Podcast Episode 36 Transcript – Artificial Sweeteners

Leah Higl

Welcome To The Ideal Nutrition Podcast. I am Leah Higl, and I am here with my co-host Aidan Muir, and today we are talking all things artificial sweeteners. So artificial sweeteners have been around for decades. The demand for them really comes down to the fact that they’re sweet and they’re delicious, but they contain no calories. So [00:00:30] a little bit of like having your cake and eating it too. But this is a really broad topic, so we’re going to go through all the pros and cons, all the questions that people typically have about artificial sweeteners, but we’re not going to have a chance to go through it in as much detail as I think it needs. We’d be here all day if we went through all of it.

Aidan Muir

Yeah, so we’re going to try and keep it just to like the 30 minutes. I know we won’t cover everything in that, there’s going to be gaps obviously, but we’re going to do the best that we can. So very [00:01:00] briefly going through categories. So they’re usually split up into three categories of like non-nutritive sweeteners. So we’re looking at sugar alcohols, low calorie sweeteners or natural sweeteners, and then artificial sweeteners. So sugar alcohols, not really talking about that much today, but that’s stuff like sorbitol, mannitol, xylitol. Oftentimes they have a little bit of calories, but it’s a bit of a separate category. Your natural sweeteners often will fall into this category, even though they’re not technically artificial sweeteners, but that’s stuff like stevia, [00:01:30] monk fruit, there’s a few things that go in there. Mostly what we’re talking about today though are artificial sweeteners. So we’re talking about sucralose, aspartame, saccharin, and those in that category.

Leah Higl

Generally the reason most people reach for non calorie sweeteners or artificial sweeteners is to manage calorie intake. So going back to the fact that most of them contain very little, if any calories, that’s like their big selling point. So it makes sense that the uptake of these products has happened quite fast, particularly in people wanting to [00:02:00] lose weight, manage their weight. But in regards to weight management, the research on utilizing these kinds of sweeteners is really, really mixed. So there is some research to, I guess, indicate that potentially, artificial sweeteners might increase appetite and actually lead to some weight gain. But then we also have other research showing that there actually quite beneficial for weight management and weight loss.

And then a whole bunch of research showing pretty neutral [00:02:30] effects. So at this point it really is a mixed bag of results. One systematic review that was done in 2019 included several studies that showed no association between non sugar sweeteners and weight gain, so that’s pretty promising. And then upon further analysis, they even found that these non sugar sweeteners used by overweight or obese individuals, particularly people that weren’t trying to lose weight, actually reduced their body weight. So [00:03:00] generally consensus has not been reached on how to use low calorie sweeteners and their effect on body weight long term, but I feel like overall it’s quite promising.

Aidan Muir

Yeah. I’ll jump in with a few thoughts. There’s two main criticisms I see on that topic, one is that it tricks your body into thinking that sugar is coming so you store body fat anyway.

Leah Higl

I’ve seen that one.

Aidan Muir

Yeah, that’s a really common one and another one that’s a very blanket statement, that’s like, that’s just as bad for you as drinking [00:03:30] full sugar Coke for example, when talking about diet Coke. People saying those two lines and it’s like, well, firstly from the fact that the research is unclear, it’s clear that that’s not a thing. It’s clear that it’s not worse for you or whatever in this particular topic, but taking a step further, I think thinking about it critically, it’s pretty clear from the research that it is what it says it is. It is zero calories and it still is coming down to calories in, calories out and stuff like that. So then the bigger thing comes more so [00:04:00] down to behavior.

If you had a 2000 calorie diet with zero artificial sweeteners and 2000 calorie diet with a small to moderate amount of artificial sweeteners, I think the results come out exactly the same. It’s just, how does it affect the rest of your results and that’s also a big thing or the rest of like your habits, behaviors, all those things. And that’s where it gets really confusing because a lot of stuff is based on food frequency questionnaires. If we’re just looking at stuff, that’s like, how many artificial sweeteners per day do these people eat or drink or whatever, [00:04:30] what do they weigh? That’s not really answering the question because that can be a bit of reverse causality to a certain degree.

Because one of the things that does crop up in the research quite a bit is people who are heavier, typically do consume more artificial sweeteners. But that’s also a hard one because it’s also got that concept of healthy user bias where it’s like, people who are trying to limit their intake of artificial sweeteners could also be doing other behaviors as well. The next thing to consider from a behavior [00:05:00] perspective that I am really interested in, is how does your taste perception change when you have a lot of sweet foods? This isn’t unique to artificial sweeteners, this is just unique to eating sweet foods. But if you have a lot of sweet foods, like say you have a ton of diet soft drink, does your perception of the taste of fruit change? Does your perception of the taste of even vegetables change?

