Effect of Sucralose (Splenda) on the Microbiome

Effect of Sucralose (Splenda) on the Microbiome
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What effect do artificial sweeteners such as sucralose (Splenda), saccharin (Sweet & Low), aspartame (Nutrasweet), and acesulfame K (Sweet One) have on our gut bacteria?

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On April Fool’s Day, 1998, the FDA approved the artificial sweetener sucralose, aka one-six-dichloro-one-six-di-deoxy-beta-D-fructo-furanosyl-four-chloro-four-deoxy-alpha-D-galacto-pyranoside, but despite its scary name, the worst it seemed to do was just be a rare migraine trigger in susceptible individuals. To which the manufacturer of sucralose replied that you have to weigh whatever risk there may be against its broader health benefits, helping to mitigate the health risks associated with our national epidemic of obesity.

That’s what the hope was, to provide a healthy sugar substitute to provide a sweet taste without the calories or spikes in blood sugar. However, that’s not how it appears to have turned out, with population studies tying consumption of artificial sweeteners, mainly in diet sodas, with increased risk of developing obesity, metabolic syndrome, and type 2 diabetes. But an association is not causation. You’ve got to put it to the test. If you give obese individuals the amount of sucralose found in like a can of diet soda, they get a significantly higher blood sugar spike in response to a sugar challenge, requiring significantly more insulin – 20% higher insulin levels in the blood – suggesting sucralose causes insulin resistance, potentially helping to explain the links between artificial sweetener consumption and the development of diabetes, heart disease, and stroke. So, sucralose is not like some inert substance, but affects the blood sugar response. But how?

The Splenda company emphasizes that sucralose is hardly even absorbed into the body and, so, stays in the digestive tract to be quickly eliminated from the body. But the fact that it’s not absorbed in the small intestine means it makes it down to the large intestine and may affect our gut flora. There had been studies done on artificial sweeteners and the gut bacteria of rats going back years, but there had never been any human studies… until now. They tested saccharin, sucralose, and aspartame, the artificial sweeteners in Sweet & Low, Splenda, and NutraSweet, and found that non-caloric artificial sweeteners induce glucose intolerance by altering the microbes in the gut. The human studies were limited, but after a few days on saccharin, for example, some people got exaggerated blood sugar responses tied to changes over just one week to the type of bacteria they had in their gut.

Acesulfame K, another common artificial sweetener, was also found subsequently to be associated with changes in gut bacteria. So, all this time, artificial sweeteners were meant to stave off chronic diseases but may actually have been contributing to the problem due to microbial alterations. Some in the scientific community were surprised that even minor concentrations of a sweetener—they’re talking about aspartame here—are sufficient to cause substantial changes in gut inhabitants. Others were less surprised. Each molecule of aspartame is metabolized into formaldehyde. That may be why some people who are allergic to formaldehyde have such bad reactions to the stuff. Therefore, it’s not unexpected that even small amounts might modify bacterial communities.  There are mixed reports about the safety of aspartame. All of the studies funded by the industry vouch for its safety, whereas 90% of independently funded studies report that aspartame can cause adverse health effects. That should tell you something.

Undoubtedly, consumers of these food additives, which are otherwise perceived as safe, are unaware that these substances may influence their gut bacteria. This may be of particular importance to patients with diseases correlated with modifications of the gut bacteria, such as inflammatory bowel diseases, like ulcerative colitis and Crohn’s disease. These individuals may not realize artificial sweeteners may be affecting their gut. Might the effect be large enough to actually cause changes in the incidence of inflammatory bowel disease? Canada was the first country to approve the use of sucralose—what happened to their rates of IBD? Rates did seem to double after the approval of sucralose. What about in the United States? After decades of stable rates of ulcerative colitis and Crohn’s disease, rates started to go up. In China, after the approval of sucralose, IBD rates rose 12-fold. Again, these could just be total flukes, but such correlations were also found on two other continents as well.  The more graphs that you see like this, the harder it is to dismiss a possible connection.

The good news, though, is that after stopping artificial sweeteners, the original balance of gut bacteria may be restored within weeks. Now, of course, the negative consequences of artificial sweeteners should not be interpreted to suggest that we should all go back to sugar and high fructose corn syrup. For optimal health, it is recommended that we all try to cut down on both.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Dave Crosby via Flickr.

