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Non-nutritive Sweeteners Can Increase Insulin Resistance In Those Who Are Obese

Sucralose may adversely affect glucose metabolism.

Even though Splenda has zero calories, it can play havoc with your blood sugars. Published in the journal Diabetes Care, researchers from the Washington University School of Medicine in St. Louis found that sucralose, most popularly known by the brand name Splenda, has effects on the body’s responses to sugar (glucose) — which could thereby impact diabetes risk.

“There seem to be differential effects of sucralose on glucose metabolism in normal-weight people and in people with obesity, so previous findings in lean subjects cannot be extrapolated to what will be the effects of sucralose in subjects with obesity (and vice versa),” said Marta Yanina Pepino De Gruev, PhD, assistant professor in food science and human nutrition at the University of Illinois in Urbana. “Clinicians may find surprising that sucralose is not metabolically inert, as generally thought, at least for people with obesity.”

The new study included 17 people who were severely obese (They had a body mass index over 42. A BMI of 30 is considered the starting point for obesity) and didn’t regularly consume artificially sweetened products. The study participants drank sucralose or water before taking a glucose challenge test. This test involves drinking a sugary solution before undergoing blood sugar measurements in order to see how well the body responds to sugar; it’s typically used as a tool to determine if a woman has gestational diabetes, according to the Mayo Clinic.

After that, the researchers asked all the study participants who first drank water to then drink sucralose before undergoing another glucose challenge test, and all those who first drank sucralose to then drink water before undergoing another glucose challenge test. Researchers found that consuming the sucralose was associated with higher blood sugar peaks and 20 percent higher insulin levels compared with consuming the water, though they noted more studies are needed to determine the actual health effects of a 20 percent increase in insulin.

Area under the curve for glucose response was similar in all tests. However, following the sucralose test, area under the curve was increased in the group with obesity by 18% for insulin response and by 12% for C-peptide (P < .02); no differences were seen between the water and sucralose tests in the group with normal weight.

Compared with the control condition, sucralose ingestion cause:

1) a greater incremental increase in peak plasma glucose concentrations (4.2 ± 0.2 vs. 4.8 ± 0.3 mmol/L),

2) a 20 ± 8% greater incremental increase in insulin area under the curve (AUC) a 22 ± 7% greater peak insulin secretion rate,

3) a 7 ± 4% decrease in insulin clearance, and

4) a 23 ± 20% decrease in SI.

There were no significant differences between conditions in active glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, glucagon incremental AUC, or indices of the sensitivity of the β-cell response to glucose.

From the conclusions, these data demonstrate that sucralose affects the glycemic and insulin responses to an oral glucose load in obese people who do not normally consume NNS. Laboratory and animal studies have found an increase in insulin with some artificial sweeteners, which could drop your blood sugar and make you crave more sugar, but there is no consistent evidence for this in humans. There is some evidence in humans that artificial sweeteners may subjectively increase appetite. However in the context of a meal, it is not known if it causes an increase in hunger and if so, if this outweighs the decrease in calories consumed.

A study released earlier this year in the American Journal of Clinical Nutrition showed an association between diet soda and higher type 2 diabetes risk. That research interestingly showed that while diet and regular soda drinkers had higher type 2 diabetes risks, those who imbibed with diet soda had an even higher diabetes risk.

However, a big study in the American Journal of Clinical Nutrition published in 2011 showed that diet sodas actually may not raise diabetes risk, and that the association could be attributed to the fact that people with diabetes or who are obese drink more diet drinks than other people.

“People who are at risk for diabetes or obesity … those may be the people who are more likely to choose artificial sweeteners because they may be more likely to be dieting,” said Dr. Rebecca Brown, an endocrinologist at the National Institutes of Health who has studied artificial sweeteners but was not involved in the current research.

Pepino also reported that this finding replicated results from a previous trial conducted by her group “that acute sucralose consumption increases insulin responses to a glucose load in people with obesity, which in the long term may have adverse effects on glucose metabolism.” She added that, “Perhaps we should revise the recommendation of replacing sugar-sweetened beverages with non-caloric sweetened beverages for subjects with obesity who are trying to control their weight….We may benefit from considering sweet-tasting beverages, regardless if sweetened with sugars or non-caloric sweeteners, really as a treat, and move toward the recommendation of replacing such beverages with water.”

Practice Pearls:

  • There seem to be differential effects of sucralose on glucose metabolism in normal-weight people and in people with obesity.
  • After taking sucralose, the area under the curve was increased in the group with obesity by 18% for insulin response and by 12% for C-peptide.
  • Sucralose consumption increases insulin responses to a glucose load in people with obesity.

Diabetes Care 2013 Apr; DC_122221. http://dx.doi.org/10.2337/dc12-2221

Pepino Y. T-OR-2024. Presented at: ObesityWeek 2016; Oct. 31-Nov. 4, 2016; New Orleans.