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In This Article:
- Are artificial sweeteners really better than sugar?
- How do sugar and artificial sweeteners impact aging?
- What is glycation, and how does it damage the skin?
- Can artificial sweeteners increase diabetes and heart disease risks?
- What are healthier alternatives to sugar and sweeteners?
Are Artificial Sweeteners More Dangerous Than Sugar?
by Sharad P. Paul, MD.
Respect your body and look forward
to feeling healthy and clean.
Your body deserves better
than laboratory-made sweetness.
—Damon Gameau
With the adverse publicity surrounding sugar, processed food manufacturers turned to artificial sweeteners like aspartame (Nutrasweet or Equal found in fizzy drinks such as Coke Zero and even chewing gum), sucralose (Splenda), or acesulfame potassium (Sweet One or Sunett). And more recently, erythritol (from fermented corn) and Stevia (from Stevia plant leaves) have been used as artificial sweeteners.
In theory, using artificial sweeteners as sugar substitutes appear plausible. But industry does not reckon with the power of the human brain or the brain-gut and brain-skin connections. If we taste something and it tastes sweet to us, our brain sends the same messages as it would when we taste sugar. Therefore the response of the gastrointestinal system is the same: insulin is secreted in response to artificial sweeteners. Studies have confirmed that as insulin levels rise in the blood in response to these artificial sweeteners, we eventually become insulin resistant and can end up with diabetes.
It therefore transpires that artificial sweeteners—rather like fake news—is no good for us. But the story gets worse. A population cohort study in France followed over 100,000 people, mostly females in their forties and fifties, for twelve years (from 2009 to 2021) and found a direct association between higher artificial sweetener consumption (especially aspartame, acesulfame potassium, and sucralose) and increased cardiovascular disease risk.
This study, published in the British Medical Journal (B.M.J.), concluded that such sweeteners might represent a modifiable risk factor for cardiovascular disease prevention and should not be considered a healthy and safe alternative to sugar. spartame was recently added to a list of potential carcinogens by the World Health Organization (W.H.O.), although the evidence for this is, at present, limited.
In a similar vein, many randomized trials have shown that artificial sweeteners do increase the risk of metabolic syndrome. Artificial sweeteners and sugary drinks not only increased the risk of type 2 diabetes and cardiovascular disease but they also increased all-cause mortality. This may be because of metabolic effects and also alterations in gut microbiomes.
Even newer artificial sweeteners are not exempt. As reported in Nature Medicine, erythritol, a “sugar alcohol,” has been found to increase blood clots and thrombotic diseases. Stevia, from the Stevia rebau-diana plant, was considered relatively safe, but increasingly there are reports about potential endocrine and metabolic dysfunction, and alterations in the gut microbiome with unknown long-term effects.
Artificial sweeteners used in candy and drinks also increase the risk of diabetes, cardiovascular diseases, and thrombotic events and are best avoided. Aspartame is a potentially cancer-causing agent, and Stevia alters the microbiome of the gut adversely.
Sugar and Aging: AGEs
As we age, sugar molecules from the foods we eat build up inside our body and stick to proteins and lipids, affecting their function. These sugar-bound complexes are called Advanced Glycation End Products (A.G.E.s).
In the skin, sugars bind to collagen and elastin, which are important dermal structural components. This makes both collagen and elastin brittle and prone to breaking, which leads to a more wrinkled, saggy skin appearance. While this process occurs naturally over time, eating too much sugar, as well as exposure to U.V. rays, may also accelerate skin glycation.
Other sources of A.G.Es are foods browned or prepared at high temperatures, such as donuts, barbequed meats, and caramel-colored soft drinks. These A.G.Es promote oxidation and inflammation, and they damage not only the skin but tissues throughout the body. The enzyme glyoxalase 1 (G.L.O.1.) is involved in the body’s defence mechanism against A.G.Es.
Research shows that variation in the G.L.O.1 gene affects the enzyme’s activity, which may make some individuals more susceptible to the skin-aging effects of A.G.Es. Research on G.L.O.1. has found that two variants of this specific gene affect the resulting enzyme’s activity in the blood. Individuals can carry zero to four copies of the risk variants, and G.L.O.1. activity decreases proportionally with each additional risk variant. Individuals who carry more risk variants may be less efficient at neutralising A.G.Es, and the resulting glycation damage could lead to fine lines, wrinkles, and sagging skin.
