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.

Is Diet Soda Bad For You?

Written by Dr. Steve Chaney on . Posted in Diet Soda and Health

Do Diet Sodas Increase Your Risk Of Stroke?

Author: Dr. Stephen Chaney

diet soda badIs diet soda bad for you?  With over two third of Americans overweight or obese, it is clear that we are in a midst of an obesity epidemic. Multiple studies have shown that over consumption of sugar-sweetened beverages (soft drinks, energy drinks, and “fruit” juices that aren’t made from real fruit) are major drivers of the obesity epidemic. Because of these trends, many experts recommend substituting artificially sweetened beverages for sugar-sweetened beverages in the American diet.

Is that advice sound? Do diet sodas help prevent weight gain? Are they safe? The answers to those questions are not as clear as you might expect.

Do Diet Sodas Prevent Weight Gain?

diet soda make you fatThe answer to that question would seem to be a no-brainer. Substituting beverages with no calories for beverages with calories should lead to less weight gain. However, as I summarized in a previous “Health Tips From the Professor” article Do Diet Sodas Make You Fat, the answer is not clear at all. Some studies suggest that diet sodas help people lose weight. Other studies suggest diet sodas cause just as much weight gain as sugar-sweetened sodas.

With so much confusion in the literature, what should we believe? More importantly, what do the experts say? This January an international consortium of experts reviewed all of the pertinent literature and published a position paper on whether artificially sweetened beverages were of value in responding to the global obesity crisis (Borges et al, PLOS Medicine, DOI: 10.1371/journal.pmed.1002195).

These authors concluded:

  • “In summary, the available evidence…does not consistently demonstrate that artificially-sweetened beverages are effective for weight loss or preventing metabolic abnormalities [pre-diabetes and diabetes]. Evidence on the impact of artificially-sweetened beverages on child health is even more limited and inconclusive than in adults.”
  • “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.”

Is Diet Soda Bad For You?

diet soda strokeAs if the lack of proven efficacy weren’t bad enough, other studies suggest that diet sodas may also be bad for your health. In previous issues of “Health Tips From the Professor,” I have discussed other studies showing that diet sodas are just as likely as regular sodas to increase risk of diabetes Artificial Sweeteners and Diabetes and heart disease Soft Drinks and Heart Disease.

Even worse, a study published earlier this month (Pase et al, Stroke, DOI: 10.1161/STROKE.AHA.116.016027 ) concluded that diet sodas may significantly increase the risk of stroke and Alzheimer’s disease.

This study looked at 2888 participants of the Framingham Heart Study. The participants evaluated for risk of stroke had a mean age of 62 on enrollment. Those evaluated for risk of dementia had a mean age of 69 on enrollment. All subjects were followed for 10 years. Three food frequency questionnaires were administered during that 10-year period to evaluate consumption of diet and sugar-sweetened sodas. The results of the study were:

  • People consuming at least one diet soda per day over a 10-year period were 3X more likely to have a stroke or develop dementia (primarily Alzheimer’s disease) than people consuming no diet sodas.
  • No increased risk of stroke or dementia was seen for people consuming sugar-sweetened beverages. However, that does not mean that sugar-sweetened beverages are good for you. Previous studies have shown they increase the risk of obesity and diabetes.
  • When the data were corrected for hypertension, cardiovascular disease, and obesity (waist to hip ratio), diet sodas still increased the risk of having a stroke by 2.6-fold.
  • This is not the only study to show a link between diet sodas and stroke. Two other studies have come to the same conclusion, and in both of those studies the increased risk was also seen only with diet soda consumption, not with sugar-sweetened soda consumption.

The author of the study concluded by saying: “As the consumption of artificially sweetened soft drinks is increasing in our community, along with the prevalence of stroke and dementia, future research is needed to replicate our findings and to investigate the mechanisms underlying the reported association.”