Does it change what other foods you want to eat? Does it change your behavior in that way? That’s something that has been looked in, particularly in children where it’s like, if you give children a lot [00:05:30] of sweet foods, they don’t like food as much. Is it really different from an adult perspective? If we have a lot of these things, does it change that? That doesn’t mean it’s a guarantee. If we look at it from the perspective of like what if person finds it so much easier to stick to their diet when they have a can of diet soft drink when they’re craving one and that changes their behaviors in a positive way because it’s like, well, if they didn’t have that option, are they going to have sugar instead? But what if at the other end of the spectrum, it does the worst case scenario I just talked about where it’s like people no longer [00:06:00] want to eat fruits or vegetables anywhere near as much as they would if they never had these foods.

Leah Higl

And then I guess you’ve also got the potential increased appetite that’s sometimes linked to artificial sweeteners as well from a behavior standpoint. So there have been a few studies that have shown somewhat of a link between increased appetite and people that are having artificial sweetened beverages. So if you are having a lot of these artificial sweeteners and your appetite is increased, does that lead [00:06:30] to more calorie intake or how does that come out? So there was one study that showed that even though people were consuming these artificial sweeteners and they reported an increase in appetite, that overall they were still actually eating a thousand kilojoules less than the other group. So even though they’ve had this appetite increase, they were still eating less calories overall. So I think sometimes that increased appetite argument falls a little bit [00:07:00] flat when you consider everything.

Aidan Muir

And to a certain degree you can also use it as a bit of a tool. Like an example I see with some people is it’s like they have one gap in the day where they’re normally hungry and they chuck a diet soft drink there and sometimes it solves it. It doesn’t always, sometimes it does, it’s a individual situation. And another study on that topic that I’m aware of is, there was one day where the rule they gave people with no further context is have 700 mil of diet soft drink per day and the other group got told, never have diet soft drink, just drink water, [00:07:30] water is all you get to drink. And in terms of weight loss, the group that was told to drink 700 mil of diet soft drink, lost significantly more weight, than the water group did.

Which is like, it’s almost ironic to a certain degree where it’s like a lot of people and myself included, I’m always one of those people like, don’t overdo artificial sweeteners. I do still say that, but a lot of people would be like, water is always best. It’s like, well, in that case, the artificial sweeteners actually did outperform the water in terms of that metric.

Leah Higl

Yeah. And even just anecdotally, working with clients, I can see it as a helpful tool when [00:08:00] someone’s in a calorie deficit and they might be struggling with that a little bit, it can help with compliance occasionally for honestly, for me, for a lot of people I work with to have that Pepsi Max in the afternoon or after dinner and that just helps with dietary compliance.

Aidan Muir

Cool. So moving on to another topic, we’ll be talking about gut health. So gut health is one of the most complex areas and it’s something that a lot of people get really passionate about. I still remember it pretty vividly, but there was [00:08:30] a phase last year when I went and watched a CrossFit game’s event thing and Instagram DMs just blew up. Mainly one guy just hit me with this one study being like, are you going to change your opinion on artificial sweeteners based on this? Dad said it was a Petri dish study. It was just like-

Leah Higl

Oh, I remember that one.

Aidan Muir

Yeah. I’ve got the title of it lined up somewhere. But yeah, I can’t find that real quickly, but it was a Petri dish study and it was basically… Oh no, I’ve got it here. So artificial sweeteners negatively [00:09:00] regulate pathogenic characteristics of two model, gut bacteria, E. coli and E. Faecalis. That’s the name of the study and basically it’s this Petri dish study, they put a bunch of artificial sweeteners on the intestinal lining in a Petri dish and it caused pathogenic changes. It doesn’t really mean anything for humans. It’s like the moment you chuck any other variable in it, it messes with things.

That change is in everything like that. What if you put fiber into the diet? Like what if there’s fiber in the diet and that’s also influencing the gut [00:09:30] microbiome. There’s so many other variables, it’s not overly relevant. But that’s jumping the gun a little bit. Let’s talk about some other stuff. So there was a study that you brought up about… It’s from 2014 titled Artificial Sweeteners Induced Glucose Intolerance by Altering the Gut Microbiome. Did you want to mention that or talk about that?

Leah Higl

So this is the most commonly referenced study I find when people are talking about changes in glucose [00:10:00] tolerance and artificial sweeteners, because I see that come up a fair amount. So basically they linked changes with reductions in glucose tolerance with artificial sweeteners in doing this study. So this particular study was using rats, so obviously that’s not going to be the most applicable to humans because we’re not rats, but they basically fed these rats a mix of sucralose, saccharin and aspartame for 11 weeks and then tested their glucose [00:10:30] tolerance, and they did find that their glucose tolerance did decrease over the course of that 11 in weeks.

