Are Artificial Sweeteners (AS) Good For Diabetes?

Good health is positively or negatively influenced by dietary habits & choices. In the current scenario, healthy fibre-rich plant-based food choices are replaced by high-fat sugary, animal fat-loaded & salty food cravings. Cumulatively this ongoing lifestyle disbalance is inviting life-threatening non-communicable diseases like obesity, type 2 diabetes mellitus, cardiovascular diseases & cancer.  

Maintaining ideal body weight & losing extra weight is gaining popularity among the health-conscious population. Sugar consumption plays an important role in every weight-related journey. Sugar appetite is getting replaced by artificial sweeteners (AS).

The efficacy, safety & advantages of AS are not fully established & controversial. This needs a clear understanding of whether a high intake of AS is harmful or useful for diabetics.

Pharmacokinetics of different AS

The distinct structure of AS makes their metabolism, digestion & fermentation different. This has raised concerns towards the unmetabolized compounds in non-communicable disease development.

Acesulfame Potassium

Shows fast absorption, does not reach the low gastrointestinal tract & not impact intestinal microbiota. Mainly excreted through urine & faeces.

Saccharin

Partially excreted through urine & faeces. Small parts do not get absorbed immediately & affect intestinal microbiota.

Aspartame

Rapidly digested & not affecting intestinal microbiota.

Sucralose

Maximum part eliminated through faeces & urine. Affects gut microbiota through bacteriostatic effects.

Steviol Glycoside

Depicts slow metabolization & excretion through urine.

AS on normal body systems

Body weight & adiposity

Energy balance gets affected by AS, thus the body weight. This process is different from natural sugar metabolism which acts through physiological processes comprising the gut microbiota, the reward system and adipogenesis.

AS interacts with the taste 1 receptor (T1R) family of sweet-taste receptors in the oral cavity and gastrointestinal tract, leading to changes in satiety, energy intake, adipogenesis & body weight. Simultaneously AS causes variation in intestinal bacterial balance by increasing short-chain fatty acid (SCFA) production. This brings enhancement in lipid oxidation, energy expenditure & disturbance in gut-brain signalling.

Gut microbiota

AS increases intestinal dysbiosis & changes the microbial composition and Bacteroidetes ratio.

Glucose homeostasis

After AS intake SGLT1 (sodium-glucose transporter 1) and GLUT2 (glucose transporter 2) get upregulated leading to an increase in intestinal glucose absorption. Also AS interacts with GPCR (G-protein coupled receptor) & affects insulin secretory capacity. AS-induced intestinal dysbiosis provokes SCFA production & affects insulin secretion. Concurrently LPS (lipopolysaccharide) levels increase, chronic inflammation & endotoxemia occur, fat accumulates & insulin resistance-mediated diabetes is established.

Conclusion

For healthy outcomes and good quality of life, adequate nutrition & positive lifestyle habits are required & not unnecessarily AS ingestion. Uncontrolled intake of AS & processed food made out of it is a threat to good health with an increased risk of chronic lifestyle diseases.

High AS usage is not a remedy to control diabetes but may alter insulin sensitivity & enhance proneness towards diabetes. AS usage should be minimized & future research is essential to understand the evidence about the safety & true benefits of AS in diabetes.