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Do Artificial Sweeteners Make Us Crave Real Sugar?

October 14th, 2013

By Julie Cummings, PharmD Student Cedarville University School of Pharmacy

Since Adam took a bite of the apple, we have been self-conscious about our bodies.  Weight management, a good diet and exercise will help the body stay lean.  But what if there is still a problem with diabetes or weight management?  How can one eat better today?  One of the many helpful inventions has been artificial sweeteners.  “Artificial sweeteners are attractive alternatives to sugar because they add virtually no calories to your diet. In addition, you need only a fraction compared with the amount of sugar you would normally use for sweetness”.(1)   They have been used for decades to help with diabetes maintenance and weight management.

Recently, an article about a study on mice and artificial sweeteners called “The Brain Cannot Be Fooled By Artificial Sweeteners – Leading To a Higher Likelihood Of Sugar Consumption Later”  was published on AlphaGalileo’s website.(2) The study was performed at Yale University by Professor de Araujo.  He wanted to study the brain signal that is critical in the choice between artificial sugar and real sugar.   When the body ingests real sugar, the brain sends signals that allow dopamine to rise.  Dopamine is a chemical in the body that makes the person feel “happy”.  When real sugar is broken down in the body into a useable fuel, dopamine is released.  In the study, the mice were given a choice to ingest an artificial sweetener or real sugar.  At the same time, their chemical responses for reward were measured in their brains.  Professor de Araujo found that when the mice were given a choice between real sugar, a substance that required their body to break down for fuel, and an artificial sweetener, they switched to the real sugar instead.  He went on to say that even when the artificial sweetener was sweeter than the real sugar item, they still switched to the real sugar item.  He felt the study would achieve the same results in humans.(2)

The human body is a miraculous invention.  This evidence really doesn’t surprise me that the brain is unsatisfied when not given something it wants.  We see this in instances when our brain is telling us it needs some hydration (water) and our human choice is something other than water, like coffee, tea or soda.  This choice, a lot of times, does not satisfy the brain’s command to hydrate and we remain in a condition of thirst.  A study done in 2010 on the effects of weight gain in children who consumed artificial sweeteners couldn’t find a plausible metabolic effect from the consumption of artificial sweeteners, but concluded that more research should be done on the subject.   Another study, observing girls ages 9 to 10, found the consumption of diet sodas was significantly associated with higher calorie intake.(3)   I do believe that Professor de Araujo may have a point that needs further research.   I would like to see a study performed in adult humans, maybe even with a disease state of diabetes or obesity to truly clarify if these disease states could be affected by the artificial sweetener/real sugar debate.

My thoughts on recommending artificial sweeteners are these:

  1. If the patient’s diabetes or weight management is in control, I would allow my patient to moderately utilize some real sugar with their artificial sweeteners for a trial period.  If they noticed a problem arising with their medical conditions, I would tell them to stop taking the real sugar.
  2. I wouldn’t allow this article to convince me to tell all of my patients to do this.  I may ask them if they notice they are craving “sweet” food or drink items, even though they are utilizing artificial sweeteners.  If they are and are satisfying this craving with binge-full sugar consumption, I would definitely ask them to start mixing artificial sweetener with a little bit of real sugar throughout the day in a more managed fashion.
  3. If my patient is new to the artificial sweetener world, I would rather them use the artificial sweetener for a couple of weeks and ask them to come back or call me about how it is going and then go from there on how to manage their sweetener/sugar intake.
  4. Make sure my patients know the FDA regulates artificial sweeteners and has an acceptable daily intake (different per product) each day for a lifetime.(4)

What would you recommend to your diabetic patient bringing you a box of Sweet-N-Low?  Do you tell her to take it by itself and significantly reduce her sugar intake?   Do you tell her to NOT take artificial sweetener or sugar at all, because she doesn’t need to have anything sweet and see a HUGE reduction in her sugar intake? (She left the pharmacy and probably won’t be back to see that psycho pharmacist, (her words, not mine)!)  Or, do you tell her that there may be a chance that she may need some real sugar with it?

 

References

 

1.  Mayo Clinic Staff. Mayo Clinic Health Information. http://www.mayoclinic.com/health/artificial-sweeteners/MY00073.  Published October 9,2012 Retrieved September 27, 2013.

2.  Wiley. (2013, 9 20). Alpha Galileo Foundation. Retrieved 9 26, 2013, from http://www.alphagalileo.org/ViewItem.aspx?ItemId=134681&CultureCode=en.  Published September 20, 2013 Retrieved September 25, 2013.

3. Brown, R. J., De Banate, M. A., & and Rother, K. I.. Artificial Sweeteners: A systematic review of metabolic effects in youth. International Journhal of Pediatric Obesity, 2010;305-312; doi: 10.3109/17477160903497027.

4. ADAM editorial team). Medline Plus. http://www.nlm.nih.gov/medlineplus/ency/article/007492.htm. Published January 23, 2012 Retrieved September 27, 2013.

