The skinny on sugar substitutes

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Here is a sweet story. Sort of. Do you know the difference between artificial sweeteners and sugar substitutes?

One tastes good and the other doesn’t?

Not quite. Artificial sweeteners have improved over the years from the early days of cyclamate. Overall, sugar substitutes are anything used as a sweetener other than table sugar (what is chemically called sucrose).

Artificial sweeteners include sugar alcohols like xylitol, which you find in sugarless gum, and natural products like maple syrup and molasses. They also include the pink, blue and yellow packets found on restaurant tables across the country. Aspartame is found in Equal, saccharin in Sweet N’ Low and sucralose in Splenda. Artificial sweeteners can also be “natural” like the recently launched Stevia products, which include Truvia. Most artificial types are known to be more intense sweeteners than natural sugar. One down side of some of these products is the aftertaste that follows.

Artificial sweeteners have been developed because they add no caloric content to the foods they are added to. They are used in a large number of food products from soft drinks to candy, jellies and jams, baked goods and more. They stimulate the sweet receptors on our tongues but do not promote tooth decay.

Noncaloric sweeteners are one of the mainstays of diet plans for those working to control their weight. For some people, no calories without sacrificing your sweet tooth make this an attractive diet supplement.

Consider yogurt. There can be 200 calories or more in sugar-sweetened types, while the artificially sweetened varieties can come in under 100 calories. For some the reality is half as many calories without losing access to a satisfying, tasty treat! Another positive aspect is that artificial sweeteners can be helpful to those with diabetes.

In terms of weight control, some of the shine may be coming off these products, as some recent studies suggest the use of artificial sweeteners may actually lead to weight gain.

There are additional negative aspects of using artificial sweeteners. In the 1970s, some studies linked them to cancer, specifically saccharin and bladder cancer. However, this has not been substantiated and generally all approved artificial sweeteners are thought to be safe for human use.

But maybe artificial sweeteners are not as inert as you would think. In a new study, scientists looked at obese people. These individuals had a Body Mass Index — BMI — of more than 42. When you reach a BMI of more than 30, you are considered to be in the obese category.

Individuals were divided into two groups and given the artificial sweetener sucralose or water before ingesting a solution of glucose. This is the same as a familiar glucose tolerance test that you or someone in your family may have experienced.

On separate days, the groups were reversed so that the results could be compared directly in each person.

The results were surprising. When individuals drank sucralose before ingesting glucose, their insulin levels increased by about 20 percent compared to those drinking water alone. This means that sucralose was affecting insulin and blood glucose levels. Why was the body making additional insulin in response to an artificial sweetener that was thought to be inert?

It turns out that there are sweet-responsive receptors in the gut and pancreas that are similar to those found on the human tongue. When they become stimulated, they can cause an increase in the release of hormones including insulin, which results in an increase in the absorption of sugar (glucose) in the gut and subsequently in the blood.

This occurs despite the fact that artificial sweeteners are used at very low levels. Interestingly, this only occurs in individuals who are obese. An elevation in insulin levels could contribute to insulin resistance and the development of Type II diabetes in obese individuals.

One thing for sure is that further research will be needed to understand the effects of artificial sweeteners on human metabolism.

Professors Norbert Herzog and David Niesel are biomedical scientists at the University of Texas Medical Branch. Learn more at

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