Diabetes is a serious, progressive disease that can drastically affect quality of life, especially if not managed properly.
So when a story comes out that tells us we might be inadvertently giving ourselves diabetes, we sit up and take notice. And when the cause is something that we think is better for us – like artificial sweeteners, the low-calorie alternative to sugar – it’s even worse. But it turns out that there’s more to the story.
Diabetes in Australia
The rate of diabetes has shot up in recent years, going from 1.5 per cent of Australians in the late 1990s to more than 6 per cent today. Diabetes Australia estimates that this is likely to increase to more than 10 per cent of Australians within a decade.
Where I work, in Sydney’s west, we estimate the numbers are already over 12 per cent, and they might be increasing by as much as 1 per cent each year.
Much of the increase in Type 2 diabetes is driven by weight gain, which is a risk factor for diabetes (although it’s important to note that not everyone who has diabetes is overweight or obese).
A balanced diet and regular exercise helps reduce a person’s risk of diabetes and helps manage the condition once diagnosed. As people seek healthier eating options, one very popular choice is to replace sugar with artificial sweeteners.
Are sweeteners linked to diabetes?
Most of the recent media hubbub has focused on research reportedly linking artificial sweeteners, such as sucralose, to weight gain and pre-diabetes.
The study, conducted by George Washington University researchers and presented at the Endocrine Society conference in March, looked at the effect of sweeteners on stem cells in a lab, as well as fat samples collected from 18 volunteers (mostly individuals with obesity) who said they consumed sweeteners.
There are limitations to this type of study, the most obvious being the small sample size, and the fact that cells in a lab don’t necessarily react in the same way as they do in our bodies.
The researchers soaked some cells in sucralose – an artificial sweetener best known for being the main ingredient in sugar substitute Splenda. They noticed that the cells started to change and express genes that are markers of metabolic syndrome, such as obesity, which is a precursor to diabetes.
To confirm their findings, the researchers took cell biopsies from the volunteers. They found cells from the obesity group reacted in a similar way to the sucralose-soaked cells.
This possibly means that sucralose is linked to obesity and metabolic syndrome, and from there diabetes. But it does not necessarily mean sweeteners are actually causing the disease.
For example, previous observational research has found that people who drink more artificial sweeteners are more likely to be overweight and obese in the first place.
— Medscape (@Medscape) March 27, 2018
What the science means for you
If you consume artificial sweeteners, whether in soft drink or by adding them to meals or coffee, there’s probably not much cause for alarm. All of the effects are reasonably small – especially compared to the harms of excess sugar.
Though water is still best, there’s not much evidence that sweeteners are harmful to your health, and good reason to believe that they can improve health outcomes. In large randomised controlled trials comparing sugar to artificial sweeteners, we find that those who use artificial sweeteners instead of sugar actually lose weight and get healthier.
If you are worried about your weight or consuming sweeteners, see a dietitian or talk to your doctor. They are far more qualified than anyone else to give you advice about what foods and drinks are best for you.
Gideon Meyerowitz-Katz is an epidemiologist who works in diabetes prevention and management in Sydney’s west. He also writes a weekly blog on public health and science communication.