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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How Long Do the Benefits of Supplements Last?

Posted October 23, 2018 by Dr. Steve Chaney

Can Supplements Set You On A Path Towards A Healthier Life?

Author: Dr. Stephen Chaney

 

benefits of supplements heartA recent study (U Alehagen et al, PLOS One, April 11, 2018, 1-15 ) reported that the heart benefits of supplementation with coenzyme Q10 and selenium persisted for 12 years after supplementation ended. You would have thought a story like that would have made the headlines. Nope. Hardly a mention. Perhaps it did not match the narrative of the media and health professionals that supplements are worthless.

This study broke new ground. Most studies last a year or two and report whether there were any benefits of supplementation. A few studies have been extended a few years beyond the original supplementation period and have reported continued benefits of supplementation. However, in those studies the intervention group was still taking supplements. The intervention period was simply extended.

However, this study was unique in that supplementation was discontinued after 4 years. However, the positive effects of supplementation during that four-year period persisted for another 12 years without additional supplementation.

 

How Was The Study Done?

benefits of supplements monitoring heartIn this study 443 elderly individuals (average age =78) were recruited from a rural village in Sweden. They were given either supplements providing 200 mg/day of coenzyme Q10 and 200 mcg/day of selenium yeast or placebo pills. They were followed for four years. At this point the intervention phase of the trial ended, and the participants were followed for another 12 years without supplementation.

Cardiovascular deaths and all-cause mortality were recorded at 4 years (the end of the original intervention period), 10 years, and 12 years. The Swedish health care system is incredibly efficient. None of the participants were lost to follow-up.

Note on study design: Both coenzyme Q10 and selenium have heart health benefits and they compliment each other. Coenzyme Q10 was included in this study because our bodies lose the ability to make coenzyme Q10 as we age. By the time we reach age 80, we only make around half the coenzyme Q10 we made when we were younger. Selenium was included in the study because most Swedes are selenium deficient.

This study measured selenium levels and confirmed that all participants were selenium deficient at the beginning of the study. Selenium levels increased to near optimal in the supplemented group during the 4-year intervention period. In contrast, the placebo group remained selenium deficient.

 

How Long Do the Benefits of Supplements Last?

benefits of supplementationThe results of the study were truly amazing.

When you compared the group that had received coenzyme Q10 and selenium during the first 4 years of the study with the placebo group:

  • Cardiovascular mortality was 38% less and all-cause mortality was 24% less 12 years later in the supplement group.
  • The decrease in cardiovascular mortality lessened slightly with time (53% lower at 4 years, 46% lower at 10 years, and 38% lower at 12 years.
  • In contrast, the decrease in all-cause mortality remained relatively constant.
  • The effect was greater for women (who have lower coenzyme Q10 levels than men) than it was for men.
  • The decrease in cardiovascular mortality was 57% for women and 22% for men.
  • Cardiovascular mortality was decreased by 40-50% for people at high risk of cardiovascular death because of atherosclerosis, diabetes, high blood pressure, or impaired heart function.

Putting This Study Into Perspective

benefits of supplements wellnessI don’t want to read too much into this study. It has multiple limitations:

  • It is a very small study.
  • It is the first study I am aware of that has followed study participants years after supplementation has ended. More studies like this are clearly needed before any firm conclusions can be drawn.
  • It may be unique to Sweden where selenium deficiency is widespread. Selenium deficiency is much less prevalent in some other countries such as the United States.
  • It is possible that once the study population heard about the results of the initial 4-year study they started self-supplementing with coenzyme Q10 and selenium. However, since the participants did not know whether they were in the supplement or placebo group, that would likely affect both groups equally.

However, it is the implications of the study that fascinate me.

  • The authors of the study speculated that the improvement in endothelial cell function (Endothelial cells line the arteries and play an important role in arterial health) and/or decreased inflammation may have persisted long after supplementation stopped.
  • A more interesting idea is that supplementation (or the effects of supplementation) caused modifications to the DNA that were persistent (something we refer to as epigenetics). Moreover, those DNA modifications may have altered gene expression in a manner that reduced heart disease risk.

Much more work needs to be done before we know whether epigenetic modifications were responsible for the persistent benefit of supplementation in this, or any other, study. However, the ramifications of this idea are substantial. We think of supplementation as something that provides benefit only while we are taking the supplement. What if, under the right conditions, supplementation could send us down an entirely different path to better health? That would be worth major headlines.

 

The Bottom Line

 

A recent study in Sweden looked at the effects of supplementation with coenzyme Q10 and selenium on heart health 12 years after supplementation had ended.

  • The study reported that cardiovascular mortality was 38% less and all-cause mortality was 24% less 12 years later in the group that supplemented during the first 4 years.

The study has multiple limitations and needs to be repeated before drawing any definite conclusions. However, if true, it has interesting implications. What if the benefits of supplementation didn’t stop when you stopped supplementing? What if supplementation sent you down an entirely different path, a path towards better health?

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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