Artificial Sweeteners And Diabetes

Written by Dr. Steve Chaney on . Posted in Food and Health, Health Current Events, Obesity

Another Myth Bites The Dust

Author: Dr. Stephen Chaney

 

artificial sweeteners and diabetesArtificial sweeteners and diabetes; is there a relationship?

Once again, artificial sweeteners have come up empty. They were supposed to help you lose weight, but several recent clinical studies have suggested that artificially sweetened beverages are just as likely to lead to weight gain as sugar sweetened beverages, see  Do Diet Sodas Make You Fat.

What about type 2 diabetes? There have been several clinical trials that have suggested that excess consumption of sugar sweetened beverages may increase your risk of developing type 2 diabetes (For example, Basu et al, Am J Pub Health, 103: 2071-2077, 2013; Malik et al, Diabetes Care, 33: 2477-2483, 2010).

As a consequence if you are at risk of developing type 2 diabetes, you’ve probably been advised by your doctor or dietitian to switch from sugar sweetened beverages to artificially sweetened beverages or natural fruit juices. But, does that really work? Maybe not.

In fact, some studies have suggested that excess consumption of artificially sweetened beverages or fruit juice may be just as likely to lead to type 2 diabetes as consuming sugar sweetened beverages (For example, Greenwood et al, Br J Nutr, 112: 725-734, 2014; Xi et al, PloS One, 9:e93471, 2014).

A Systematic Study Of Beverage Consumption And Diabetes Risk

However, this has been a very controversial topic. The problem is that it is devilishly difficult to design studies that provide definitive answers to these important questions.

To start with there are problems with confounding factors. For example,

  • It is pretty well established that consumption of sugar sweetened beverages leads to obesity and obesity leads to type 2 diabetes, but many of the studies did not adjust the data for obesity.
  • In addition, many people who are overweight often switch to artificially sweetened beverages in the mistaken belief that they will help them lose weight. Once again, many of the published studies did not correct for that.

There are also problems with study design. For example, many of the studies did not directly compare sugar sweetened and artificially sweetened beverages in the same population group. If the population groups are different enough between studies, it can be a little like trying to compare apples to oranges.

Because of these limitations an international team of experts designed a major systematic review and meta-analysis (Imamura et al, Br J Med, doi: 101136/bmj.h3576, 2015) of all reasonably well designed prospective studies that measured the effect of beverage consumption on the development of type 2 diabetes over time.

They evaluated the data from 17 studies that represented 38,253 people who developed type 2 diabetes over a period of at least two years. They used the most rigorous statistical analysis methods available, and they interpreted their results very cautiously.

In short, this was a major study. So, what did the study show?

Is There a Relationship Between Artificial Sweeteners And  Diabetes?

On face value, the data appeared to be fairly clear:

  • prevent diabetesAn additional one serving per day of a sugar-sweetened beverage increases your risk of developing type 2 diabetes by 18%. When you correct for obesity, the increased risk is 13%. (Note: we are talking about an 8 ounce serving here, not a 32 ounce Big Gulp or 64 ounce Double Gulp).
  • An additional one serving per day of an artificially-sweetened beverage increases your risk of developing type 2 diabetes by 25%. When you correct for obesity, the increased risk is 8%.
  • An additional one serving per day of fruit juice increases your risk of developing type 2 diabetes by 5%. When you correct for obesity, the risk actually increases to 7%.

In short, if you want to decrease your risk of developing type 2 diabetes, none of these options is a particularly good choice.

How Were These Data Interpreted

Of course, the strength of any meta-analysis is limited by the quality of the studies that were included in the meta-analysis. It is the old GIGO (garbage in, garbage out) principle. The authors acknowledged that limitation and analyzed in great detail the quality of the individual studies included in their meta-analysis. Their conclusions were as follows:

  • garbage in garbage outThe quality of the data on sugar sweetened beverages was strong enough that they could conclude that “habitual consumption of sugar sweetened beverages is associated with a greater incidence of type 2 diabetes, independent of obesity”. In short, you want to stay away from sugar sweetened beverages. They can cause obesity AND they can cause type 2 diabetes.
  • They also said that “…artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes”, but did not feel the existing data were strong enough to make a definitive conclusion. They felt that more studies are needed.
  • However, they did feel that the existing data were strong enough to conclude that “neither artificially sweetened beverages nor fruit juice are suitable alternatives to sugar sweetened beverages for the preventing of type 2 diabetes.” In short, consumption of artificially sweetened beverages and fruit juice may not cause type 2 diabetes, but they clearly don’t prevent it.