Aidan Muir

Yeah. And another thing they found in that study, which is part of why it made waves, was that they also then did food frequency questionnaires on humans and were like, how much artificial sweeteners do you consume every day/week or whatever. And then they measured their gut microbiome and they’re like, oh, so they’ve got similar characteristics to what these rodents developed over 11 weeks basically. And [00:11:00] they also had reductions in glucose tolerance. So it’s interesting to look at it from that perspective and it’s being like, okay, people who have more artificial sweeteners seem to end up in that category. It’s not really a nail in the coffin, but it is definitely something that’s interesting. From the rodents’ perspective though, they had a lot of artificial sweeteners. When you talked about this morning being like, “Okay, how much do they have?”

And I’ve a hundred percent got confirmation on it, and it was a lot.

Leah Higl

A lot, yeah.

Aidan Muir

It was like a 5% solution of saccharin. It was in their drinking water and 5% of [00:11:30] their drinking water was saccharin or aspartame, they got different variations on it. And they also had sucrose in there as well. So just straight sugar. But when we think about these sweeteners, they’re hundreds of thousands times sweeter than sugar in some cases. And at minimum they’re like a hundred times sweeter than sugar. So it’s like if we’re looking at 5%, like imagine just putting your water and having 5% of that being sugar, but then thinking about it, actually in proportion being like a hundred times that amount [00:12:00] or whatever, it is a lot, that’s a lot more than humans were actually consuming.

But the whole thing about the food frequency questionnaire, it’s interesting, but that would be more interesting if we didn’t have human data, more controlled data. So firstly, we’ve got a 2020 review from Greyling et al, which identified that there’s no acute glycemic and insulin response to non chloric sweeteners. That’s really important because a lot of people say it spikes glucose or insulin or whatever, but that’s just acute stuff. [00:12:30] Like what they measured in the original study we were just talking about, is chronic like over 11 weeks or whatever. So this short term, it doesn’t do anything from that perspective. That’s still really useful information. I don’t want to brush over it, that’s still useful information. But then the next one I want to talk about is a 2021 randomized control trial, which is really important because randomized control trials is like the peak of evidence before we look at like systematic reviews of randomized control trials.

So from 2021, titled high dose saccharin supplementation does not induce gut microbiota [00:13:00] changes or glucose intolerance in healthy humans and mice. The title sums it up. But basically they gave two weeks of saccharin consumption at the maximum acceptable dosage, which is a lot. You know how people talk about 21 cans of diet Coke is the equivalent of the maximum acceptable dosage of aspartame, they use that a lot and it’s like, that’s a lot of saccharin that they use. They use the maximum amount. Like they use that equivalent. That’s stupidly high, more than anybody who’s going to be consuming. And they did that every [00:13:30] day for two weeks. Two weeks is not long, but as I talked about with the low FODMAP diet in the last podcast, things change quickly in the microbiome, like four weeks of the low FODMAP diet dramatically changes things.

Therefore, two weeks of this at a stupidly high dosage should show some form of change, which it didn’t, and it didn’t affect glucose tolerance. And then the next study I wanted to briefly touch on, I’ll probably finish up on studies after that, but they did the same thing or a similar thing with aspartame and sucralose and they [00:14:00] had stupidly high dosages of that for two weeks and there was no change in the microbiome as assessed by fecal samples. So basically we’re not really seeing these changes when done in human studies. I’m not ruling it out, it’s a possibility for sure. And that’s something based on that previous study being like isn’t of interesting that in the food frequency questionnaires and measuring their gut microbiome, that there were changes. But it’s like when we do have things that’s more concrete actually measuring this in a controlled setting, it’s not coming out anywhere near as clear cut as you would think if you just looked at that previous study.

Leah Higl

[00:14:30] Yeah. I think that’s what makes this a really hard topic to navigate, is that nothing in it is clear cut. So we also know that stevia, so not an artificial sweetener, but a non-nutritive sweetener may also affect the gut microbiota composition, but more studies are really needed to confirm this too. It is again, a really mixed bag of things. And then stevia specifically, I found a lot fewer [00:15:00] research papers and stuff on stevia in particular. So yeah, more needed there. Sugar alcohol, so mainly things like polyols, they’re something that we can talk about. So the research behind them and their links to gut health are more in relation to IBS. So people with IBS sometimes do have adverse gastrointestinal reactions to the consumption of polyols. And that’s really true for things like sorbitol [00:15:30] and mannitol which is found in a lot of naturally occurring foods.

