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Should we give up sweeteners?

I was going to write about the campaign against highly processed foods this week.

If you follow nutrition trends, then you will know that this takes a commonsensical position: Try to eat natural foods, not those that have been created in factories.


Except that it then ruins the basic message by throwing in excess after excess: You must avoid ketchup because it is made in an industrial plant (as, in fact, are most of the condiments used in the Western world). And, in the general hysteria it creates, it neglects to specify which cooking processes are bad for us. Nor does it set limits on how much ketchup, for instance, is okay and how much is dangerous.


   Just as I was getting down to writing about this, a new bombshell exploded. The World Health Organization (WHO) came out against artificial sweeteners. This provoked even more widespread hysteria. WHO had discovered that sweeteners were bad for you, went the commentary. Television channels organised debates, to which doctors, who had sadly been exiled from TV studios once concerns about Covid faded, were invited. This led, oddly enough, to even more hysteria. Endocrinologists were inundated with calls from diabetes patients, who asked if it was better to go back to sugar.


   Many of the arguments advanced by the anti-sugar processed foods guys and the anti-sweetener people are similar. So, I abandoned the column about processed food (Actually, delayed, not abandoned; I will do it later.) and decided that the sweetener debate was more urgent.


   First, let’s be clear about what WHO said. It did not conduct any new research of its own. It was not responding to any sudden and new health emergency. It issued a general statement based, it said, on an examination of around 280 older studies. By rereading these studies, the folks at WHO had concluded that sweeteners did not contribute to weight loss.


   This was interesting but hardly surprising. A sweetener is not a diet pill. It is not the equivalent of Semaglutide or some fancy drug. Nobody takes it thinking it will suddenly cause weight loss.


   But sugar, medical research has demonstrated, does cause weight gain. So people use sweeteners to reduce their dependence on sugar. Therefore, they avoid the weight gain that would otherwise be caused by the consumption of sugar.


   Besides, many of those who use sweeteners are diabetic or pre-diabetic. The weight gain/ weight loss argument is peripheral for them. Should they also give up sweeteners?


   WHO suggests they should. Should they go back to sugar? No, that’s bad too. So what should they do?


   Well, according to WHO and some of the doctors quoted in reports about its recommendations, they should just give up eating sweet things. Ok, maybe they can eat some fruit. (The fruit thing is controversial; endocrinologists are divided on this and say some fruits should be avoided by diabetics.)


   Is this realistic? All civilisation is built on cooked food. And throughout the ages, all over the world, people have valued sweet tastes. Human beings are designed to eat sweet things: why else would we have taste receptors for sweetness on our tongues?


   So, no matter what WHO says, hardly anyone is going to give up all sweets. It is possible to argue that we should cut back on sweets, but foolish and unrealistic to say that we should all give them up completely.


"WHO does not distinguish between Stevia, chemical sweeteners and sugar alcohol. It treats all sweeteners on par."

   Once you accept that, then it comes down to a simple question: Which is less harmful? Sugar or sweetener.


   Frustratingly, WHO does not go into this question. Nor does it distinguish between various kinds of sweeteners though there are many differences, at a basic scientific level, between sweeteners. Some (like aspartame) are created in labs. Others (stevia, for instance) are actually plant based. Are we to treat all of them in exactly the same way?


   While I am not on the side of lunatic fringe of the anti-processed foods movement, I am intuitively suspicious of anything created in a lab. And in over two decades of writing about health and food, the subject of sweeteners has become something of a hardy perennial. I have lost count of the number of articles I have done on the subject because new research keeps being released every year.


   If you study the literature, you discover that many of the early sweeteners, saccharin, cyclamate etc., have been found to have adverse health effects in laboratory tests in animals. Nobody would recommend most of them today. More recently, developed sweeteners have also been the subject of concern.


   Erythritol, a sugar substitute used mainly by the food industry, has come under a cloud lately. And though its manufacturers will tell you that it is completely safe, there have always been, at an anecdotal level, doubts about aspartame, a chemically formulated sweetener. That’s why products that use it are regarded as less desirable.


   But they can be cheaper, so aspartame turns up in sugar-free products all the time. Diet drinks are one example. Both Coke and Pepsi use different sweeteners for various drinks in different markets, but never tell you explicitly what sweetener they are using for each drink.


   Many products labelled as ‘low-sugar’ or ‘sugar-free’ use aspartame. (General rule: except for colas, I never buy a diet product because manufacturers either use cheap sweeteners to make up for the lack of sugar or if it is described as sugar-free, pump up the fat content!)


   But there is a new generation of sweeteners that seems to have fewer stigmas attached. Stevia, for instance comes from a plant and is 300 times sweeter than sugar so you only need to use a tiny quantity. WHO does not distinguish between Stevia, chemical sweeteners and sugar alcohol. It treats all sweeteners on par.


   There are two major new reasons for objecting to sweeteners; both still being more fully researched. The first is the view (reported by some observational studies but dismissed by others) that sweeteners may make you eat more. They fool the body into believing that a sugar treat is coming and when it doesn’t, the body compensates by keeping you hungry. This may or may not be the case: the science is disputed.


   The second is that we do not know exactly what effect sweeteners have on the bacteria in our gut. This is a new field of study, and the current wisdom is that bacteria may influence how we get fat, how we store calories and what our emotional state is. Some scientists have claimed that the gut microbiome does not respond well to sweeteners. Once again, there is not enough research to provide a conclusive answer.


   So, what should you do?


   Most doctors will tell you (unless they are keen to appear on TV as prophets of doom) that the WHO statement has led to unnecessary panic and some of the news coverage has been needlessly alarmist. Apart from anything else, WHO should have been more specific in its claims.


   I asked my doctor, Ambrish Mithal, probably the top endocrinologist in India. (He keeps a watch on my own sugars, which, due to the nature of my work, I measure regularly. So I have personal experience of the depth of his knowledge.) Dr Mithal makes a distinction between people who use sweeteners to lose weight and diabetics. He says diabetics should steer clear of sugar whenever they can and should not be misled by coverage which suggests that sugar is better for them than sweeteners.


   On sweeteners themselves, he is not an absolutist. He does not believe that all sweeteners are the same and is closely watching the new research on the microbiome and metabolism before he comes to any conclusions. His recommendation: if you are a diabetic, don’t completely abandon sweeteners. But don’t over-indulge either. As in all things: moderation is the key.


   And common sense is always more reliable than a media-created panic.



Posted On: 26 May 2023 10:45 AM
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