This is a great analysis, but anytime I see conversations around artificial sweeteners and aspartame I think it's worth reminding ourselves how many people we know who consume diet sodas in large quantities are are afflicted with terrible health maladies.
It is unfortunate that some of the science around why this is the case is only coming to light now. Here is a recent one where we can see how artificial sweeteners can lead to insulin resistance, a fact that we should all find shocking.
I didn't see any mention in your article about how artificial sweeteners induce an insulin response, something many consumers were probably unaware of since they assumed it wasn't "real caloric sugar" after all. There is contradictory evidence out there on whether it affects insulin levels, and I think the fact that there are studies showing it does should be considered just as much as ones that claim it doesn't.
What we know for sure is that we have a diabetes and obesity epidemic in America. Artificial sweeteners were marketed as a healthier option than sugar, but since they might still induce an insulin response when consumed it disrupts the ability of autophagy, ketosis, and other positive biological processes to heal our bodies. It also doesn't provide calories, which means people will still need to seek their calories elsewhere, whereas a coke could actually sate someone for a few hours causing a skipped meal, or something of the like.
Thus, even if we can break down aspartame into its constituent parts and say, "none of these are inherently toxic", which you're probably right about, we cannot ignore HOW it's marketed, WHEN it's consumed, WHAT else it causes us to consume, and the lack of understanding people have around how their bodies function and heal.
The fact that most people who fast will not consume aspartame because they consider it to break their fast is enough for me to say it shouldn't be consumed when aiming to attain better health outcomes.
You might be interested in to read Rogers et al. (https://doi.org/10.1038/ijo.2015.177), who do a systematic meta-analysis of these types of claims. Here is their abstract.
> By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with ad libitum access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning’ paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and body mass index (−0.002 kg m−2 per year, 95% confidence interval (CI) −0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (129 comparisons) showed reduced total EI for LES versus sugar- sweetened food or beverage consumption before an ad libitum meal (−94 kcal, 95% CI −122 to −66), with no difference versus water (−2 kcal, 95% CI −30 to 26). This was consistent with EI results from sustained intervention randomized controlled trials (10 comparisons). Meta-analysis of sustained intervention randomized controlled trials (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; −1.35 kg, 95% CI –2.28 to −0.42), and a similar relative reduction in BW versus water (three comparisons; −1.24 kg, 95% CI –2.22 to −0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human randomized controlled trials indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.
(By the way, it is my impression that other artificial sweeteners have somewhat less abundant evidence for their safety compared to aspartame. They do not immediately break down in the gut like aspartame does. (I still tend to believe the experts that they are safe though!))
I'm not arguing that aspartame is inherently toxic or dangerous to your health. What I'm saying is that our health goes beyond calories in and calories out, and the constituent components of aspartame as it's broken down in your gut. There's nothing surprising about a study that controls all the food the participants eat, and merely swaps out sugared soda for diet soda, and finds that there's not a big difference one way or the other. That's not real life though. In real life people contend with variations in the food they eat, when they eat, and they have to contend with misleading marketing gimmicks, all of which impact their health.
IF some people DO have an insulin response to aspartame, and they're drinking it late at night because they think, "it doesn't have calories so I'm good" then that can lead to a pro-inflammatory response, stop ketosis, and autophagy from happening in their body. All of those things you do not want to happen while you're sleeping.
Now, the same argument can be made about a candy bar, BUT the person drinking the "diet soda" can somehow convince themselves they're alright because there are no calories in it. The point is your body still has to process that food you fed it, and that initiates a slew of biological processes that directly impact your well-being.
Most of the people I know who drink diet soda aren't healthy, and they drink the stuff like it's a replacement for water. It can't be good to do that, in the same way it's not good to drink regular soda or candy bars all the time. But they feel some type of immunity to bad health outcomes because they're not consuming calories. It just doesn't work that way.
