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Lupus and Artificial Sweeteners

Artificial sweeteners have become a prevalent way to reduce sugar and its potentially harmful effects.  Yet, is there a downside to consuming artificial sweeteners for someone living with lupus?  Read on to find out.

 

Introduction: 

Artificial sweeteners are sometimes called non-nutritive sweeteners (NNS), because they provide the sensation of a sweet taste without adding calories (or any other nutritional value) to a person’s diet.  They include chemicals, like the saccharine (Sweet ‘N Low), aspartame (NutraSweet and Equal), stevia and erythritol, which are often found in low calorie or zero calorie foods and diet drinks.

Here are some important things to consider regarding sugar, artificial sweeteners and lupus:

  • Refined sugar has been found to cause a wide variety of health problems and
  • Artificial sweeteners are a popular sugar replacement.  However, if too much is consumed, there are some health effects to consider.
  • It is recommended that those living with lupus limit the use of artificial sweeteners as much as possible.  However, there are no significant or proven direct health risks associated between artificial sweeteners and lupus.
  • Fortunately, there are many healthy ways to reduce your consumption of sugar without over-consuming artificial sweeteners.

To learn more about all of these topics and more … read on!

 

The Problem with Sugar … and Artificial Sweeteners to the Rescue!

Artificial sweeteners, as sugar replacements, have become a very common part of many people’s diets – and for good reason.  Sugar has been linked to significant health issues, many of which are especially important to those living with lupus:

  • Sugar is known to cause inflammation. This is an obvious problem for those living with lupus who are already dealing with an overactive inflammatory response.
  • Sugar is a risk factor for cardiovascular disease, which is the leading cause of death for those living with SLE.
  • Sugar is associated with obesity. This can be a real issue for many with autoimmune conditions like lupus.  Weakness, joint pain, even the fatigue can keep some from getting adequate exercise.  At the same time, medications like prednisone can also increase a person’s risks for unwanted weight gain.
  • All of the above may lead to diabetes and possible kidney damage.
  • Sugar consumption has also been linked to mood swings and brain fog – again, symptoms that can be particularly problematic for someone living with lupus.

So, there are many reasons for anyone – including those with SLE – to replace sugars with artificial sweeteners.  As a matter of fact, one study in 2017 found that up to 25% of children and 41% of adults in the U.S. reported consumed artificial sweeteners in food or drink.

This has undoubtably improved the health of many people who may have otherwise consumed unhealthy amounts of sugar.  Yet, is there a cost and what should those living with lupus think about using artificial sweeteners?

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Artificial Sweeteners and Lupus

How do artificial sweeteners work?  Artificial sweeteners are a class of chemicals that fool us into thinking that we are consuming sugar.

As you may know, our sense of taste comes from chemical receptors on the tongue and mouth that are triggered based upon five types of taste sensations: salty, sour, bitter, savory and of course sweet.  These tastes, together with our sense of smell, evolved so that we could judge the nutritional value – or the possible toxicity – of whatever we are about to eat or drink.  In evolutionary terms, this could have life or death consequences.

So, we are genetically predisposed to having quick and emotional responses to what we taste.

In nature, sweetness is a relatively rare thing.  It is found only in certain foods that are very concentrated sources of quick energy – calories. These become the most desirable foods to eat if you are starving.  Sweetness can be so desirable that it is easy to develop cravings for it.  Therein lies the problem.  Sweetness can encourage a person to eat too much – consume too many calories.

How can artificial sweeteners affect health?

Artificial sweeteners are chemically engineered to affect the taste receptors for sweetness and fool us into thinking that we are consuming sugar.  Yet, they are also designed to have few if any calories.  So, they can help with reducing the need for sugar, but they come with other possible effects.

  • Since artificial sweeteners have little nutritional value, the body may have to consume more in order to feel full or satisfied.  They reduce the consumption of sugar, but not the craving for sugar.
  • Artificial sweeteners can be so addictively sweet, especially in diet sodas that they might replace the consumption of healthy, natural fruits that a person should eat instead.
  • The over consumption of food or drinks with artificial sweeteners may actually increase the risk of diabetes, the very disease that many may be trying to avoid in the first place.
  • Since artificial sweeteners are not digested or absorbed as naturally occurring nutrients, they can affect the natural bacteria (microbiome) of the digestive tract and this might hold consequences for your lupus.

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Examples of Some Artificial Sweeteners:

Aspartame:  Sold as NutriSweet or Equal, this artificial sweetener is actually a combination of two nutrients: aspartic acid and phenylalanine.  Both aspartic acid and phenylalanine are naturally occurring amino acids that your body can use.

