The introduction of artificial sweeteners into the food supply was seen as a promising way of combatting the obesity epidemic, by providing a sweet taste without the extra calories. These low or no sugar alternatives were thought to lead to a decreased caloric intake, reduced weight gain, and decrease in the incidence of Type 2 Diabetes (1). Individuals with diabetes benefit from their use, to achieve optimum blood glucose control. However, the use of artificial sweeteners is debated across the literature, as there is growing evidence to suggest they increase appetite, calorie consumption, and may not decrease chronic disease risk as originally thought (1, 2).
Sweeteners can be classified into non-nutritive sweeteners (NNS), low calorie sweeteners (LCS) and nutritive sweeteners (NS).
The table below outlines the major classes of sweeteners seen in today’s food supply that are viewed as safe by global leading food regulatory bodies.
| Class | Different names seen | Sweetness compared to regular sugar |
|---|---|---|
| NNS* (1, 3, 4) |
Saccharin Aspartame Acesulfame K Neotame Steviol glucosides Luo Han Guo extracts (monkfruit) |
300% 200% 320-1000% 200% 200-400% 100-250% |
| LCS (4) |
Xylitol Mannitol Sorbitol Erythritol Maltitol Isomalt Lactitol |
100% 50-70% 50-70% 60-80% 75-90% 50% 40% |
| NS (5) |
Sucrose/sugar High fructose corn syrup (HFCS) Agave syrup Maple syrup |
100% 170% |
*Non-nutritive sweeteners may achieve the most appropriate blood glucose control for individuals with diabetes. Speak with your health professional about appropriate sweeteners if you are diabetic.
Sugar alcohols or polyols are the most well-documented sweetener that is relevant for those with IBS. A number of factors affect their absorption including molecular size and dose of the polyol (6). They are slowly absorbed along the length of the small intestine (only about 30% is absorbed), which draws water in and cause symptoms of abdominal distension and diarrhea (6, 7). They may reach the large intestine mainly intact, where gas is produced as a result of bacterial fermentation (6). A study from our Monash University FODMAP team showed that a 10g dose of sorbitol or mannitol significantly increased gastrointestinal symptoms in individuals with IBS compared to healthy controls (7). There is often a disclaimer on polyol sweetened food items such as gums that alerts consumers of laxative effects if the product is consumed in excess (6).
High fructose corn syrup (HFCS) is made from manipulating corn syrup, which is 100% glucose, to increase the fructose content for extra sweetness (5). When the fructose exceeds glucose in HFCS, the fructose is absorbed slowly and becomes problematic for individuals with IBS. HFCS-55, HFCS-80 and HFCS-90 are examples of different HFCS that contain fructose in excess of glucose and should be avoided if sensitive to excess fructose.
There is a growing body of research investigating the effects of non-nutritive sweeteners on the gut microbiome, predominantly from animal models. Mouse fed saccharin in FDA acceptable daily intakes (ADIs) developed glucose intolerance and showed signs of gut dysbiosis in faecal samples (8). This was then further examined and confirmed in the stools of non-diabetic human volunteers who consumed non-nutritive artificial sweeteners (8). Other groups have found changes to the composition of the gut microbiome of animals using different non-nutritive sweeteners, which has not been replicated in human clinical trials (4).
In summary, research into the use of sweeteners for people with IBS are limited to the well-documented effects of polyols. More robust, human clinical trials are needed investigating the effects of sweeteners on the microbiome, to translate the interesting findings seen in animal studies. Although sweeteners are considered safe in the food supply, they generally aren’t used in the setting of a nutrient-dense meal and may encourage the taste for sweet foods. Sweeteners, whether they contain calories or not, are best used as a ‘sometimes’ food.
1. Pearlman M, Obert J, Casey L. The Association Between Artificial Sweeteners and Obesity. Current Gastroenterology Reports. 2017;19(12):64.
2. Liauchonak I, Qorri B, Dawoud F, Riat Y, Szewczuk MR. Non-Nutritive Sweeteners and Their Implications on the Development of Metabolic Syndrome. Nutrients. 2019;11(3):644.
3. Roberts A. The safety and regulatory process for low calorie sweeteners in the United States. Physiology & Behavior. 2016;164(Pt B):439-44.
4. Ruiz-Ojeda FJ, Plaza-Diaz J, Saez-Lara MJ, Gil A. Effects of Sweeteners on the Gut Microbiota: A Review of Experimental Studies and Clinical Trials. Adv Nutr. 2019;10(suppl_1):S31-s48.
5. Fitch C, Keim KS. Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners. Journal of the Academy of Nutrition and Dietetics. 2012;112(5):739-58.
6. Lenhart A, Chey WD. A Systematic Review of the Effects of Polyols on Gastrointestinal Health and Irritable Bowel Syndrome. Advances in nutrition (Bethesda, Md). 2017;8(4):587-96.
7. Yao CK, Tan HL, van Langenberg DR, Barrett JS, Rose R, Liels K, et al. Dietary sorbitol and mannitol: food content and distinct absorption patterns between healthy individuals and patients with irritable bowel syndrome. J Hum Nutr Diet. 2014;27 Suppl 2:263-75.
8. Jotham S, Tal K, David Z, Gili Z-S, Christoph AT, Ori M, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514(7521).