 

The Bottom Line

If you are overweight or otherwise at risk of developing type 2 diabetes, you have probably been advised to switch from sugar-sweetened beverages to either artificially sweetened beverages or fruit juices. A major study has just turned that advice on its head!

This study (Imamura et al, Br J Med, doi: 101136/bmj.h3576, 2015) was a systematic review and meta-analysis of 17 previously published clinical studies that measured the effect of beverage consumption on the development of type 2 diabetes over time. Based on a very careful analysis of the data from this meta-analysis the authors concluded:

  • The quality of the data on sugar sweetened beverages was strong enough that they could unequivocally state that “habitual consumption of sugar sweetened beverages is associated with a greater incidence of type 2 diabetes, independent of obesity”. In short, you want to stay away from sugar sweetened beverages. They can cause obesity AND they can cause type 2 diabetes.
  • They also said that “…artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes”, but did not feel the existing data were strong enough to make a definitive conclusion. They felt that more studies are needed.
  • However, they did feel that the existing data were strong enough to conclude that “neither artificially sweetened beverages nor fruit juice are suitable alternatives to sugar sweetened beverages for the preventing of type 2 diabetes.” In short, consumption of artificially sweetened beverages and fruit juice may not cause type 2 diabetes, but they clearly don’t prevent it.

So what kind of beverages should you consume if you don’t want your beverage intake to contribute to type 2 diabetes?

  • Water is always the first choice.
  • Milk, protein shakes and similar beverages can also be an excellent choice as long as you take the calories into account. The protein content of those beverages generally slows the rate of sugar uptake. Look for products with a low glycemic index.
  • High intensity or long endurance exercise requires a lot of carbohydrate, so sugars in rehydration or recovery sports supplements are well tolerated. However, those same sports drinks would be a concern if used as part of a sedentary lifestyle.
  • Finally, tea, coffee, and non-caffeinated herbal teas are excellent choices as long as you learn to enjoy them without adding sugar or artificial sweeteners.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (4)

  • Leah

    |

    Thank you for this valuable information, Dr. Chaney.
    I use stevia to sweeten my drinks for lemonade, hot chocolate, etc. I am assuming that because it is a natural ingredient by a good company, that it is not included in the category of artificial sweeteners and would be a good choice for people who have high blood sugars issues. Do you have any thoughts on that?. Also, I was wondering if you thought that Agave nectar can be used as well to substitute for sugar, if used within reason. Thank you.

    Reply

    • Dr. Steve Chaney

      |

      Dear Leah,
      We are not really sure why artificial sweeteners in sodas are not particularly helpful for losing weight or causing diabetes. One theory is that the intense sweetness creates food cravings. If that is true, it really wouldn’t matter whether you sweetened your soda with artificial sweeteners, natural sugar, or a natural sweetener like stevia. It is much better to focus on foods. Sugars and natural sweeteners are much better tolerated in foods that have ample amounts of protein and fiber.
      The chemical composition of agave nectar and honey are not much different from sugar or high fructose corn syrup (see my video “The Truth About Sugar”). I have never used agave nectar personally, but my wife occasionally uses honey in cooking. It’s only advantage is that it has a stronger flavor so one tends to use a little less.
      Dr. Chaney

      Reply

  • Joan

    |

    One must be VERY careful when choosing a Stevia product because many of them are filled with other ingredients you don’t want to ingest. Read the label before you choose your Stevia product.

    Thank you Dr. Chaney for this excellent explanation of what you and others have been saying for years!

    To your health!

    Reply

    • Dr. Steve Chaney

      |

      Dear Joan,

      You are so right. I’ve seen products that advertise they use stevia, but also use artificial sweeteners. It’s always good advice to actually read the label.

      Steve

      Reply

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Latest Article

What Is The Planetary Diet?

