Are Sweeteners Harmful or Helpful to Weight Reduction?

Are Sweeteners Harmful or Helpful to Weight Reduction?

The world’s most comprehensive research about:

Effects Of Sweeteners On Weight Loss, Cravings and Diabetes

Authors: Don K. Juravin, Rouzbeh Motiei-Langroudi, Waqar Ahmad, Kelly Daly

Research goals

  1. Should overweight and obese people use artificial sweeteners?
  2. Do artificial sweeteners and their fillers have zero calories as claimed?
  3. Do FDA labeling regulations provide a loophole for sweetener manufacturers to trick their consumers?
  4. If one teaspoon of sugar contains an additional 11 calories than artificially sweeteners, is this amount enough to cause concern considering an average daily intake of 2,000 calories?
  5. Are there any side effects of using artificial sweeteners, and if so, what are they?
  6. Do artificial sweeteners increase or decrease cravings?
  7. Do sweeteners help or harm glycemic control for diabetics?
  8. Overall, are artificial sweeteners a help or hindrance for weight reduction?
  9. What is the best artificial sweetener to use, if any?

Research summary (abstract):

  1. There is a positive, dose-dependant correlation between artificial sweetener use and weight gain (Yang 2010).
  2. Long-term artificial sweetener use does not support weight loss (Stellman 1986).
  3. Consuming artificially sweetened beverages doubles the risk of obesity (Fowler 2008).
  4. Sweeteners and sugars stimulate brain reward pathways because of their sweetness intensity, not caloric value (Lenoir 2006).
  5. Sweeteners carry energy. Each packet yields kinds of milk calories from fillers such as maltodextrin and dextrose. Excessive consumption may be responsible for weight gain (Yang 2010, FDA 2016, The Canadian Sugar Institute 2016).
  6. Saccharin stimulates brain reward pathways similar to sucrose and even more than drugs of abuse like cocaine (Lenoir 2006), signifying it has addicting potentials.
  7. Saccharin consumption prior a meal significantly increases the amount of food consumed (Rogers 1989).
  8. Sucralose has been approved for use by the FDA and is currently in use by over 4,000 products (U.S. Food and Drug Administration 2016, IFICF 2016, Torres 2011).
  9. Sucralose can increase weight, migraines, and cravings for sweet food (Green 2012, Patel 2006).
  10. Aspartame increases stress-related cortisol levels more than sucrose does, resulting in stress-related eating (Tyron 2015).
  11. Aspartame is made of 10% methyl esters, which when broken down is converted in the body to format, which can either be excreted or can give rise to formaldehyde, diketopiperazine (a carcinogen) and a number of other highly toxic derivatives (Humphries 2008).
  12. Aspartame is suspected to increase malignant and benign brain tumors risk (Rycerz 2013, Olney 1996).
  13. Aspartame increases subjective hunger ratings compared to glucose (Blundell 1986), therefore leading to subsequent energy intake (Yang 2010).
  14. Stevia can increase the weight gain process and cravings for sweet food (Green 2012).
  15. Aspartame is associated with increased onset of diabetes in normal weight individuals (Yarmolinsky 2016).

What are sugars?

Sugar is the common name for a simple, short chained carbohydrates, consisting essentially of sucrose, and are used to sweeten food and beverages.

What are carbohydrates?

  • Carbohydrates are natural and biological molecules which contain carbon, hydrogen, and oxygen (Cm(H2O)n), and can be classed as:
  1. Monosaccharides: Monosaccharides are the simplest carbohydrates and are often called ‘single sugars’. They are the building blocks from which all bigger carbohydrates are made. E.g. Glucose, fructose and ribose.
  2. Disaccharides: Disaccharides contain two monosaccharides linked via a chemical bond. E.g. Sucrose (table sugar) and lactose.
  3. Oligosaccharides: Oligosaccharides contain 3 to 9 monosaccharides linked via chemical bonds. E.g. Maltodextrin.
  4. Polysaccharides: Polysaccharides contain 10 or more monosaccharides linked via chemical bonds. E.g. Starch, cellulose and pectin.

What is sweetness?

  • Sweetness can be described as a pleasant taste characteristic of sugar or honey. There are different levels of sweetness which can be scored on a Sweetness Perception Rating. Sugars and sweeteners have varying levels of sweetness. While various chemicals and plants produce a sweet taste, sugars are the main biological and chemical molecules associated with sweetness. All carbohydrates are broken down into simple sugars and produce a sweet taste.
  • The taste of sweetness is produced when a sweet substance reacts chemically with taste receptor cells located on taste buds in the oral cavity, mostly on the tongue. The tongue has 5 different taste receptors, sweet being one of them.

Sweetness Perception Rating

  • Sweetness perception rating is a scale used to determine the sweetness of a substance. The reference commonly used is sucrose (table sugar). The sweetness of every substance or chemical is compared with the sweetness of sucrose and is given a rating of intensity and pleasantness.
  • The reference value of sucrose is set to be 1 or 100.
  • Fructose has a value of 1.2 to 1.7 or 120 to 170, which means fructose is 120% to 170% sweeter than sucrose.
  • Glucose and dextrose have 0.7 to 0.8 relative sweetness, therefore it is 70% to 80% sweeter compared to sucrose (Fontvieille 1989, The Canadian Sugar Institute 2016).

