Artificial Sweeteners and Sugar Substitutes

Prepared by: 3rd year medicine students in King AbdulAziz University.

Objectives

• 1. Outline metabolic aspects of sugar substitutes .

• 2. Evaluate health implications of various sugar substitutes.

• 3. Discuss safety and efficacy in using sugar substitutes.

• 4. Explain indication potentials of sugar substitutes in some metabolic diseases.

1st Objective

•Outline metabolic aspects of sugar substitutes.

What are sugar substitutes?• A sugar substitute is a food additive that

duplicates the effect of sugar in taste, usually with less food energy. Some sugar substitutes are natural and some are synthetic. Those that are not natural are, in general, called artificial sweeteners.

• An important class of sugar substitutes is known as high-intensity sweeteners. These are compounds with many times the sweetness of sucrose, common table sugar. As a result, much less sweetener is required and energy contribution is often negligible. The sensation of sweetness caused by these compounds (the "sweetness profile") is sometimes notably different from sucrose, so they are often used in complex mixtures that achieve the most natural sweet sensation.

Cont.• If the sucrose (or other sugar) that is replaced has

contributed to the texture of the product, then a bulking agent is often also needed. This may be seen in soft drinks or sweet tea that are labeled as "diet" or "light" that contain artificial sweeteners and often have notably different mouth feel, or in table sugar replacements that mix maltodextrins with an intense sweetener to achieve satisfactory texture sensation.

Do artificial sweeteners affect metabolism? • It hasn’t been 100 % scientifically confirmed but

studies show that they do have an effect on metabolism although further research is required to prove that long term use is harmful.

Weight gain and insulin response to artificial sweeteners

• Animal studies have indicated that a sweet taste induces an insulin response in rats. However, the extension of animal model findings to humans is unclear, as human studies of intragastric infusion of sucralose have shown no insulin response from taste receptors. The release of insulin causes blood sugar to be stored in tissues (including fat). In the case of a response to artificial sweeteners, even if blood sugar does not increase, there can be increased hypoglycemia or hyperinsulinemia and increased food intake the next time there is a meal. Rats given sweeteners have steadily increased calorie intake, increased body weight, and increased fatness.

Cont.

• Furthermore, the natural responses to eating sugary foods (eating less at the next meal and using some of the extra calories to warm the body after the sugary meal) are gradually lost.• A 2012 study showed that addition of

either saccharin or aspartame to the diet of test rats resulted in increased weight gain compared to addition of sucrose, when total caloric intake was similar among groups.

Cont.

• A 2014 study by a collaboration of seventeen scientists from nine Israeli research institutes presented experimental evidence that artificial sweeteners may exacerbate, rather than prevent, metabolic disorders such as Type 2 diabetes. They reported that artificial sweeteners increase the blood sugar levels in both mice and humans by altering the composition and function of the gut flora. Excessive blood sugar levels are an early indicator of Type 2 diabetes and metabolic disease.

Cont.

• Mice given drinking water supplemented with artificial sweetener (commercial formulations of saccharin, sucralose or aspartame) developed greater glucose intolerance than mice drinking pure water, or water with only sugar added. The effect occurred both in mice fed standard chow and those on a high-fat diet. Changes in the composition of the gut flora were observed by sequencing a ribosomal RNA gene.

Cont.

• When antibiotics were then used to kill off gut bacteria, the degree of glucose intolerance in mice fed either diet was restored to normal levels present before artificial sweetener was introduced. Human subjects were also studied. Gut bacteria from 381 non-diabetics averaging age 43 were analyzed, revealing differences in the gut bacteria between those subjects who habitually consumed artificial sweeteners and those who did not, as well as "markers" for diabetes, such as raised blood sugar levels and glucose intolerance.

Cont.

• The researchers noted that the increase in human consumption of artificial sweeteners coincides with the modern epidemic incidence of obesity and diabetes.

2nd Objective

•Evaluate health implications of various sugar substitutes.

Sugar substitutes can be categorized in three groups:

Natural Sweeteners

Artificial Sweeteners

Sugar Alcohols

• Natural sweeteners, such as agave nectar and honey, are still as calorie-dense as sugar, but can be safe for diabetics in moderation because their glycemic index (GI) is lower than table sugar.

• Natural sweeteners are sugar substitutes that are often promoted as healthier options than processed table sugar or other sugar substitutes.

Natural Sweeteners

• Natural sweeteners are generally safe.

• But consuming too much natural sweeteners, can lead to health problems such as:

Tooth decay. Weight gain.Increased triglycerides.

• Also honey can contain small amounts of bacterial spores that can produce botulism toxin. For that, honey shouldn't be given to children less than 1 year old.

Health effects of natural sweeteners

Artificial Sweeteners• They are synthetic sugar substitutes but may be

derived from naturally occurring substances, including herbs or sugar itself. They are also known as intense sweeteners because they are sweeter than regular sugar.

• Usually they don’t have calories.Aspartame

(Equal®)

Saccharin

(Sweet’N Low®)

Sucralose

(Splenda®)

Acesulfame potassium

(Sweet one®)

• Another possible danger of saccharin is the possibility of allergic reactions, can include:

headaches, breathing difficulties, skin eruptions, and diarrhea.