On April Fool’s Day, 1998, the FDA approved the artificial sweetener sucralose, aka one-six-dichloro-one-six-di-deoxy-beta-D-fructo-furanosyl-four-chloro-four-deoxy-alpha-D-galacto-pyranoside, but despite its scary name, the worst it seemed to do was just be a rare migraine trigger in susceptible individuals. To which the manufacturer of sucralose replied that you have to weigh whatever risk there may be against its broader health benefits, helping to mitigate the health risks associated with our national epidemic of obesity.

That’s what the hope was, to provide a healthy sugar substitute to provide a sweet taste without the calories or spikes in blood sugar. However, that’s not how it appears to have turned out, with population studies tying consumption of artificial sweeteners, mainly in diet sodas, with increased risk of developing obesity, metabolic syndrome, and type 2 diabetes. But an association is not causation. You’ve got to put it to the test. If you give obese individuals the amount of sucralose found in like a can of diet soda, they get a significantly higher blood sugar spike in response to a sugar challenge, requiring significantly more insulin – 20% higher insulin levels in the blood – suggesting sucralose causes insulin resistance, potentially helping to explain the links between artificial sweetener consumption and the development of diabetes, heart disease, and stroke. So, sucralose is not like some inert substance, but affects the blood sugar response. But how?

The Splenda company emphasizes that sucralose is hardly even absorbed into the body and, so, stays in the digestive tract to be quickly eliminated from the body. But the fact that it’s not absorbed in the small intestine means it makes it down to the large intestine and may affect our gut flora. There had been studies done on artificial sweeteners and the gut bacteria of rats going back years, but there had never been any human studies… until now. They tested saccharin, sucralose, and aspartame, the artificial sweeteners in Sweet & Low, Splenda, and NutraSweet, and found that non-caloric artificial sweeteners induce glucose intolerance by altering the microbes in the gut. The human studies were limited, but after a few days on saccharin, for example, some people got exaggerated blood sugar responses tied to changes over just one week to the type of bacteria they had in their gut.

Acesulfame K, another common artificial sweetener, was also found subsequently to be associated with changes in gut bacteria. So, all this time, artificial sweeteners were meant to stave off chronic diseases but may actually have been contributing to the problem due to microbial alterations. Some in the scientific community were surprised that even minor concentrations of a sweetener—they’re talking about aspartame here—are sufficient to cause substantial changes in gut inhabitants. Others were less surprised. Each molecule of aspartame is metabolized into formaldehyde. That may be why some people who are allergic to formaldehyde have such bad reactions to the stuff. Therefore, it’s not unexpected that even small amounts might modify bacterial communities.  There are mixed reports about the safety of aspartame. All of the studies funded by the industry vouch for its safety, whereas 90% of independently funded studies report that aspartame can cause adverse health effects. That should tell you something.

Undoubtedly, consumers of these food additives, which are otherwise perceived as safe, are unaware that these substances may influence their gut bacteria. This may be of particular importance to patients with diseases correlated with modifications of the gut bacteria, such as inflammatory bowel diseases, like ulcerative colitis and Crohn’s disease. These individuals may not realize artificial sweeteners may be affecting their gut. Might the effect be large enough to actually cause changes in the incidence of inflammatory bowel disease? Canada was the first country to approve the use of sucralose—what happened to their rates of IBD? Rates did seem to double after the approval of sucralose. What about in the United States? After decades of stable rates of ulcerative colitis and Crohn’s disease, rates started to go up. In China, after the approval of sucralose, IBD rates rose 12-fold. Again, these could just be total flukes, but such correlations were also found on two other continents as well.  The more graphs that you see like this, the harder it is to dismiss a possible connection.

The good news, though, is that after stopping artificial sweeteners, the original balance of gut bacteria may be restored within weeks. Now, of course, the negative consequences of artificial sweeteners should not be interpreted to suggest that we should all go back to sugar and high fructose corn syrup. For optimal health, it is recommended that we all try to cut down on both.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Dave Crosby via Flickr.

134 responses to “Effect of Sucralose (Splenda) on the Microbiome

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      1. This is inappropriate. Please leave politics to the political forums. This is not the place for these types of political propaganda video.




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        1. guest: The video is about economics, not politics. And what do you consider all the talk in these comments about corporate greed and snide remarks about capitalism.




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          1. After watching hundreds of the videos here, and reading hundreds of the blog postw, I take STRONG issue with your statement regarding “snide remarks about capitalism”. While food companies are called out for their egregious behavior that is risks human health, they are not called out for wanting to make a return on their invested capital, The problem with big food companies is not that they are capitalists. The problem is they are continuing to make claims about the safety of their products even after they have reason to believe those claims may not be true, and they are continuing to falsely mislead the public and their regulators about those claims. I am personally a strong believer in capitalism and free enterprise, and in the fair and effective regulation of any company that sells food products that may endanger the health and safety of public. I hardly think of those as mutually exclusive beliefs.




