Sweeteners, better known as sugar substitutes, are substances added to food to make it more palatable, as they provide a sweet flavor without increasing calorie intake.
The growing prevalence of obesity, diabetes mellitus, and issues related to increased blood sugar has led to an increase in the production and consumption of these substances, which have good sweetening power, in breakfast foods and beyond—for example: sweets, cereals, biscuits, jams, candies, chewing gum, various types of drinks, and medications, including some dietary supplements.
But for those who suffer from lactose intolerance, the intestine is the first organ to be mindful of, so let’s try to understand if these substances have a negative effect on its health.
What are sweeteners?
Sweeteners are divided into two categories: natural and synthetic.
You have surely used one, for example, to sweeten your coffee, such as the sweetener Stevia rebaudiana.
Natural sweeteners are so called because they are found naturally in fruits and vegetables (although those used industrially are obtained from corn).
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The most common are:
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They are easily recognizable in the list of ingredients, as they end with the suffix "-ol". The most famous natural sweetener is probably xylitol. They do not show side effects, although if consumed in large quantities, they can cause flatulence, stomach aches, and diarrhea, and symptoms similar to the gastrointestinal reaction to beans and some fiber-rich foods.
These symptoms depend on an individual's sensitivity and the other foods consumed at the same time.
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Artificial sweeteners are synthetic, meaning they are produced in a laboratory. They are chemical substances added to certain food and industrial preparations. The most common are:
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Is there a contraindication for our gut?
Some scientific studies have shown that the long-term consumption of artificial sweeteners can disrupt the balance and diversity of the gut microbiome in both mice and humans, decreasing the number of beneficial bacteria such as lactobacilli and bifidobacteria.
For example, significant dysbiosis of the gut microbiome has been reported after feeding rats saccharin, sucralose, aspartame, and acesulfame K. This would mean that in sensitive subjects, it could lead to a negative effect on gut health.
Gut microbial communities play a significant role in human health and disease; in fact, the gut microbiome is involved in metabolism, immunity, growth, and the fermentation of undigested carbohydrates.
More importantly, the gut microbiota cooperates with the immune system, providing signals to promote the maturation of immune cells and the induction of susceptibility to many pathophysiological conditions.
The composition and function of the microbiome are modulated and can be rapidly altered by an improper diet.
The mechanisms through which artificial sweeteners can affect the gut microbiome have not been clearly understood but may be related to their metabolites.
The metabolism of aspartame produces methanol and small amounts (~1.5%) of aspartyl-phenylalanine diketopiperazine (DKP), both of which appear to have antimicrobial properties and can influence the gut microbiota.
It has also been suggested that sucralose could be metabolized into 1,6-dichloro-1,6-dideoxyfructose (1,6-DCF) or other aldehydes in the gut. These metabolites can negatively affect various biological processes in bacterial and mammalian cells.
Furthermore, it seems that their consumption perhaps affects the gut microflora of some individuals more than others, likely due to individual differences in genetic and microbiome composition, or related to dietary habits, medications taken, and so on.
In conclusion, consumers should simply be aware of the potential side effects of artificial sweeteners, even though there are no conclusive clinical data on such adverse effects.
At first glance, it is difficult to understand whether a sweetener is natural or not; you have to investigate and read carefully what is reported on the packaging. This does not just apply to the sachets in the café used to sweeten our beloved coffee... we must in fact pay attention to the information on the labels of all the foods we ingest.
Medicines or dietary supplements can also contain sweeteners to mask the bitter taste of chemical compositions (to find out which lactase supplements contain sweeteners, click HERE).
Therefore, at the moment, we can only recommend a limited use of sweeteners.
Bibliography
- Ebrahimzadeh (2018) “A review of the health hazards of artificial sweeteners: are they safe?” Progress in Nutrition 2018; Vol. 20, Supplement 2: 36-43
- Nettleton JE, Reimer RA, Shearer J. (2016) “Reshaping the gut microbiota: Impact of low calorie sweeteners and the link to insulin resistance?” Physiol Beha.
- Shreiner AB, Kao JY, Young VB. (2015) “The gut microbiome in health and in disease”. Curr Opin Gastroenterol
- Parekh PJ, Balart LA, Johnson DA. (2015) “The influence of the gut microbiome on obesity, metabolic syndrome and gastrointestinal disease”. Clin Transl Gastroenterol
- Palmnäs et al. (2014) “Low-dose aspartame consumption differentially affects gut microbiota-host metabolic interactions in the diet-induced obese rat”. PLoS ONE
- Haro et al (2016) “The gut microbial community in metabolic syndrome patients is modified by diet” J Nutr Biochem.
- David LA (2014) “Diet rapidly and reproducibly alters the human gut microbiome.” Nature
- Suez J et al (2014) “Artificial sweeteners induce glucose intolerance by altering the gut microbiota.” Nature