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Sweeteners and metabolism

Artificial sweetener enhances blood insulin

More studies are need to assess long-term use

Artificial sweeteners are related to enhanced blood insulin and glucose response, according to researchers at Washington University School of Medicine in St Louis. Although the findings reveal that the elevated insulin response shows patients are able to make enough insulin to deal with spiking glucose levels, it also shows that patients are secreting more insulin and if they can become resistant to its effects it could lead to type 2 diabetes.

"Our results indicate that this artificial sweetener is not inert, it does have an effect," said first author of the Study Dr M Yanina Pepino. "And we need to do more studies to determine whether this observation means long-term use could be harmful."

The small study, published in the journal Diabetes Care, analysed the sweetener sucralose (Splenda) in 17 severely obese patients (BMI42.3±1.6) who do not have diabetes and do not use artificial sweeteners regularly.

The researchers gave subjects either water or sucralose to drink before they consumed a glucose challenge test. The glucose dosage is very similar to what a person might receive as part of a glucose-tolerance test. The researchers wanted to learn whether the combination of sucralose and glucose would affect insulin and blood sugar levels.

"We wanted to study this population because these sweeteners frequently are recommended to them as a way to make their diets healthier by limiting calorie intake," said Pepino.

Every participant was tested twice. Those who drank water followed by glucose in one visit drank sucralose followed by glucose in the next. In this way, each subject served as his or her own control group.

Compared with the control condition, sucralose ingestion caused a greater incremental increase in peak plasma glucose concentrations (4.2 ± 0.2 vs. 4.8 ± 0.3 mmol/L; p=0.03), 2) and a 20±8% greater incremental increase in insulin area under the curve (p<0.03).

They also noted a 22±7% greater peak insulin secretion rate (p<0.02), a 7±4% decrease in insulin clearance (p=0.04), and a 23±20% decrease in insulin sensitivity (p=0.01).

There were no significant differences reported between conditions in active glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, glucagon incremental AUC, or indices of the sensitivity of the β-cell response to glucose.

"When study participants drank sucralose, their blood sugar peaked at a higher level than when they drank only water before consuming glucose," she explained. "Insulin levels also rose about 20% higher. So the artificial sweetener was related to an enhanced blood insulin and glucose response."

It has been thought that artificial sweeteners, such as sucralose, do not have an effect on metabolism. However, recent findings in animal studies suggest that some sweeteners may be doing more than just making foods and drinks taste sweeter. One finding indicates that the gastrointestinal tract and the pancreas can detect sweet foods and drinks with receptors that are virtually identical to those in the mouth. That causes an increased release of hormones, such as insulin. Some animal studies also have found that when receptors in the gut are activated by artificial sweeteners, the absorption of glucose also increases.

Pepino said those studies could help explain how sweeteners may affect metabolism, even at very low doses.

"Most of the studies of artificial sweeteners have been conducted in healthy, lean individuals," said Pepino. "In many of these studies, the artificial sweetener is given by itself. But in real life, people rarely consume a sweetener by itself. They use it in their coffee or on breakfast cereal or when they want to sweeten some other food they are eating or drinking."

Just how sucralose influences glucose and insulin levels in people who are obese is still unknown.

"Although we found that sucralose affects the glucose and insulin response to glucose ingestion, we don't know the mechanism responsible," said Pepino. "We have shown that sucralose is having an effect. In obese people without diabetes, we have shown sucralose is more than just something sweet that you put into your mouth with no other consequences."

She said further studies are needed to learn more about the mechanism through which sucralose may influence glucose and insulin levels, as well as whether those changes are harmful. A 20 percent increase in insulin may or may not be clinically significant, she added.

"What these all mean for daily life scenarios is still unknown, but our findings are stressing the need for more studies," she said. "Whether these acute effects of sucralose will influence how our bodies handle sugar in the long term is something we need to know."

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