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      2. >50% of capitalism is great and positive. But there is a huge % that is destructive & negative and I am not just talking about child prostitution & kid porn, crack cocaine, Splenda, secret Genetically Engineered fruits, nuts and vegetables, underground animal concentration torture factories, the meat dairy & egg industry advertisements & propaganda, the coming nuclear bomb suitcase industry, etc….. but also lobbyists, kickbacks, corruption in Government, etc… & not only in USA but everywhere else too including Islamic states.




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  1. What do you expect from a chemical that was originally being developed as an insecticide?:
    https://thepeopleschemist.com/splenda-the-artificial-sweetener-that-explodes-internally/

    “Unlike ionic bonds, covalently bound chlorine atoms are a big no-no for the human body. They yield insecticides, pesticides, and herbicides – not something you want in the lunch box of your precious child. It’s therefore no surprise that the originators of sucralose, chemists Hough and Phadnis, were attempting to design new insecticides when they discovered it! It wasn’t until the young Phadnis accidentally tasted his new “insecticide” that he learned it was sweet. And because sugars are more profitable than insecticides, the whole insecticide idea got canned and a new sweetener called Splenda got packaged.”




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    1. Well the good thing about Aspartame is, if one ingests enough of it, they will not have to worry about a retirement plan, and if there are any spiders in their body, they will die also ! Gee, what a great product. It takes care of the over population and kills bugs in your body as well. Let’s hear it for Monsanto, and the like. Isn’t capitalism without limits a wonderful thing. Now where did I leave my Rolls Royce !




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      1. Formaldehyde is the active ingredient in embalming fluid, so those who use aspartame wouldn’t need embalming either when they died; they get embalmed slowly while alive.




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        1. Great, now I have some advice for when I try to pass on some important health facts and get flipped off with, “Ah something is gonna kill ya.”




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      2. One of my neighbor has cancer, going through chemo but still smoking. She told me that she knows she shouldn’t smoke, but… I didn’t say anything but was thinking that she probably doesn’t have to worry about her retirement plan. I certainly hope she will be OK but, Allen Cohen, I appreciate your post and your sense of humor!




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    2. My favorite story about sucralose is when they first cobbled it together and the chemist’s boss told him to “test” it, and he thought he was instructed to “taste” it. Hey, it could happen. :P




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  2. I know that it’s a different thing altogether, but stevia is becoming more and more prevalent—is much known much about its health effects?




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        1. It was traditionally used by the Natives of Paraguay as a birth control drug, so my wife and I stopped using it when we were trying to get her pregnant. Warning to all in such a way.




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    1. Good question, two great ways to add a little sweetness to an amazing breakfast of oatmeal is molasses or date sugar which is just dried dates, alternatively dried fruit can add a bit of a sugar kick. Dr Greger has a great page on sugar, with lots of links and videos to explore, I have added it below. This may help answer all your questions on the health impacts of sugar

      sugar




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      1. I’ve become a big fan of molasses as a result of Dr. Greger’s report. I make a delicious latte every morning using coffee, soymilk, pumpkin pie spice, molasses and cayenne pepper. Just be sure it is blackstrap molasses. There is a big difference in nutritional value between it and regular molasses as well as between brands. Regular molasses has around 130 mg. of potassium per tbsp.whereas the blackstrap I’m using has a whopping 720 mg. Blackstrap is also a significant source of magnesium, calcium and iron and interestingly has less sugar than plain molasses.




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      2. The “sugar” hyperlink associated with the comment “Daniel K. Morris- NF moderator March 14th, 2016 at 10:17 am” is broken. I tried to place this, my comment , immediately under his comment, but it repeatedly failed to appear there. That is why you may find it here: far removed from it’s parent comment. Maybe this misbehavior is due to my cheap Android 5.1 phone.




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        1. Paul Schneider: It’s not you or your phone – it’s our poorly designed commenting system. When you first do a reply, you have to enter it at the bottom of the page. But when you come back to the page, you should see the post underneath the comment you are replying to. When I look now, your comment is under Daniel’s comment.