I don't think "a study that controls all the food the participants eat, and merely swaps out sugared soda for diet soda" is a fair description of the research Rogers et al. are summarizing. Here's a quote:
> Studies were included only if 1) there was an explicit instruction or requirement to consume LES-sweetened foods or beverages as an alternative to or substitute for consumption of sugar-sweetened products, water or habitual diet (the comparison treatment); 2) participants had ad libitum access to (other) dietary energy sources
That is they deliberately excluded any studies where participant diet was controlled in any way other than regarding the sweetener used. They did this to address exactly the "real life" concerns you bring up.
I am not aware of any credible sources that support the idea that aspartame causes a pro-inflammatory response, stops ketosis, or causes autophagy. I also must disagree with the implication that the structure of reality somehow precludes the possibility of artificial sweeteners without bad health outcomes.
I see, I did miss that part of it, admittedly didn't read the entire study. In any case, my claim still stands. Swapping out soda for diet soda wouldn't result in any remarkable change in ones health. The biggest indicator that these individuals are probably afflicted with maladies is the fact that they're consuming soda of any kind to begin with.
You don't need studies to tell you that consuming food causes a pro-inflammatory response, stops ketosis, and inhibits autophagy. These are just well-established biological facts. Since aspartame is a food, in particular one that likely causes an insulin response, it must interfere with these processes.
Not everyone who consumes diet soda is inherently unhealthy, that's obvious. But again, by inspecting what people eat you can most likely determine their well-being. I think it's worth considering the effects of marketing and psychology as it pertains to how people consume beverages with aspartame. People were told that "zero calories" means "healthy" and I just don't see it that way.
I generally follow and agree with your logic and generally start with a prior that it’s likely to be harmless in most cases.
My caveat is that a close family member was recently diagnosed with prediabetes. Their doctor and the diabetic nurse both recommended not only avoiding the usual culprits, but also artificially sweetened food, specifically naming Diet Coke.
The information they gave was that it does seem like — from “recent research” — it might provoke an insulin response, which concurs with the other poster’s perception.
The snippet you posted above performed its meta-analysis on, if I’m not mistaken, EI as measured calories, and body weight, but not specifically blood sugar levels at various times. Presumably because that was more often studied. At least one of the studies in that analysis (citation 133) did also specifically look at glucose levels after aspartame and found that the effects correlated with the drinker’s subjective perception of sweetness. That matches the description given by the doctor and nurse my family recently spoke with on the subjectively-powered mechanism impacting insulin response.
So! I haven’t read the research in depth. I don’t know anything. But there is a possible psychosomatic mechanism for insulin response from aspartame independent of its chemical safety. It seems to me credible enough that at least some studies have looked into it and some medical doctors believe in it (least charitably: if only enough to offer the most conservative CYA recommendations).
To me that doesn’t conflict with robust evidence of its physical safety, but provides some update force along the vector of “may still have some chemical impact and not be safe for diabetic populations.”
Nice piece, dynomight. Have you ever tried neotame? It's my favorite artificial sweetener, economical with a clean and sugar-like taste. You can get the sweetness equivalent of 450 lbs of sugar (20g) for $20 on Amazon. Titrate ~11mg/mL in vodka or similar to get 1 tsp sugar equivalent per drop.
Neotame doesn't metabolize quite as cleanly as aspartame. However, it is 50x more potent than aspartame and one of my priors is that more potent drugs tend to be safer because they have more targeted receptor effects and lower total metabolite mass.
Oh and licking the pure powder is a terrible idea, it is mind-bendingly sweet.
Wow, that's extremely potent! I think the biggest drawback of aspartame is that it doesn't work in hot food/drinks. (A sign of just how eager it is to break down, I guess.) As far as I know I've never tried neotame but I'll have to look into it. After a brief glance the metabolism story does indeed look more complicated, as you said.
Does this also include effects on the gut microbiome? I've heard from people I somewhat trust that aspartame is bad for your gut health by causing gut dysbiosis. I only skimmed the article and searched it for the words "gut health", "microbiome" and "dysbiosis" (They aren't there). At first glance it still seems possible that aspartam is bad for you because it's effect on the gut. I've also heard it's common that research confirms that "X is not bad for you", but never checks whether "is it also ok for your gut microbiome". I personally have no idea. What's your take on this?
