Do Artificial Sweeteners Help You Lose Weight?

Written by Dr. Steve Chaney on . Posted in artificial sweeteners and weight loss, Blood Sugar, Diet Soda and Health

Sucralose and Weight Loss

Author: Dr. Stephen Chaney

 

Do artificial sweeteners help you lose weight?

It’s a puzzle. We are drinking more artificially sweetened foods and sodas than ever. We’ve been told that those artificially sweeteners will help us cut calories and keep us slender. Yet, surprisingly, we’re fatter than ever.

Let me put some numbers to that statement. The number of people consuming calorie free sodas in the US alone increased from 70 million to 260 million between 1987 and 2000. During that same time period, the percentage of overweight adults in this country increased from 52% to 66%; the percentage of obese adults increased from 20% to 32%; and the percentage of obese children increased from 10% to 17%. Clearly something isn’t working.

And, it may just be the artificial sweeteners that aren’t working. A study published in 2007 (R. Dingra et al, Circulation, 116: 480-484, 2007 ) showed that people consuming regular (sugar containing) sodas were 48% more likely to become obese over a four-year period than people who primarily drank water. That wasn’t surprising. The surprising finding from this study was that people who consumed diet sodas were just as likely to become obese as those drinking regular sodas.

Now you may be saying: “Wait a minute. I thought I read that consuming diet sodas actually helps people lose weight.” The answer is that in those studies dietitians rigorously controlled the caloric intake from other foods so that the only caloric difference was between the diet sodas and the regular sodas. Under those conditions the results are fairly obvious. Fewer calories from sodas = weight loss. But those aren’t the results that you see in free living populations where you don’t have a dietitian peering over your shoulder. In those populations people consuming diet sodas tend to take in the same number of total calories overall and gain just as much weight as people drinking regular sodas.

 

Do Artificial Sweeteners Prevent Weight Loss?

 

Obviously, people consuming diet sodas which contain artificial sweeteners must compensate by consuming extra calories from other foods. But, why are they consuming those extra calories? Some experts hypothesize that the answer is physiological. The sweet taste of the diet sodas triggers the release of insulin, which drives down blood sugar levels and makes people hungrier. Other experts hypothesize that the answer is psychological. People simply feel virtuous for consuming the diet sodas and feel they can now splurge somewhere else.

do artificial sweeteners help you lose weightAnimal studies have suggested that the cause may actually be physiological. Those studies have shown that there are “sweetness receptors” in the intestine that respond to the sweetness of sugars and trigger an increase in the level of proteins that transport sugars from the intestine into the bloodstream. That makes great sense from an evolutionary point of view. If we’re eating a low carbohydrate diet we really don’t want to waste a lot of energy producing proteins that transport sugars into our bloodstream. However, whenever we eat foods high in carbohydrates we don’t want to waste that carbohydrate. So, our intestine rapidly breaks the carbohydrates down to simple sugars, and our body responds by increasing our ability to transport those simple sugars into the bloodstream.

This can lead to blood sugar swings and increased food cravings. You’ve heard about the blood sugar swings associated with meals high in simple sugars. When sugars enter the bloodstream very rapidly, blood sugar levels increase, which causes insulin to be secreted. The insulin drives down blood sugar levels, leading to hypoglycemia and increased hunger. That’s a highly simplified scenario, but you get the general idea.

Now the interesting thing is that animal studies have suggested that artificial sweeteners are also recognized by the intestinal “sweetness receptors”. So artificial sweeteners also trigger an increase in the intestinal sugar transporters and prime the body so that blood sugar swings are more likely to occur whenever we eat carbohydrates.

While the results from animal studies have been very consistent with this model, the results from human clinical studies have been mixed. Some studies have suggested that artificial sweeteners do increase the likelihood of blood sugar swings, while other studies have reported that artificial sweeteners have no effect on blood glucose and insulin levels.

With this in mind, do artificial sweeteners help you lose weight?  Let’s continue to investigate.

 

Do Artificial Sweeteners Help You Lose Weight?

 

A recent study (M.Y. Pepinoet al, Diabetes Care, 36: 2530-2535, 2013 ) provides a possible explanation for these conflicting results. This study was similar to many of the previous studies in that obese adults were given either sucralose (an artificial sweetener) or water 10 min before being given a fixed amount of glucose, and blood sugar and insulin levels were followed over the next five hours. What made this study unique was that overweight participants were selected who did not normally consume artificially sweetened beverages or foods (Those people are hard to find in the overweight US population).

artificial sweetenersAnd the results were fairly clear-cut. The participants consuming sucralose prior to the glucose load had a 20% greater increase in blood sugar levels, a 20% greater increase in the amount of insulin produced, and significantly lower blood sugar levels three hours after the glucose load than participants consuming water prior to the glucose load. In the words of the authors: “These data suggest that sucralose ingestion is not physiologically inert but affects the glycemic [blood sugar] response to oral glucose load and potentiates glucose stimulated insulin secretion in obese people.” Basically, what they are saying is that sucralose primes their bodies so that they are more likely to experience blood sugar swings when they subsequently consume carbohydrates. [And that can lead to food cravings and weight gain.]

