Every year, worldwide renowned researchers on nutrition and diabetes come together at the International Symposium on Diabetes and Nutrition, organised by the Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), to discuss new evidence on the field of diabetes diet. This year, at the 35th International Symposium on Diabetes and Nutrition, held between June 19th and 22nd in Skagen, Denmark, there was a high interest in low calorie sweeteners’ role in glycaemic control and diabetes management, with experts presenting several new study findings on this topic.
New human study shows no effect of low calorie sweeteners on glycaemia
The findings of a new two-arm randomised controlled trial (RCT) conducted and funded by the German Institute for Human Nutrition, in order to examine low calorie sweeteners’ short- and long-term effect on insulin and incretin release, were presented for the first time at the DNSG Symposium.
In the first study (ILIAS-1 trial), the investigators conducted 7 consecutive single oral stimulations with glucose or different low calorie sweeteners alone (saccharin, aspartame and sucralose) or in combination, in 14 male subjects with normal glucose metabolism. The results confirmed previous findings that low calorie sweeteners do not affect postprandial glucose, insulin, c-peptide or incretin levels (GIP, GLP-1, GLP-2). Furthermore, adding low calorie sweeteners to glucose did not significantly change the overall metabolic profile.
In addition to the first short-term study, a cross-over 4-week intervention study (ILIAS-2 trial) to assess metabolic response of the consumption of 1L of low calorie sweetened vs non-sweetened soft drinks on glycaemic indexes was conducted, and concluded that the long-term exposure with a saccharin-sweetened beverage did not affect glucose and hormones levels nor insulin sensitivity, which is a finding of particular importance reassuring that high diet drink consumption doesn’t affect insulin resistance.
Key remarks of the session on ‘Low calorie sweeteners in diabetes diet’
In a session about ‘Low calorie sweeteners in diabetes diet’, renowned experts in this scientific field provided an overview of the scientific evidence in relation to the role of low calorie sweeteners in the epidemic of diabetes from a public health perspective as well as about controversies about sweeteners' consumption and health.
With a long experience on low calorie sweeteners research in both humans and animals, Dr Per Bendix Jeppesen, Associated Professor at Aarhus University, Denmark, and organiser of the DNSG Symposium this year, presented the outcomes of a new 8-week intervention study in rats investigating the effects of different low calorie sweeteners (aspartame and steviol glycosides vs high-fructose corn syrup-HFCS) on insulin resistance and liver fat accumulation, indexes of metabolic syndrome, and concluded that both low calorie sweeteners tested did not induce insulin resistance nor liver steatosis, contrary to HFCS which increased insulin resistance significantly.
The new findings are in line with a previous human study conducted by the same University at Aarhus, a 6-month randomised controlled intervention trial which compared the intake of daily intake of 1L of low calorie sweetened beverage with the same quantity of sugar-sweetened beverage, low-fat milk and water (control group) for 6 months. Indeed, diet beverages had very similar metabolic effects to water and beneficial impact on fat accumulation (e.g. liver fat, visceral adipose tissue, muscle fat) and blood lipids (triglycerides and total cholesterol) compared to sugar-sweetened beverages' consumption.
The issue of reverse causality in observational studies showing an association between low calorie sweeteners' use and diabetes was one of the topics addressed during this session by Dr Caomhan Logue, Ulster University, UK. As Dr Logue emphasised, reverse causation may explain observed associations, meaning that people with diabetes turn to low calorie sweeteners in order to reduce sugar intake rather the other way round, and highlighted that the methods used to estimate dietary intake of low calorie sweetened foods in epidemiological studies is likely to be inadequate. Finally, presenting an overview of the latest scientific data and regulation on low calorie sweeteners and diabetes, he stressed that current evidence suggests a beneficial role for low calorie sweeteners when used in place of sugar for glycaemia and weight status, which reinforces their potential value on sugar reduction and food reformulation.
Overall, there is a consensus within the scientific and medical community that the collective body of evidence supports the use of low calorie sweeteners in place of sugar in the diet of people with diabetes, as they can provide an alternative to sugar without the calories and without affecting glucose control while potentially increasing compliance to the dietary advice. Of course, people with diabetes should always read the food labels to check for other ingredients in sugar-free products (e.g. other carbohydrates) that might still affect their glucose control. In any case, the wide availability of low calorie sweetened foods on the market today is especially important for people with diabetes who are looking for good-tasting foods and beverages that provide the desired sweet taste but can also help them meet the dietary recommendations regarding sugar reduction.
Please click here to watch a video interview with Dr Caomhan Logue talking about World Diabetes Day and the role low calorie sweeteners can play in diabetes diet.