- Non-caloric artificial sweetener (NAS) consumption appears to increase risk of metabolic syndrome, particularly glucose intolerance.
- The findings of this study may be partially
explained by a change in gut microbiota resulting in dysbiosis in persons consuming NAS.
By Donald Brown, ND
Managing Director, Natural Product Research Consultants, Seattle, WA
Dr. Brown reports he is a retained consultant for Nature’s Way and Linnea.
Suez J, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 2014;514:181-186. doi: 10.1038/nature13793. Epub 2014 Sep 17.
Researchers from the Weizmann Institute of Science in Israel demonstrated that mice consuming non-caloric artificial sweeteners (NAS; e.g., saccharin, sucralose, and aspartame) in drinking water developed marked glucose intolerance compared to mice consuming only glucose or sucrose in drinking water. A link was made to alterations in the intestinal microbiota.* To study the effect of long-term NAS consumption in humans, data were collected from 381 non-diabetic individuals (44% male and 56% females; age 43.3 ± 13.2 years) using a validated food frequency questionnaire. Significant positive correlation was found between NAS consumption and several metabolic syndrome-related parameters such as increased weight and waist-to-hip ratio (measures of central obesity), higher fasting blood glucose, glycosylated hemoglobin (HbA1c), and glucose tolerance test. HbA1c was significantly increased in a subgroup of high NAS consumers (n = 40) compared to 236 non-NAS consumers (P < 0.002), and remained significant even when the calculation was corrected for body weight (P < 0.015).
Analysis of intestinal microbiome in 172 subjects (randomly selected from the cohort of 381 subjects)using 16S RNA gene sequencing found that suggested taxonomic changes indicative of dysbiosis.* Notably, several of the bacterial taxa that changed following NAS consumption were previously associated with type 2 diabetes in humans.1,2 In an assessment of seven volunteers consuming NAS (saccharin, 5 mg/kg of body weight) for 1 week, four out of seven showed impaired glucose tolerance (measured by continuous glucose measurements and daily glucose tolerance tests). Of these four "NAS responders," all demonstrated bacterial taxonomic changes indicative of dysbiosis compared to the "NAS non-responders."
The results of this study (actually multiple studies in one paper!) suggest that consumption of NAS may be another dietary factor contributing to dysbiosis. What is interesting (particularly in the mouse portion of the paper) is the link to impaired glucose tolerance. Most NAS pass through the gastrointestinal tract without being digested by the host and directly encounter the intestinal microbiota. In addition to previous data pointing to weight gain3 and increased risk of type 2 diabetes4 in persons consuming NAS, these data provide a compelling argument to counsel our patients to remove NAS from their diet.
*Note: A more detailed overview of the mouse data and changes in NAS responder bacterial taxa can be read in the reviewed paper.
References
- Qin J, et al. A metagenome-wide association study of gut microbiota in type 2 diabetes. Nature 2012;490:55-60.
- Karlsson F, et al. Gut metagenome in European women with normal, impaired and diabetic glucose control. Nature 2013;498:99-103.
- Horwitz DL, et al. Response to single dose of aspartame by NIDDM patients. Diabetes Care 1988;11:230-234.
- Nettleton JA, et al. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2009;32:688-694.