White and brown sugar

Sucrose (aka table sugar) is a crystalline tabletop and industrial sweetener used in foods and beverages. 1 teaspoon (~4g) of sugar = 16 calories, or 1g of sugar = 4 calories.

Source: (Yang 2010)

The difference between white and brown sugar

  • Both white and brown sugar are sweet granules derived from the sugarcane plant. Sugarcane juice is extracted and boiled until molasses-rich sugar crystals form. These crystals behavioral (spun rapidly) to remove the molasses.
  • White sugar has all molasses removed and is considered ‘pure’, whereas brown sugar is 96% pure (4% molasses) and is considered ‘raw’ (The Sugar Association 2016).
  • Both white and brown sugar contain 4 calories per gram, or 16 calories per teaspoon.

History of sugar

When sugar was first discovered (1099 AD), it was extremely expensive and considered ‘white gold’. Through technological advancements, sugar is now a cheap commodity no longer reserved for only the rich.

Functions of sugar

  • Sugar performs a variety of functions in food products, in addition to providing a sweet taste and flavor (Canadian Sugar Institute 2016):
  1. Preservative: Jams and jellies
  2. Inhibits growth of microorganisms: Jams and jellies
  3. Holds moisture and prevents staleness: Baked goods such as cakes
  4. Enhances texture and color: Canned fruits and vegetables
  5. Prevents ice crystal formation: Frozen sweet mixtures such as ice creams
  6. Supports fermentation: Products containing yeast such as bread.

Sugar (sucrose) interactions with the brain

Sugar consumption activates brain reward pathways, promoting food cravings and consumption.

  • Sugar recruits a distributed pathway within the brain which is associated with a rise in dopamine, prioritizing energy-seeking over taste quality, resulting in promotion of food consumption (Tellez 2016).
  • Glucose increases food-seeking behavior by sweet-tasting mechanisms in the mouth and gut and by glucose-sensing mechanisms in the gut (Ochoa 2015).
  • Glucose impacts brain reward regions and eating behavior both directly by entering the brain and indirectly by peripheral neural input and oral and intestinal sweet-tasting/sugar-sensing mechanisms (Ochoa 2015).

Different effects of different sugars on the brain

Sugar is made from equal parts of fructose and glucose. Almost all sugars and sweeteners activate brain reward system, but in different extents. For instance,  fructose consumption is accompanied by a higher activity rising in brain reward system and less satiety inducing. The effect is seen in a relatively less extent in glucose, saccharin and sucralose.

  • Sweeteners and sugars stimulate brain reward pathways because of their sweetness intensity, not caloric value (Lenoir 2006).
  • Glucose and fructose ingestion differentially modulate the release of satiation hormones (Wölnerhanssen 2015). Fructose provides less satiating effects than glucose.
  • Relative to fructose, glucose ingestion induces greater elevations in plasma glucose (by ~1.3 to 1.4 times) and insulin (by ~3 times), increasing feelings of fullness and decreasing consequent food consumption (Wölnerhanssen 2015, Page 2013). Furthermore, fructose causes higher increases in the activity of brain regions within the limbic network involved in reward behavior in comparison to glucose (Wölnerhanssen 2015).
  • Different sugars affect control of intake differently. For instance, while fructose results in doubling of blood triglycerides, glucose intake upregulates 7 and affects 6 satiety-related hypothalamic peptides (Colley 2015) resulting in increased sense of satiety after glucose intake compared to fructose.
  • Glucose and fructose intake increase dopamine in brain reward regions (Dela Cruz 2015) resulting in increased desire for more foods, especially carbohydrates.
  • Fructose ingestion results in higher brain reactivity to food cues, more hunger and desire for food and smaller increases in plasma insulin in comparison to glucose ingestion, resulting in more promotion of feeding behavior after fructose ingestion (Luo 2015).
  • Blood flow in the hypothalamus is reduced less after fructose consumption in comparison to glucose consumption, resulting in less hunger suppression (Page 2013).
  • A higher fructose to glucose ratio in foods enhances the reinforcing effects of sugar and leads to neurobiological and physiological alterations associated with higher desire to food intake (Levy 2016).
  • Sugar bingeing is higher after consumption of fructose in comparison to glucose and sucrose (Rorabaugh 2015).
  • Saccharin causes lower rises in dopamine metabolites of the brain in comparison to other carbohydrates indicating less rewarding properties of saccharin compared to other sugars (McCutcheon 2012, Blackburn 1986).
  • Sucralose causes lower activation of brain regions involved in reward and lower dopamine rise in comparison to sucrose (Frank 2008).

