What’s Up With Sugar Substitutes After WLS?
June 2, 2017I am frequently asked questions from clients, acquaintances, and family (as well as pretty much anyone who finds out I am a dietitian) about what's up with sugar substitutes. In addition, I'm also asked about using sugar substitutes after WLS. At a surface level, artificial sweeteners (Splenda, NutraSweet, Sweet N’Low, Equal, etc.) appear to be the perfect solution to reducing overall energy intake and achieving weight loss, if that is the goal. However as research of artificial sweeteners is increasing, it seems the downside of using these sweeteners continues to increase.
The foremost thing most people are concerned about when it comes to artificial sweeteners are the cancer risk claims.
However, the majority of these cancer studies have been conducted using rats as the sample population (as opposed to humans). Though saccharine and aspartame are two sweeteners that have especially been in the hot seat in regards to their suspected cancer risk, their negative effects have not been shown in humans (1,2).
Further, the doses of artificial sweeteners administered to the rats in these research studies have been far higher than anything a human would consume on any given day, no matter how many diet sodas they are downing.
One study found a link between brain tumors in rats and aspartame consumption. BUT, this study also had the rats consuming the equivalent of up to 2,083 cans of diet soda daily (3). Now, I have seen some pretty intense diet soda addictions, but thankfully nothing in the ballpark of 2,083 cans per day.
Though the link between cancer risk in humans and artificial sweetener consumption is inconclusive at best, there are some issues with artificial sweetener use that are worth pondering, especially when it comes to those who have undergone weight loss surgery and are on the journey to retrain their brain, hunger and fullness cues, and in the process of repopulating their gut with healthy, beneficial bacteria.
Below are three areas of concern in relation to artificial sweetener use. These factors are important to consider so that you, as the consumer, can make an informed decision of how you choose to sweeten your morning cup of Joe.
Three Concerns to Consider for Using Artificial Sweeteners
1. The Brain Argument
When we consume something sweet, excitatory neurons in our brains react. These neurons are primed to receive this message of sweetness. When compared to the level of sweetness that regular table sugar offers, artificial sweeteners, depending on what type, can be anywhere from 200 to 20,000 times sweeter than table sugar.
The brain argument is that artificial sweeteners prime your brain to expect a level of sweetness that is not available through natural food sources. And the theory is that this leads to a decreased satisfaction with the subtle sweetness of naturally sweet and highly nutritious foods such as an apple or milk (4).
This higher tolerance for sweetness has been hypothesized to increase cravings for highly sweetened foods. When you think about it, this makes sense. If you are used to something that is 20,000 times sweeter than sugar, the natural sweetness of an apple starts to seem a bit shabby in comparison to a pastry.
2. Gut Microbiome Argument
Preliminary findings from a study published in the journal Nature in 2014 found that consuming artificial sugars changed the bacterial composition of the gut in mice, actually making the bacteria more efficient at absorbing and utilizing calories consumed within the diet (5). In other words, the mice became better at getting the best bang for the calorie buck that came into their bodies. The first part of this study just focused on conducting the experiment in mice samples, however, the second portion utilized human samples and found similar impacts.
The study was carried out in healthy volunteers who did not normally consume artificial sweeteners. For the sake of the study, these individuals were asked to consume the maximum acceptable intake established by the Food and Drug Administration (FDA) of commercial saccharin for days 2-7 out of a 7 day study period (5,6).
Findings revealed that for 4 out of 7 individuals, blood sugar response was worse on days 5 through 7, as compared to days 1-4 of the study suggesting that the longer the individuals consumed these artificial sweeteners, the more their glucose response was negatively affected.
Three out of the 7 volunteers who did not have an impaired blood sugar response remained even with their blood sugar, but did not experience any improvements as a result of consuming the artificial sweeteners. Upon analysis of the gut bacterial composition of individuals with worse glucose tolerance after consuming the artificial sweeteners, dysbiosis was observed.
In other words, over half of the participants with previously healthy gut bacteria developed a whacky gut bacteria composition after incorporating artificial sweeteners into their diet.
