Artificial sweeteners linked to increased diabetes risk, ISA refutes small scale study

15 Sep 2017 --- New research presented this week at the annual meeting of the European Association for the Study of Diabetes (EASD) in Lisbon, Portugal, has suggested that consuming large amounts of artificial sweeteners may increase the risk of developing Type 2 diabetes. In response, the International Sweeteners Association (ISA) has issued a strongly-worded statement on the research saying that it “would like to draw attention to the overwhelming body of evidence, including from studies by the same Australian research team, showing that low-calorie sweeteners do not affect glucose control.”

Study’s controversial results
The small study on sweeteners referenced by the ISA was conducted by Associate Professor Richard Young of the Adelaide Medical School, University of Adelaide, Adelaide, Australia, as well as colleagues from other Adelaide-based research institutions, and aimed to investigate the effects of consuming large amounts of non-caloric artificial sweeteners (NAS) on the body's response to glucose.

The researchers recruited 27 healthy subjects who were given a quantity of two different NAS (sucralose and acesulfame-K) equivalent to drinking 1.5L of diet beverage per day, or an inactive placebo. These were consumed in the form of capsules taken three times a day before meals over the two-week period of the study. At the end of the two weeks, subjects had their response to glucose tested, examining glucose absorption, plasma glucose, and levels of insulin and gut peptides.

The team found that NAS supplementation caused an increase in measures of the body's response to glucose, measured using a technique known as the incremental area under the curve (iAUC). This was greater for both glucose absorption and blood glucose, while the iAUC for the gut peptide GLP-1, which acts to limit the rise in blood glucose after meals, was reduced. None of these measures were altered in those subjects who were given a placebo.

The study authors conclude: “This study supports the concept that artificial sweeteners could reduce the body's control of blood sugar levels and highlights the potential for exaggerated post-meal glucose levels in high habitual NAS users, which could predispose them to developing Type 2 diabetes.”

Pointing to other outcomes
In its statement, the ISA notes: “This press release neglected to report the outcomes of a considerable number of studies published by the same authors, which consistently found no impact of low-calorie sweeteners on blood glucose regulation. Additionally, the collective evidence from well-designed human studies supports that low-calorie sweeteners do not adversely affect glycemic control in healthy individuals and in people with diabetes, e.g. by affecting total insulin secretion, glucose uptake and/or glucose utilization either by direct effect or via effects on incretins (gut hormones).”

The organization also points to beneficial effects of low-calorie sweeteners in post-prandial glucose being recognized in a health claim authorized in Europe, further to the scientific opinion by EFSA: “Consumption of foods with low-calorie sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods”.

“Low-calorie sweeteners cannot increase diabetes risk, while on the contrary, when used instead of sugar, they can be a helpful strategy for people with diabetes for whom glycemic control is fundamental,” the ISA asserts. “This is in line with the fact that low-calorie sweeteners contribute no carbohydrates to the diet.”

The 2017 guidelines “Standards of Medical Care in Diabetes” by the American Diabetes Association are also cited by the ISA for their support of the idea that “non-nutritive sweeteners have the potential to reduce overall calorie and carbohydrate intake.”

“For people with diabetes, low-calorie sweeteners used in foods and drinks as well as table-top sweeteners and as part of a healthy diet are an option that can aid in glucose control and offer broader food choices by providing the pleasure of sweet taste without raising blood glucose,” the ISA concludes.