I agree. Current evidence does not definitively prove that diet sodas cause stroke and Alzheimer’s, but these are life-changing adverse health outcomes. Further research to test this association is desperately needed to know whether or not diet soda is bad for you.

Are Diet Sodas Safe and Effective?

diet soda dangerousAs you might expect these studies have caused quite a bit of controversy. Some experts have embraced these studies and have concluded that health professionals should stop recommending diet sodas as a safe and effective alternative to sugar-sweetened sodas.
Others have been unwilling to change their recommendation of diet sodas for people who are obese and/or diabetic. Their rationale is 3-fold:

  • These studies merely show that diet soda consumption is associated with weight gain, diabetes, heart disease, stroke and Alzheimer’s. Association does not prove causation, so their viewpoint is that there is no conclusive proof that diet sodas cause weight gain and health risks.
  • The obesity epidemic is a major health crisis, and consumption of sugar-sweetened beverages plays an important role in weight gain.
  • They are convinced that most people are so addicted to the sweet taste of sugar that they would be unwilling to switch to calorie free options like water or herbal teas.

In short, they are desperately clinging to the hope that substituting diet sodas for sugar-sweetened sodas will put a dent in the obesity crises because they don’t believe there are any other viable options.

What Do These Studies Mean For You?

I side with those experts who have looked at the data from the opposite perspective and concluded there is no convincing evidence that diet sodas are either safe or effective.

If the conversation were just centered around weight gain, diabetes, and heart disease, this could be considered an academic discussion. One could argue that diet sodas might have some benefit, and, at the worst, would have the same health risks as the regular sodas they replaced.

However, the possibility that diet sodas may increase the risk of stroke and dementia is a game-changer in my mind. That’s because consumption of sugar-sweetened sodas does not appear to increase the risk of either stroke or dementia. If true, that means that substitution of diet sodas for sugar-sweetened sodas is not a neutral substitution. It could cause serious harm.

With no good evidence that diet sodas help people control weight and the possibility that they may have serious health risks, it is difficult to see how anyone in good conscience can continue to recommend diet sodas in place of regular sodas.

My recommendation is to substitute water and other unsweetened beverages for the sugar sweetened beverages you are currently consuming. If you crave the fizz of sodas, drink carbonated water. If you need more taste, try herbal teas or infuse water with slices of lemon, lime, or your favorite fruit. If you buy commercial brands of flavored water, check the labels carefully. They may contain sugars or artificial sweeteners. Those you want to avoid.

So, is diet soda bad for you?  Well, it’s not good for you.

The Bottom Line

  • This January an international consortium of experts reviewed all of the pertinent literature and concluded: “The available evidence…does not consistently demonstrate that artificially-sweetened beverages are effective for weight loss or preventing metabolic abnormalities. The absence of evidence to support the role of artificially sweetened beverages in preventing weight gain and the lack of studies on other long-term effects on health strengthen the position that artificially-sweetened beverages should not be promoted as part of a healthy diet.”
  • This April a study was published reporting that people consuming at least one diet soda per day over a 10-year period were 3X more likely to have a stroke or develop dementia (primarily Alzheimer’s disease) than people consuming no diet sodas. Two other studies on the effect of diet sodas on the risk of stroke have come to similar conclusions.
  • We cannot yet say definitively that diet sodas cause stroke and dementia. Further research is clearly needed to test these associations. However, at this point it is safe to say there is no convincing evidence that diet sodas are either safe or effective.
  • With no good evidence that diet sodas help people control weight and the possibility that they may have serious health risks, it is difficult to see how anyone in good conscience can continue to recommend diet sodas as a substitute for sugar-sweetened sodas.
  • My recommendation is to substitute water and other unsweetened beverages for the sugar sweetened beverages you are currently consuming. If you crave the fizz of sodas, drink carbonated water. If you need more taste, try herbal teas or infuse water with slices of lemon, lime, or your favorite fruit. If you buy commercial brands of flavored water, check the labels carefully. They may contain sugars or artificial sweeteners. Those you want to avoid.
  • For a more nuanced discussion of this issue, 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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Do Omega-3s Lower Blood Pressure in Young, Healthy Adults?