Aspartame is considered 200-times as sweet as sugar and is found in a wide variety of foods, especially diet drinks.  It is probably the most widely studied artificial sweetener in history, and both the U.S. Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA) have determined that it is safe.

However, there are some people who should avoid aspartame:

  • Those with phenylketonuria (PKU), a rare genetic disorder, are unable to digest phenylalanine and so it can accumulate to dangerous levels in the body and possibly cause brain damage. It is the reason why the FDA requires all processed foods containing aspartame to be labeled with a phenylketonuria warning.
  • People with advanced liver disease, and
  • Those who are pregnant and already diagnosed with high phenylalanine blood levels.

 

Stevia:  Stevia, is actually not an artificial sweetener at all.  It is naturally derived from the leaves of Stevia rebaudiana, a plant native to South America where it has been used by indigenous people for thousands of years.  Stevia is 50 to 300 times more sweet than sugar, though it takes longer to have the affect.

Stevia has been determined by many studies to be a safe sugar replacement and is widely available in most countries.  Other versions or extracts of stevia include EverSweet, Rebiana, and PureVia.

Erythritol:  Sometimes sold as Zerose, this sweetener is a naturally occurring sugar alcohol.  It was first developed in the 1990’s in Japan and quickly became a popular food additive. It is considered to be slightly less sweet than sugar, but has almost no calories and seems to be protective against tooth decay.  Erythritol is available widely and usually considered safe, though recently it has been linked to an increased risk for heart problems.

Saccharin:  Saccharin, also sold as Sweet ‘N Low, has been around for decades and was particularly popular in the 1960’s and 1970’s.   It is over 300 times sweeter than sugar though it can have a bitter aftertaste and so it is often combined with other sweeteners.  In the 1970’s it was temporarily banned due to concerns that it increased the risk for cancer.  Currently, it is considered a safe alternative to sugar, with many of the same benefits and risks associated with other artificial sweeteners.

The list of artificial sweeteners continues to grow as manufactures and food processors look to find the next sugar substitute.

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In Conclusion:  What is best for you?

To date, there a scarcity of specific research studies that have proven a significant relationship between artificial sweeteners and lupus symptoms. However, there are reasons to be thoughtful about consuming artificial sweeteners.

If you have lupus, here are some things to keep in mind:

  • First, it is a good idea to reduce your consumption of refined sugars as much as possible. Sugar is inflammatory and contributes to a number of health problems that can add to your lupus symptoms.
  • Use artificial sweeteners in moderation or eliminate them completely if you can.
  • Eat fresh fruits and vegetables that are naturally sweet, but also provide other nutritional benefits and they can reduce your cravings.
  • Reduce your consumption of processed foods, and read labels so that you are aware of the sugar and food additives like artificial sweeteners, that may be hidden in your diet.
  • Stay active and/or maintain a healthy exercise routine. This can benefit not only your overall health, but also lead to a healthy appetite.

Remember that everyone’s digestive system, metabolism and natural intestinal microbiome are different.  You know how your body reacts to foods and food additives, like artificial sweeteners better than anyone else.  Learn to “listen” to what your body is “telling” you and talk to your healthcare providers about what is best for you!

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References

Bailey, D. (2023, February 9). The truth about aspartame side effects. Healthline. https://www.healthline.com/health/aspartame-side-effects

Correa-Rodríguez, M., Pocovi-Gerardino, G., Callejas-Rubio, J. L., Ríos Fernández, R., Martín-Amada, M., Cruz-Caparros, M. G., Medina-Martínez, I., Ortego-Centeno, N., & Rueda-Medina, B. (2020). Dietary intake of free sugars is associated with disease activity and dyslipidemia in systemic lupus erythematosus patients. Nutrients, 12(4), 1094. https://doi.org/10.3390/nu12041094

Johns Hopkins Medicine. (2023, March 3). Diet. Johns Hopkins lupus center. https://www.hopkinslupus.org/lupus-info/lifestyle-additional-information/lupus-diet/

Witkowski, M., Nemet, I., Alamri, H., Wilcox, J., Gupta, N., Nimer, N., landmesser, U., & Hasen, S.L. (2023) The artificial sweetener erythritol and cardiovascular event risk. Nature Medicine. https://doi.org/10.1038/s41591-023-02223-9

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Author: Greg Dardis, MS      

Professor Dardis was formerly the Chair of the Science Department at Marylhurst University and is currently an Assistant Professor at Portland State University.  His focus has been human biology and physiology with an interest in  autoimmunity.  Professor Dardis is also a former President of the Board of Directors of Kaleidoscope Fighting Lupus.

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All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

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