Sugar effects on weight

  • If an individual were to consume 5 beverages with high-intensity teaspoons of sugar in each daily, this would be an additional 212 calories per day, or 77, 380 calories per year, leading to a weight gain of ~10 kg (~22 lbs) per year.
  • Sugar is highly addictive and increases cravings, resulting in increased food intake and weight gain.

Sugar substitutes (aka sweeteners)

  • Sugar substitutes are low-calorie or calorie-free chemical substances used instead of sugar to sweeten foods and drinks.
  • Sweeteners can be natural or artificial. Sweeteners have a large sweetness perception rating, meaning a very low amount of sweetener is required to produce the taste of sugar has and provides minimal calories (U.S. Food and Drug Administration 2016). These substitutes are 200 to 600 times sweeter than sugar, and therefore the addition of 2mg to 6mg is enough to generate sweetness equal to one teaspoon of sugar.

Types Of Sweeteners Used in America

  • A total of six high-intensity artificial sweeteners has been approved by the FDA, including saccharin, aspartame, sucralose, acesulfame potassium (Ace-K), neotame, and advantage (U.S. Food and Drug Administration 2016).
  • Natural sweeteners with GRAS status include stevia and monk fruit (U.S. Food and Drug Administration 2016).
  • The most commonly used sweeteners in America are saccharin, aspartame, sucralose and stevia.

Sweeteners effects on weight and diabetes

If an individual consumes 5 beverages with 3 packets of sweetener in each daily, this would be an additional 53 calories per day, or 19,345 calories per year, leading to a weight gain of ~2.3 kg (~5 lbs) per year.

  • Regarding nutritional benefits, the available studies, while numerous, do not provide proof that the consumption of artificial sweeteners as sugar substitutes is beneficial in terms of weight management, blood glucose regulation in diabetic subjects or the incidence of type 2 diabetes (Olivier 2015).
  • There is a positive, dose-dependant correlation between artificial sweetener use and weight gain (Yang 2010).
  • Long-term artificial sweetener use does not support weight loss (Stellman 1986).
  • Consuming artificially sweetened beverages (ASB) doubles the risk of obesity and increases BMI by 47% (Fowler 2008).
  • Artificially sweetened beverage consumption is linked to obesity and considerable exposure to non-nutritive sweeteners is associated with impaired energy regulation (Green 2012) resulting in weight gain.
  • Saccharin and aspartame promote greater weight gain than table sugar (sucrose). This weight gain is unrelated to caloric intake (Feijó 2013).
  • Similar to sugar-sweetened beverages, ASB are linked to obesity (Swithers 2013).
  • ASB may increase the risk for diabetes, metabolic syndrome, and cardiovascular disease (Swithers 2013).

Saccharin

Source: (Yang 2010)

Science of saccharin

  • Saccharin is an artificial, non-nutritive and high-intensity sweetener first synthesized in 1879. Saccharin contains benzene attached to a heterocyclic ring with nitrogen, sulphur and oxygen.

Saccharin interactions with the brain

  • Saccharin stimulates brain reward pathways similar to sucrose and even more than drugs of abuse like cocaine (Lenoir 2006), signifying it has addicting potentials.
  • High saccharin intake causes consumption of greater amounts of highly palatable foods and elevated cocaine-seeking behavior in several phases of addiction (Holtz 2012).
  • Saccharin stimulates brain reward system as much as reinforcing drugs (cocaine or heroin) (Madsen 2015).
  • Regular diet soda drinkers (containing artificial sweeteners) demonstrate greater activation to sweet taste in brain reward regions, indicating alterations in reward processing of sweet taste in individuals who regularly consume diet soda (Green 2012). In other words, consuming sweetener-containing diet soda results in more food-seeking behavior and consumption of more calories.

Saccharin and fillers

  • Saccharin is combined with nutritive dextrose for the popular tabletop sweetener in a pink packet.

Sweetness level of saccharin

  • Saccharin is 200 to 700 times sweeter than sucrose but also has a bitter taste (U.S. Food and Drug Administration 2016, Yang 2010).

Uses of saccharin

  • Saccharin has been approved for use by the FDA in the following foods (U.S. Food and Drug Administration 2016, Saccharin 2016, Family Dr 2016):
  1. Beverages (diet soda)
  2. Fruit juice drinks
  3. Diet and light milk powders
  4. Mixes and bases of processed foods
  5. Canned fruit
  6. Supplements
  7. Low calorie jams
  8. Desserts
  9. Flavoured syrups
  10. Table and home use
  11. Iced tea
  12. Cereals
  • Saccharin is heat stable, meaning that it stays sweet even when used at high temperatures during baking (U.S. Food and Drug Administration 2016); however, saccharin has a bitter taste in some solutions (Jakopin 2010, U.S. Food and Drug Administration 2016).

