Sucralose vs. sugar: Which is better for your gut health?

  • The continual rise in obesity worldwide has reemphasized the need for healthier sugar substitutes.
  • The past few years have seen various new sugar substitutes become available.
  • Previous research shows some artificial sweeteners can potentially cause health issues.
  • Researchers from the University of Vienna found that consuming the artificial sweetener sucralose did not cause an increase in bacterial endotoxin levels in the body, compared to consuming sugar.

A new study in Austria examined how artificial sweetener sucralose impacts our gut health and found that it may be a safer alternative to consuming sugar.

While sugar substitutes have been popular for some time, the continual rise in global obesity numbers has reemphasized the need for healthier alternatives to the sweet stuff we all enjoy.

The past few years have seen various new sugar substitutes become available, including aspartame, sucralose, erythritol, monk fruit, and stevia leaf extracts.

While the Food and Drug Administration (FDA) approves all sugar substitutes for use in foods, previous research has shown some artificial sweeteners can potentially cause health issues such as increased risk for cardiovascular disease, modifications to the gut microbiome, and depression.

Now, researchers from the University of Vienna in Austria found when consumed, the artificial sweetener sucralose did not cause an increase in bacterial endotoxin levels in the body when compared to consuming sugar, also known as sucrose.

This study was recently published in the journal Nutrients.

What is sucralose? 

Sucralose is an artificial sweetener sold under the name Splenda.

Although sucralose was discovered in 1976, it was not approved in the United States by the FDA until 1998.

Although sucralose does not contain any calories, it is made from a process that starts off by using real sugar. Certain groups in sugar are replaced with chloride atoms. For this reason, most sucralose passes through the body without being broken down, making it zero calories.

Sucralose is known as a high intensity sweetener as it is 600 times sweeter than normal sugar. That means you need less of a sucralose artificial sweetener to create the same sweetness as you would with sugar.

Previous studies show sucralose may help lower body weight compared to sugar and other artificial sweeteners.

However, other research says sucralose may cause negative effects on the body, such as increased insulin resistance and liver inflammation.

Bacterial endotoxins and how it impacts gut health

Endotoxins — also known as lipopolysaccharides — make up about 75% of the outer membrane of the cell walls of gram-negative bacteria.

The endotoxins in the outer membrane help gram-negative bacteria stay extremely resistant to antibiotics and other drugs.

Gram-negative bacteria also have the capability to figure out how to be resistant to drugs and then pass that information on through genetic materials to other bacteria.

E. coli and Salmonella are types of gram-negative bacteria. Gram-negative bacteria are responsible for diseases like pneumonia, urinary tract infections, meningitis, cholera, typhoid fever, and gastrointestinal infections.

When a gram-negative bacteria is destroyed, it releases some of the endotoxins it contains, which can negatively impact the body.

For instance, endotoxins are pyrogens, which when around stimulate the release of proinflammatory cytokines interleukin causing inflammation in the body.

Previous research shows certain foods, such as those high in fat or high in sugar, can increase the levels of endotoxins in the gut microbiome, causing post-meal or metabolic endotoxemia.

Sucrose vs. sucralose: What are the effects on the gut?

For this study, researchers recruited 18 non-smoking participants with a specified Body Mass Index (BMI) range. Only 11 participants reportedly completed the study.

Study participants were asked not to eat intense sweeteners for three weeks before the study. For the study, they were given dietary adjustments based on different nutrition guidelines.

On certain days, the study participants were fed a light breakfast and a drink containing sucrose, sucralose, or a sucralose-maltodextrin blended beverage.

Upon analysis, the researchers reported those who drank the sucrose-sweetened drink had higher bacterial endotoxin levels in their blood plasma compared to those who consumed the sucralose-sweetened or sucralose-maltodextrin blended beverage.

To see if the increase in endotoxin levels in blood plasma was due to changes in intestinal barrier function, the scientists used a model of colon cells. These cells were grown in a membrane dividing an upper and lower chamber. The upper chamber was treated with either sucralose or sucrose and then exposed to bacterial endotoxin. If treatment with the sweeteners affects the intestinal barrier, bacterial endotoxin should pass through the cell layer and be detectable in the lower chamber.