Posted May 21, 2019 by Dr. Steve Chaney

Is Your Diet Destroying The Planet?

Author: Dr. Stephen Chaney

 

Earth Day has come and gone, but you are still committed to saving the planet. You save energy. You recycle. You drive an electric car. But is your diet destroying the planet?

This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019 ) serves as a dire warning of what will happen if we don’t change our ways. I touched on this report briefly in a previous issue of “Health Tips From The Professor,” What Is The Flexitarian Diet , but this topic is important enough that it deserves an issue all its own.

The commission carefully evaluated diet and food production methods and asked three questions:

  • Are they good for us?
  • Are they good for the planet?
  • Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The commission described the typical American diet as a “lose-lose diet.” It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win diet.”  It is good for our health. It is good for the planet. And, it is sustainable.

In their publication they refer to their diet as the “universal healthy reference diet” (What else would you expect from a committee?). However, it has become popularly known as the “Planetary Diet.”

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about global warming…If you care about saving our planet, there is no other choice.

How Was The Study Done?

The study (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019 ) was the report of the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. This Commission convened 30 of the top experts from across the globe to prepare a science-based evaluation of the effect of diet on both health and sustainable food production through the year 2050. The Commission included world class experts on healthy diets, agricultural methods, climate change, and earth sciences. The Commission reviewed 356 published studies in preparing their report.

 

Is Your Diet Destroying The Planet?

When they looked at the effect of food production on the environment, the Commission concluded:

  • “Strong evidence indicates that food production is among the largest drivers of global environmental change.” Specifically, the commission reported:
  • Agriculture occupies 40% of global land (58% of that is for pasture use).
  • Food production is responsible for 30% of global greenhouse gas emissions and 70% of freshwater use.
  • Conversion of natural ecosystems to croplands and pastures is the largest factor causing species to be threatened with extinction. Specifically, 80% of extinction threats to mammals and bird species are due to agricultural practices.
  • Overuse and misuse of nitrogen and phosphorous in fertilizers causes eutrophication. In case you are wondering, eutrophication is defined as the process by which a body of water becomes enriched in dissolved nutrients (such as phosphates from commercial fertilizer) that stimulate the growth of algae and other aquatic plant life, usually resulting in the depletion of dissolved oxygen. This creates dead zones in lakes and coastal regions where fish and other marine organisms cannot survive.
  • About 60% of world fish stocks are fully fished and more than 30% are overfished. Because of this, catch by global marine fisheries has been declining since 1996.
  • “Reaching the Paris Agreement of limiting global warming…is not possible by only decarbonizing the global energy systems. Transformation to healthy diets from sustainable food systems is essential to achieving the Paris Agreement.”
  • The world’s population is expected to increase to 10 billion by 2050. The current system of food production is unsustainable.

When they looked at the effect of the foods we eat on the environment, the Commission concluded:

  • Beef and lamb are the biggest contributors to greenhouse gas emissions and land use.
  • The concern about land use is obvious because of the large amount of pasture land required to raise cattle and sheep.
  • The concern about greenhouse gas emissions is because cattle and sheep are ruminants. They not only breathe out CO2, but they also release methane into the atmosphere from fermentation in their rumens of the food they eat. Methane is a potent greenhouse gas, and it persists in the atmosphere 25 times longer than CO2. The single most important thing we can do as individuals to reduce greenhouse gas emissions is to eat less beef and lamb. [Note: grass fed cattle produce more greenhouse gas emissions than cattle raised on corn because they require 3 years to bring to market rather than 2 years.]
  • In terms of energy use beef, lamb, pork, chicken, dairy and eggs all require much more energy to produce than any of the plant foods.
  • In terms of eutrophication, beef, lamb, and pork, all cause much more eutrophication than any plant food. Dairy and eggs cause more eutrophication than any plant food except fruits.
  • In contrast, plant crops reduce greenhouse gas emissions by removing CO2 from the atmosphere.

 

What Is The Planetary Diet?

In the words of the Commission: “[The Planetary Diet] largely consists of vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils. It includes a low to moderate amount of seafood, poultry, and eggs. It includes no or a very low amount of red meat, processed meat, sugar, refined grains, and starchy vegetables.”