Saccharin effects on weight

  • Saccharin promotes greater weight gain than table sugar (sucrose). This weight gain is unrelated to caloric intake (Feijó 2013).
  • The sweet taste of saccharin increases ratings of hunger and increases food intake (Rolls 1991).
  • Saccharin increases food intake because of its sweet taste (Tordoff 1989).
  • In general, artificially sweetened beverage consumption (more than 21 packs per week) is associated with doubled risk of overweight and obesity, resulting in 0.77 increase in BMI over 7 to 8 years (Fowler 2008).
  • Saccharin use is associated with eight-year weight gain (Colditz 1990).
  • Saccharin consumption prior a meal significantly increases the amount of food consumed (Rogers 1989).
  • Saccharin increases weight as a result of increased cravings for sweet food (Green 2012).

Side effects of saccharin

  • Saccharin may cause an allergic reaction in those sensitive to sulfonamides (Tandal 2011).

Drug interactions of saccharin

  • There are no drug interactions (FDA 2016).

Sucralose

Source: (Yang 2010)

Science of sucralose

  • Sucralose is an artificial, non-nutritive and high-intensity sweetener. It was artificially synthesized in 1976 (U.S. Food and Drug Administration 2016). FDA approved it for general use in 1999.
  • Sucralose is very similar to sucrose in chemical structure but it has chlorine (-Cl) at 3 different carbon positions that replace hydroxyl groups (-OH) in both rings of sucrose. It is obtained by the chlorination of sucrose.

Sucralose interactions with the brain

  • Sucralose causes lower activation of brain regions involved in reward and lower dopamine rise in comparison to sucrose (Frank 2008).
  • Regular diet soda drinkers (containing artificial sweeteners) demonstrate greater activation to sweet taste in brain reward regions, indicating alterations in reward processing of sweet taste in individuals who regularly consume diet soda (Green 2012).

Sucralose and fillers

  • Sucralose (8%) is generally mixed with Maltodextrin (92%) to provide optimal taste and texture (USDA 2016).
  • Sucralose is mixed with maltodextrin to mimic the sweetness of sugar. While sucralose contains zero calories, the maltodextrin it is mixed with contains 3.5 calories per gram (USDA 2016). Any product containing less than 5 calories per serve can be marketed as “Zero calories” (U.S. Food and Drug Administration 2015b). This combination is therefore not recommended for diabetics as maltodextrin requires insulin for metabolism.
  • Sucralose is always sold in yellow sachets as it is sold under the brand name SPLENDA®.

Sweetness level of sucralose

  • Sucralose is ~600 times sweeter than sugar (Soffritti 2016, U.S. Food and Drug Administration 2016, Binns 2003).

Uses of sucralose

  • Sucralose has been approved for use by the FDA and is currently used internationally by over 4,000 products (U.S. Food and Drug Administration 2016, IFICF 2016, Torres 2011):
  1. General purpose sweetener
  2. Baked goods
  3. Chewing gum
  4. Gelatins
  5. Frozen dairy desserts
  6. Beverages (Ice tea, coffee beverages, light juice, diet soda)
  7. Dairy products (low-fat flavored kind of milks, light yogurt)
  8. Cereals and cereal bars
  9. Snack foods
  10. Syrups and condiments
  11. Dietary supplements
  • Sucralose is heat stable, meaning that it stays sweet even when used at high temperatures during baking (U.S. Food and Drug Administration 2016, Binns 2003).

Sucralose effects on weight

  • In general, artificially sweetened beverage consumption (more than 21 packs per week) is associated with doubled risk of overweight and obesity, resulting in 0.77 increase in BMI over 7-8 years (Fowler 2008).
  • Sucralose consumption does not decrease appetite or slow gastric emptying in healthy individuals (Ford 2011, Ma 2009).
  • Sucralose can increase weight gain and cravings for sweet food (Green 2012).
  • Sucralose is a relatively inert sweetener with regard to hunger signaling, post-consumption food intake and short-term glucose homeostasis (Brown 2011, Ma 2010).

Side effects of sucralose

  • Sucralose consumers may suffer migraines (Patel 2006).
  • Sucralose ingestion in obese individuals causes:
    • An increase in peak plasma glucose concentrations
    • 22% greater increase in insulin release
    • 7.4% decrease in insulin clearance (Pepino 2013)
  • Sucralose increased the risk of development of leukemia in mice (Soffritti 2016).

Drug interactions of sucralose

  • Sucralose has no known drug interactions (FDA 2016).

Aspartame

Source: (Yang 2010)

Science of aspartame

  • Aspartame (chemical name: L-aspartyl-L-phenylalanine methyl ester) is a non-nutritive artificial sweetener, first synthesized in 1965.
  • Aspartame consists of two amino acids; aspartic acid (40%) and phenylalanine (50%), which are linked by a methyl ester (10%) (Humphries 2008, U.S. Food and Drug Administration 2016).
  • Acceptable Daily Intake (ADI) of aspartame is 50mg/kg of body weight. The European Food Safety Authority (EFSA), which regulates food additives in the European Union, recommends a slightly lower ADI for aspartame (40 mg/kg of body weight). This would be 3,750mg per day for a typical adult weighing 165 lbs (75 kg), far more than most adults take in daily.
  • A 12 ounce can of diet soda usually contains ~192mg of aspartame and a packet of the tabletop sweetener contains ~35mg. An adult weighing 75 kgs (165 lbs) would have to drink more than 19 cans of diet soda per day or consume more than 107 packets to go over the recommended level (American Cancer Society 2016).

