When it comes to sugar substitutes, can you really have your sugar and eat it too? What affects do they have on our health? Do they cause cancer, lead to diabetes or simply make no difference at all? Let’s take a look!
Sugar substitutes (AKA artificial sweeteners) are generally considered any form of sweetener you use instead of table sugar (sucrose). These are often found in “diet” or “sugar-free” products such as fizzy drinks, yoghurt, chewing gum and some baked goods. How do they work? These types of sweetener are super sweet; we are talking many, many times sweeter than sugar (Stevia is 300 times sweeter than sugar). Because of this, you need a lot less of them. The result? The same amount of sweetness with far less kilojoules. Win-win right?
Now if you’re anything like me, you’re probably thinking that this sounds a little too good to be true. Sugar substitutes have been a hot topic of discussion – so many rumours and catchy headlines about cancer, weight gain and other scary sounding health problems. But what does the science say? And by this we mean all of the science that relates to human health on this topic, not just the one or two extreme or scary articles.
Firstly, what impact do sugar substitutes have on body weight and food consumption? In short – it’s a pretty mixed bag of results. On the positive side, just over two thirds of studies showed that consuming sugar substitutes instead of table sugar had a helpful effect on weight or food consumption (i.e. participants tended to lose weight and eat less)1-8. On the not-so-positive side, around one fifth of studies reported an increase in weight and body mass index (BMI) of people who ate/drank sugar substituted products2,9-14. Many also showed that consuming sugar substituted products had no effect on weight and appetite13,15-22. Talk about mixed messages! Although the jury is definitely not out on this one, what we can say is that most of the evidence indicates that sugar substitutes do not have a negative effect on appetite and weight gain.
Now, lets take a look at type 2 diabetes and blood sugar levels. This one is a little more clear-cut, where most studies showed that sugar substitutes have no effect on blood sugar, insulin levels and the presence of bad fats (think triglycerides and cholesterol)6,23-40. Hurrah! Unfortunately, it’s not all kittens and roses. Some evidence suggests that consuming sugar substitutes can increase the risk of developing type II diabetes41-43. Like anything, it’s important to take some sugar science with a grain of salt, as many of these studies were not representative or had very few participants.
What about sugar substitutes and cancer? As there are so many different types of cancer, which are caused by a mix of genetics, our environment and other unknown factors, this one is a little tricky! The majority of studies acknowledge this, reporting that it was difficult to show any link between the two given that they did not take factors such as pollutants into consideration23. Those that did (as well as is possible) showed no relationship between sugar substitutes and risk of developing cancer. One study does report a link between particular cancers (non-Hodgkin lymphomas and multiple myelomas) and the consumption of sugar substitutes44. However, the researchers who carried out this study noted that this was only observed in males and that they did not take into consideration other cancer causing substances, such as pollutants. Lifetime consumption of sugar substitutes and increased risk of cancer has been reported in rats, however only at reasonably high doses relative to the recommended dietary intake (RDI) in humans45. Remember, even water can be toxic at high concentrations!
Last of all, do sugar substitutes cause any harm to our brains? Three-quarters of studies showed no effect on things such as reaction time, headaches, hunger and sedation46-49. Some negative effects were seen with the consumption of sugar substitutes in patients who suffered migraines, however the methodology in these studies was limited23,50-53. For the most part, it seems that sugar substitutes don’t cause too much of a headache!
All in all, the evidence for adverse health effects from sugar substitutes is fairly limited. In most cases, sugar substitutes have little or no effect on food consumption, body weight, blood glucose levels and cancer. Although we are yet to fully understand their affect on human health. Remember – sometimes we don’t know what we don’t know, and there is still a lot to learn about these wee molecules!
Our overall message is that we recommend drinking water or water with natural flavours added like mint, real lemon, lime, orange or frozen berries. Sometimes artificial sweeteners can help as a transition from a high sugar diet but ultimately we think there are just too many unknowns and we strongly encourage ‘stepping away from everything needing to be sweet’ so your palate can adjust and you can enjoy the subtle and wonderful favours of real foods. It will happen if you give it time. Respect your body, eat and drink real foods as often as you can.
(A huge thanks to Elyse Dunn PhD for her help with this article)
- la Hunty, De, A., Gibson, S. & Ashwell, M. A review of the effectiveness of aspartame in helping with weight control. Nutrition Bulletin 31, 115–128 (2006).
- Miller, P. E. & Perez, V. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. Am. J. Clin. Nutr. 100, 765–777 (2014).
- Maersk, M. et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am. J. Clin. Nutr. 95, 283–289 (2012).
- Tate, D. F. et al. Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial. Am. J. Clin. Nutr. 95, 555–563 (2012).