This is a great analysis, but anytime I see conversations around artificial sweeteners and aspartame I think it's worth reminding ourselves how many people we know who consume diet sodas in large quantities are are afflicted with terrible health maladies.
It is unfortunate that some of the science around why this is the case is only coming to light now. Here is a recent one where we can see how artificial sweeteners can lead to insulin resistance, a fact that we should all find shocking.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014832/
I'm interested: Do you find that paper more credible than the systematic reviews I cited that explicitly reject the risk you are suggesting exists?
I didn't see any mention in your article about how artificial sweeteners induce an insulin response, something many consumers were probably unaware of since they assumed it wasn't "real caloric sugar" after all. There is contradictory evidence out there on whether it affects insulin levels, and I think the fact that there are studies showing it does should be considered just as much as ones that claim it doesn't.
What we know for sure is that we have a diabetes and obesity epidemic in America. Artificial sweeteners were marketed as a healthier option than sugar, but since they might still induce an insulin response when consumed it disrupts the ability of autophagy, ketosis, and other positive biological processes to heal our bodies. It also doesn't provide calories, which means people will still need to seek their calories elsewhere, whereas a coke could actually sate someone for a few hours causing a skipped meal, or something of the like.
Thus, even if we can break down aspartame into its constituent parts and say, "none of these are inherently toxic", which you're probably right about, we cannot ignore HOW it's marketed, WHEN it's consumed, WHAT else it causes us to consume, and the lack of understanding people have around how their bodies function and heal.
The fact that most people who fast will not consume aspartame because they consider it to break their fast is enough for me to say it shouldn't be consumed when aiming to attain better health outcomes.
https://www.zerofasting.com/which-sweeteners-break-your-fast/
You might be interested in to read Rogers et al. (https://doi.org/10.1038/ijo.2015.177), who do a systematic meta-analysis of these types of claims. Here is their abstract.
> By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with ad libitum access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning’ paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and body mass index (−0.002 kg m−2 per year, 95% confidence interval (CI) −0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (129 comparisons) showed reduced total EI for LES versus sugar- sweetened food or beverage consumption before an ad libitum meal (−94 kcal, 95% CI −122 to −66), with no difference versus water (−2 kcal, 95% CI −30 to 26). This was consistent with EI results from sustained intervention randomized controlled trials (10 comparisons). Meta-analysis of sustained intervention randomized controlled trials (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; −1.35 kg, 95% CI –2.28 to −0.42), and a similar relative reduction in BW versus water (three comparisons; −1.24 kg, 95% CI –2.22 to −0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human randomized controlled trials indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.
(By the way, it is my impression that other artificial sweeteners have somewhat less abundant evidence for their safety compared to aspartame. They do not immediately break down in the gut like aspartame does. (I still tend to believe the experts that they are safe though!))
I'm not arguing that aspartame is inherently toxic or dangerous to your health. What I'm saying is that our health goes beyond calories in and calories out, and the constituent components of aspartame as it's broken down in your gut. There's nothing surprising about a study that controls all the food the participants eat, and merely swaps out sugared soda for diet soda, and finds that there's not a big difference one way or the other. That's not real life though. In real life people contend with variations in the food they eat, when they eat, and they have to contend with misleading marketing gimmicks, all of which impact their health.
IF some people DO have an insulin response to aspartame, and they're drinking it late at night because they think, "it doesn't have calories so I'm good" then that can lead to a pro-inflammatory response, stop ketosis, and autophagy from happening in their body. All of those things you do not want to happen while you're sleeping.
Now, the same argument can be made about a candy bar, BUT the person drinking the "diet soda" can somehow convince themselves they're alright because there are no calories in it. The point is your body still has to process that food you fed it, and that initiates a slew of biological processes that directly impact your well-being.
Most of the people I know who drink diet soda aren't healthy, and they drink the stuff like it's a replacement for water. It can't be good to do that, in the same way it's not good to drink regular soda or candy bars all the time. But they feel some type of immunity to bad health outcomes because they're not consuming calories. It just doesn't work that way.