Aspartame interactions with the brain

  • Regular ASB consumers demonstrate greater activation to a sweet taste in brain reward regions, indicating alterations in reward processing of sweet taste (Green 2012).
  • Aspartame increases stress-related cortisol levels more than sucrose does, resulting in increased stress-related eating (Tyron 2015).
  • Excessive aspartame consumption could cause neurological and behavioral disturbances including headaches, insomnia, seizures, compromised learning and emotional functioning due to changes in regional brain concentrations of norepinephrine, epinephrine and dopamine (Humphries 2008, Yokogoshi 1986).

Aspartame and fillers

  • Aspartame is combined with nutritive dextrose and maltodextrin for the popular tabletop sweetener in a blue packet.

Sweetness level of aspartame

  • Aspartame is up to 200 times sweeter than sugar (NHS 2016, Mazur 1976).

Uses of aspartame

  • Aspartame has been approved for use by the FDA in the following foods (U.S. Food and Drug Administration 2016):
  1. Tabletop sweetener
  2. Chewing gum
  3. Cold breakfast cereals
  4. Toppings
  5. Puddings
  6. Dairy products
  7. Carbonated beverages
  8. Beverage syrups
  9. General purpose sweetener
  • It is not suitable for baking as it cannot tolerate heat and loses its sweetness (U.S. Food and Drug Administration 2016).

Aspartame effects on weight

  • Females lose an additional 1.5 kg (3.5 lbs) over 12 weeks when using aspartame sweetened foods on a Balanced Deficit Diet (BDD), as oppose to diet alone (Kanders 1988).
  • Dieters consuming aspartame in their weight loss regimen lose more and regain less weight in comparison to those who abstain (regained 4.8% less than those abstaining) (Blackburn 1997).
  • Aspartame-sweetened soda consumption for 3 weeks reduces calorie intake of both females and males and decreases body weight of males but not of females, in comparison to high fructose corn syrup-sweetened soda which increases the calorie intake and body weight of both sexes (Tordoff 1990). Aspartame and saccharin promote greater weight gain than table sugar (sucrose) (Feijo 2013, Polyak 2010). This weight gain is unrelated to caloric intake (Feijó 2013).
  • Aspartame-sweetened mineral water consumption produces a short-term increase in subjective appetite (Black 1993).
  • Aspartame consumption (2.7g per day for 13 weeks) does not reduce weight, blood glucose, glucagon or lipids in comparison to placebos in overweight individuals (Knopp 1976).
  • The sweet taste of aspartame and saccharin increases ratings of hunger and increases food intake, especially after saccharin (Rolls 1991).
  • Aspartame consumption not only does not reduce total daily energy intake in dieters compared to sucrose consumption but also is accompanied by an increase in energy intake (Lavin 1997).
  • Aspartame loading (225mg) does not increase plasma glucose or insulin levels in diabetic individuals (Shigeta 1985).
  • In general, artificially sweetened beverage consumption (more than 21 packs per week) is associated with doubled risk of overweight and obesity, resulting in 0.77 increase in BMI over 7 to 8 years (Fowler 2008).
  • Aspartame ingestion (24mg to 48mg daily for 3 days) does not increase fasting plasma glucose levels (Shigeta 1985).

Side effects of aspartame

  • Aspartame is associated with increased prevalence of diabetes in normal weight individuals (Yarmolinsky 2016).
  • Aspartame is associated with decreased β-cell function and increased fasting glucose levels (Yarmolinsky 2016).
  • Aspartame contains phenylalanine which is not metabolized in individuals with Phenylketonuria (inability to metabolize phenylalanines) and hence should be avoided. This condition leads to memory loss, mental problems and seizures (U.S. Food and Drug Administration 2016).
  • Aspartame consumption causes headaches (U.S. Food and Drug Administration 2016).
  • Aspartame consumption causes seizures due to rise in phenylalanine (Maher 1987).
  • Excessive aspartame consumption could cause neurological and behavioural disturbances including headaches, insomnia, seizures and compromised learning and emotional functioning (Humphries 2008).
  • Aspartame is suspected to increase malignant and benign brain tumors risk (Rycerz 2013, Olney 1996).
  • Aspartame may increase the risk of hematologic malignancies like lymphoma and multiple myelomas (Marinovich 2013).
  • Aspartame increases subjective hunger ratings compared to glucose (Blundell 1986), therefore leading to subsequent energy intake (Yang 2010).
  • Aspartame can cause allergic reactions and hypersensitivity (Yang 2010).
  • Aspartame is made of 10% methyl esters, which when broken down is converted in the body to format, which can either be excreted or can give rise to formaldehyde, diketopiperazine (a carcinogen) and a number of other highly toxic derivatives (Humphries 2008).