The glyoxalase system, mediated by this GLO1, has a protective effect against formation of A.G.Es. Impairment of this enzymatic activity leads to a higher risk of a multitude of age-related-diseases such as Alzheimer’s disease, Parkinson’s disease, and cancer.
I originally became interested in A.G.Es because they make our skin age faster. Many medical researchers have studied blood sugar levels and the impact of stress. One study from Germany found that during stressful examinations, H.b.A.1c (blood glucose levels) increased significantly in healthy medical students which reverted to normal after a few months. These findings were noted in healthy, nondiabetic individuals, yet psychological stress increased glycation, and therefore, prolonged stress can possibly increase your risk of diabetes.
Glycation, when due to stress as opposed to diet, is also at play in how quickly we appear to age. Glycation in skin reduces elasticity and increases wrinkles, as A.G.Es bind to collagen protein.
For people with higher sugar intake, diabetes, or high stress, the skin elasticity curve shifts downward, confirming that glycation stress is a major factor in the reduction of skin elasticity (i.e., making your skin saggy).
If your genetic profile suggests that you are at a higher risk of glycation, it is important for you to reduce sugar intake, reduce stress (by practicing meditation or yoga, for example), and increase muscular exercise to help your skin look younger.
Muscle load or weight training is particularly important as well, as more than 80 percent of blood glucose is consumed in skeletal muscle, and the more muscle one maintains, the less insulin resistance—if tissue becomes less resistant to insulin, cells can break down sugar better using insulin, thereby leading to less glycation end products. In fact, this research into glycation led to my skin research lab, Healthy Skin Lab, creating a range of skin products designed to reduce wrinkling of skin and the effects of aging.
Glycemic Index (GI)
The glycemic index (G.I.) of any food indicates the rate at which the carbohydrate in that food is broken down into glucose and absorbed from the gut into the blood. In high G.I. foods, this occurs quickly, causing your blood glucose (sugar) level to rise rapidly. In low G.I. foods, carbohydrate is digested slowly, resulting in a more gradual rise in blood glucose levels. Therefore, low G.I. foods are inherently preferable.
Starch basically contains amylose (which makes up about 20 to 30 percent of the starch) and amylopectin (70 to 80 per-cent)—the former is soluble, while starches like rice, with high amylopectin content, become sticky when cooked. The lower the amylose, the higher the GI index.
Not all starches are bad. An example of this is brown rice, which is high in resistant starch and has been shown to reduce both blood sugars and triglycerides.
As a skin doctor, I often talk about skin cancer, especially my preference for cleansers being pH-neutral. This means that these products must have the same pH as skin, which is acidic with a p.H. of around 5.5. As humans reach puberty, our skin becomes acidic, probably to inhibit bacterial colonization. Soaps, as we know, are alkaline with a pH of 7 to 9 and disrupt the skin barrier and affect the skin microbiome, making people prone to dermatitis and skin irritations.
When it comes to our guts, the stomach is extremely acidic due to the need to break down foods and has a p.H. that ranges from 1 to 2.5. The p.H. rises to 6.6 to 7.5 in the small and the large intestine (i.e., progressively rises from 5.5–7.0 in the small bowel to 6.5–7.5 in the distal ileum).
If we consider breads, sourdough breads have p.H. levels that typically fall between 3.5 and 5.5, making them mildly acidic, whereas other breads have a p.H. of 5 to 6.5. The more acidic the bread, the lower the glycemic index (G.I.). The higher the glycemic index, the more the food causes higher sugar levels in the body, and therefore low G.I. foods are preferable.
Similarly, the higher the fiber content of the food, such as brown rice or quinoa, the lower the glycemic index. This is because increasing fiber, or the acidity, slows the rate of digestion, resulting in a lower G.I..
Some people with variants of the T.C.F.7.L.2 gene have an inherently higher risk of developing type 2 diabetes if they consume high G.I. foods. Research shows that American women with the high-risk G.T. or T.T. variant of the gene are at greater risk of developing type 2 diabetes, so they are better off consuming more whole grains.
Evolutionary Biology
Evolutionary biology is also something to consider, as your ancestral diets can shape your starch-digestion genes. If your ancestors ate high-starch diets, you are more likely to have the T.T. or A.T. variant of the A.M.Y.1. gene; if they consumed lower starch diets, you may end up with the AA variant of the A.M.Y.1. gene and find it difficult to digest starch.
