No-Calorie Sweeteners and Type 2 Diabetes, Good Idea or Bad?
I have several friends who have type 2 diabetes, and sometimes I kid them by saying they drink so much diet soda the should buy stock in companies that make no-calorie sweeteners. Although they laugh it off, the important question is whether no-calorie sweeteners (artificial sweeteners and natural ones) are safe and if consuming them is a good idea or a bad one.
Many individuals, experts, and health-related organizations and institutions have an opinion on this question. The Academy of Nutrition and Dietetics, for example, stated its position in May 2012 when it noted that “consumers can safely enjoy a range of nutritive sweeteners [i.e., naturally sweet and sugar-added foods] and nonnutritive sweeteners (NNS) [no-calorie sweeteners] when consumed within an eating plan that is guided by current federal nutrition recommendations.”
People with diabetes are not the only ones who use these sweeteners. According to a 2011 report in Diabetes Care, about 85 percent of Americans use NNS in some form.
Are no-calorie sweeteners safe?
The Food and Drug Administration (FDA) regulates seven NNS as food additives or GRAS (generally recognized as safe) ingredients. This vote of confidence on the part of the FDA takes into account the likely amount of use by consumers, the cumulative effect of such use, and toxicology test results from animal studies.
The seven NNS approved for consumer use in the United States include five artificial sweeteners (acesulfame K, aspartame, neotame, saccharin, and sucralose) and two natural ones (luo han guo fruit extract and stevia). An overview of consumer use of six of these sweeteners appeared in a Diabetes Care report.
In that article, the executive director of the Calorie Control Council (which represents the low-calorie food and drink industry), Beth Hubrich, explained that the maximum amounts considered safe for daily use over a person’s lifespan were 15, 50, 18, 12, and 5 milligrams per kilogram of body weight per day of acesulfame K, aspartame, neotame, saccharin, stevia, and sucralose, respectively.
To put that into perspective, an average adult would need to use 97 of those little packets of sweetener or drink twenty 12-ounce cans of diet soda with acesulfame K per day to reach that maximum. In other words, it appears the possibility of experiencing harm from artificial sweeteners is unlikely.
However, not everyone agrees. The Centers for Science in the Public Interest (CSPI), for example, a nonprofit that advocates for food safety and consumer health, places acesulfame K, aspartame, and saccharin on its “avoid” list, sucralose on its “caution” list, and both neotame and stevia on its “safe” list.
(Note: luo han guo did not appear on any list, and since it seems to be a fascinating and often neglected sweetener, it will be the topic of a future article.)
CPSI points out the lack of sufficient scientific research on the impact of acesulfame K, aspartame, (a recent study points out new dangers), saccharin, and sucralose on human health and the evidence that these sweeteners cause cancer and other health problems in animals. In addition, countless numbers of consumers have complained about headaches, allergic reactions, and other symptoms they associate with use of these artificial sweeteners.
Andrew Weil, MD, founder and director of the Arizona Center for Integrative Medicine, clinical professor of medicine at the University of Arizona, and well-published author, warns that “synthetic noncaloric sweeteners are not a good alternative” to sugar. He points out in a Prevention article that these chemicals have “never been shown to help anyone lose weight, and some of them are downright bad for you.” It has also been suggested that use of artificial sweeteners may lead to type 2 diabetes.
Instead of these chemicals, Weil suggests stevia or a naturally processed sugar alcohol called erythritol. At the same time, he explains that both artificial and natural no-calorie sweeteners can lead to an increase in sugar and food cravings and thus overeating, so it is best to stick to naturally sweet foods like fresh and dried fruits or foods sweetened with natural no-calorie products in moderation.
So what should you do?
Since it is not ethical to expose people to high, controlled amounts of these artificial sweeteners in clinical trials, for now we are left with a few animal studies and reassuring words from diet soda and artificial sweetener makers. I also want to point out that another vastly unexplored area is the cumulative effect of consuming artificial sweeteners along with the many other artificial flavorings and colorings, preservatives, and pollutants to which the human body is exposed.
If you have type 2 diabetes (and even if you don’t), it seems wise to avoid the use of artificial sweeteners or to at least choose occasional use. As noted in the Diabetes Care article referenced in this article, “lack of evidence of harm is not the same as evidence of lack of harm!”
Bloomgarden ZT. Nonnutritive sweeteners, fructose, and other aspects of diet. Diabetes Care 2011 May; 34(5): e46-e51
Fitch C et al. Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners. Journal of the Academy of Nutrition and Dietetics 2012 May; 112(5): 739-58