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Artificial Sweeteners
and Your Gut

by Kelly James-Enger

CAN'T LIVE WITHOUT your diet soda or sugar-free gum? You’re not alone, but while foods with artificial sweeteners may help you maintain your waistline, some of them may wreak havoc on your stomach.

Artificial Sweeteners: More Popular Than Ever

“According to national consumer surveys by the Calorie Control Council, the use of artificially sweetened foods and beverages has soared in the U.S. from 68 million adults in 1984 to 180 million in 2004,” says Victoria Shanta-Retelny, R.D., a registered dietitian at Northwestern Memorial Hospital in Chicago. “From a weight management perspective, people want low-calorie options for their favorite foods like ice cream, cookies, and cake. With 65% of people being obese and overweight in the United States, the need for lower calorie options is essential to not only fight the battle of the bulge, but stave off diabetes, heart disease and certain cancers.” Artificial sweeteners can also help reduce tooth decay and help people with diabetes maintain good blood sugar control.

Artificial sweeteners are found in many foods including carbonated beverages, yogurt, ice cream, salad dressing, gum, candy, baked goods, and ready-to-eat desserts such as puddings and snack cakes. They fall into different categories of artificial sweeteners, each of which has its own properties, says Prabhakar Swaroop, M.D., assistant professor of gastroenterology at St. Louis University. Commonly used artificial sweeteners include saccharin (Sweet ‘N Low), aspartame (NutraSweet and Equal), sucralose (Splenda), acesulfame-K (Sunett), and sugar alcohols such as sorbitol and malitol.

Not So Sweet In Your Stomach

Usually artificial sweeteners don’t cause stomach problems, but sugar alcohols or polyols, a group of artificial sweeteners often used in sugarless gum and candy, can create gastro-intestinal problems. Polyols also may be combined with other sweeteners like aspartame and sucralose in foods including sugar-free baked goods and ice creams.

Polyols include sorbitol, malitol, isomalt, mannitol, xylitol, erythritol, lactitol, and hydrogenated starch hydrolysates. While these substances provide bulk and sweetness like sugar does, they contain fewer calories than sugar (between .2-3 calories/gram compared to 4 calories/gram for sugar.)

Polyols tend to be incompletely absorbed in the intestine, and it’s that lack of absorption that may cause problems. “These sugar alcohols are made up of long chains and our bodies have a hard time breaking them down,” explains Dr. Swaroop. In large amounts, they can cause diarrhea, gas and bloating — what people sometimes refer to as a ‘laxative effect.’ While people’s reactions may vary, sorbitol and mannitol appear to cause the most severe effects.

Another potential problem occurs when your body has too many good bacteria in your small intestine. When this good bacteria goes to work breaking down the sugar alcohols, it can cause excessive bloating and gassiness and diarrhea, especially in people who have Irritable Bowel Syndrome.

Some people may have trouble digesting aspartame if they’re deficient in the enzyme that breaks it down. In a similar fashion, people can lack enzymes that let them break down other sugars such as lactose (the sugar in dairy products) and fructose (the sugar found in fruits and other foods.) As a result, they may have similar symptoms after eating foods that contain these natural sugars.

Identifying Potential Problems

If you have diarrhea, gas or bloating after eating certain foods, Dr. Swaroop recommends that you read food labels to see if they contain sorbitol, malitol, or other sugar alcohols. If a food does contain sugar alcohols and you notice symptoms immediately, it’s likely that you’ve found the culprit as it takes 10-30 minutes for the sugar alcohols to reach the small intestine. An exclusion diet — where you eliminate certain foods for a period of time to see if your symptoms go away — can help you identify potential problems.

And not surprisingly, a healthy overall diet can help you reduce your risk of stomach problems overall. “To make your eating plan a healthy one and to stave off gastric upset, incorporate lower calorie, artificially sweetened foods and beverages with a variety of whole foods, such as fruits, vegetables, whole grains, low-fat dairy and lean protein,” says Shanta-Retelny. “By making artificially sweetened foods a piece of the overall nutrition scheme, people will lose or maintain body weight better, control blood sugar better, and keep teeth healthy for life.” •

from the January-February 2010 issue

COMMONLY USED
ARTIFICIAL SWEETENERS
saccharin
(Sweet ‘N Low)
aspartame
(NutraSweet and Equal)
sucralose
(Splenda)
acesulfame-K
(Sunett)
sugar alcohols
such as
sorbitol and malitol
If you have diarrhea,
gas or bloating
after eating certain foods,
read food labels
to see if they contain
sorbitol, malitol,
or other sugar alcohols.