‘I’m drinking diet soda, so it’s OK to have cake’ — the problem with artificial sweeteners

Diabetics have more options nowadays in choosing sugar substitutes than they did years ago, when Splenda, Equal, Sweet’N Low were the go-to brands.

But even with all of the sugar substitutes and naturally derived sugar options, from stevia to monk fruit extract, America’s obesity epidemic has grown significantly, with 40 percent of U.S. adults considered obese as of 2015-2016, up from 31 percent in 1999-2000, according to the Centers for Disease Control and Prevention.

Michelle Pearlman, M.D., a gastroenterologist with the University of Miami Health System, recently published a paper in Current Diabetes Reports that reviewed data on natural alternative sweeteners and their effects on the body’s blood sugar levels.

“Sugar-laden diets are ubiquitous because humans and animals display preferences for sweet taste that starts early in life,” she says.

Pearlman says the use of artificial sweeteners has grown along with the obesity epidemic.

“Artificial sweeteners were developed as a sugar substitute to help reduce insulin resistance and obesity and are marketed as a healthy alternative to sugar and as a tool for weight loss,” she says.

But data in both animal models and humans suggest that artificial sweeteners may actually contribute to metabolic syndrome — a cluster of conditions that increase the risk of heart disease, stroke, and diabetes, she noted.

To maintain healthy eating habits and a healthy weight, the American Diabetes Association (ADA) recommends reducing total daily caloric intake, and limiting carbohydrate consumption and artificial sweeteners.

According to Cleveland Clinic of Florida, non-nutritive sweeteners (also called sugar substitutes or artificial sweeteners) contain few or no calories or nutrients and may be derived from plants or herbs, or even sugar itself. They have a greater intensity of sweetness compared with sugar and some are not metabolized, so they pass through the digestive tract essentially unchanged.

The U.S. Food and Drug Administration (FDA) has approved eight non-nutritive sweeteners: aspartame, acesulfame potassium, luo han guo (monk) fruit extract, neotame, saccharin, stevia, sucralose and advantame.

When looking at ingredients on food or drink labels, table sugar is often listed by its chemical name: sucrose. The ADA says one way to recognize sugars is to look for words that end in “ose.” Fruit sugar is often referred to as fructose just as the sugar in milk is most often listed as lactose. Glucose is called dextrose; fructose is also called levulose.

According to a Harvard Medical School special health report, “Reducing Sugar in Your Diet,” Americans consume an average of more than 17 teaspoons of sugar (about 290 calories) a day from added sugars, often from sweetened beverages. The American Heart Association recommends women consume no more than 6 teaspoons of sugar per day and that men consume no more than 9 teaspoons of sugar per day.

On average, Americans get more than 200 calories a day from sugary drinks, about four times what was consumed in 1965, according to the Harvard report.

Amy Kimberlain, a registered dietitian and certified diabetes educator at Baptist Health South Florida, advises her patients to cut back on consuming artificial sweeteners.

“By offering the taste of sweetness without any calories, artificial sweeteners seem like they could be one answer to effective weight loss and blood sugar control,” she says.

“However, my general recommendation to people with diabetes is to see how much or how frequent you are using these products and aim to cut back on your overall total consumption. Artificial sweeteners can be a stepping stone, so that you use them for only a while to help wean yourself off of drinking sugary beverages, but the end goal is to not use them at all,” she says.

She says people who use artificial sweeteners may ramp up other sugary foods.

“This can happen because we like to fool ourselves: ‘I’m drinking diet soda, so it’s okay to have cake,”’ she says.

Kimberlain says sugar substitutes can change the way people taste food.

“Non-nutritive sweeteners are far more potent than table sugar and high-fructose corn syrup,” she says. “A minuscule amount produces a sweet taste comparable to that of sugar, without comparable calories. By overstimulating our sugar receptors from frequent use of these hyper-intense sweeteners, this may then limit our tolerance for more complex tastes.”

Kimberlain says that people who routinely consume artificial sweeteners may find less intensely sweet foods, such as fruit, less appealing and foods such as vegetables, unpalatable.

Finally, she says that artificial sweeteners may prevent people from associating sweetness with caloric intake.

“As a result, we may crave more sweets, tend to choose sweet food over nutritious food and gain weight,” she says.

A San Antonio Heart Study found that, among 3,682 middle-aged adults, those who drank more than 21 diet drinks a week, were twice as likely to become overweight or obese over the next seven to eight years, compared with participants who didn’t drink diet soft drinks.

For diabetics who still crave sugar and have trouble reducing their sugar intake, Kimberlain offers this advice:

▪ Delay. Wait 10 to 20 minutes (or as long as you can) before giving into the craving. In the best-case scenario, often the craving will subside in that time period. Even when you can’t fully fight the craving, the time delay helps reduce its power.

▪ Distract. By distracting yourself so you’re not thinking about the craved food, the craving weakens.

▪ Avoid. Finding alternatives to your most difficult-to-control foods that are equally satisfying and consuming these in moderation in a planned way (not in response to a craving) allows you to not feel deprived while controlling food consumption.

Kimberlain says making the following four changes to your diet can have a big impact on preventing type 2 diabetes:

▪ Choose whole grains and whole grain products over refined grains and other highly processed carbohydrates. “The bran and fiber in whole grains makes it more difficult for digestive enzymes to break down the starches into glucose,” she says. “This leads to lower, slower increases in blood sugar and insulin.”

▪ Skip the sugary drinks, and choose water, coffee or tea. “Like refined grains, sugary beverages have a high glycemic load, and drinking more of this sugary stuff is associated with increased risk of diabetes,” says Kimberlain.

▪ Choose healthy fats. “The type of fats in your diet can affect the development of diabetes,” she says. “Healthful fat, such as the polyunsaturated fats found in liquid oils, nuts and seeds, can help ward off type 2 diabetes. Trans-fats do just the opposite.”

▪ Limit red meat and avoid processed meat. “Choose nuts, beans, whole grains, poultry or fish instead,” she says. “The evidence is growing stronger that eating red meat (beef, pork, lamb) and processed red meat (bacon, hot dogs, deli meats) increases the risk of diabetes.”

“Managing diabetes is not always a science but also an art,” says Kimberlain. “There will be days when you’re just unsure why your blood sugar is high. The key is not to judge the number but rather try to understand it — having a team approach (endocrinologist, dietitian, nurse, social worker, and YOU the patient) is critical when it comes to your diabetes care.”

Hypoglycemia

When monitoring blood sugar, diabetics also have to be concerned with hypoglycemia, when blood sugar levels drop below 70 mg/dL.

“Hypoglycemia (low blood sugar) in diabetic patients could be lethal,” said Dr. Agustin Andrade, the chief of the endocrinology department at Mount Sinai Medical Center in Miami Beach. “It’s important that diabetic patients understand the different levels of hypoglycemia and understand that no artificial sweetener will improve hypoglycemia.”

Early signs of hypoglycemia include shakiness, dizziness, sweating, hunger.

Diabetics suffering from hypoglycemia should apply the “Rule of 15” which consists of ingesting 15 grams of glucose, which he says will raise sugar levels in 15 minutes, Andrade said.

“This includes glucose tablets, oral glucose gel, four ounces of juice or non-diet soda or one tablespoon of sugar,” he says.

This story was originally published November 19, 2019 at 6:00 AM.