          Sadly, however, your comment will not likely reach Daniel, also because of this forum system. I’ve been told that we will get improvements to the new forum system when a new version of this NutritionFacts site is rolled out — hopefully in the not too distant future. You could try posting again then…




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    2. In the “Unsweetening the Diet,” http://nutritionfacts.org/video/unsweetening-the-diet/ ,

      Dr Greger points out a dynamic that I have noticed, and perhaps, you have too. After making a dietary change, your taste buds take a few weeks to adjust to the new normal, but after they do, everything tastes just fine, and your old way of eating taste strange, too sweet, too salty, too oily, etc.

      I find that a ripe banana or some other sweet fruit in my morning porridge to be very satisfying, and its sweetness comes with real nutritional value. Something one does not find in refined sweeteners.




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      1. I put 6 oz of frozen cranberries in the blender, fill with water to 4 cups, and blend away.That’s my breakfast juice. As you can imagine, it was extremely tart at first and not very pleasant tasting at all. After drinking this daily for several months I can honestly say that I really like it now. Something I never thought would happen when I first started drinking it. This demonstrated conclusively that “taste” is entirely conditioned. Whatever you’re used to eating is what “tastes” good to you. More reason to choose a WFPB diet.




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        1. Why confine it to a single type of berry? I get an excellent organic frozen berry combo at Costco: blueberries, blackberries, strawberries, and pomegranate seeds.




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          1. Psych MD: I, too, get those frozen berry combos at Costco. They make a great smoothie. I’ve always wondered, though, if eating all those blackberry seeds is healthy. I would think that they’re indigestible, so couldn’t they easily get lodged in the colon?




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              1. Psych MD: Very informative video, although those pictures of diverticulosis are scary ;-) It’s looks like it’s safe to eat nuts and seed regardless if one has diverticulosis or not, so I’ll continue with the blackberries. Thanks for pointing out the video. I had forgotten to do a search. This website has so much great information, and a search usually turns up something of value on almost any topic!




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          2. I eat other berries too. From what I read in “How Not to Die”, and this website, they are the best of the best. But as I remember, cranberries were the top cancer fighters in at least one study. So I definitely want to eat my cranberries every day. And if that’s not enough, frozen cranberries are really cheap. $1.67 for a 12 oz bag. That clinches it for me.




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  3. I would like to ask the community about whether there are examples of synthetic chemicals unavailable in foods, that truly pass the test of being helpful to the body. Like most WFPB advocates, I am deeply suspicious of putting anything developed in a lab for profit into my body. (We evolved in parallel to the natural foods we eat. We were made for each other!)

    I recently began experimenting with taking SAM-e for depression. I am having very good results, but I am nervous about the fact that it is a chemical and not a food.




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    1. SAM-e seems to be a natural substance produced in our liver. The Mayo clinic website has a monograph which goes into a great deal of detail, including data on efficacy, doses etc. It does say there can be interactions with other medications. I was struck by the fact that duration of therapy is nowhere mentioned, and whether taking this substance would suppress the body’s own ability to produce it, whether there would be any rebound or difficulty when one stops (such as happens with steroids, where the adrenal glands can become suppressed.) Personally I think depression is a multidimensional kind of thing (not only chemical) and it is only in the last decades that treatments have been primarily chemical i.e. medications which improve mood. Even the use of exercise which can be as effective as medication is still in a way treating symptoms. Not a bad thing in itself but apart from the physical aspect, sometimes a depression can be a call to change something in one’s life, and therapy or counselling can be a tool to help one reflect or see where things are stuck. I am just wary of a reductionist approach (not saying that you have one or that addressing depression from the chemical side is wrong) Hope that is helpful.




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    2. Thanks for the replies. Any other examples of non-food source substances/chemicals (regardless of whether they occur naturally in the body), that are indisputably helpful/healthful? I hope this is at least marginally on-topic.




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    3. George is correct, SAM-E is involved in methylation. People who have a single nucleotide polymorphism (SNP) on the MTHFR gene can have impaired synthesis of some neurotransmitters due to impaired methylation. It is speculated that supplementing SAM-E in these individuals increases levels of the neurotransmitter serotonin.




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  4. Such garbage will continue to be developed, packaged, and sold/purchased so long as folks believe that reducing caloric intake (only) is going to help them control their weight.

    Calorie counting has been proven over and over again to be useless in the quest for long-term weight reduction. But if that bell could be un-rung, if that fact could be known by the masses, then there’d be no market for the fake sweets we have today.

    Talk about addiction and denial/defense, just TRY to get one Diet Soda user to give up his/her little can/bottle of joy. They hang on to that “habit” like a dog hangs onto a new chew toy.

