Too much sugar is not good, but are sugar substitutes better? First of all, let's look at why too much sugar is not a good thing for health...
Sugar can alter the make up of the microbiome and lead to dysbiosis, or imbalanced bacteria, and candida or fungal overgrowth. According to this study, when in balance, the intestinal microbiota protects against the development of obesity, metabolic syndrome, and pre-diabetic phenotypes by inducing commensal-specific Th17 cells (Kawano, Y et al). These cells reduce the absorption of pathogenic fats from our intestinal epithelial cells, reducing inflammation. Th17 cells are produced from bacteria in our guts, and Th17 cells, and the bacteria that produce these cells, are depleted with sugar intake.
(Kawano, Y et al)
Our gut bacteria do so much for our health! The above study shows that the bacteria in our gut, when in balance, protect us from obesity and metabolic syndrome and lower inflammation throughout our bodies. A high fat, high sugar diet promotes gut inflammation and metabolic syndrome while a high fat, low sugar diet has protective effects against inflammation. Read more about fats here.
So what about sugar substitutes?
There are many variations of artificial sweeteners...
Non-nutritive sweeteners (NNS) such as acesulfame K, aspartame, cyclamate, saccharin, neotame, advantame, and sucralose.
Natural sweeteners (NS) such as thaumatin, steviol glucosides, monellin, neohesperidin dihydrochalcone, and glycyrrhizin.
Nutritive sweeteners such as polyols or sugar alcohols.
So, is consuming sweeteners a good thing?
Not all sweeteners have deleterious effects on the microbiome and health. In fact, some sweeteners, like xylitol, have been shown to increase bifidobacterium in humans which is a good thing as bifidobacterium are a benefical type of bacteria. Xylitol can be used as a biofilm breaker especially in the formation of dental plaque i.e. gum that contains xylitol can prevent cavities. This study shows, xylitol is efficient at preventing multispecies biofilms for the prevention of oral diseases caused by dental plaque (Badet, C.) In contrast, Xylitol also reduces the abundance of fecal Bacteroidetes and the genus Barnesiella, increases Firmicutes and the genus Prevotella, and affects C. difficile in mice (Ruiz-Ojeda, F.J. et al). Xylitol can be an irritant to conditions like SIBO (small intestinal bacterial overgrowth) by causing the growth of these above organisms in the small intestine. Not so good.
Another example is lactitol which showed positive and negative effects on the microbiome. Lactitol decreases the populations of Bacteroides, Clostridium, coliforms, and Eubacterium. However, lactitol increased the production of butyrate (a short chain fatty acid used for colonic cell energy) and IgA secretion (immune modulation) without signs of mucosal inflammation and presents symbiotic effects (Ruiz-Ojeda, F.J. et al).
Sacchrin and sucrolose (NNS) and Stevia (NS) ingestion showed changes to the microbiome. The ingestion of saccharin by animals and humans showed alterations in metabolic pathways linked to glucose tolerance and dysbiosis in humans which might contribute to the development of obesity, T2D, and cardiovascular disease (Ruiz-Ojeda, F.J. et al). Also, not so good...
Everything in moderation! The use of sweeteners has taken hold as a way to get that sweet taste without all the extra calories. With the rise of obesity, this seems like a plausible alternative, however, the evidence shows both deleterious and beneficial effects. My favorite sweeteners, which I use minimally to be fair, are honey, coconut sugar, and pure maple syrup. As you reduce sugars in your diet your palate will change from craving sweet to craving the actual taste of the food you are eating. Another good option to reduce the need for sweeteners is to consume full fat foods and use coconut oil, real butter or ghee, full fat dairy, olive oil and avocado oil. The creamy flavor of the fat will negate the need for sugar!
Click on the links below for further reading:
As always, these are general recommendations and each person is unique in their needs. It is best to consult with your practitioner for personalized guidance. Anything posted here is not to be considered medical advice.
Badet C, Furiga A, Thébaud N. Effect of xylitol on an in vitro model of oral biofilm. Oral Health Prev Dent. 2008;6(4):337-41. PMID: 19178100.
Kawano, Y., Edwards, M., Huang, Y., Mucinda, D., Honda, K. & Ivanov, I.I. (2022). Microbiota imbalance induced by dietary sugar disrupts immune-mediated protection from metabolic syndrome. Cell Press Journal. DOI:https://doi.org/10.1016/j.cell.2022.08.005.
Ruiz-Ojeda FJ, Plaza-Díaz J, Sáez-Lara MJ, Gil A. Effects of Sweeteners on the Gut Microbiota: A Review of Experimental Studies and Clinical Trials. Adv Nutr. 2019 Jan 1;10(suppl_1):S31-S48. doi: 10.1093/advances/nmy037. Erratum in: Adv Nutr. 2020 Mar 1;11(2):468. PMID: 30721958; PMCID: PMC6363527.