3. Compensation Argument
The compensation argument for the use of artificial sweeteners boils down to the theory that your brain is not fooled by non-caloric artificial sweeteners. When the brain receives the message that you have consumed something sweet, it is going to begin preparing the brain and the body to take in calories in the form of carbohydrates (7).
When the brain discovers that you have fooled it by sending it a message that you are giving it something sweet, but that sweetness ends up being devoid of carbohydrates/sugar, this is going to result in an increase in cravings for foods that contain carbohydrates. Given that carbohydrate cravings are something that many individuals who have undergone weight loss surgery may already experience from time to time, these added cravings can complicate things.
With all the above being said, these reasons certainly don’t mean that a pack or two a day of Splenda in your coffee is going to send your body into a tailspin. It is also important to base the decision of what sweetener you use on your personal experience and how your body feels after using various different types of sweeteners. You know what causes you to experience gastrointestinal discomfort and what doesn’t. However, the above points are important to consider.
When it comes down to it, it is best to view artificial sweeteners as you would a pack of normal sugar. Use it to enhance the taste of something, but don’t view it as a freebie.
It is also important to state that for those who have just undergone WLS, the use of table sugar or other natural sweeteners may cause dumping syndrome. Your bariatric surgeon and dietitian are the best resource for recommendations of sweeteners to use since they know your history and the specific type of WLS you have undergone. It is important to first and foremost follow their guidelines for the use of sweeteners/artificial sweeteners.
If you have difficulties or gastrointestinal upset with using small amounts of table sugar or other natural sweeteners, some more natural alternatives to the traditional artificial sweeteners include Stevia or Monk Fruit extract. Stevia is made from a plant while Monk Fruit extract is derived from the Monk Fruit. Though these sweeteners are newer to the market, there are no hard and fast negative impacts that have been associated with their use thus far.
However, as research around artificial sweeteners continues to grow, there may be some negative effects that are discovered in relation to these sweeteners in the future. However, for now, the safest bet seems to be to use Stevia, Monk Fruit extract, or a tiny bit of real sweetener.
References
- Artificial Sweeteners and Cancer. National Cancer Institute. Retrieved April 16, 2017 from https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/artificial-sweeteners-fact-sheet#ref1
- Lim U, Subar AF, Mouw T, et al. Consumption of aspartame-containing beverages and incidence of hematopoietic and brain malignancies. Cancer Epidemiology, Biomarkers and Prevention. 2006;15(9):1654–1659.
- Soffritti M, Belpoggi F, Esposti DD, Lambertini L. Aspartame induces lymphomas and leukemias in rats. European Journal of Oncology. 2005;10(2):107–116.
- Food Forum; Food and Nutrition Board; Institute of Medicine. Relationships Among the Brain, the Digestive System, and Eating Behavior: Workshop Summary. Washington (DC): National Academies Press (US). 2015. Integrating the Evidence. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279987/
- Suez J, Korem T, Zeevi D, Zilberman-Schapira G, Thaiss CA, Maza O, Israeli D, Zmora N, Gilad S, Weinberger A, Kuperman Y. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014; 514(7521):181-6.
- Additional Information about High-Intensity Sweeteners Permitted for use in Food in the United State. US Food and Drug Administration. Retrieved April 16, 2017 from https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm
- Murray S,Tulloch A, Criscitelli K, Avena NM. Recent studies of the effects of sugars on brain systems involved in energy balance and reward: Relevance to low-calorie sweeteners. Physiology & Behavior. 2016;164:504-508.
 | ABOUT THE AUTHOR Tiffany Haug, MS, RDN, EDOC is a Master's level Registered Dietitian Nutritionist who specializes in treating eating disorders as well as obesity. Tiffany holds a Certificate of Graduate Study in Eating Disorders and Obesity (EDOC) from Northern Illinois University—the only graduate certificate of its kind in the nation. She currently works as an outpatient Dietitian at a private practice and tiffanyhaugrd.wixsite.com/freedomwithnutritionRead more articles from Tiffany! |