Posted August 14, 2018 by Dr. Steve Chaney

What Is The Omega-3 Index And Why Is It Important?

Author: Dr. Stephen Chaney

 

Do omega-3s lower blood pressure in healthy adults?

omega-3s lower blood pressure young adultsThe literature on the potential health benefits of omega-3s is very confusing. That’s because a lot of bad studies have been published. Many of them never determined the omega-3 status of their subjects prior to omega-3 supplementation. Others relied on dietary recalls of fish consumption, which can be inaccurate.

Fortunately, a much more accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes. Using modern technology, it can be determined from a single finger prick blood sample. It is a very accurate reflection of omega-3 intake relative to other fats in the diet over the past few months. More importantly, it is a measure of the omega-3 content of your cell membranes, which is a direct measure of your omega-3 nutritional status.

A recent extension of the Framingham Heart Study reported that participants with an Omega-3 Index >6.8% had a 39% lower risk of cardiovascular disease than those with an Omega-3 Index <4.2% (WS Harris et al, Journal of Clinical Lipidology, 12: 718-724, 2018 ). Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk, while 8% or better is considered indicative of low cardiovascular risk. For reference, the average American has an Omega-3 Index in the 4-5% range. In Japan, where fish consumption is much higher and cardiovascular risk much lower, the Omega-3 Index is in the 9-11% range.

Previous studies have suggested that omega-3 fatty acids lower blood pressure to a modest extent. Thus, it is not surprising that more recent studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, those studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Unfortunately, there were no studies looking at that population. The current study was designed to fill that gap.

 

How Was The Study Done?

omega-3s lower blood pressure young healthy adultsThe current study (M.G. Filipovic et al, Journal of Hypertension, 36: 1548-1554, 2018 ) was based on data collected from 2036 healthy adults, aged 25-41, from Liechtenstein. They were participants in the GAPP (Genetic and Phenotypic Determinants of Blood Pressure) study. Participants were excluded from the study if they had been diagnosed with high blood pressure and were taking medication to lower their blood pressure. They were also excluded if they had heart disease, chronic kidney disease, other severe illnesses, obesity, sleep apnea, or daily use of non-steroidal anti-inflammatory medications.

Blood samples were collected at the time of their enrollment in the study and frozen for subsequent determination of Omega-3 Index. Blood pressure was also measured at their time of enrollment in two different ways. The first was a standard blood pressure measurement in a doctor’s office.

For the second measurement they were given a wearable blood pressure monitor that recorded their blood pressure over 24 hours every 15 minutes during the day and every 30 minutes while they were sleeping. This is considered more accurate than a resting blood pressure measurement in a doctor’s office because it records the variation in blood pressure, while you are sleeping, while you are exercising, and while you go about your everyday activities.

 

Do Omega-3s Lower Blood Pressure In Young, Healthy Adults?

omega-3s lower blood pressure young adults equipmentNone of the participants in the study had significantly elevated blood pressure. The mean systolic and diastolic office blood pressures were 120±13 and 78±9 respectively. The average Omega-3 Index in this population was 4.6%, which is similar to the average Omega-3 Index in the United States.

When they compared the group with the highest Omega-3 Index (average = 5.8%) with the group with the lowest Omega-3 Index (average = 4.6%):

  • The office measurement of systolic and diastolic blood pressure was decreased by 3.3% and 2.6% respectively
  • While those numbers appear small, the differences were highly significant.
  • The 24-hour blood pressure measurements showed a similar decrease.
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index. [In studies of this kind, a linear dose-response is considered an internal validation of the differences observed between the group with the highest Omega-3 Index and the group with the lowest Omega-3 Index.]