- Mozaffarian, D., Hao, T., Rimm, E. B., Willett, W. C. & Hu, F. B. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. New Engl J Med 364, 2392–2404 (2011).
- Schulze, M. B. et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Jama-J Am Med Assoc 292, 927–934 (2004).
- de Ruyter, J. C., Olthof, M. R., Seidell, J. C. & Katan, M. B. A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children. New Engl J Med 367, 1397–1406 (2012).
- Reid, M., Hammersley, R., Hill, A. J. & Skidmore, P. Long-term dietary compensation for added sugar: effects of supplementary sucrose drinks over a 4-week period. Br. J. Nutr. 97, 193–203 (2007).
- Colditz, G. A. et al. Patterns of Weight Change and Their Relation to Diet in a Cohort of Healthy Women. Am. J. Clin. Nutr. 51, 1100–1105 (1990).
- Duffey, K. J., Steffen, L. M., Van Horn, L., Jacobs, D. R. J. & Popkin, B. M. Dietary patterns matter: diet beverages and cardiometabolic risks in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am. J. Clin. Nutr. 95, 909–915 (2012).
- Fowler, S. P. et al. Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring) 16, 1894–1900 (2008).
- Stellman, S. D. & Garfinkel, L. Patterns of Artificial Sweetener Use and Weight Change in an American Cancer Society Prospective-Study. Appetite 11, 85–91 (1988).
- Brown, R. J., de Banate, M. A. & Rother, K. I. Artificial Sweeteners: A systematic review of metabolic effects in youth. Int J Pediatr Obes 5, 305–312 (2010).
- Vanselow, M. S., Pereira, M. A., Neumark-Sztainer, D. & Raatz, S. K. Adolescent beverage habits and changes in weight over time: findings from Project EAT. Am. J. Clin. Nutr. 90, 1489–1495 (2009).
- de Ruyter, J. C., Katan, M. B., Kuijper, L. D. J., Liem, D. G. & Olthof, M. R. The Effect of Sugar-Free Versus Sugar-Sweetened Beverages on Satiety, Liking and Wanting: An 18 Month Randomized Double-Blind Trial in Children. PLoS ONE 8, (2013).
- Raben, A., Vasilaras, T. H., Møller, A. C. & Astrup, A. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am. J. Clin. Nutr. 76, 721–729 (2002).
- Raben, A. et al. Increased postprandial glycaemia, insulinemia, and lipidemia after 10 weeks’ sucrose-rich diet compared to an artificially sweetened diet: a randomised controlled trial. Food & Nutrition Research 55, 537 (2011).
- Reid, M., Hammersley, R. & Duffy, M. Effects of sucrose drinks on macronutrient intake, body weight, and mood state in overweight women over 4 weeks. Appetite 55, 130–136 (2010).
- Sorensen, L. B., Raben, A., Stender, S. & Astrup, A. Effect of sucrose on inflammatory markers in overweight humans. Am. J. Clin. Nutr. 82, 421–427 (2005).
- Ebbeling, C. B. et al. Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: A randomized, controlled pilot study. Pediatrics 117, 673–680 (2006).
- Knopp, R. H., Brandt, K. & Arky, R. A. Effects of Aspartame in Young Persons During Weight-Reduction. J Toxicol Environ Health 2, 417–428 (1976).
- Williams, C. L., Strobino, B. A. & Brotanek, J. Weight control among obese adolescents: A pilot study. International Journal of Food Sciences and Nutrition 58, 217–230 (2007).
- Olivier, B. et al. Review of the nutritional benefits and risks related to intense sweeteners. Arch Public Health 73, 41 (2015).
- Burns, T. S., Stargel, W. W., Tschanz, C., Kotsonis, F. N. & Hurwitz, A. Aspartame and Sucrose Produce a Similar Increase in the Plasma Phenylalanine to Large Neutral Amino-Acid Ratio in Healthy-Subjects. Pharmacology 43, 210–219 (1991).
- Horwitz, D. L., McLane, M. & Kobe, P. Response to Single Dose of Aspartame or Saccharin by Niddm Patients. Diabetes Care 11, 230–234 (1988).
- Moller, S. E. Effect of Aspartame and Protein, Administered in Phenylalanine-Equivalent Doses, on Plasma Neutral Amino-Acids, Aspartate, Insulin and Glucose in Man. Pharmacol. Toxicol. 68, 408–412 (1991).
- Rodin, J. Comparative Effects of Fructose, Aspartame, Glucose, and Water Preloads on Calorie and Macronutrient Intake. Am. J. Clin. Nutr. 51, 428–435 (1990).
