Not So Sweet: Artificial Sweeteners

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SWEET TEA: The perfect drink for hot summer days in the South. Cool, refreshing, delicious…and full of sugar. I know, I know…I am raining on the parade of a southern tradition, but the sugar content of beverages is a huge contributing factor to the obesity and chronic illness epidemics. As a result, I am honor bound to address this with my patients and with you. Unsweetened tea? Drink water? Some people are receptive to these ideas, but others are horrified that I would suggest such things. This conversation naturally leads to the topic of artificial sweeteners. If I can’t have sugar in my tea, what else can I use to make it sweet?

Artificial sweeteners are sugar substitutes that duplicate the sweetness of sugar without the calories. On the surface, this seems like the perfect solution. It turns out, though, that artificial sweeteners are not the solution for which we had hoped. In my opinion, artificial sweeteners are a big NO.

Six high-intensity sweeteners are approved by the US Food and Drug Administration at this time: saccharin (Sweet’N Low), acesulfame potassium (Sunnett), aspartame (Equal), neotame (Newtame), sucralose (Splenda), and advantame. Steviol glycosides (Stevia, Truvia) are designated GRAS, or Generally Recognized As Safe by the FDA. These sweeteners are at least 200 times sweeter than table sugar. Artificial sweeteners entered the beverage space in the 1950s with drinks like Diet Rite, Tab and Fresca. Aspartame was approved in the 1980s and gained popularity in beverages such as Diet Coke. Sucralose followed in the 1990s and is now the most commonly used sugar substitute in food and drinks. It is heat stable, so it is considered to be a suitable substitute for sugar in baked goods. Stevia is derived from a plant and is, therefore, marketed as the “natural” sweetener. All of these sweeteners offer the same thing: sweet without the calories. Unfortunately, it is not that simple.

The average 12-ounce glass of sweet tea or can of sugar-sweetened soda delivers about 150 calories. The same amount of the diet variety? Zero calories. This should be great news, but, as I tell my children (much to their dismay and constant challenge to prove me wrong), nothing is free. The lack of sugar brings a host of chemicals that can wreak havoc on the body. Health optimization is not just about managing calories. How our bodies respond to these sweeteners turns out to be complex.

When we consume sugar, our brain gets a message that something sweet is on the way and it initiates a host of reactions to manage it. When we consume artificial sweeteners, our brains get that same message of sweetness and behave in a similar manner. However, when this message is not actually followed by sugar, it stimulates our appetites and encourages our sweet tooth. Studies have shown that the use of diet drinks, rather than promoting weight loss, actually leads to weight gain. Therefore, the very thing that we use to try to cut calories and lose weight is causing us to gain! The consumption of diet drinks contributes to obesity, metabolic syndrome, and type 2 diabetes. Artificial sweeteners affect the microbiome, the complex system of microorganisms living in our gut that play an instrumental role in human health. In addition, there is ongoing controversy as to whether some artificial sweeteners increase cancer risk. Cyclamate, originally in Tab, was banned by the FDA because it was shown to cause bladder cancer in rats. There have been similar concerns with saccharin, but human studies have lacked confirmation. Certain people are allergic or sensitive to these sweeteners and report a myriad of negative effects after their consumption, ranging from headaches to widespread muscle pain to seizures.

Artificial sweeteners are highly addictive, just like sugar. Because they are much sweeter than sugar, it is possible that the regular consumption of sweeteners changes the way we perceive food. We become so used to the super sweet taste of our food and drinks that we begin to find less sweet foods, such as fruits and vegetables, unappealing. By substituting artificial sweeteners for sugar, we are trading one addictive and health-crumbling product for another.

These sweeteners have found their way into processed foods, many of these marketed towards parents and children. A popular brand of granola bars, for example, in the U.S. has a “less sugar” option. I was alarmed when I read the ingredients, though, to find out that the reason it has less sugar is the addition of an artificial sweetener. Yogurt is another example of a product that frequently has artificial sweeteners to cut the amount of sugar it contains. As always, I strongly recommend reading the ingredients of anything you consume and be skeptical of items that claim to be sugar-free, low-cal, light, or low in sugar because it likely means that the sugar has simply been replaced by an artificial sweetener.

What, then, is the answer for sweet tea? Refined sugar (the white table sugar used to make sweet tea) has no nutritional benefit. Artificial sweeteners are the perfect example of a well-intentioned intervention gone awry. The answer to our sweet addiction is changing our palates. We are so accustomed to sweet that we feel dependent on it. However, if we exclude or at least decrease the constant sweet from our daily diets, our palates will rapidly adapt.  The best sweetener is no sweetener at all. However, foods that are naturally sweet, such as whole fruit, can be highly nutritious and are a great way to satisfy the sweet tooth without the negative health consequences of refined sugar and artificial sweeteners.

Integrate Your Health With Dr. Nicole Cotter:

Nicole M. Cotter, MD is an integrative physician in Shreveport, Louisiana. She was the first board-certified Integrative Medicine physician in northwest Louisiana and is one of the few integrative rheumatologists in the nation. She is the owner of Integrative Medicine of Shreveport-Bossier, a consultative practice where she partners with patients to create personalized health plans that integrate complementary medicine with conventional to care for the whole person.