Are Diet Drinks Contributing to Irritable Bowel Syndrome?
Could “diet”, low-calorie, or weight loss beverages be contributing to your irritable bowel symptoms?
If you’re like many Canadians, you may reach for artificial sweeteners or “diet” drinks over products filled with refined sugars. Often, this is done for the proposed health benefits of decreasing one’s sugar intake.
While we can all agree that decreasing sugar intake will be beneficial, replacing it with artificial sweeteners may not be the best solution.
Artificial sweeteners (AS) are ubiquitous in food and beverage products, yet little is known about their effects on the gastrointestinal (GI) tract, and whether they play a role in the development of GI symptoms, especially in patients with irritable bowel syndrome.
What are artificial sweeteners?
In our modern world, artificial sweeteners are in processed foods and beverages. They’re often marketed as “healthy”, “beneficial”, or “natural” as they don’t contain the calories found in sugar.
In North America, the use of artificial sweeteners is on the rise. From 2007–2008, use of artificial sweeteners by adults increased from 18% to 24%. More alarming, the rate doubled from 6% to 12% in children. (1)
Common varieties of artificial sweeteners include: (2)
- NutraSweet™, Equal™
- Aspartame is approximately 200 times sweeter than sucrose.
- The FDA’s acceptable daily intake (ADI) of aspartame is 50 mg/kg/day.
- Sucralose is around 600 times as sweet as sucrose.
- The FDA’s acceptable daily intake (ADI) of sucralose is 1500mg/kg/day
- Sweet N Low™
- Saccharin is 200–700 times sweeter than sucrose.
- The FDA’s acceptable daily limit of saccharin is 5 mg/kg/day.
In restaurants, you’ll often see these sweeteners in paper packaging used for tea or coffee additives. In North America, the colors are typically white for sucrose, blue for aspartame, pink for saccharin, yellow for sucralose (United States) or cyclamate (Canada), tan for turbinado, orange for monk fruit extract, and green for stevia.
- Weight gain
- Impaired ability to tolerate sugar
- Increased incidence of type 2 diabetes
Artificial sweeteners do not affect your blood sugar in the same way a simple sugar does — via a spike in insulin levels. Instead, artificial sweeteners are excreted in the urine or feces unchanged from the time you initially consumed them. Artificial sweeteners have been shown to alter metabolism through affecting changes in the beneficial bacteria found in your gut. At the same time, this could be contributing to the symptoms found in irritable bowel syndrome. (5)
The difference between sugar and artificial sweeteners
What’s the difference between a nutritive sweetener and a non-nutritive sweetener? Caloric content. Nutritive sweeteners contain calories while non-nutritive sweeteners have zero calories or are virtually calorie-free. No-calorie sweeteners may sound like a good idea when you’re looking to lose weight, but the research seems to suggest otherwise.
Studies have shown that the regular consumption of calorie-free sweeteners actually leads to weight gain. (6,7,8) Normally, when the body breaks down calories from food, it regulates how much is enough. When sufficient amounts are consumed, the digestive system sends signals to the brain that say “I’m full.”
If the calories don’t arrive after activating sweet taste receptors, your brain gets confused. The feeling of hunger remains as calories have not arrived to initiate the satiety (I’m full) effect. Continued use of artificial sweeteners confuses the system so that our brain can no longer accurately register when the sweet taste signals carry calories, and when it doesn’t. In turn, this leads to consumption of excess calories which results in weight gain.
Irritable bowel syndrome and artificial sweeteners
Irritable bowel syndrome (IBS), a syndrome that is characterized by recurring episodes of abdominal pain, bloating, and altered
bowel habits. 5 million Canadians suffer from IBS with 120,000 Canadians developing IBS each year. (9) Up to two-thirds of patients with IBS associate the onset or worsening of their symptoms with food intake.
Canada has one of the highest rates of IBS in the world with five million Canadians currently suffering. IBS affects significantly more women than men and is one of the most common causes of work and school absenteeism. (10)
To date, the common treatment recommendations for irritable bowel syndrome are focused on diets that exclude FODMAPs (fermentable oligo-di-monosaccharides and polyols) and gluten. To learn more about the low FODMAP diet, please see this post. But what about foods containing artificial sweeteners? Could they be contributing to symptoms commonly found in IBS?
