Non-caloric or very low-calorie sweeteners seem like the answer to our prayers: with our proven sweetness bias on one side of the scale and the deleterious effects of free sugars on the other, I don’t know how we don’t make an annual pilgrimage to Johns Hopkins to pay homage to Fahlberg, the discoverer of saccharin (as we have already told you in El Comidista).
The presence of these sweeteners in many products has increased in recent years, but so have overweight and obesity. Obviously there doesn’t have to be a direct relationship, but it also doesn’t seem like cutting calories by cutting out sugar has been very successful. The products Light were not the solution we expected?
If they do not provide calories, why worry about their effect on our weight?
If these sweeteners affected our weight control in any way, it would not be because they gave us energy, that is clear: with 0 kilocalories it is difficult to blame them. Why is this possibility raised? Because, despite the insistent messages that have convinced us that high-calorie food is equal to bad and that low-calorie food is dietary paradise, calories are not the only thing that matters (as our colleague Juan Juan Revenge). Focusing on them to nutritionally assess a food is a mistake: the energy that food gives us is important, but the origin of that energy is even more important. Let’s see if calories are important, but not more than the ability of food to produce satiety or regulate our appetite?
That is why it is worrying that sweeteners have some role in our appetite, that they affect in some way our sensation of hunger and satiety. For sweeteners to be effective in reducing our caloric intake, they must not cause us to consume more energy throughout the day to compensate. Let’s see if you’re drinking your “sugar-free” soda and you feel like putting a bag of chips between your chest and back. Can this really happen?
This studio on the effects of sweeteners on the human appetitepublished in the American Journal of Clinical Nutrition in 2009, has been widely cited because it proposes and reviews several of the mechanisms by which sweeteners could affect appetite and intake:
1. Modifying the cephalic phase of eating, when the food is in our mouth and signals are sent to prepare the digestive system for the arrival of food. For example, activating the secretion of insulin even if there is no glucose.
2. Once the food is in the stomach, affecting the rate of gastric emptying and the subsequent absorption of nutrients in the intestine.
3. Altering the secretion of intestinal peptides that send satiety signals.
4. Increasing the palatability of food, which makes us eat more.
5. Making us more indulgent: we know that food is less caloric, so we neglect the quality and quantity of what we eat.
6. Making us lose references: with exposure to different foods we establish associations, so that the sensory qualities of a food give us information about nutritional and energy value and prepare our physiological response. If the food does not provide us with the energy we expect -for example, because we usually take sweetened foods and switch to the version with sugar- we can consume more by undervaluing its energy contribution.
7. Affecting our reward system.
8. Modifying our food preferences, making us inclined to consume sweet products of all kinds: with sweeteners and with pure and hard sugar.
After the review, the study concludes that there is not enough evidence to consider these mechanisms valid, but neither to reject them. Subsequent research that has analyzed these possible mechanisms of action does not give us the key either and we continue more or less at the same point: we know very little.
What if they affect the intestinal microbiota?
That research does not take it into account, but, since it was published, our microorganisms are being the protagonists of many others due to their possible role in health -including obesity-, so if something harms them it can affect us. The answer is more or less the same: we don’t have an answer. This is reflected, for example, in the recent review Effects of sweeteners on the intestinal microbiota: review of experimental studies and clinical trials This is mainly due to the fact that there are few studies in humans, but also because there are many different non-caloric sweeteners and we do not have data on the effects of each of them on the microbiota.
What effect do they have on weight control?
Okay: we don’t know the ins and outs, the mechanisms by which sweeteners could affect our weight. But let others take care of that, that we go to what interests us when we are thinking of taking away the can of Coca Cola with 35 grams of sugar and switching to the “innocent” Zero version. Let’s focus on the final result, what marks the scale: for the purposes of producing overweight and obesity, are they “as bad as sugar”? Or is it possible that they can even help us lose weight?
We cannot say one thing or the other. The problem is that there are few high-quality studies examining the role of sweeteners in weight management, so there are mixed results. In some cases, it is observed that, compared to sugar, they can be effective in reducing weight or preventing us from gaining it, but other research does not find this advantage.
In the meta-analysis published in the BMJ Regarding the effects of sweeteners on health, no relevant differences were found in body weight, or in satiety and appetite between people who consume sweeteners and those who eat sugar. A lower energy intake can be seen, but the quality of the evidence is very low.
Similar to what was reflected in 2017 a meta-analysis published in the Canadian Medical Journal, which also found no benefit in weight control. On the contrary, they observed a certain association between its consumption and weight gain, although they highlighted that these findings may have limitations. Because it is not crazy to think that the relationship is inverse: it is not that sweeteners cause weight gain, but that people with excess weight consume more sweeteners.
More optimistic are the results published in Obesity Reviews in 2020, which did find weight loss, but again with very low evidence. Ultimately, there needs to be more research on the subject. It is not ideal, we all want clear and irrefutable answers, but for now it is what it is.
Well my nutritionist tells me to switch to sweeteners
Let’s get something straight about nutritionists: we’re healthcare professionals who want you to achieve and maintain your best possible health by helping you make the best food choices. We do not guarantee weight loss, we do not sell miracle products and we do not want you to stay in the practice forever.
The idea is not to put restrictions on yourself until your existence stops making sense. How can you not want to murder with your own hands the one who takes away the cane with bravas that gives you life? The intention is that you can take it with the minimum impact on your health, because the rest of your habits already protect you; and above all that you do it consciously and freely.
If foods with sweeteners can help us make non-traumatic transitions in your diet, they are welcome, but always as an intermediate objective. What freaks you out about the soda in the middle of the afternoon? Ok, but the Zero version is better, and always keeping in mind that, as the British Dietetic Association indicates in its position paper on the subject, they are helpful, but the approach with patients should be based on the quality of the diet and not focus on ingredients and nutrients separately.
Healthy foods require a little effort on your part to produce the instant pleasure that sugary or sweetened foods achieve. You have to meet them again, give them a chance, explore, try different ways of preparing them. But the ultimate goal is worth it, because it is that you enjoy food without relying on flavors that the industry has been responsible for amplifying stratospherically. At the end of the day: that you be a little freer.
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