Processing sugar: Could artificial sweeteners promote diabetes?

ColaNearly all of us have consumed a product or two containing artificial sweeteners— jams, chocolate, cookies and soft drinks, to name a few. These food additives are consumed by hundreds of millions of consumers worldwide. But new research suggests that sugar substitutes (including zero-calorie varieties) and added natural sugars may do more harm than good.

Studies over the past decade, including several emanating from UF Health, have linked over-consumption of added natural sugars — including fructose, a major component of high-fructose corn syrup in western diets — to the epidemics of Type 2 diabetes and obesity

Researchers at Harvard Medical School recently identified a hormone that rises sharply in response to consuming fructose. The hormone which regulates accumulation of fat, called fibroblast growth factor 21 (FGF21), was shown to be overstimulated by consumption of the natural sweetener, according to the findings published in the journal Molecular Metabolism.

Several research studies also suggest artificial sweeteners may play an even greater role. Researchers in Israel reported in the journal Nature, that artificial sweeteners can disrupt microbes, or good bacteria, that lives in the gut. This may cause higher blood sugar levels, and even diabetes. The study reported findings mostly in mice, accompanied by small human studies. 

Yuri Sautin, Ph.D., Associate Professor of Medicine, Division of Nephrology, Hypertension & Renal Transplantation

Affiliate UF Diabetes Institute researcher Dr. Yuri Sautin, Ph.D., an associate professor in the Division of Nephrology, Hypertension and Transplantation at the University of Florida, called the above study findings “remarkable” when reviewed together, prompting attention to a recent study his team conducted on fructose; the results published in the September issue of Diabetes.

“Our study demonstrates that blocking a key enzyme and redirecting fructose metabolism to alternative pathways is an effective way to prevent visceral obesity and insulin resistance induced by high fructose” he said.

Most research investigators acknowledge that it is too early for broad or definitive evidence implicating artificial sweeteners in the development of diabetes or obesity. Continued basic research and clinical studies are further needed to address this important possibility.

“Type 2 diabetes is caused by changes in myriads of signaling pathways. Modification of microbiota might not be the only mechanism by which artificial sweeteners affect normal glucose tolerance,” said Sautin. “Studies like these should be known to all people who consume zero-calorie soft drinks and sweetened coffee with sugar replacements.

In the future, Sautin and his team aim to pilot several studies building on these findings.

Original Publications:

  • Suez J., Korem T., et. al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014 Oct 9;514(7521):181-6.
  • Dushay, J., Herman, M., et. al. Fructose ingestion acutely stimulates circulating FGF21 levels in humans. Molecular Metabolism. In press.
  • Sautin, YY. Marek G., Adiponectin resistance and pro-inflammatory changes in the visceral adipose tissue induced by fructose consumption via ketohexokinase-dependent pathway. Diabetes. 2014 Sep 3. pii: DB_140411.
  • Editorial on fructose features UF Health diabetes research study