When described in that fashion it sounds very much like other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable. Here is a more detailed description of the diet:

  • It starts with a vegetarian diet. Vegetables, fruits, beans, nuts, soy foods, and whole grains are the foundation of the diet.
  • It allows the option of adding one serving of dairy a day (It turns out that cows produce much less greenhouse emissions per serving of dairy than per serving of beef. That’s because cows take several years to mature before they can be converted to meat, and they are emitting greenhouse gases the entire time).
  • It allows the option of adding one 3 oz serving of fish or poultry or one egg per day.
  • It allows the option of swapping seafood, poultry, or egg for a 3 oz serving of red meat no more than once a week. If you want a 12 oz steak, that would be no more than once a month.

This is obviously very different from the way most Americans currently eat. According to the Commission:

  • “This would require greater than 50% reduction in consumption of unhealthy foods, such as red meat and sugar, and greater than 100% increase in the consumption of healthy foods, such as nuts, fruits, vegetables, and legumes.”
  • “In addition to the benefits for the environment, “dietary changes from current diets to healthy diets are likely to substantially benefit human health, averting about 10.8-11.6 million deaths per year globally.”

What Else Did The Commission Recommend?

In addition to changes in our diets, the Commission also recommended several changes in the way food is produced. Here are a few of them.

  • Reduce greenhouse gas emissions from the fuel used to transport food to market.
  • Reduce food losses and waste by at least 50%.
  • Make radical improvements in the efficiency of fertilizer and water use. In terms of fertilizer, the change would be two-fold:
    • In developed countries, reduce fertilizer use and put in place systems to capture runoff and recycle the phosphorous.
    • In third world countries, make fertilizer more available so that crop yields can be increased, something the Commission refer to as eliminating the “yield gap” between third world and developed countries.
  • Stop the expansion of new agricultural land use into natural ecosystems and put in place policies aimed at restoring and re-foresting degraded land.
  • Manage the world’s oceans effectively to ensure that fish stocks are used responsibly and global aquaculture (fish farm) production is expanded sustainability.

What we can do: While most of these are government level policies, we can contribute to the first three by reducing personal food waste and purchasing organic produce locally whenever possible.

What Does This Mean For You?

If you are a vegan, you are probably asking why the Commission did not recommend a completely plant-based diet. The answer is that a vegan diet is perfect for the health of our planet. However, the Commission wanted to make a diet that was as consumer-friendly as possible and still meet their goals of a healthy, environmentally friendly, and sustainable diet.

If you are eating a typical American diet or one of the fad diets that encourage meat consumption, you are probably wondering how you can ever make such drastic changes to your diet. The answer is “one step at a time.”  If you have read my books “Slaying The Food Myths” or “Slaying the Supplement Myths,”  you know that my wife and I did not change our diet overnight. Our diet evolved to something very close to the Planetary Diet over a period of years.

The Commission also purposely designed the Planetary Diet so that you “never have to say never” to your favorite foods. Three ounces of red meat a week does not sound like much, but it allows you a juicy steak once a month.

Sometimes you just need to develop a new mindset. As I shared in my books, my father prided himself on grilling the perfect steak. I love steaks, but I decided to set a few parameters. I don’t waste my red meat calories on anything besides filet mignon at a fine restaurant. It must be a special occasion, and someone else must be buying. That limits it to 2-3 times a year. I still get to enjoy good steak, and I stay well within the parameters of the Planetary diet.

Develop your strategy for enjoying some of your favorite foods within the parameters of the Planetary Diet and have fun with it.

The Bottom Line

 

Is your diet destroying the planet? This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report serves as a dire warning of what will happen to us and our planet if we don’t change our ways.

The Commission carefully evaluated diet and food production methods and asked three questions:

  • Are they good for us?
  • Are they good for the planet?
  • Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The Commission described the typical American diet as a “lose-lose diet.”  It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win diet.”  It is good for our health. It is good for the planet. And, it is sustainable.

In their publication they refer to their diet as the “universal healthy reference diet” (What else would you expect from a committee?). However, it has become popularly known as the “Planetary Diet.”

The Planetary Diet is similar to other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable (for details, read the article above).

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about global warming…If you care about saving our planet, there is no other choice.

For more details read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

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