March 2, 2024
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Bittersweet: Burgeoning Research on the Impact of Sugar Substitutes on Gut Health

Let’s face it: People love their sugar. It evokes beautiful childhood memories, imparts happiness, and comes in all sorts of delicious forms and flavors. It’s hard to shut off that craving for some sweetness, in whatever style tickles your fancy. However, the average consumer is increasingly aware of the havoc sugar may wreak on our bodies. Fat, the macronutrient that once was the king of dietary malevolence, has since been replaced with carbohydrates, or more specifically, sugar.

Sugar has been associated with increased rates of obesity, type 2 Diabetes Mellitus (T2DM), cardiovascular disease (CVD), cancer and inflammation, just to name a few. In a scramble to concomitantly clean up our health while holding on to that sweetness we all know and love, consumers are veering towards sugar substitutes or non-nutritive sweeteners (NNS). But are they as innocuous as they are thought out to be?

NNS are sugar substitutes that mimic the sweet taste of sugar (sucrose) but have a negligible impact on caloric/energy intake. NNS include advantame, acesulfame potassium, aspartame (Equal), neotame, sucralose (Splenda), and saccharin (Sweet’N Low). There are other sugar substitutes that consumers can use as well, called sugar alcohols and polyols, which include xylitol and sorbitol, which have some impact on caloric intake, but significantly less than the usual table sugar. There are also plant-based NNS which include Stevia and monk fruit. All of these substitutes’ sweetness is based off of sucrose and are significantly sweetener than sucrose, so you don’t need much of it to cater to your needs. Since they have few to no calories, they have been thought to be inert or convey no negativity to our metabolism/general health. In fact, they have been touted as a great alternative to sugar for diabetics and those trying to curb their sugar intake. While this may be true in the short term, sugar substitutes may be harming their consumers in other ways in the long run.

A 2014 study in the journal Nature indicated that aspartame, saccharin and sucralose can prompt abnormal blood sugar levels through changes in the gut microbiome in both human and animal models. Another study, a randomized-controlled trial, which is the gold standard for research, completed by Suez et al. (2022) presented data that showed sucralose and saccharin impairs glycemic response in healthy adults by negatively impacting our microbiome. A review by Ruiz-Ojeda et al. (2019) found that saccharin, sucralose and stevia change the composition of the gut microbiota by harming the good bacterial species. Polyols, such as xylitol, may impart some gastrointestinal (GI) benefit by increasing the number of bifidobacteria in humans by its inherent composition of being a prebiotic, which is essentially sustenance for the bacteria in our gut. More research needs to elucidate the mechanisms behind why this may occur, but long-term prospective studies (which means studies over time) may indicate that NNS contribute to the development of metabolic instability, which can lead to obesity, T2DM and CVD.

Though the study of the gut microbiome is only in its infancy, the quantity of research is growing on the gut’s profound importance to our overall health and well-being. It is involved in optimal immunity, mental health, GI maintenance and blood glucose regulation, just to name a few. It is truly a symbiotic relationship that starts from birth, and we as consumers are stewards for these creatures that cohabitate with us. We should do our best to give them the right nutrition, such as fruits and vegetables, as fiber gives them nourishment to survive and thrive. It is becoming more and more evident that consumers need to take care of the good bugs in our body so that they can take care of us. Though sugar in all forms is a difficult ingredient to banish from our dietary repertoire, the less of it we consume is beneficial for every aspect of our health. The more natural sweets we consume (i.e., fruits and vegetables), the less we’ll want to eat the artificial versions.


Melissa Papir is a registered dietitian working in long term care nutrition in Washington Heights, New York. She works with middle-aged-elderly residents to provide nutrition that can help boost their quality of life. She loves to write about nutrition in her spare time. She can be reached at [email protected].

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