The document discusses the metabolic aspects and health implications of artificial sweeteners and sugar substitutes, outlining their differences, potential effects on metabolism, and safety evaluations. It highlights concerns regarding weight gain and metabolic disorders, while also categorizing sugar substitutes into natural sweeteners, artificial sweeteners, and sugar alcohols. Additionally, the document emphasizes the potential use of these sweeteners in managing diabetes and other metabolic diseases.

1. Artificial Sweeteners
and Sugar Substitutes
Prepared by:3rd year medicinestudentsin
King AbdulAzizUniversity.

2. Objectives
• 1. Outline metabolic aspects of sugar substitutes .
• 2. Evaluate health implications of various sugar
substitutes.
• 3. Discuss safety and efficacy in using sugar
substitutes.
• 4. Explain indication potentials of sugar substitutes
in some metabolic diseases.

3. 1st Objective
•Outline metabolic aspects of
sugar substitutes.

4. What are sugar substitutes?
• A sugar substitute is a food additive that
duplicates the effect of sugar in taste,
usually with less food energy. Some sugar
substitutes are natural and some are
synthetic. Those that are not natural are,
in general, called artificial sweeteners.
• An important class of sugar substitutes is known as high-intensity
sweeteners. These are compounds with many times the sweetness
of sucrose, common table sugar. As a result, much less sweetener is
required and energy contribution is often negligible. The sensation
of sweetness caused by these compounds (the "sweetness profile")
is sometimes notably different from sucrose, so they are often used
in complex mixtures that achieve the most natural sweet sensation.

5. Cont.
• If the sucrose (or other sugar) that is replaced has
contributed to the texture of the product, then a bulking
agent is often also needed. This may be seen in soft
drinks or sweet tea that are labeled as "diet" or "light"
that contain artificial sweeteners and often have notably
different mouth feel, or in table sugar replacements that
mix maltodextrins with an intense sweetener to achieve
satisfactory texture sensation.

6. Do artificial sweeteners affect
metabolism?
• It hasn’t been 100 % scientifically confirmed but
studies show that they do have an effect on
metabolism although further research is
required to prove that long term use is harmful.

7. Weight gain and insulin
response to artificial sweeteners
• Animal studies have indicated that a sweet taste induces
an insulin response in rats. However, the extension of
animal model findings to humans is unclear, as human
studies of intragastric infusion of sucralose have shown
no insulin response from taste receptors. The release
of insulin causes blood sugar to be stored in tissues
(including fat). In the case of a response to artificial
sweeteners, even if blood sugar does not increase, there
can be increased hypoglycemia or hyperinsulinemia and
increased food intake the next time there is a meal. Rats
given sweeteners have steadily increased calorie intake,
increased body weight, and increased fatness.

8. Cont.
• Furthermore, the natural responses to eating
sugary foods (eating less at the next meal and
using some of the extra calories to warm the
body after the sugary meal) are gradually lost.
• A 2012 study showed that addition of
either saccharin or aspartame to the diet of test
rats resulted in increased weight gain compared
to addition of sucrose, when total caloric intake
was similar among groups.

9. Cont.
• A 2014 study by a collaboration of seventeen
scientists from nine Israeli research institutes
presented experimental evidence that artificial
sweeteners may exacerbate, rather than
prevent, metabolic disorders such as Type 2
diabetes. They reported that artificial sweeteners
increase the blood sugar levels in both mice and
humans by altering the composition and
function of the gut flora. Excessive blood sugar
levels are an early indicator of Type 2 diabetes
and metabolic disease.

10. Cont.
• Mice given drinking water supplemented with
artificial sweetener (commercial formulations of
saccharin, sucralose or aspartame) developed
greater glucose intolerance than mice drinking
pure water, or water with only sugar added. The
effect occurred both in mice fed standard chow
and those on a high-fat diet. Changes in the
composition of the gut flora were observed by
sequencing a ribosomal RNA gene.

11. Cont.
• When antibiotics were then used to kill off gut
bacteria, the degree of glucose intolerance in
mice fed either diet was restored to normal
levels present before artificial sweetener was
introduced. Human subjects were also studied.
Gut bacteria from 381 non-diabetics averaging
age 43 were analyzed, revealing differences in
the gut bacteria between those subjects who
habitually consumed artificial sweeteners and
those who did not, as well as "markers" for
diabetes, such as raised blood sugar levels and
glucose intolerance.

12. Cont.
• The researchers noted that the increase in
human consumption of artificial sweeteners
coincides with the modern epidemic incidence of
obesity and diabetes.

13. 2nd Objective
•Evaluate health implications of
various sugar substitutes.

14. Sugar substitutes can be categorized
in three groups:
Natural Sweeteners
Artificial Sweeteners
Sugar Alcohols

15. • Natural sweeteners, such as agave
nectar and honey, are still as calorie-
dense as sugar, but can be safe for
diabetics in moderation because their
glycemic index (GI) is lower than table
sugar.
• Natural sweeteners are sugar substitutes
that are often promoted as healthier
options than processed table sugar or
other sugar substitutes.
Natural Sweeteners

16. • Natural sweeteners are generally safe.
• But consuming too much natural sweeteners, can lead
to health problems such as:
 Tooth decay.
 Weight gain.
Increased triglycerides.
• Also honey can contain small amounts of bacterial
spores that can produce botulism toxin. For that, honey
shouldn't be given to children less than 1 year old.
Health effects of natural sweeteners