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

 

What Does This Mean For You?

omega-3s lower blood pressure young adults questionPerhaps I should first comment on the significance of the relatively small decrease in blood pressure observed in this study.

  • These were young adults, all of whom had normal or near normal blood pressure.
  • The difference in Omega-3 Index was rather small (5.8% to 4.6%). None of the participants in the study were at the 8% or above that is considered optimal.
  • Liechtenstein is a small country located between Switzerland and Spain. Fish consumption is low and omega-3 supplement consumption is rare.

Under these conditions, even a small, but statistically significant, decrease in blood pressure is remarkable.

We should think of this study as the start of the investigation of the relationship between omega-3 status and blood pressure. Its weakness is that it only shows an association between high Omega-3 Index and low blood pressure. It does not prove cause and effect.

Its strength is that it is consistent with many other studies showing omega-3 fatty acids lower blood pressure. Furthermore, it suggests that the effect of omega-3s on blood pressure may also be seen in young, healthy adults who have not yet developed high blood pressure.

Finally, the authors suggested that a diet rich in omega-3s might reduce the incidence of high blood pressure by slowing the age-related increase in blood pressure that most Americans experience. This idea is logical, but speculative at present.

However, the GAPP study is designed to provide the answer to that question. It is a long-term study with follow-up examinations scheduled every 3-5 years. It will be interesting to see whether the author’s prediction holds true, and a higher Omega-3 Index is associated with a slower increase in blood pressure as the participants age.

 

Why Is The Omega-3 Index Important?

 

The authors of this study said: “The Omega-3 Index is very robust to short-term intake of omega-3 fatty acids and reliably reflects an individual’s long-term omega-3 status and tissue omega-3 content. Therefore, the Omega-3 Index has the potential to become a cardiovascular risk factor as much as the HbA1c is for people with diabetes…” That is a bit of an overstatement. HbA1c is a measure of disease progression for diabetes because it is a direct measure of blood sugar control.

In contrast, Omega-3 Index is merely a risk factor for cardiovascular disease. However, if it is further validated by future studies, it is likely to be as important for predicting cardiovascular risk as are cholesterol levels and markers of inflammation.

However, to me the most important role of Omega-3 Index is in the design of future clinical studies. If anyone really wants to determine whether omega-3 supplementation reduces cardiovascular risk, high blood pressure, diabetes or any other health outcome they should:

  • Start with a population group with an Omega-3 Index in the deficient (4-5%) range.
  • Supplement with omega-3 fatty acids in a double blind, placebo-controlled manner.
  • Show that supplementation brought participants up to an optimal Omega-3 Index of 8% or greater.
  • Look at health outcomes such as heart attacks, cardiovascular deaths, hypertension, stroke, or depression.
  • Continue the study long enough for the beneficial effects of omega-3 supplementation to be measurable. For cardiovascular outcomes the American Heart Association has stated that at least two years are required to obtain meaningful results.

These are the kind of experiments that will be required to give definitive, reproducible results and resolve the confusion about the health effects of omega-3 fatty acids.

 

The Bottom Line

 

An accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes.

Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk while 8% or better is considered indicative of low cardiovascular risk.

Previous studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, these studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Until now, there have been no studies looking at that population.

The study described in this article was designed to fill that gap. The participants in this study were ages 25-41, were healthy, and none of them had elevated blood pressure.

When the group with the highest Omega-3 Index (average = 5.8%) was compared with the group with the lowest Omega-3 Index (average = 4.6%):

  • Both systolic and diastolic blood pressure were decreased
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index.

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

Let me translate that last sentence into plain English for you. The authors were saying that optimizing omega-3 intake in young adults may slow the age-related increase in blood pressure and reduce the risk of them developing high blood pressure as they age. This may begin to answer the question “Do omega-3s lower blood pressure in young, healthy adults?”

Or even more simply put: Aging is inevitable. Becoming unhealthy is not.

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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