Aidan Muir

Yeah. And that’s also a key point though. It’s like, if you give a ton of like mannitol, maltitol, isomalt, like all of those things to people with IBS, if you just give them a lot, they’ll get symptoms anyway. People with IBS are often, they’re more likely to get symptoms. And this is also a key point where it’s like, we talk about gut health and we come to the conclusion, it’s like, oh, it doesn’t change the microbiota and then people will always jump in and they’ll be like, yeah but like I get symptoms every time I touch it. [00:16:00] It’s like, well firstly, that sugar alcohol we just mentioned there, it’s not technical artificial sweeteners. But like even with that, that’s why it’s not just gut health and IBS symptoms don’t a hundred percent overlap. We can talk about both and there is some overlap, but they are also separate topics and something can be a trigger for IBS without really affecting the microbiome in the long term.

Leah Higl

Yeah, just because polyols give you symptoms doesn’t mean it’s degrading gut health.

Aidan Muir

Yeah. Yeah. So another big one, cancer. Do you want to talk about cancer?

Leah Higl

[00:16:30] Yeah, let’s start like at the very basics. So worries around artificial sweeteners, I feel like cancer was the first thing people are really, really concerned about when it came to artificial sweeteners and this particularly arose even in the 1970s. So when saccharin was shown in one study to cause bladder cancer in, I think there were rats. So this did trigger further research in the space and particularly human studies and [00:17:00] so far to date, there’s not been any link between saccharin and bladder cancer or any other kinds of cancer this far. Next one we’ll talk about is aspartame. So I find generally people are most scared of aspartame, do you feel that?

Aidan Muir

Yeah. For a lot of reasons, but yeah.

Leah Higl

Yeah. So before it’s FDA approval in 1981, aspartame did undergo lots of laboratory testing to assess its cancer [00:17:30] risk and the FDA found no adverse effects. So aspartame will probably likely always be tainted by this one particular study that did come out in 2005 that showed that very, very high doses of it might cause lymphoma and leukemia. So this particular study again was done in rats and the research was assessed by the FDA and they deemed it to be [00:18:00] unfit take into consideration when they were thinking about, is this safe for human consumption? But every time we go down that aspartame topic, this study always comes up in terms of, oh it causes lymphoma, it causes leukemia. But again, this has only been shown in rats. So it’s really hard to assess whether that is something that does happen in humans as well at this point with the research that we have.

Aidan Muir

Yeah. I think a big issue with a lot of this is, it’s [00:18:30] almost like artificial sweeteners seem too good to be true. It’s like we’re looking for the flaw. It’s like, no, surely not. Surely it doesn’t make food taste nice and have zero calories and have no detrimental effects, there’s got to be a catch. And the other key thing is the fact that it has artificial in the name is another key thing. A lot of people are very much more receptive to things like stevia, from what I can see working with people, because it’s a natural sweetener, it has natural in the name because [00:19:00] it does taint a lot of these things. If people didn’t view it through these lens, would they be as concerned about this?

Some of the things that I question or think about is, we often talk about cretin being a really safe supplement. It’s got about 30 years of long term data. It’s got a bit more than 30 years, but a lot of the long term data, and I was like, people have been taking it for 30 years, no adverse effects, not many people get concerned with it, but artificial sweeteners like, “Oh, these have been the system for hundred years.” People have had high dosages for-

Leah Higl

That’s true. I guess, [00:19:30] in comparison to other things and particularly supplements, we have actually been consuming artificial sweeteners for quite some time now but I think we’re reaching a peak in terms of our consumption. I don’t think we’re consuming this much in like the 1950s.

Aidan Muir

Yeah. I always talk about this with artificial sweeteners, but, a lot of health conscious people might be avoiding diet soft drinks, but they might be having protein powder, which has artificial sweeteners. They might be having pre-workout, which has artificial sweeteners. They might be having NCAAs or other supplements [00:20:00] and it can turn into a pretty long list pretty quickly. The way I view it, from everything that I see with it is, I see it as relatively safe, I see that I’m going to quote, Layne Norton here, but every single randomized control trial that has ever been done on artificial sweeteners has shown no adverse health effects. That’s his words I’m using that quote because I do think there are some that have shown some, it’s a bit more complex than that.

But using his words and the fact that it’s debated is like, okay, it’s [00:20:30] clearly not worse for you than sugar is. If you give people high amounts of sugar, we know things go wrong, we know bad things happen. It’s clearly not tricking your body into all of these things. But I still do have caution. I’m not personally out there being completely fine, I’m going to replace all my water with diet soft drink for the rest of my life, I’m not that little.

Leah Higl

Like most things, I think artificial sweeteners can be over consumed. And probably at some point we’re going to see some adverse [00:21:00] effect, like most things. So I think I wouldn’t throw caution to the wind and have four liters of Pepsi Max per day, but I’m also not going to give up my one can with dinner.

Aidan Muir

For sure. So this has been a complex topic. We’ve obviously not covered every single thing. It’s such a deep, deep topic, but I’m happy with how we’ve done it in this short timeframe that we’ve got. So hopefully it has been helpful for some of you guys listening, but apart from that, thank you for listening.