Sugar is an essential nutrient that not only provides energy for the human body, but also brings the wonderful taste and pleasant feeling of "sweetness". But eating too much sugar is harmful to health, increasing the risk of obesity, type 2 diabetes, cardiovascular disease, and even cancer.
The emergence of sugar substitutes seems to help people avoid some of the harm of sugar, and brings taste and psychological feelings. But is this really the case? Can I drink foods with added sugar substitutes, such as sugar-free drinks, etc.?
According to a new study published in JAMA Network Open, a sub-issue of the Journal of the American Medical Association, beverages containing sucralose (a sugar substitute) may increase food cravings and appetites in women and obese people, and do not play a role in weight loss.
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What is a sugar substitute?
Before we learn about this study, we need to understand what sugar substitutes are.
Sugar substitutes, which belong to a type of food additive, are not sugars themselves, but can produce sweetness, make people's brain feel sweet, can be divided into nutritional sweeteners (with calories) and non-nutritive sweeteners (without calories).
According to the source of sugar substitutes, it can be divided into 3 categories:
1) Natural plant sources, such as monk glycosides extracted from monk fruit, steviol glycosides extracted from stevia, licorice, somatian, etc.;
2) Sugar alcohols, similar in structure and sugar, are semi-natural sugars, such as sorbitol, xylitol, mannitol, erythritol and maltol;
3) Artificial sweeteners, such as sucralose, aspartame, acesulfame potassium, new sweet, etc., these are substances that did not exist in nature.
In general, artificial sweeteners have the highest sweetness, at least 200 times that of sucrose; sugar alcohols have the lowest sweetness, taste similar to sucrose, and the sweetness is 0.7-1.2 times that of sucrose.
How the new research was conducted
The new study, published in JAMA Network Open, included a total of 74 participants aged 18-35, of whom 43 (58%) were women. The average age of the participants was 23.40 years, and the body mass index (BMI) was in the range of 19.18 kg/m2-40.27 kg/m2.
The study was conducted in 3 sessions. After the start of each study, participants who had been fasting for 12 hours were randomly divided into 3 groups who drank 300 ml of beverage or water: sucrose-containing beverages, sucralose-containing beverages, and water.
After drinking a drink or water:
At about 20 minutes, magnetic resonance imaging (MRI) techniques were used to measure the activation of areas of the participants' brains responsible for appetite when they saw pictures of high-calorie foods such as hamburgers and donuts.
At minutes 0, 10, 35, and 120 minutes, blood samples from participants were collected to measure marker levels such as blood glucose, blood insulin, glucagon-like peptide-1 (GLP-1), acyl-auxin-releasing peptide, and leptin.
At the 120th minute, participants are offered a buffet to assess their food consumption.
What the new study finds
After adjusting for other factors, the findings found that drinking sucralose-containing beverages may have made some participants feel hungrier.
MRI measurements showed that both female and obese (BMI≥ 30 kg/m2) participants, after drinking sucralose-containing beverages, were responsible for areas of the brain responsible for appetite, and their activities were more active than when drinking sucrose-containing beverages, which meant increased appetite.
Compared with drinking sucralose-containing beverages, after drinking sucralose-containing beverages, the secretion of hormones associated with satiety in the blood is suppressed and levels are reduced, such as acyl-growth hormone-releasing peptide, which means that drinking sucralose-containing beverages may not be effective in suppressing hunger.
In addition, female participants who drank sucralose-containing beverages ate more food in the buffet than female participants who drank sucrose-containing beverages. And there is no difference in men.
The study concluded by noting that women and obese people, especially obese women, may be more sensitive to sucralose than sucrose consumption. For these people, drinking sucralose-containing beverages may cause the brain to feel hungry, eat more food, lead to more calorie intake, and do not play a role in weight loss. For women and obese people, do not pin the hope of weight loss on sugar substitutes, control total energy intake and cooperate with exercise is the key.
Sugar substitutes have far more health effects than that
A growing body of research has found that the health effects of sugar substitutes are not as harmless as people think, but are associated with an increased risk of diseases such as diabetes and cardiovascular disease.
Increased risk of diabetes
In 2019, a Harvard-led study involving nearly 200,000 participants published in Diabetes Care, a journal of the American Diabetes Association, showed that people who love sweet drinks, whether they are sugary drinks, 100 percent pure fruit juices, or sugar substitutes, face a higher risk of diabetes, and the more they drink, the higher the risk.
Compared with people whose intake remained unchanged, people who drank at least 0.5 servings (about 120ml) of sweet drinks per day on average increased their risk of diabetes by 16% over the next 4 years; if they drank only sugary drinks, the risk increased by 9%; if they drank more than 100% juice, the risk increase was even higher, at 15%,; and drinking more artificial sweetener beverages seemed to be the most harmful, with an increase of 18%.
Increased risk of cardiovascular disease
In 2020, a study of more than 100,000 participants published in the Journal of the American College of Cardiology (JACC) showed that drinking small amounts of sugary and artificial sweetener beverages per day was associated with an increased risk of cardiovascular disease.
The risk of cardiovascular disease increased by 20% compared with those who drank the most sugary drinks (median 185 ml per day), compared with those who did not drink artificial sweetener beverages, and the people who drank the most artificial sweetener drinks (median of 176.7 ml per day) had a 32% increased risk of cardiovascular disease.
Increased risk of death
In 2019, a study involving 450,000 participants published in JAMA Internal Medicine, a sub-issue of the Journal of the American Medical Association, showed that artificial sweetener beverages increased the risk of "life loss."
Compared to participants who drank the least amount of artificial sweetener beverages (less than 1 cup per month, about 250 ml) and the participants who drank artificial sweetener beverages the most often (two or more drinks per day, ≥500 ml), the risk of all-cause death increased by 26% and the risk of death from circulatory diseases increased by 52%!
Affects metabolism and neurological response
In 2020, a study published by Yale researchers in Cell Metabolism showed that when consuming a "package" of sugar-substituted beverages with carbohydrates without sweetness, it can adversely affect people's metabolic and neurological responses.
In the study, 45 healthy youth were divided into 3 groups, each of whom drank 7 bottles of drink over a two-week period. Sucralose was added to the beverages in group 1; sucralose of equal sweetness was added to the beverages in group 2; and sucralose and maltodextrin were added to the beverages of group 3. Maltodextrin does not bring extra sweetness, but as a carbohydrate can provide the same calories as group 1.
The results showed that the brains of the participants in group 3 responded less to sweetness, the body's insulin sensitivity decreased, and glucose metabolism changed significantly in a short period of time.
brief summary
All in all, there is currently insufficient evidence to prove that sugar substitutes, especially sugar substitutes, are health benefits. Moreover, in recent years, more and more studies have begun to suggest the potential health hazards of sugar substitutes. In order to promote health, based on the available research evidence, in the daily diet, not only should be avoided drinking sugar-containing beverages, but also restrictions should be imposed on sugar-substituted beverages, preferably drinking water, or tea, coffee, milk, etc. that do not contain sugar and sugar.