    I gave up “full flavor” sodas to go WFPB, and now they are so sweet I couldn’t drink one. I didn’t quit them for caloric reasons either. I drink coffee, tea, and water and have become skinny. My co-workers drink diet soda and diet tea and are obese.

    The only skinny gals I’ve ever seen “drinking” a diet soda did it while filming a commercial as paid actresses.




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    1. It’s funny that you mention addiction in reference to
      diet sodas. Ten years ago I would have
      laughed at your assertion. Not
      today. I once worked with someone who
      had to have her diet coke every day.
      Once, on a trip to NYC, a planned walk turned into a hunt for a store,
      vendor or soda machine that sold diet coke. It was ll she could think about.
      She had to get her fix.

      Since that day, I have noticed many co-workers who ALWAYS
      have a diet soda with them. And yes,
      they are almost always obese.




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      1. I know that… I am an avid “consumer” of everything nutritionfacts.org, I’ve read the book and watched pretty much all the videos, so no need to redirect me. That’s why my question was is it “still” safe? Meaning, “are there any newer updates on the data we have so far?”. Thanks anyway @danielkmorris:disqus !




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  5. I am sorry to say that Aspartame is a poison, and the mfg is well aware of it, but profits are the only thing that is important to these companies. If it kills someone, soooooo, tough !




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  6. This is Allen again. If someone is diabetic or obese and they do not wish to ingest these make believe sweeteners, why not simply not use any of them !




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    1. “Agave syrup has been marketed as a “healthful” sweetener, but this fact has been the subject of criticism due to its very high fructose content (which is even more than high fructose corn syrup in its fructose content by weight) and its potential to lead to insulin resistance and significantly increased triglyceride levels (a risk factor for heart disease).” https://en.wikipedia.org/wiki/Agave_nectar




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    1. Not particularly. It is dose dependent. Stevia can be harmful if one consumes more than two servings of it.
      In “Is Stevia Good For You?,” http://nutritionfacts.org/video/is-stevia-good-for-you/ , Dr. Greger notes:

      “we know that when we eat stevia, mutagenic compounds are produced in our colons and absorbed into our bloodstream. The only remaining question was, how much?” AND

      “as long as you only drink, like, two stevia-sweetened beverages a day, it can be considered harmless.”

      The question is, why would anyone want to absorb any mutagenic compounds into their bodies?




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    1. Date sugar and molasses seem to be the healthiest sweeteners. (Date sugar being just ground up dried dates, which still contains fiber). It is still sugar and doesn’t have that much else going for it, but it is probably ok as long as it doesn’t make up a big proportion of the daily calories. You can see Dr Greger’s video “The Healthiest Sweetner”http://nutritionfacts.org/video/the-healthiest-sweetener/




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        1. Yes, I am not saying dates are not a good food, but they would be the side dish or desert, not the main course. I absolutely love them!




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    1. This paper looks at the link between the microbiome and metabolic syndrome.

      “Possible pathways include involvement with energy homeostasis and metabolic processes, modulation of inflammatory signaling pathways, interferences with the immune system, and interference with the renin-angiotensin system.”




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      1. Thanks so much. Like kale, is there anything the gut flora can’t do?! Or akin to inflammation as the common denominator for so many maladies, gut flora seems to be even earlier on the etiological (causation) chain. I am experiencing the sense of responsibility felt by a pregnant woman (eating for two), but I’m eating for trillions.




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        1. re”Eating for two” Funny guy! I got to the end of your post and had a little laugh. :-) Now men too can understand what it is like to feel such grave responsibility! ;-)




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          1. Truth be told, I was not jealous of my wife’s pregnancies (better her than me), but I was jealous of her ability to nurse and nurture the babies, a special kind of closeness that the papa just cannot experience. But now I see that there was no reason to be jealous. I’ve always had my own brood to nurture and pamper.

            To be serious for a moment, this insight is quite profound for me. Better than the (existential) “you are what you eat,” or what I preferred, “we are made of food,” way of expressing the importance of healthy eating, the metaphor of nurturing the body and all those living organisms upon which good health depends every time I put a fork in my mouth is about relationships, which I find to be deeper and more motivating. Serious or silly, I’m not sure.




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            1. Not silly to me. In fact, this may very well act as another strong motivator for me to really make count what I put into my mouth. When we start treating our gut bacteria as partners and focus on the powerful role they play in our well being, it gives our food choices even more relevance. “If you do them trillions wrong, they can do you in.” Thanks for a great thought and a chuckle, Steve.