Drug interactions of aspartame

  • Aspartame should be avoided with products containing phenylalanine such as cheese, soy food and fish oil because it increases the concentration of phenylalanine which may cause neurological problems such as memory loss, seizures and tremors in individuals suffering from Phenylketonuria (FDA 2016).

Stevia

Source: (Yang 2010)

Science of stevia

  • Stevia is a natural, non-nutritive and high intensity sweetener with GRAS status obtained from the plant Stevia Rebaudiana (U.S. Food and Drug Administration 2016, Gupta, 2013, Cardello 1999).
  • Stevia Rebaudiana yields more than 100 chemicals, but Stevia only uses a number of chemicals. A few steviol glycosides including Stevioside, Rebaudioside A, Rebaudioside C, Dulcoside A, Rebaudioside B, Rebaudioside D, Rebaudioside E are the main components of stevia (U.S. Food and Drug Administration 2016, Gupta, 2013, Cardello 1999).

Stevia interactions with the brain

  • Stevia has no known interactions with the brain.

Stevia and fillers

  • Stevia is used with numerous fillers depending on the type (dried, powder, liquid) and brand purchased, including dextrose, lactose and erythritol (sugar alcohol).

Sweetness level of stevia

  • Stevia is 200 to 400 times sweeter than sugar (Brandle 1998, Goyal 2010, U.S. Food and Drug Administration 2016, Midmore 2002, Gardana 2003, Gupta, 2013, Cardello 1999).

Uses of stevia

  • Stevia is used as an alternative to sugar for a wide variety of foods including (Singh 2005, Midmore 2002):
  1. Confectionaries: Sherbets, chocolate, chewing gum
  2. Baked products: Pastries, biscuits, cakes
  3. Beverages: Fruit juices, cordials, soft drinks
  4. Jams
  5. General purpose use
  6. Ice cream
  7. Yoghurts
  8. Pickles
  9. Diet convenience foods
  10. Toothpaste and mouthwash
  11. Supplements and medication
  • Stevia is heat stable, meaning that it stays sweet even when used at high temperatures during baking (Midmore 2002).
  • Health properties of stevia (Singh 2005, Midmore 2002, Gupta 2013, Ulbricht 2010):
  1. Flavor enhancer
  2. Antioxidant
  3. Antimicrobial and antiplaque properties
  4. Increases mental alertness
  5. Increases energy levels
  6. Reduces hypertension
  7. Skin toning
  8. Anti-craving (tobacco and alcohol)

Stevia effects on weight

  • Stevia does not lead to increased food consumption, and in fact significantly lowers postprandial glucose levels (Anton 2010, Shivana 2013). Lower postprandial glucose levels leads to a decrease in cravings.
  • Stevia reduces cravings for sweets and fatty foods leading to weight loss (Arora 2010).
  • Stevia is an appetite regulator by resetting the appetite mechanism in the brain (Arora 2010). This improves appetite control and reduces overeating.

Side effects of stevia

  • Stevia reduces postprandial glucose levels compared to sucrose and reduces postprandial insulin levels compared to both aspartame and sucrose (Anton 2010). Diabetics using Stevia therefore need to monitor blood glucose levels to avoid hypoglycemia.
  • Stevia does not have known neurologic side effects (Bilton 2013).

Drug interactions of stevia

  • Stevia has no known drug interactions (FDA 2016).

Fillers

  • Fillers, such as dextrose and maltodextrin, are nutritive substances used to improve weight, color, volume and aesthetic appeal of the sugar substitute.
  • FDA labelling requirements state that anything with less than 5 calories per serve can be marketed as “Calorie Free” or “Zero Calories” (U.S. Food and Drug Administration 2015b). Dextrose and maltodextrin have 3.5 calories per gram, therefore allowing every packet to claim it is calorie free.
  • The sweetness comes from the sugar substitute added to the filler, such as saccharin, sucralose, aspartame and stevia.

Maltodextrin

Source: (Yang 2010)

Science of maltodextrin

  • Maltodextrin (C6nH(10n+2)O(5n+1)) is a non-sweet nutritive saccharide polymer which consists of D-glucose units linked primarily by [alpha]-1-4 bonds and has a dextrose equivalent of less than 20 (Kennedy 1995, U.S. Food and Drug Administration 2015).
  • It is prepared as a white powder or concentrated solution by partial hydrolysis of corn starch, potato starch, or rice starch with safe and suitable acids and enzymes (Kennedy 1995, U.S. Food and Drug Administration 2015).
  • Maltodextrin has 3.5 calories per gram (USDA 2016). Products containing less than 5 calories per serve can be marketed as “Zero calories” (U.S. Food and Drug Administration 2015b).

Maltodextrin interactions with the brain

  • Maltodextrin does not stimulate the brain reward system (van Rijn 2015, De Pauw 1985). It is the sweet taste of sweeteners and sugars which stimulate the brain reward pathways, and because maltodextrin is almost tasteless, it does not exert this effect (Lenoir 2006).
  • Maltodextrin does not influence hypothalamus activity, a region involved in hunger and satiety behavior (Smeet 2005).