In an animal study, aspartame, sucralose, and saccharin created a state where the mice were unable to tolerate sugar intake. This occurred by altering the beneficial bacteria in the animal’s digestive tract. (11) Researchers then took this a step further by studying the effects of artificial sweeteners in a small-scale human study. Subjects consumed saccharin (sweet ‘n low) at the upper limit for one week.
Of the 7 individuals studied, 4 showed an elevated response to sugar. Researchers then transplanted the bacteria found in these individuals GI tract into mice that had a sterile (no bacteria) GI tract. After the transplant, all the mice had impaired glucose tolerance. (12)
While more research is needed, the early findings suggest that consumption of artificial sweeteners does affect the beneficial bacteria in our digestive tract. Those with irritable bowel syndrome are thought to already have an altered gut microbiome.(13,14,15,16) Consumption of artificial sweeteners is likely to contribute to a dysbiotic bacterial colony in your GI tract.
Those with irritable bowel syndrome and other gut issues would be wise to limit consumption of artificial sweeteners.
Artificial sweetener’s effect on bowel motility
At the time of this writing, the evidence that artificial sweeteners may cause alterations in GI motility (the rate at which the stool moves through the intestinal tract) is mostly indirect. The research we do have is based on their effects on the secretion of serotonin. You may know serotonin for its role in treating depression. Most antidepressants are called SSRI’s — selective serotonin reuptake inhibitors. Their role is to keep serotonin in your brain. But serotonin is also necessary for regular bowel movements. (17)
Certain artificial sweeteners, sucralose being the most studied, have been shown to cause a delay in the time it takes food to leave your stomach. (18) Additionally, sucralose has been shown to affect the migrating motor complex (MMC). This causes a slowing of stool transit time which contributes to constipation. (19) Those suffering from IBS-C should completely avoid consumption of sucralose.
Additional risks from artificial sweeteners
A study published by the American Diabetes Association showed that daily consumption of diet soda resulted in a 36% increased risk of developing metabolic syndrome. Additionally, there was a 67% greater risk of developing type 2 diabetes when compared to those that did not consume diet soda. (20)
Stroke and Dementia:
A study published in April of 2017 suggested that there was a strong connection between increased risk of having a stroke and/or developing dementia with the consumption of artificial sweeteners. (21) However, this study has recently been refuted as it may not have taken into consideration additional lifestyle factors that can contribute towards strokes and dementia. (22)
While there may not be a causal link between artificial sweeteners and strokes or dementia, there is likely a correlation. If you have a family history of either stroke or dementia, limiting consumption of artificial sweeteners is likely a great idea.
- Granola (look for monk fruit extract)
- English muffins (often contain sucralose)
- Iced tea (bottled varieties often contain sucralose and/or acesulfame K)
- Non-diet ginger ale
- Microwave kettle corn
- Marinated meats at the grocery store
- Toothpaste and mouthwash
- Children’s chewable vitamins
- Cough syrup and liquid medicines
- Chewing gum
- Dehydrated fruits
- No-calorie waters and drinks
- Alcoholic beverages
- Salad dressings
- Frozen yogurt and other frozen desserts
- Baked goods
- Breakfast cereals
- Processed snack foods
- “Lite” or diet fruit juices and beverages
- Prepared meats
- Nicotine gum
Natural alternatives to artificial sweeteners
Fret not, there are many (delicious) natural alternatives you can use in place of artificial sweeteners. Some of my personal favorites include:
- Maple syrup
- Coconut sugar
If you have been diagnosed with irritable bowel syndrome, or, if you suffer from a GI-related illness, removing artificial sweeteners will be in your best interest.
Those with a family history of metabolic disorders like diabetes will also benefit from a diet free from artificial sweeteners.
For the rest of you, modest amounts of artificial sweeteners are likely safe. However, with delicious natural alternatives like maple syrup, there’s really no reason to consume substances like sucralose or aspartame.
Now, I want to hear from you!
What is your favorite sweetener?
Personally, I love maple syrup in my morning coffee ;)
Originally published at Flourish Clinic.