Researchers reported no significant change in bacterial endotoxin levels in the lower chamber when cells were treated with sucralose.

However, when cells were treated with sucrose, there was a significant increase in bacterial endotoxin levels in the lower chamber. Additionally, there was a boost in intestinal fatty acid binding protein (iFABP) concentration, which can be a sign of intestinal barrier disruption.

No conclusive evidence

After reviewing this study, Monique Richard, a registered dietitian nutritionist, owner of Nutrition-In-Sight, and national media spokesperson for the Academy of Nutrition Dietetics told Medical News Today she was struck by how limited the participant sample size was and would have liked more information on the study participants.

“I also observed that 110gm of sucrose was given in a beverage which would equate to a little over 26 teaspoons of sugar, higher than most regular soft drinks,” Richard continued. “The glycemic response, metabolic process, and affected gut health from the cascade of this intense concentration are not necessarily surprising.”

“The findings from this study do not conclusively provide evidence that artificial sweeteners such as sucralose are a ‘better alternative’ to sucrose or that they do not affect a person’s overall metabolic health in other ways — it is much more complex.

It would be important to see a larger sample and specifically gather more standard baseline control factors for the human participants. More research on artificial sweeteners’ impact on satiety, taste-bud and sensory receptors, and neurotransmitter activity in the brain would also be important to explore. A deeper dive into the diversity of gut microbiomes being affected — as we have seen some limited research related to artificial sweeteners affecting diversity — would also be interesting.”

– Monique Richard, registered dietitian nutritionist

Dr. Amy Sapola, Director of Pharmacy at The Chef’s Garden and a certified wellness coach with a degree in nutrition, agreed.

“This study, in particular, needs to be conducted in a much larger population, in type 2 diabetics, and for a longer duration, with daily consumption,” she told Medical News Today. “Overall, I am less interested in advocating for more research dollars going to studying artificial sweeteners, and more interested in this type of funding going to communicating the message that there are many unsweetened beverages that are less expensive and will better support overall health.”

Is there a healthy sugar substitute? 

Richard said whatever sugar substitute you incorporate into your diet is an individual decision.

She recommends asking yourself these questions when considering a beverage with an artificial sweetener or sweetened beverage such as a soft drink, energy drink, or coffee drink:

  • How often am I drinking this? How much am I having? Do I always want more or crave food to eat with it?
  • Do I understand how those ingredients may affect my health?
  • How do I feel after? Do I experience any bloating, gastrointestinal discomfort, or headaches?
  • How may my taste buds be affected? For example, does fruit taste sweet to me? (hint: it is naturally sweet, and should)
  • Is this something that is supporting my nutritional needs or simply for pleasure? Are there better alternatives?

Dr. Sapola said the safest and healthiest beverages and foods you can consume are not artificially sweetened:

“Think about filtered water, sparkling waters, club soda, mineral water, unsweetened non-dairy milk, organic teas, water with fruit squeezed into it,” she detailed. “Instead of going for artificially sweetened foods consider mindfully eating a few bites of the real version of what you are craving — which is often much more satisfying — or try naturally sweet foods such as sweet potatoes, fresh fruit — like bananas, which can also be used to sweeten baked goods — berries, or a 70% or higher good quality dark chocolate, such as Lindt.”

“Also consider pairing naturally sweet foods along with foods that contain fiber, protein, and/or fat in order to slow down the rise in blood glucose,” Dr. Sapola added. “For example, with a sweet potato, eat the skin of the sweet potato (has fiber and phytonutrients), add coconut oil (fat), and pumpkin seeds (vitamins, minerals, fat, and protein).”

“What is important to remember is that the purpose of food — to fuel our bodies — with the highest quality of ingredients we can find should be our focus,” Richard concluded. “When we narrow in on meeting our needs with the appropriate servings of whole foods and natural hydration from quality, not synthetically or artificially manufactured sources, it automatically tends to push out a lot of room for adding unnecessary calories or lower/no-calorie foods with no benefits to our overall health possible.”

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