The authors hypothesized that some previous studies had not found an effect of artificial sweeteners on blood sugar and insulin levels because most of the people in those studies were already consuming artificially sweetened beverages on a regular basis and their intestinal sugar transport proteins were already maximally stimulated. Basically, what they are saying is that when someone is regularly consuming artificial sweeteners the damage has already been done (sugar transport is already maximal), and a single dose of an artificial sweetener will not have any significant additional effect.

So, do artificial sweeteners help you lose weight?  I think you know.

 

The Bottom Line

 

It has become clear in recent years that artificially-sweetened diet sodas and diet foods are not effective at preventing weight gain, and may, in fact, contribute to weight gain. There is also increasing evidence that artificially-sweetened diet sodas may be harmful to our health. In fact, an international consortium of obesity experts recently concluded: “The absence of evidence to support the role of artificially sweetened beverages in preventing weight gain and the lack of studies on their long-term effects on health strengthen the position that artificially-sweetened beverages should not be promoted as part of a healthy diet.”

 

However, the reason why diet sodas appear to promote obesity rather than prevent it has remained elusive.

  • A recent study suggests that sucralose (and presumably other artificial sweeteners) triggers a complex serious of metabolic responses that lead to increased appetite and food cravings.
  • However, this is just one small study. Many more studies will be required before we understand why artificial sweeteners promote obesity, rather than prevent it.
  • However, it is clear that artificial sweeteners are not the simple, magical solutions for weight control that food manufacturers and advertisers would have you believe.
    • There are unresolved safety issues with all the artificial sweeteners – but that’s another subject for another day.
    • There is no convincing evidence that artificial sweeteners actually help you lose weight unless you are very carefully controlling the calories from all the other foods you’re eating – and if you’re doing that successfully, you probably don’t need artificial sweeteners in the first place.
    • There is some evidence that artificial sweeteners may actually cause blood sugar swings and make you hungrier, thus making it harder – not easier – to control your weight.
  • The best solution to weight control is always true lifestyle change that includes exercise, healthy foods, and reduced caloric intake and is not based on gimmicks or artificial ingredients.

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.

Which Foods Lower Blood Sugar?

Written by Dr. Steve Chaney on . Posted in Blood Sugar

Can You Believe The “Experts”?

Author: Dr. Stephen Chaney

which foods lower blood sugarYour blood sugar levels have been creeping up. Your doctor has been bugging you to do something about it – even threatening to put you on medications if you don’t get your blood sugar under control. So, which foods lower blood sugar?

Now it’s the first of the year, and you’ve vowed to do something about it. You have vowed to make better food choices. That should be easy. There is lots of great advice about foods that lower blood sugar on the internet. For example, in a recent search, I found articles proclaiming “9 foods that lower blood sugar”, “7 foods that control blood sugar”, and “12 power foods to beat diabetes”.

But, are those foods the right ones for you? What if we are remarkably different in our blood sugar responses to the same food? This is just what a recent study suggests.

How Was The Study Designed?

A group of scientists in Isreal set out to test the hypothesis that people eating identical meals might have a high variability in their post-meal blood glucose response (Zeevi et al, Cell, 163, 1079-1094, 2015).

measure glucoseThe investigators enrolled 800 subjects ages 18-70 into their study. None of the individuals had diabetes. However, 54% of them were overweight (BMI ≥ 25 kg/m2) and 22% of them were obese (BMI ≥ 30 kg/m2). Thus, their subject population was typical of the adult population of almost every Western, industrialized country.

All 800 subjects were followed for one week during which time:

  • They were connected to a continuous glucose monitor, which measured their blood glucose levels every 5 seconds.
  • They were given a Smartphone app and instructed to log their food intake, exercise, and sleep in real time.
  • They were told to follow their normal daily routine and dietary habits except for the first meal of every day, which consisted of five different types of standardized “meals” (glucose, fructose, bread, bread with butter, bread with chocolate), all providing 50 gm of available carbohydrate.

The glucose monitor recorded blood sugar responses for 2 hours following each meal. From that information, the investigators calculated a PPGR (post-prandial glycemic response), which I will mercifully refer to as “blood sugar response”, for every meal eaten by every subject throughout the week.

