Sweetener - the bitter truth of sweet things - Dr. Milind Patil
People love the sweet taste. The commonly used sweet substances are sugar and jaggary which contain sucrose. The problem with these substances is that they have a high glycemic load. This means that it will increase blood glucose levels to a great extent. Another issue is they are associated with calories which can increase obesity, which is the root cause of diabetes, hypertension, cholesterol issues, and ultimately cardiovascular diseases like heart attack and paralysis.
To avoid these issues ongoing research has led to the development of non-nutritional sweeteners. As the name suggests, these molecules give a sweet taste without having an impact on blood glucose levels and calories. The use of these molecules has been linked to decreased body weight, body mass index, percentage of body fat, and intrahepatocellular fat which will be beneficial in reducing cardiovascular disease.
Artificial sweeteners, (AS) common substitutes for sugar, were first introduced to the food market in the 1800s, but their consumption did not increase dramatically until the 2000s. Since its invention, it has been used in various products like cold drinks, ice creams, chewing gums, candy, puddings, canned foods, jams and jellies, dairy products, and many other foods and beverages. As per a recent survey, one out of three urban Indians consume artificial sweeteners in India. As per industry estimates, the market size for tabletop sweeteners in India in March 2022, was approx. USD 60 million, growing at a CAGR of 8-10%.
Currently, the US FDA has approved aspartame, sucralose, neotame, acesulfame potassium, saccharin, advantame, and stevia. These can be classified as artificial sweeteners and plant-based sweeteners. The other class of substances is sugar alcohols and other sugars.
They are 200 to 20000 times sweeter than table sugar.
While treating patients with diabetes the common question is- Can I use these substances safely?
Well, there is no clear-cut answer to this question.
Why?
Because all that glitter is not gold. Scientific studies have produced mixed conclusions about these products. Some studies attribute beneficial effects while others say they produce harmful effects. Artificial sweeteners are associated with an increased risk of metabolic syndrome, a cardiometabolic risk factor that includes hypertension, insulin resistance, excessive blood sugar, abdominal obesity, and dyslipidemia The possible mechanism of their harmful effect is the change in healthy microorganisms in the gut, changes in the good cholesterol HDL, direct effect on the heart.
The International Agency for Research on Cancer has classified aspartame as a possible carcinogen to humans. WHO had warned against the use of artificial sweeteners for weight loss saying that long-term use is not effective and could pose health risks.
However, ADA and USFDA have classified these substances in the generally safe category. That means people can consume these substances in limited amounts which is calculated based on toxicological studies. The confusion can be solved by proper randomized controlled clinical trials in specific populations.
Till then what to advise to the patients of diabetes and the general population
Should be avoided in children, pregnant women, and lactating mothers.
For weight loss if someone is using then avoid compensatory increase in calories. E.g. it is not ok to cake as you are taking diet soda.
Avoid the long-term use of these substances.
If you are using them use them in very small amounts.
Lastly, always ask your doctor before using them.
To conclude, not all sweet tastes good, and bitter is sometimes better than being sweet.
References-
Singh, S., Kohli, A., Trivedi, S. et al. The contentious relationship between artificial sweeteners and cardiovascular health. Egypt J Intern Med 35, 43 (2023). https://doi.org/10.1186/s43162-023-00232-1
Use of non-sugar sweeteners: WHO guideline
American Diabetes Association Professional Practice Committee; 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S77–S110
Chattopadhyay S, Raychaudhuri U, Chakraborty R. Artificial sweeteners - a review. J Food Sci Technol. 2014 Apr;51(4):611-21. doi: 10.1007/s13197-011-0571-1. Epub 2011 Oct 21
Disclaimer: The information provided here should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. The information is provided solely for educational purpose and should not be considered a substitute for medical advice.
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