A study done on Korean men found that individuals who have the AA variant of the A.M.Y.1. gene have a decreased ability to break down starch and a greater risk for insulin resistance when consuming a high-starch diet.
Are All Carbohydrates Bad?
Not all carbohydrates are bad. Indeed, carbohydrates are the main source of energy for our brain and working muscles, so this discussion is not meant to scare you away from consuming carbohydrates completely.
There are three main types of carbohydrates: sugar, starch, and fiber. Healthful sources of carbohydrates in the diet include minimally processed starches such as whole grain breads and cereals, rice, root vegetables, beans, lentils, chickpeas, fruits, and low-fat dairy products, when they are consumed in moderation. Unhealthy sources of carbohydrates include refined grains, sugar-sweetened beverages, and certain baked goods. Instead of white breads and baked goods, white rice, and pasta, incorporate more 100 percent whole grains, brown rice, and whole wheat foods.
Sweet Taste Preference and Cravings
Sugar intake is partly determined by our sweet taste preference and cravings for certain foods and beverages. There is considerable variability in individuals’ preferences and cravings for sweet foods and beverages. There are many factors that may impact your preference for sugary foods, including the age that you are first introduced to sweets and psychological associations between consuming these foods and certain life experiences or emotions.
In addition to “pleasure-generating” signals in the brain given off in response to eating or drinking something sweet, there are specialized areas in the brain that regulate both food intake and glucose (sugar) levels in the body. Research has shown that your intake of sweet foods can be determined by a genetic variant that regulates blood glucose levels in your body.
Glucose transporter type 2 (G.L.U.T2) is involved in regulating glucose (sugar) in the body. The expression of this gene has been found in areas of the brain that are involved in controlling food intake. Individuals who possess the T.T. or T.C. variant of this gene seem to have a greater preference for sweet foods and beverages and are more likely to over consume sugar. In addition, those who have the variant associated with higher sweet food intake, have also been shown to have a higher risk of dental cavities.
Hidden and Disguised Sugars
High-sugar foods are often disguised in food and drinks we wouldn’t typically assume were high in sugar. For example, 1 cup (250 mL) of iced cappuccino has 28 g of sugar; however, 1 cup of citrus juice has 32 g of sugar.
The W.H.O. recommends that we derive less than 10 percent of our energy intake from sugar, or less than 5 percent if possible. For an average human, with a normal B.M.I., that works out to about 25 g of sugar per day. One can of cola or 30 mL (2 tablespoons) of maple syrup means that you’ve already exceeded your daily sugar limit.
Food Sources High in Sugar
Sources of High-Sugar Foods |
Amount (g) |
Chocolate milkshake (250 mL) |
52 |
Caramel candies (40 g) |
26 |
Milk chocolate (50 g) |
26 |
Cola (250 mL) |
24 |
Orange juice, frozen, diluted (250 mL) |
22 |
Caramel-coated popcorn (37 g) |
20 |
Jellybeans (28 g) |
20 |
Maple syrup (15 mL) |
12 |
Jams and Preserves (15 mL) |
10 |
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About the Author
Sharad P. Paul, MD, is a skin cancer specialist, family physician, evolutionary biologist, storyteller, social entrepreneur, and an adjunct professor at Auckland University of Technology. Born in England, with a childhood in India, he’s a global citizen and a noted polymath. He received the Ko Awatea International Excellence Award for “leading health Improvement on a global scale, and his work towards patient-centered medicine across several countries.” He has authored works of fiction, non-fiction, poetry, and medical textbooks. His new book is Biohacking Your Genes: 25 Laws for a Smarter, Healthier, and Longer Life (Beyond Words Publishing, Oct. 14, 2024). Learn more at BiohackingYourGenes.com
More books by this Author.
Article Recap:
Artificial sweeteners and health concerns have been rising as studies link these sugar substitutes to metabolic syndrome, insulin resistance, and cardiovascular risks. While promoted as safe alternatives, artificial sweeteners trigger sugar and aging effects, increasing glycation, which accelerates skin aging and collagen breakdown. Some sweeteners, like aspartame, have even been linked to cancer risks. This article examines the hidden dangers of sugar substitutes, their impact on gut health, and ways to make better dietary choices.
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