Introduction
Insulin is a hormone created by the pancreas that controls the amount of glucose in a person’s bloodstream at any given moment. It helps store glucose in the liver, fat, and muscles, and regulates the body’s metabolism of carbohydrates, fats, and proteins. Comprehending the interplay of insulin and blood glucose levels is important in understanding the effect of artificial sweeteners.
After consumption and digestion of food, carbohydrates are broken down into sugar and absorbed in the bloodstream. Consequently, blood sugar levels rise. Insulin released by the pancreas helps the cells to absorb blood sugar for energy and storage. This leads to a decline in glucose levels. The pancreas then produces glucagon, a hormone that prompts the liver to release stored sugar. This interaction of glucagon and blood sugar ensures stable blood glucose levels in the body and the brain. But small quantities of insulin are also secreted before any sugar enters the bloodstream. This response is known as cephalic phase insulin release. It is prompted by the sight, smell, and taste of food, in addition to chewing and swallowing. The interference in this process is claimed to be caused by artificial sweeteners.
What are artificial sweeteners?
For years now, some people have been trying to remove sugar from their diets and find healthier replacements that can serve the same function as sugar without the added risk. That’s where artificial sweeteners come in. Artificial sweeteners are synthetic sugar substitutes.
Artificial sweeteners promise to be a fewer-calorie substitute to sugar, helping to combat obesity, metabolic syndrome, and diabetes, all risk factors for heart disease. The American Food and Drug Administration has approved five artificial sweeteners—saccharin, acesulfame, aspartame, neotame, and sucralose—as well as one natural low-calorie sweetener, stevia. Studies have shown that stevia extract, a compound called Reb A, is free from side effects. Purified steviol glycosides, which are natural components of stevia leaves, are observed to be safe by the FDA. However, whole leaf stevia and crude stevia extracts, different from purified extracts, are not deemed safe, and need more research to label it safe.
Impact of artificial sweeteners on blood glucose levels
Sugar substitutes are also called ‘high-intensity’ sweeteners because a small amount of them can provide great sweetness. They add few or no calories, and generally do not raise blood sugar levels.
However, there are harmful artificial sweeteners.
According to a study, daily consumption of diet drinks, sweetened by sugar substitutes, was associated with a 36% greater risk for metabolic syndrome—a group of five conditions that can lead to heart disease, diabetes, stroke and other health problems—and a 67% increased risk for type 2 diabetes. Artificial sweeteners in beverages/foods increase the desire for, and subsequently the consumption of, sugar-sweetened, energy-dense beverages/foods, thereby resulting in overconsumption, increased body weight, and consequent metabolic dysfunction.
The known effects of artificial sweeteners include the triggering of cephalic phase insulin release, causing a small rise in insulin levels, prompted by the sweet taste. Regular use of sweeteners also changes the balance of our gut bacteria. This could make our cells resistant to the insulin we produce, leading to both increased blood sugar and insulin levels.
Aspartame, another commonly used artificial sweetener, has been a controversial product. Also 200 times sweeter than sugar, it has negligible effects on blood glucose levels. However, research suggests that aspartame intake may lead to an increased risk of weight gain rather than weight loss, and cause impaired blood glucose tolerance.
There are artificial sweeteners that are labeled safe for consumption by the FDA and do not impact your blood glucose levels.
Stevia, a natural plant that has been used to sweeten foods and drinks for centuries. It is made from a herb, not chemicals, has no calories, and is about 200 times sweeter than regular sugar. It was proven in a study that intake of stevia sweetener does not affect the blood glucose level.
Erythritol is one such sweetener widely available for consumption. Despite being a low-calorie sweetener with no serious side effects detected, its unique chemical structure makes it difficult for the human body to digest it, causing it to pass unchanged through most of the digestive system, or until it reaches the colon. In the colon, it is fermented by the resident bacteria, which produce gas as a side product. It does present a potential for digestive issues that may come up as side effects.
The varying compositions and effects of different artificial sweeteners show that some of them might be better for an individual than others. The FDA has established an acceptable daily intake (ADI) level for a number of high-intensity sweeteners. An ADI is the amount of a substance that is considered safe to consume each day over the course of a person’s lifetime. For each of these sweeteners, FDA determined that the estimated daily intake even for a high consumer of the substance would not exceed the ADI.
Artificial sweeteners may have fewer calories, but are still processed and do not offer any additional nutritional benefits. Natural sweeteners in small portions depending on the individual’s current health parameters can be a safe alternative. Sweeteners such as honey, dates, maple syrup, molasses, etc.,—not including the other natural sweetener, stevia—are organic and can contain small amounts of antioxidants, minerals, and vitamins. Although the latter are empty calories, because of their nutritional value they can be considered a better alternative to sugar than artificial sweeteners.
However, both remain better alternatives to sugar in terms of maintaining or improving one’s health. Eventually, the key is to consume any kind of sugar in moderation. For individuals who have pre-existing underlying conditions, there is some merit to the idea of consuming unrefined and unprocessed foods. You can avoid overconsumption of refined foods and opt for more whole foods. There can’t be a single diet plan across the board for each person because each body, metabolism and lifestyle is different. If you are looking at achieving holistic wellness and longevity, it’s important to find healthier alternatives and adopt practices that help you maintain a healthy relationship with your food.
Conclusion
A collective review of various studies concluded that the effect of artificial sweeteners on blood glucose levels is largely inconclusive. Even in subjects with diabetes and hypertension, the evidence regarding health outcomes of sugar substitute-use is also inconsistent. Blood sugar levels should be monitored closely despite the use of safer sugar alternatives, and a doctor should be consulted in the presence of any unusual activities or underlying health conditions. Having said that, erythritol and stevia extract (Reb A) is considered safe for consumption with minimal side effects.
References
- Choudhary AK. Aspartame: Should Individuals with Type II Diabetes be Taking it? Curr Diabetes Rev. 2018;14(4):350-362. doi: 10.2174/1573399813666170601093336. PMID: 28571543.
- Is Aspartame Really Safer in Reducing the Risk of Hypoglycemia During Exercise in Patients With Type 2 Diabetes? Annie Ferland, Patrice Brassard, Paul Poirier, Diabetes Care Jul 2007, 30 (7) e59; DOI: 10.2337/dc06-1888
- Ajami M, Seyfi M, Abdollah Pouri Hosseini F, et al. Effects of stevia on glycemic and lipid profile of type 2 diabetic patients: A randomized controlled trial. Avicenna J Phytomed. 2020;10(2):118-127.
- Holly Strawbridge, Artificial sweeteners: sugar-free, but at what cost?, Harvard Health Publishing, Jan 2020.
- Lisa Jaffe and Amy Hess-Fischl, What is Insulin?, Endocrine Web