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  7. Not so hard to fathom, my experience and others I know sure bears it out. The whole carbophobia ploy came crashing down when I learned about the Kempner rice diet. A “bit” extreme but it really drives home that carbs and even sugar are NOT the enemy of diabetics! Not that I think sugar is a nutrient either and mostly avoid it, but it used to be the poison to avoid at all costs, especially diabetics! We eat WAY too much of those empty calories and do not need them, but a tsp in your morning beverage isn’t as lethal as a tsp of unpronounceable chemicals!




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    1. Well said. The devil’s in the dose. What worked for me was eating the same exact foods for a few days eating NO sugar, waiting a day, and then eating those exact same foods and incorporating around 40 grams of organic sugar in a natural sweet. This way you see how the body responds, but you have to really dial in on your awareness to your body. Sugar for me just doesn’t work. It makes me lethargic, gives me brain fog, and probably sets off many detox pathways for the body to try and get back into balance. If your really aware of how your body reacts, you’ll probably come to the conclusion that any food/chemical man messes around with, usually always for money, will cause the body to jump through many hoops to try and detox it out of the system.




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      1. Oh don’t get me on my soapbox about man and chemical pollution, planetary destruction, greed and other of those types of charming disasters! I’m older and try to take care of myself, butI have grandkids who have their whole lives ahead of them and forced to deal with this horrendous nightmare, it infuriates me no end! I thought our species is supposed to have advanced intellect? Here in S FL I recently learned that they are dumping glyphosate into the canals to bastardize nature, ahem, control weeds, those dastardly evil greens that must be banished with poisons! I am livid, my well is deep but not so far away. We live out in the sticks and I thought we were pretty safe from most of those issues. Ha, thought wrong again! You can run but ya can’t hide, huh?




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  8. At about 1:30 on this video, the graphs seem to show that plain ol’ water significantly raises the blood sugar level- almost as much as these bad sweetening chemicals. Is this true? If so, how? does this mean that we should stop drinking water in between meals?




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    1. Very observant of you Rodger! In the experiment the groups were given either sucralose or plain water, followed by an identical glucose load. The blood sugar levels went higher in the sucralose-plus-sugar group then in the water-plus-sugar group. The blood insulin levels were also 20% higher in the sucralose-plus-sugar group. The aim of the experiment was to try to understand the effect of sucralose on how the body handles sugar, based on the knowledge that artificial sweetener ingestion is associated with an increase in obesity and diabetes. What is interesting to me is that later in video, it is stated that the insulin resistance is a result of changes in the gut microflora which can be seen after a week of artificial sweetener ingestion. I personally think a change in gut microflora would not occur after a single dose, so there may be a different mechanism responsible for the changes shown in the graphs.




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  9. Anyone have information about using xylose as a sweetener? My diabetic partner has been using it for some time as a sweetener.




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    1. Xylose actually is a sugar (5 carbon based) which is only partially absorbed by the intestines and then excreted in the urine. Do you mean xylitol? This is also a naturally occurring sugar, which, like other sugar-alcohols (including glycerol, mannitol, sorbitol) is poorly absorbed. The American diabetic Association says these contain fewer calories than ordinary sugar and less of an effect on blood sugar. Because of poor absorbtion they can contribute to diarrhea, also to flatulence according to Dr Greger’s video herehttp://nutritionfacts.org/2011/12/05/beans-and-gas-clearing-the-air/




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      1. please accept my apologies for my tardiness in replying. I didn’t know that Xylitol was a sugar, but it seems to be well tolerated by both my partner and myself as we still keep the sweet stuff to a minimum. It is a bit expensive but we both dislike the aftertaste of Stevia. Thanks for the info.




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    1. Great question!

      In this video from 2009, Dr. Greger discusses eryrhritol.
      “Harmless. Found naturally in pears, melons, and grapes, absorbed in the intestine so it doesn’t have a laxative effect, and it’s excreted virtually unchanged in the urine.”

      In this video from 2012, Dr. Greger elaborates to describe the anti-oxidant effects of erythritol and so Dr. Greger moves the sweetner from being classified as harmless to helpful.




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  10. I use the herb stevia, it took a while to get used to and doesent work in all cases, but gives me the fun of ‘sweet’ without damage when I use it.




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  11. Have you heard of the practice of “oil pulling” (the practice of “pulling” oil – usually coconut oil -back and forth in your mouth for 20 minutes or so) to control bacteria? If so what do you think about this practice?




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    1. Dr. Greger has not commented on this practice. Premilinary studies that I looked at seem to suggest that the practice can be helpful in mild gingivitis, halitosis, and controling the microbes associated with these conditions. More research is needed to answer the question definitively.




