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:
- 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.
- 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.
- 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.
- 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?
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.
Posted in: Diabetes