- Smeets, P., de Graaf, C., Stafleu, A., van Osch, M. & van der Grond, J. Functional magnetic resonance imaging of human hypothalamic responses to sweet taste and calories. Am. J. Clin. Nutr. 82, 1011–1016 (2005).
- Stegink, L. D. et al. Effect of Sucrose on the Metabolic Disposition of Aspartame. Am. J. Clin. Nutr. 52, 335–341 (1990).
- Goldfine, I. D., Ryan, W. G. & Schwartz, T. B. The effect of glucola, diet cola and water ingestion on blood glucose and plasma insulin. Proc. Soc. Exp. Biol. Med. 131, 329–330 (1969).
- Ma, J. et al. Effect of the artificial sweetener, sucralose, on gastric emptying and incretin hormone release in healthy subjects. Am. J. Physiol. Gastrointest. Liver Physiol. 296, G735–G739 (2009).
- Ma, J. et al. Effect of the artificial sweetener, sucralose, on small intestinal glucose absorption in healthy human subjects. Br. J. Nutr. 104, 803–806 (2010).
- Grotz, V. L. et al. Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. Journal of the American Dietetic Association 103, 1607–1612 (2003).
- Colagiuri, S., MILLER, J. J. & Edwards, R. A. Metabolic Effects of Adding Sucrose and Aspartame to the Diet of Subjects with Noninsulin-Dependent Diabetes-Mellitus. Am. J. Clin. Nutr. 50, 474–478 (1989).
- Nehrling, J. K. et al. Aspartame use by persons with diabetes. Diabetes Care 8, 415–417 (1985).
- Stern, S. B. et al. Administration of Aspartame in Non-Insulin-Dependent Diabetics. J Toxicol Environ Health 2, 429–439 (1976).
- Curi, R. et al. Effect of Stevia-Rebaudiana on Glucose-Tolerance in Normal Adult Humans. Braz. J. Med. Biol. Res. 19, 771–774 (1986).
- Romaguera, D. et al. Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct. Diabetologia 56, 1520–1530 (2013).
- Bhupathiraju, S. N. et al. Caffeinated and caffeine-free beverages and risk of type 2 diabetes. Am. J. Clin. Nutr. 97, 155–166 (2013).
- de Koning, L., Malik, V. S., Rimm, E. B., Willett, W. C. & Hu, F. B. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am. J. Clin. Nutr. 93, 1321–1327 (2011).
- Fagherazzi, G. et al. Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort. Am. J. Clin. Nutr. 97, 517–523 (2013).
- Nettleton, J. A. et al. Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 32, 688–694 (2009).
- Sakurai, T. & Hosoya, H. Charge-transfer complexes of nicotinamide-adenine dinucleotide analogues and flavin mononucleotide. Bibl Laeger 112, 459–468 (1966).
- Schernhammer, E. S. et al. Consumption of artificial sweetener- and sugar-containing soda and risk of lymphoma and leukemia in men and women. Am. J. Clin. Nutr. 96, 1419–1428 (2012).
- Soffritti, M., Belpoggi, F., Tibaldi, E. & Esposti, D. D. Life-span exposure to low doses of aspartame beginning during prenatal life increases cancer effects in rats. Environmental Health … (2007). doi:10.2307/4626891
- Lapierre, K. A., Greenblatt, D. J., Goddard, J. E., Harmatz, J. S. & Shader, R. I. The Neuropsychiatric Effects of Aspartame in Normal Volunteers. J Clin Pharmacol 30, 454–460 (1990).
- Spiers, P. A. et al. Aspartame: neuropsychologic and neurophysiologic evaluation of acute and chronic effects. Am. J. Clin. Nutr. 68, 531–537 (1998).
- Shaywitz, B. A. et al. Aspartame, Behavior, and Cognitive Function in Children with Attention-Deficit Disorder. Pediatrics 93, 70–75 (1994).
- Shaywitz, B. A. et al. Aspartame Has No Effect on Seizures or Epileptiform Discharges in Epileptic Children. Ann. Neurol. 35, 98–103 (1994).
- Koehler, S. M. & Glaros, A. The Effect of Aspartame on Migraine Headache. Headache 28, 10–13 (1988).
- Lipton, R. B., Newman, L. C., Cohen, J. S. & Solomon, S. Aspartame as a Dietary Trigger of Headache. Headache 29, 90–92 (1989).
- Schiffman, S. S. et al. Aspartame and Susceptibility to Headache. New Engl J Med 317, 1181–1185 (1987).
- Van den Eeden, S. K. et al. Aspartame ingestion and headaches: a randomized crossover trial. Neurology 44, 1787–1793 (1994).