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    1. Great question!

      Erythritol is non-caloric and does not effect blood sugar levels.
      This small study looked in to the question you asked.

      Also, take a look at my earlier comment linking to some Dr. Greger videos. In this video, Dr. Greger describes the antioxidant effects of Erythritol as reported in this study.




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      1. “In the streptozotocin diabetic rat, erythritol displayed an endothelium-protective effect…” The second was a rat study. Although so far, so good, still may be best to limit this along with all sugar substitutes.




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    1. Glycerin is absorbed by the gut efficiently and it occurs naturally in the body as a component of many lipids. The body can even use it to make glucose under conditions of starvation. Xylitol is poorly absorbed by the gut, so most of it ends up in the colon and processed by the bacteria, which is why some people get tummy trouble when they consume xylitol, but I don’t know if xylitol causes more than just tummy trouble.




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    2. In this video, Dr. Greger recommended against the use of xylitol, stating “Unlike erythritol, these other sugar alcohols are not absorbed and so they draw fluid into your colon and can have a laxative effect.”




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      1. David, that video on prebiotics, which discusses that inadequate fiber is a possible cause of inflammatory bowel disease (i.e. Crohn’s and ulcerative colitis), is just amazing. I will share it with my favorite gastroenterologist. Thank you for sharing the link!!




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  12. A few days ago numerous articles appeared in the new about a recent study findings that sucralose appears to increase cancer/leukemia risks. Articles can be found by going to news.google.com and entering either sucralose or splenda in the search box.

    Even though erythritol is believed to be safe, I worry that maybe we just haven’t yet discovered that it’s a problem. I used a little of it several days a week, but I think that I’m going to just go back to my days of using fruit only to sweeten my oatmeal, and I can’t use dates because they give me acid reflux :(. Seems like everything refined (oils and carbs), concentrated (juices), man-made (synthetic vitamin, preservatives and additives), or just generally processed, ends up having health consequences.

    Mark G.




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  13. Dr. Greger has commented favorably on erythritol, one of a class of naturally occurring sugar alcohols used in lower calorie foods. Sugar alcohols are poorly absorbed, but some are fermented by the colonic microbiota into beneficial short chain fatty acids, and are candidate prebiotics (compounds that beneficially modulate the microbiota). How do these fare?

    In batch fecal culture, erythritol, maltitol, lactitol, and sorbitol markedly increased SCFA production, with minor effects on bacterial fractions (1). Xylitol, the best studied sugar alcohol, increases SCFA production in a colon simulator (2). In rats, xylitol improves viceral fat and plasma lipids and insulin (3), muscle glucose uptake (4), prevents insulin resistance (5), and improvs pancreatic islet pathology (6). Lactitol is a prebiotic candidate (7) and inreases SCFA production in healthy adults (8). In rats, sorbitol selectively enriched (good) lactobacilli (9), while maltitol had prebiotic effects (10). Erythritol may have the most neutral effects of the sugar alcohols, as it’s not fermented by the human gut microbiota (11).

    Most sugar alcohols appear to have prebiotic effects not shared by other low-calorie sweeteners, and xylitol appears to merit a longer term trial in humans.

    Personally, I simply avoid sweetened foods. The taste buds adapt, and now a ripe tomato or other fruit is so much more delicious.




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  14. I take a B12 pill (under the tongue) that has manitol and sucralose in it. It sounds like even small doses could be harmful. Are there any alternative B12 pills without artificial sweeteners?




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    1. Oh dear. I just looked at the ingredient list of my own sublingual B12 supplement and it has the same two ingredients. I will be replacing them this week.
      I am usually a scrupulous label reader. I missed that one.
      Thank you for the heads up Kathryn.




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      1. After seeing your post and Kathryn’s, I checked mine and found that it has manitol, xylitol, and stevia. My guess is that all sublingual B12 products have artificial sweeteners, but I’m going to search for one without the crap. Let’s keep the community informed of our findings Thank you both for the alert.




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  15. what about highly processed stevia? Can that be considered a “natural ” sweetener, or does that also have side effects not present in simple ground stevia leaf??




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    1. Thanks for your question Rosemary! I am a Registered Dietitian and I have recently joined NF as a Moderator.

      According to the FDA, all stevia products sold in the US are ultra-processed and so far there has been no objection to its use. On the other hand, unrefined whole Stevia leaf has not been approved because there are “concerns over control of blood sugar and effects on the reproductive, cardiovascular, and renal systems”.

