eating habits.
On top of this, consuming large amounts of sugar in a short period can lead to rapid spikes in blood sugar levels, followed by crashes.
These fluctuations can result in increased hunger and cravings, making it difficult to maintain stable energy levels and control your food intake.
Also - Sugar is like an all-you-can-eat buffet for mouth bacteria.
Excessive sugar consumption is known to be a major contributor to dental problems, such as tooth decay and cavities.
I can’t tell you the amount of times I’ve gone to the dentist and they ask me how many cans of sugary drinks I have each day. (Zero, obviously).
Bacteria in the mouth feed on sugar, producing acids that erode tooth enamel. Over time, this can lead to dental issues, including gum disease.
Arguably the most important reason for reducing sugar content is that overconsumption contributes to the risk of developing conditions like obesity, diabetes, heart disease, fatty liver disease and some cancers.
And while sugar itself is not inherently "bad," the issue lies in the quantity consumed and the sources from which it comes.
Natural sugars found in fruits and dairy products, for example, are typically accompanied by essential nutrients and fibre, making them a healthier choice compared to the added sugars you get in sugary drinks, sweets, and processed snacks.
So what are the benefits of taking these sweeteners?
There are actually quite a few.
One of the main benefits is calorie reduction.
Most sweeteners are low in calories or are calorie-free, making them a good option for those looking to manage their calorie intake, control their weight, or reduce their overall sugar consumption.
This is especially true for those people who consume sugary drinks like I used to and want to cut them out of your diet.
They can be a valuable tool for people with diabetes or those aiming to regulate their blood sugar levels.
Since many sweeteners do not directly impact your blood sugar levels, they can be used as part of a diabetic diet or to reduce the glycemic load of meals.
Another benefit is that non-nutritive sweeteners do not contribute to tooth decay in the same way that sugar does.
Bacteria in the mouth can’t metabolise non-nutritive sweeteners, meaning they are less likely to cause cavities or tooth decay when compared to sugar.
For those trying to lose or maintain their weight, sweeteners can help reduce overall calorie consumption without sacrificing sweetness. This can be especially useful when trying to reduce calorie intake from fizzy drinks or coffee.
Sweeteners can be part of various diet plans, including low-carb, keto, and low-sugar diets.
They provide a way to enjoy sweet-tasting foods and drinks while adhering to specific dietary restrictions.
Using sweeteners can be a gradual step towards reducing sugar consumption.
People can transition from sugar to sweeteners in recipes, which may help them adjust to a less sweet taste over time.
Let’s dive into the main arguments against using sweeteners.
One of the most widely debated concerns about non-nutritive sweeteners is the potential link to cancer.
I think these concerns initially arose when early studies linked the combination of one or two sweeteners and bladder cancer in rats.
Most studies of approved sweeteners have provided no evidence that they cause cancer or other adverse health effects in lab animals.
On top of this, The European Food Safety Authority have set an acceptable daily intake for aspartame. It’s equals around 15 cans of diet fizzy drink for a 70 kilo adult.
There have been a few epidemiological studies - these are studies based on populations - looking at the links between non-nutritive sweeteners and cancer in humans. Some have yielded interesting results.
One particular study was the NutriNet-Santé Study, which looked at intake of artificial sweeteners from all dietary sources and found that people who consumed the greatest amounts of artificial sweeteners, were slightly more likely to develop cancer than those who did not consume any.
This study looked at over 100,000 French people - a good sample size.
People in the study reported what they ate and drank, including how much artificial sweeteners they consumed, through questionnaires and interviews.
They also provided information about their health and habits. The researchers observed the participants over a period of time, looking for any cases of cancer that developed during the study. The researchers analysed the data to see if there was a connection between how much artificial sweeteners people consumed and their risk of getting cancer.
Sounds legit, right? One crucial consideration when interpreting the results of studies like this one is the reliance on self-reported dietary intake data.
Participants were asked to recall and report their dietary habits, including the consumption of artificial sweeteners, which can be subject to recall bias.
People might not accurately remember or report their dietary habits, leading to potential inaccuracies in the data.
Misreporting is another problem. Some participants may not be aware of the presence of artificial sweeteners in certain foods and drinks, leading to underreporting of their intake - affecting the reliability of the study's findings.
It was also an observational study, meaning it observes participants in their natural environments and collects data without intervening or manipulating variables.
While observational studies are valuable for identifying associations and links, they can’t establish causation.
In other words, they can show a relationship between variables but cannot prove that one variable causes the other.
In the context of this study, associations between artificial sweetener consumption and cancer risk can be identified, but they cannot definitively conclude that artificial sweeteners directly cause cancer.
Reverse causality is an important concept to consider in observational studies.
It refers to the possibility that the observed relationship between two variables may be due to the effects of the outcome variable on the exposure variable, rather than the other way around.
In the context of this study, reverse causality could mean that individuals who are already at a higher risk of cancer may choose to consume more artificial sweeteners as part of their dietary changes or health-conscious behaviours.
In this case, the association observed between artificial sweeteners and cancer may not reflect a causal relationship, but rather the influence of an underlying factor (e.g. preexisting health conditions) on both variables.
Another key argument against the use of artificial or non-nutritive sweeteners is that they might modify our gut microbiota.
The gut microbiota refers to the trillions of microbes including bacteria, that live in the human gut.
Most microbes in the body are useful, but they may become harmful when out of balance.
There was a study published in a well known and credible journal called Cell, that looked at 4 non-nutritive sweeteners and their effects on blood glucose levels, insulin as well as the oral and stool microbiome in 120 adults over a 2 week period.
They had participants wear a continuous glucose monitor and it was a randomised controlled trial or RCT. Let me explain briefly what an RCT is.
In simple terms it’s like an experiment to see if something new works, like a medicine or treatment.
It's like flipping a coin to decide who gets the new thing and who doesn't. This way, we can be sure that the results are fair and not influenced by anything else.
Randomisation is important because it helps to ensure that your groups are similar in every way at the beginning of the experiment.
RCTs are the most trusted method for testing new treatments, medicines, or interventions in many fields of science and medicine.
It's the gold standard because it gives you strong, dependable answers about whether a cause-effect relation exists between the intervention and the outcome.
So what did they find?
They found that at realistic doses, consumption of all 4 non-nutritive sweeteners in the study lead to measurable changes in the gut microbiota of the participants.
They also found that these sweeteners also impact your blood sugar levels - mainly saccharin and sucralose.
The fact that they impact blood glucose levels is quite interesting because non-nutritive sweeteners don’t actually enter the blood stream, they stay in the digestive tract until they pass in the stool.
So just because a sweetener is not absorbable and doesn’t enter the blood stream, it doesn’t mean that it’s inert.
A really interesting study but unfortunately, it doesn’t show the long-term health effects of sweeteners on blood glucose control.
At the end of the day, we are consuming excessive amounts of sugar, and there is compelling evidence that shows excessive sugar intake has negative effects on our health.
I’m talking inflammation, obesity, as well as impacting your hunger and energy levels.
So it you struggle with overconsumption of sugar, I think it’s important to develop strategies aimed at reducing sugar consumption - i.e. using sweeteners as a sugar substitute.
But will using artificial sweeteners alone improve your health? I don’t think so.
I think it’s a useful tool for those looking to reduce the amount of calories in their diet. But it doesn't address the broader aspects of healthy eating habits.
Building a sustainable and balanced relationship with food, making informed choices, and practicing portion control are big components of a healthy lifestyle.
So in my opinion, changing your behaviour and attitude towards nutrition is far more powerful than just swapping out your regular coke for a diet one.
A quote from a great
Have a sweet day,
Z
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