Without research to support these claims, the FDA has not imposed any limitations.

• Old studies linked saccharin to bladder cancer in rats. Because of those studies, saccharin once carried a warning label that it may be hazardous to health.

• As a result of the newer studies, the warning label for saccharin was dropped.

Saccharin health effects

Aspartame health effects

• Activists claim there’s a link between aspartame and a multitude of ailments, including:

Cancer.Seizures.Depression.Lupus.Multiple sclerosis .

• Despite extensive testing on aspartame, these claims have not been supported in clinical studies.

• For new generation sweeteners (i.e. acesulfame potassium and sucralose) , it is too early to establish any epidemiological evidence about possible carcinogenic risks.

• Numerous studies confirmed that artificial sweeteners are safe in reasonable quantities, even for pregnant women.

Artificial sweeteners health effects

Sugar Alcohols

• Examples for sugar alcohols: Sorbitol, Mannitol, and Xylitol.

• They are found in many processed foods and products and including chocolate, chewing gum, and toothpastes.

• Sugar alcohols are carbohydrates that occur naturally in certain fruits and vegetables, but they also can be manufactured. They're not considered intense sweeteners, because they aren't sweeter than sugar.

• There are few health concerns associated with sugar alcohols. When eaten in large amounts, usually more than 50 grams but sometimes as little as 10 grams, they can have a laxative effect causing:

Bloating.Intestinal gas. Diarrhea.

• Product labels may carry a warning about this potential laxative effect.

Health effects of sugar alcohols

3rd Objective

•Discuss safety and efficacy in using sugar substitutes.

Safety of artificial sweeteners

• Some research has associated artificial sweeteners with health conditions such as cancers, hepatotoxicity, migraines, and low birth weight. Much controversy concerning this issue still exists, but lots of studies demonstrated the safety of these sweeteners.

Efficacy of artificial sweeteners

• It has been suggested that the use of artificial sweeteners may have a stimulating effect on appetite and, therefore, may play a role in weight gain and obesity. However, research into sweeteners and appetite stimulation is inconsistent. Also, there is little evidence from longer-term studies to show that sweeteners lead to increased energy intake and contribute to the risk of obesity.

4th Objective

•Explain indication potentials of sugar substitutes in some metabolic diseases.

Sugar substitutes in the diabetic diet

•Using artificial sweeteners is considered a safe way to help control blood sugar levels.

• There are more choices than ever.

There are six artificial sweeteners that have been tested and approved by the U.S. Food and Drug Administration (FDA): • Aspartame• Acesulfame potassium • Saccharin• Sucralose• Neotame • Advantame

Also, with the exception of aspartame, all of the sweeteners listed above cannot be broken down by the body.

Phenylketonuria• Phenylketonuria (PKU) is a genetic disorder

in which the body can't break down an amino acid called phenylalanine (Phe).

• People who have phenylketonuria (PKU) cannot use aspartame, because it contains phenylalanine.

References• Garner C, et al. Nonnutritive sweeteners: Current use and health perspectives. A Scientific

Statement From the American Heart Association and the American Diabetes Association. Circulation. 2012;126:509.

• Levin G, Zehner L, Saunders J, and Beadle J. Sugar substitutes: their energy values, bulk characteristics, and potential health . Am J Clin Nutr l995;62(suppl): 1 1615-85.

• The Potential Toxicity of Artificial Sweeteners, Whitehouse, C. R., Boullata, J., & McCauley, L. A. AAOHN Journal 2008; 56(6), 251-259.

• Kroger K, Meister K, Kava R. Low-calorie Sweeteners and Other Sugar Substitutes: A Review of the Safety Issues. Comprehensive Reviews in Food Science and Food Safety 2006;5(2):35-47

• Mattes D, et al. Nonnutritive sweetener consumption in humans: Effects on appetite and food intake and their putative mechanisms. American Journal of Clinical Nutrition. 2009;89:1.

• Aguilar, F. et al. (2013). Scientific Opinion on the re-evaluation of aspartame (E 951) as a food additive. European Food Safety Authority Journal, 11(12), 3496. Retrieved July 25, 2014

• How sweet it is: All about sugar substitutes. Food and Drug Administration. http://www.fda.gov/forconsumers/consumerupdates/ucm397711.htm. Accessed June 3, 2014.

• http://www.nhs.uk/Livewell/Goodfood/Pages/the-truth-about-artificial-sweeteners.aspx• https://www.sciencenews.org/article/artificial-sweeteners-may-tip-scales-toward-metabolic-

problems• http://www.medicinenet.com/artificial_sweeteners/article.htm• http://www.nature.com/news/sugar-substitutes-linked-to-obesity-1.15938• http://www.medicalnewstoday.com/articles/261179.php• http://www.nlm.nih.gov/medlineplus/ency/article/001166.htm• http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/artificial-

sweeteners/art-20046936

Thank you

3rd year Medicine Students in King AbdulAziz University.