17. Artificial Sweeteners
• They are synthetic sugar substitutes but may be
derived from naturally occurring substances, including
herbs or sugar itself. They are also known as intense
sweeteners because they are sweeter than regular
sugar.
• Usually they don’t have calories.
Aspartame
(Equal®)
Saccharin
(Sweet’N Low®)
Sucralose
(Splenda®)
Acesulfame
potassium
(Sweet one®)

18. • Another possible danger of saccharin is the possibility of
allergic reactions, can include:
headaches, breathing difficulties, skin eruptions, and diarrhea.
Without research to support these claims, the FDA has not
imposed any limitations.
• Old studies linked saccharin to bladder cancer in rats. Because
of those studies, saccharin once carried a warning label that it
may be hazardous to health.
• As a result of the newer studies, the warning label for
saccharin was dropped.
Saccharin health effects

19. Aspartame health effects
• Activists claim there’s a link between aspartame and
a multitude of ailments, including:
Cancer.
Seizures.
Depression.
Lupus.
Multiple sclerosis .
• Despite extensive testing on aspartame, these claims
have not been supported in clinical studies.

20. • For new generation sweeteners (i.e. acesulfame
potassium and sucralose) , it is too early to establish
any epidemiological evidence about possible
carcinogenic risks.
• Numerous studies confirmed that artificial
sweeteners are safe in reasonable quantities, even
for pregnant women.
Artificial sweeteners health effects

21. Sugar Alcohols
• Examples for sugar alcohols:
Sorbitol, Mannitol, and Xylitol.
• They are found in many processed foods
and products and including chocolate,
chewing gum, and toothpastes.
• Sugar alcohols are carbohydrates that
occur naturally in certain fruits and
vegetables, but they also can be
manufactured. They're not considered
intense sweeteners, because they aren't
sweeter than sugar.

22. • There are few health concerns associated with sugar
alcohols. When eaten in large amounts, usually more
than 50 grams but sometimes as little as 10 grams,
they can have a laxative effect causing:
Bloating.
Intestinal gas.
Diarrhea.
• Product labels may carry a warning about this
potential laxative effect.
Health effects of sugar alcohols

23. 3rd Objective
•Discuss safety and efficacy in
using sugar substitutes.

24. Safety of artificial sweeteners
• Some research has associated artificial
sweeteners with health conditions such as
cancers, hepatotoxicity, migraines, and low birth
weight. Much controversy concerning this issue
still exists, but lots of studies demonstrated the
safety of these sweeteners.

25. Efficacy of artificial sweeteners
• It has been suggested that the use of artificial
sweeteners may have a stimulating effect on
appetite and, therefore, may play a role in
weight gain and obesity. However, research into
sweeteners and appetite stimulation is
inconsistent. Also, there is little evidence from
longer-term studies to show that sweeteners
lead to increased energy intake and contribute to
the risk of obesity.

26. 4th Objective
•Explain indication potentials of
sugar substitutes in some
metabolic diseases.

27. Sugar substitutes in the diabetic diet
•Using artificial sweeteners is considered a
safe way to help control blood sugar levels.
•There are more choices than ever.

28. There are six artificial sweeteners that have been
tested and approved by the U.S. Food and Drug
Administration (FDA):
• Aspartame
• Acesulfame potassium
• Saccharin
• Sucralose
• Neotame
• Advantame
Also, with the exception of aspartame, all of the
sweeteners listed above cannot be broken down
by the body.

29. Phenylketonuria
• Phenylketonuria (PKU) is a genetic disorder
in which the body can't break down an amino acid
called phenylalanine (Phe).
• People who have phenylketonuria (PKU) cannot
use aspartame, because it contains
phenylalanine.

30. References
• Garner C, et al. Nonnutritive sweeteners: Current use and health perspectives. A Scientific
Statement From the American Heart Association and the American Diabetes Association.
Circulation. 2012;126:509.
• Levin G, Zehner L, Saunders J, and Beadle J. Sugar substitutes: their energy values, bulk
characteristics, and potential health . Am J Clin Nutr l995;62(suppl): 1 1615-85.
• The Potential Toxicity of Artificial Sweeteners, Whitehouse, C. R., Boullata, J., & McCauley, L. A.
AAOHN Journal 2008; 56(6), 251-259.
• Kroger K, Meister K, Kava R. Low-calorie Sweeteners and Other Sugar Substitutes: A Review of the
Safety Issues. Comprehensive Reviews in Food Science and Food Safety 2006;5(2):35-47
• Mattes D, et al. Nonnutritive sweetener consumption in humans: Effects on appetite and food
intake and their putative mechanisms. American Journal of Clinical Nutrition. 2009;89:1.
• Aguilar, F. et al. (2013). Scientific Opinion on the re-evaluation of aspartame (E 951) as a food
additive. European Food Safety Authority Journal, 11(12), 3496. Retrieved July 25, 2014
• How sweet it is: All about sugar substitutes. Food and Drug Administration.
http://www.fda.gov/forconsumers/consumerupdates/ucm397711.htm. Accessed June 3, 2014.
• http://www.nhs.uk/Livewell/Goodfood/Pages/the-truth-about-artificial-sweeteners.aspx
• https://www.sciencenews.org/article/artificial-sweeteners-may-tip-scales-toward-metabolic-
problems
• http://www.medicinenet.com/artificial_sweeteners/article.htm
• http://www.nature.com/news/sugar-substitutes-linked-to-obesity-1.15938
• http://www.medicalnewstoday.com/articles/261179.php
• http://www.nlm.nih.gov/medlineplus/ency/article/001166.htm
• http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/artificial-
sweeteners/art-20046936

31. Thank you
3rd year Medicine
Students in King
AbdulAziz University.