Sweetness level of maltodextrin

  • Maltodextrin is a non-sweet nutritive saccharide polymer (U.S. Food and Drug Administration 2015).

Uses of maltodextrin in sugar substitutes

  • Maltodextrin is used as a filler in sugar substitutes, such as sucralose. The white powder often looks similar to that of sweeteners, and therefore it can stretch the quantity of the sweeteners without affecting the taste (Kennedy 1995).
  • It is used widely due to its taste to add weight and volume in the defined serving of a sweetener (Kennedy 1995).

Maltodextrin effects on weight

  • There are no studies to show the effects of maltodextrin on weight.

Side effects of maltodextrin

  • Maltodextrin ingestion increases insulin and glucose (Ford 2011). Therefore, it should be used with caution in diabetics.
  • Maltodextrin has 3.5 calories per gram (USDA 2016), and is therefore not encouraged for diabetics or those monitoring blood glucose levels.

Drug interactions of maltodextrin

  • There are no known drug interactions of maltodextrin (FDA 2016).

Dextrose

Source: (Yang 2010)

Science of dextrose

  • Dextrose is a natural sugar prepared by the hydrolysis of starch obtained from wheat, rice and potato.
  • It is the D-isomer of glucose that is why it is also known as D-glucose.
  • Its chemical formula is C6H12O6.
  • Dextrose has ~3.5 calories per gram.

Dextrose interactions with the brain

  • Glucose and dextrose cause increases in the activity of brain regions within the limbic network involved in reward behavior (Wölnerhanssen 2015, Dela Cruz 2015), resulting in more desire to take more foods, especially carbohydrates.
  • Sugar bingeing occurs after glucose ingestion (Rorabaugh 2015).

Sweetness level of dextrose

  • Dextrose has a 0.7 to 0.8 relative sweetness, therefore its has 70% to 80% sweetness of sucrose (Fontvieille 1989, The Canadian Sugar Institute 2016).

Uses of dextrose in sugar substitute

  • Dextrose is a natural sugar.
  • Dextrose is used as a filler to improve the weight, volume and texture of the defined serving (packet) of the product.
  • Dextrose is used with saccharin to mask its bitter taste.

Dextrose effects on weight

  • Dextrose promotes weight gain as excess amounts will be stored as fat in the body (Sandberg 2005).
  • If an individual were to consume 5 beverages with 3 packets of sweetener in each daily, this would be an additional 53 calories per day, or 19, 345 calories per year, leading to a weight gain of ~2.3 kg (~5 lbs) per year.

Side effects of dextrose

  • Dextrose can cause hyperglycemia in diabetics. Its use (oral or parenteral) should be avoided in the patients of diabetes (FDA 2016).
  • Dextrose ingestion induces elevations in plasma glucose (by ~1.6 times) and insulin (by ~7.4 times) (Page 2013). Therefore, it should be used with caution in diabetics.

Drug interactions of dextrose

  • Dextrose taken orally has no known drug interactions (FDA 2016).

Research findings

 

  • Should overweight and obese people use artificial sweeteners?

 

Artificial sweeteners are a beneficial aid for those attempting to lose weight as they provide the sweetness with significantly reduced calories, however, regular daily exposure (more than 21 sachets per week) significantly increases weight gain, adiposity, incidence of obesity, cardiometabolic risk, and even total mortality (Fowler 2016, Fowler 2008). It is therefore encouraged to keep sweetener use to below 21 sachets or 350mg per week.

 

  • Do artificial sweeteners and their fillers really have zero calories?

 

Artificial sweeteners, such as sucralose, saccharin, aspartame and stevia, are non-nutritive, meaning they have zero calories. However, the fillers they are combined with, such as dextrose and maltodextrin both contain ~3.5 calories per gram. Therefore, most sachets of artificial sweeteners contain ~3.5 calories.

 

  • Do FDA labeling regulations provide a loophole for sweetener manufacturers to trick their consumers?

 

Yes. FDA labeling allows any product with <5 calories per serve to be labeled as “Calorie Free”, “Zero Calories” or “Low Calorie”. Because the fillers provide ~3.5 calories per sachet, the manufacturers are legally allowed to use these claims.

 

  • If 1 teaspoon of sugar contains an additional 11 calories than artificial sweeteners, is this amount enough to cause concern considering an average daily intake of 2,000 calories?

 

Yes and no. If an individual were to only consume 1 to  6 serves of sugar per day, then it would be of little concern. However, while it is only an 11 calorie difference per serve, an individual consuming an average of 10 serves per day (sweetened beverages, hot beverages, ‘diet’ or ‘lite’ products)  would consume an additional 110 calories which can ultimately result in weight gain of 250g per week or 13 kg (29 lbs) per year.

 

  • Are there any side effects of using artificial sweeteners, and if so, what are they?