The standardized “meals” eaten at the beginning of the day were used to validate the study. For example:

  • Two of the standardized meals were given to each subject twice during the study separated by at least one day.
    • There was very little variability in blood sugar response when the same standardized meal was given to the same subject on different days.
    • However, there was a significant amount of variability in blood sugar response when the same standardized meal was given to different subjects.
  • The average blood sugar response to each of the standardized meals was very similar to literature values from previous studies (Most previous studies have reported only average blood sugar responses, not individual variability).

In short, the results from the standardized “meals” validated both the reliability and reproducibility of the data.

Finally, to eliminate as many confounding variables as possible, the investigators compared blood sugar response only for those meals in which a single food was the major component of the meal and that food provided 20-40 gm of carbohydrate.

Here is where things got really interesting!

Which Foods Lower Blood Sugar?

breadThis study showed that there is tremendous individual variability in the blood sugar response to any given food. For example, individual blood sugar responses varied by:

  • 4-fold for sugar-sweetened soft drinks, grapes and apples.
  • 5-fold for rice.
  • 6-fold for bread and potatoes.
  • 7-fold for ice cream and dates.

Put another way:

  • Some people had almost no blood sugar response to cookies, but a very high blood sugar response to a banana.
  • Other people had almost no blood sugar response to bananas, but a very high blood sugar response to cookies.

That is a pretty striking result. Which foods lower blood sugar? This study suggests that some people trying to control their blood sugar can eat bananas, while others should avoid them. It might even mean that some people trying to control blood sugar can eat cookies. I know that is what many people would like to hear, but I’m not ready to make that recommendation.

Why Is There So Much Individuality in Blood Sugar Response?

good food choicesYou are probably wondering why there is such variability in blood sugar response to the same foods. There are several factors that influence individual blood sugar response. For example,

  • Overweight and obesity (Both tend to increase blood sugar response).
  • Dietary habits (Meats, particularly fatty meats, processed grains, and simple sugars tend to increase blood sugar response to a given amount of carbohydrate. Unprocessed grains, fresh fruits & vegetables tend to decrease blood sugar response to a given amount of carbohydrate).
  • What we eat with a given meal (Protein, fiber, and fat in a meal can decrease blood sugar response to the carbohydrate in that meal).
  • Physical activity (Increased muscle mass decreases blood sugar response to a given amount of carbohydrate).
  • The bacteria in our intestine (This may be a chicken-and egg thing. The bacteria in our intestine are influenced by our dietary habits.)
  • Genetics.
  • Things we don’t yet know about.

The good news is that we can actually control some of these variables. The ones over which we have the most control are weight, dietary habits, what we eat along with the carbohydrates in our meals, and physical activity.

What Does This Mean For You?

blood sugarThe authors concluded that “universal dietary recommendations [for lowering blood sugar levels] may have limited utility.”  That is because dietary recommendations are based on average responses and none of us are average. As the saying goes “We are all wonderfully [and differently] made”.

So, when you read about diets and foods that will help you keep your blood sugar levels under control, take those recommendations with a grain of…sugar. They are a good starting place, but you need to listen to your body, and eat the foods that work best for you.  So, which foods lower blood sugar?  It is different for different people, but there are some variables you can control.

Don’t get carried away, however. I’m pretty sure Twinkies washed down with a soft drink are bad for just about everyone.

More importantly, control the variables you can – weight, dietary habits, foods you eat along with carbohydrates, and physical activity. If you control those four variables, you will be well on your way to ideal blood sugar control.

 

The Bottom Line

 

  • A recent study has shown that there is tremendous variability in blood sugar response to identical meals from one individual to the next.
  • The authors of the study concluded that “universal dietary recommendations [for lowering blood sugar levels] may have limited utility.” That is because dietary recommendations are based on average responses, and none of us are average.
  • So, when you read about diets and foods that will help you keep your blood sugar levels under control, take those recommendations with a grain of…sugar. They are a good starting place, but you need to listen to your body, and eat the foods that work best for you.
  • There are variables influencing our blood sugar response that we cannot control, such as genetics. However, there are some very important variables that we can control. For example, we can improve our blood sugar response by:
    • Attaining and maintaining ideal weight. Losing as little as 5-10 pounds can result in a significant improvement.

 

    • Eating a diet that emphasizes fresh fruits & vegetables, nuts, and whole grains and minimizes meats, especially fatty meats, processed grains, and simple sugars. This may act by influencing the bacteria that populate our intestine.

 

    • Consuming carbohydrates along with protein, fiber-rich foods, and even some fat in the same meal.

 

    • Increasing physical activity, especially activity that increases lean muscle mass.

 

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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High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

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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