      Dr Greger addresses stevia in a previous video, however, it is from 2010. Today, we know that stevia has many applications, including health promoting properties but further research is required to determine interactions of stevia metabolites with food components and to corroborate the Acceptable Daily Intake (ADI) of this food additive (1, 2).

      Also, it’s worth noting that ADI for sterol equivalents is 4 mg/kg of body weight per day. This equates to approximately 12 mg of high-purity stevia extracts/kg of body weight per day (3)

      Hope this answer helps!




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  16. Splenda has contributed to the hypoglycemia epidemic. Some sugar might be good for you. The body, on artificial sweetener, has to store insulin, in my opinion.




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    1. Thanks for your question! I am a Registered Dietitian and I have recently joined NF as a Moderator.

      Dr Greger addresses stevia in a previous video, however, it is from 2010. Today, we know that stevia has many applications, including health promoting properties but further research is required to determine interactions of stevia metabolites with food components and to corroborate the acceptable daily intake of this food additive (1, 2).

      Also, it’s worth noting that The Acceptable Daily Intake (ADI) for sterol equivalents is set at 4 mg/kg of body weight per day. This equates to approximately 12 mg of high-purity stevia extracts/kg of body weight per day (3)

      Hope this answer helps!




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  17. Dear Folks, Dear Mr. Greger MD, Dear all helpers of Mr. Greger – please help me not to go crazy. I try for weeks now to get any B12 (1000µg) sublingual without any sugar or artificial sugar, without stearic acids, without artificial or nature identical aroma or other scary stuff inside.
    I would appreciate every hint – Thank you soooooooo much.




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    1. Good Question KathyKale! I’m not finding any information specific to Stevia powder on NutritionFacts.org but in Dr. Greger’s new book “How Not to Die” on page389 he cites the World Health Organization’s statement that “up to 1.8mg of stevia compounds per pound of body weight to be a safe amount.” Since he uses the word “compounds” I would assess that to include Stevia powder. Dr. Greger goes on to say that “if we sweetened everything with stevia we could exceed that safety limit but drinking one or two stevia-sweetened beverages a day should be considered harmless.” The citation for the study behind this statement is the “Joint FAO/WHO Expert Committee on Food Additives. Evaluation of certain food additives. World Health Organ.Tech Rep Ser. 2009;(952):1-208.” I hope this helps a little.




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    1. I’m sorry Jennifer, I’m not finding any information on NutritionFacts.org about this particular sweetner, nor is it mentioned in Dr. Greger’s book. I’ll leave your question open for another NFModerator who might be more familiar with this product and the evidence base behind it. You might be interested to know that the sweetner Dr. Greger lists as one that could be used to make consumption of green-light foods like grapefruit and cranberries easier is erythritol. If you type “erythritol” into the search box at the top of the NutritionFacts.org page you will see several videos to provide you with additional information. Thank you for your question!




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  18. Is stevia safe? I have been trying to cross over from Splenda because I read that Stevia is a plant derived natural sweetener.
    Also – does anyone know if either aspartame or Splenda cause skin rash? I have switched to a lacto-ovo vegetarian diet since May of last year – but I am still having issue with a skin irritation and trying to find the right fix thru plant based eating.




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  19. Thanks Doctor Greger. I Just got back from my grocery shopping and was amazed to see a lot of icecreams touting low fat, no sugar lable with a tiny picture stating “sweetened with splenda” . How many people are thinking they do not consume “artificial sweetners” when infact they unknowingly are .




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  20. I don’t eat artificial sweeteners, but I admit to having sugarless gum anytime after meals or coffee, as I was told this was a good way to neutralize acids and clean teeth without damaging enamel. I am now questioning this “wisdom” and wondering if I should be cutting down or eliminating it entirely. Does anyone have expertise on this?




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  21. If sugar alchohol affects intestinal flora negatively, why doesn’t erythritol also affect intestinal flora negatively?




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  22. I was just looking at an article on the Pritikin website about artificial sweeteners that totally glossed over the drawbacks and basically said they are fine in moderation, which I know not to be true, for me anyway…and you just enlightened us on some of the many drawbacks. I hate when a website has no option for comment or questions, it makes it seem like like their agenda is set in stone and I lose respect. After seeing a recipe for “healthy” chicken, I really lost faith. The whole philosophy of pandering to the lowest common denominator is what got me sick in the first place, give me the FACTS and let me decide, thanks Dr G!




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  23. So what’s worse, sucralose or sucrose, in the same amounts of sweetness?

    I can’t seem to avoid both, so better go for the lesser of two evils.




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