 

Saccharin

  • Saccharin promotes greater weight gain than table sugar (sucrose). This weight gain is unrelated to caloric intake (Feijó 2013).
  • The sweet taste of saccharin increases ratings of hunger and increases food intake (Rolls 1991).
  • Saccharin increases weight as a result of increased cravings for sweet food (Green 2012).

Sucralose

  • Sucralose consumers may suffer migraines (Patel 2006).
  • Sucralose ingestion in obese individuals causes an increase in peak plasma glucose concentrations, a 22% greater increase in insulin release, and a 7.4% decrease in insulin clearance (Pepino 2013).
  • Sucralose increases weight gain and cravings for sweet food (Green 2012).

Aspartame

  • The sweet taste of aspartame increases ratings of hunger and subsequent food intake (Yang 2010, Rolls 1991, Blundell 1986).
  • Aspartame is associated with increased prevalence of diabetes in normal weight individuals (Yarmolinsky 2016).
  • Excessive aspartame consumption could cause neurological and behavioral disturbances including headaches, insomnia, seizures and compromised learning and emotional functioning (Humphries 2008, U.S. Food and Drug Administration 2016).
  • Aspartame is suspected to increase malignant and benign brain tumors risk (Rycerz 2013, Olney 1996).
  • Aspartame is made of 10% methyl esters, which when broken down is converted in the body to format, which can either be excreted or can give rise to formaldehyde, diketopiperazine (a carcinogen) and a number of other highly toxic derivatives (Humphries 2008).
  • Aspartame contains phenylalanine which is not metabolized in individuals with Phenylketonuria (inability to metabolize phenylalanines), and hence should be avoided. This condition leads to memory loss, mental problems and seizures (U.S. Food and Drug Administration 2016).

Stevia

  • Stevia significantly lowers postprandial glucose levels (Anton 2010, Shivana 2013).
  • Stevia is an appetite regulator by resetting the appetite mechanism in the brain (Arora 2010). This improves appetite control and reduces overeating.
  • Stevia preloads significantly reduces postprandial glucose levels (Anton 2010). Diabetics using stevia, therefore, need to monitor blood glucose levels to avoid hypoglycemia.
  • Stevia has no known neurologic side effects (Bilton 2013).

 

  • Do artificial sweeteners increase or decrease cravings?

 

  • Saccharin – Increases cravings for sweet food
  • Sucralose – Increases cravings for sweet food
  • Aspartame – Increases cravings for sweet food
  • Stevia – Decreases cravings for sweet and fatty foods

 

  • Do sweeteners help or harm glycemic control for diabetics?

 

Saccharin, sucralose and aspartame do not affect glycemic control, however, the fillers (dextrose and maltodextrin) are mixed with increased blood glucose levels. Diabetics are not encouraged to use these products as insulin is required for their digestion. Stevia on the other hand significantly decreases blood glucose levels. Diabetics, therefore, need to monitor blood glucose levels to avoid hypoglycemic episodes.

 

  • Overall, are artificial sweeteners a help or hindrance for weight reduction?

 

If artificial sweeteners are not taken excessively (<3 sachets or 60mg daily), they are helpful to aid in weight reduction given their reduced caloric load. However, there is a striking congruence between results from animal research and a number of large-scale, long-term observational studies in humans, in finding significantly increased weight gain, adiposity, incidence of obesity, cardiometabolic risk, speculated risk of tumors and malignancies, and even total mortality among individuals with chronic, daily exposure to low-calorie sweeteners (Fowler 2016, Rycerz 2013, Humphries 2008, Olney 1996).

  1. What is the best artificial sweetener to use, if any?

Stevia remains the best option for artificial sweeteners as it does not increase appetite, cravings or weight, and helps to decrease postprandial glucose levels. It also has no known drug interactions or negative implications.


Research: the Gastric Bypass ALTERNATIVE team at gastric.care (achieving a healthy weight without surgery is possible)

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Footnote

This research was sponsored by Must Cure Obesity Co. Florida, 2,000.

Points For The Public:

Sugar, if consumed in fair amounts (2 to 3 teaspoons daily), is healthier than artificial sweeteners. Here are the reasons:

  1. There is a correlation between artificial sweetener use and weight gain: 3 packets per day leads to 5 lbs per year weight gain
  2. Long-term artificial sweetener use does not support weight loss
  3. Sweeteners carry energy. Each packet yields 4 calories from fillers such as maltodextrin and dextrose. Excessive consumption (more than 3 packets per day) may be responsible for weight gain
  4. Sweeteners and sugars stimulate brain reward pathways (resulting in food seeking and cravings) because of their sweetness intensity, not caloric value
  5. Saccharin stimulates brain reward pathways similar to sucrose and even more than drugs of abuse like cocaine, signifying it has addicting potentials and its consumption prior a meal increases the amount of food consumed
  6. Sucralose can increase weight, cause headaches and cravings for sweet food
  7. Aspartame increases stress-related cortisol levels more than sucrose does, resulting in stress-related eating. It is also suspected to increase malignant and benign brain tumors risk
  8. Stevia can increase the weight gain process and cravings for sweet food