10 Responses to “Do Artificial Sweeteners Make Us Crave Real Sugar?”

  1. Rebecca A Kyper Says:

    I think you bring up a really good point when comparing the body’s response to artificial sugar to it’s response of a beverage other than water when we are thirsty. This comparison makes a lot of sense to me and and clarifies the study’s findings. There are a lot of other studies out there that show that artificial sweeteners may have harmful implications on our bodies in general, so I would be very cautious when suggesting any patient to use them. I would want to make sure they are aware, as you said, of the FDA regulations. I would recommend in healthy patients they would eat a balanced diet without artificial sweeteners. In a patient with diabetes, it is a more difficult decision. I would recommend if their blood sugar is under control, as you said, to try to use natural sugars in small amounts to see if it curbed their sugar cravings. I know it is impractical to tell a patient not to have anything sweet, but I would stress they should have a limited intake of the artificial sweeteners.

  2. Jesse D Hickey Says:

    Anytime a patient asks for sugar and they are a diabetic, your mind throws up red flags and starts to make you worry. I agree with you that if they have their diabetes controlled well and want to try to relieve that sugar craving, small amounts of sugar can be added unless their health starts to turn. My father has diabetes and uses nothing but artificial sweeteners. His diet, however, shows something very different. He eats high amounts of sweets and food with his iced tea. So I’m not surprised at all to hear about the dopamine response in your brain for sugar and not the sweetener. Further studies can have a major impact on how we look at sweeteners versus sugar.

  3. Lauren Callahan Says:

    I think that it was great that you acknowledged that the solution is not simply “black” and “white.” So, patients should not be encouraged to utilize sugars or artificial sweeteners alone. There is an appropriate balance. And, I think that with the evidence at hand, that is a great recommendation. I also think that we should be sure to educate our patients about the potential for sugar craving that exists with artificial sweetener use. I think that increasing their awareness of the potential for extra caloric intake with artificial sweetener use would motivate the patients to monitor their caloric intake. If this were the case, perhaps patients would benefit most from artificial sweeteners if they can successfully recognize their overindulgence and control there caloric intake thereafter.

  4. Julie K Cummings Says:

    Becca – thanks for commenting! I think that the harmful effects of the artificial sweeteners sometimes does outweigh the benefits, however, they are a great tool for diabetic or weight watchers. Like you said, some sugar is not harmful for most. I think that it is beneficial for a person, trying to use the artificial sweeteners as a tool for lower sugar levels, to know why they may still crave something sweet.

  5. Julie K Cummings Says:

    Jesse – thanks for visiting! Wow! So your dad may be an example of what this article is stating! Hypothetically, I wonder, if he utilized a little sugar in his diet instead of all artificial sweeteners, if he would crave less sweets? I agree, before we start telling our diabetic patients to change up their decision making process, further research needs to confirm these findings.

  6. Julie K Cummings Says:

    Lauren – Thank you for your comments. We agree that using both products in balance with one another may be the most beneficial. I am sure that there are going to be people that it may not be beneficial for due to physiological differences and also psychological differences as well. We could definitely benefit from further research.

  7. Nicholas C Daniels Says:

    Very interesting Julie. To go along with what Jesse said the dopamine response does make a lot of sense. I know that anytime I have tried to go on a low carbohydrate diet, as soon as I get off of it seems like I try to make up for it by over-consuming sugar. I think this physiologic response is something that the average person would not be aware of and it would be beneficial to address this with diabetic patients that come into our pharmacies. To answer your question I feel that it might be best to still include some form of real sugar in a patient’s diet. This might help to decrease the impact of dopamine’s response in the brain and prevent mass overindulgence by patients that could potentially be negatively effected by it, like diabetics.

  8. Megan Buck Says:

    Thank you for bringing light to this health concern, Julie. Like Lauren said, this is not a “black and white” issue. I would not want my patients to suffer from a sugar imbalance by completing converting to real sugar when their bodies are used to artificial sweeteners. Patients may benefit from consuming real sugar mixed into sweetener so that the brain feels satisfied, as indicated by dopamine levels, but the body does not have to process as much real sugar. Satisfaction from a real sugar-artificial sweetener blend may allow diabetic and other sugar-conscious patients to better manage proportions of sweet food and beverages and their blood sugar.

  9. Julie K Cummings Says:

    Nick – thanks for posting! You know when I have been dieting and have reduced my carbohydrate intake, this made me NOT crave sugar. Of course, I didn’t totally take it out of my diet, so maybe that has something to do with what I was experiencing.

  10. Julie K Cummings Says:

    Meg – thanks for your comments! You have made me think of a new product. How about 50/50 sugar/artificial sweetener blends in little sugar packets! After more research is done on this topic and they conclude that reducing sugar is better for us than totally taking it out of the diet, maybe I will market those little packets! This could lead to different products that we buy as well, such as: diet (50/50) soda and diet (50/50) cookies!

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