I don't think "a study that controls all the food the participants eat, and merely swaps out sugared soda for diet soda" is a fair description of the research Rogers et al. are summarizing. Here's a quote:
> Studies were included only if 1) there was an explicit instruction or requirement to consume LES-sweetened foods or beverages as an alternative to or substitute for consumption of sugar-sweetened products, water or habitual diet (the comparison treatment); 2) participants had ad libitum access to (other) dietary energy sources
That is they deliberately excluded any studies where participant diet was controlled in any way other than regarding the sweetener used. They did this to address exactly the "real life" concerns you bring up.
I am not aware of any credible sources that support the idea that aspartame causes a pro-inflammatory response, stops ketosis, or causes autophagy. I also must disagree with the implication that the structure of reality somehow precludes the possibility of artificial sweeteners without bad health outcomes.
I see, I did miss that part of it, admittedly didn't read the entire study. In any case, my claim still stands. Swapping out soda for diet soda wouldn't result in any remarkable change in ones health. The biggest indicator that these individuals are probably afflicted with maladies is the fact that they're consuming soda of any kind to begin with.
You don't need studies to tell you that consuming food causes a pro-inflammatory response, stops ketosis, and inhibits autophagy. These are just well-established biological facts. Since aspartame is a food, in particular one that likely causes an insulin response, it must interfere with these processes.
Not everyone who consumes diet soda is inherently unhealthy, that's obvious. But again, by inspecting what people eat you can most likely determine their well-being. I think it's worth considering the effects of marketing and psychology as it pertains to how people consume beverages with aspartame. People were told that "zero calories" means "healthy" and I just don't see it that way.
I generally follow and agree with your logic and generally start with a prior that it’s likely to be harmless in most cases.
My caveat is that a close family member was recently diagnosed with prediabetes. Their doctor and the diabetic nurse both recommended not only avoiding the usual culprits, but also artificially sweetened food, specifically naming Diet Coke.
The information they gave was that it does seem like — from “recent research” — it might provoke an insulin response, which concurs with the other poster’s perception.
The snippet you posted above performed its meta-analysis on, if I’m not mistaken, EI as measured calories, and body weight, but not specifically blood sugar levels at various times. Presumably because that was more often studied. At least one of the studies in that analysis (citation 133) did also specifically look at glucose levels after aspartame and found that the effects correlated with the drinker’s subjective perception of sweetness. That matches the description given by the doctor and nurse my family recently spoke with on the subjectively-powered mechanism impacting insulin response.
So! I haven’t read the research in depth. I don’t know anything. But there is a possible psychosomatic mechanism for insulin response from aspartame independent of its chemical safety. It seems to me credible enough that at least some studies have looked into it and some medical doctors believe in it (least charitably: if only enough to offer the most conservative CYA recommendations).
To me that doesn’t conflict with robust evidence of its physical safety, but provides some update force along the vector of “may still have some chemical impact and not be safe for diabetic populations.”
Nice piece, dynomight. Have you ever tried neotame? It's my favorite artificial sweetener, economical with a clean and sugar-like taste. You can get the sweetness equivalent of 450 lbs of sugar (20g) for $20 on Amazon. Titrate ~11mg/mL in vodka or similar to get 1 tsp sugar equivalent per drop.
Neotame doesn't metabolize quite as cleanly as aspartame. However, it is 50x more potent than aspartame and one of my priors is that more potent drugs tend to be safer because they have more targeted receptor effects and lower total metabolite mass.
Oh and licking the pure powder is a terrible idea, it is mind-bendingly sweet.
Wow, that's extremely potent! I think the biggest drawback of aspartame is that it doesn't work in hot food/drinks. (A sign of just how eager it is to break down, I guess.) As far as I know I've never tried neotame but I'll have to look into it. After a brief glance the metabolism story does indeed look more complicated, as you said.
Does this also include effects on the gut microbiome? I've heard from people I somewhat trust that aspartame is bad for your gut health by causing gut dysbiosis. I only skimmed the article and searched it for the words "gut health", "microbiome" and "dysbiosis" (They aren't there). At first glance it still seems possible that aspartam is bad for you because it's effect on the gut. I've also heard it's common that research confirms that "X is not bad for you", but never checks whether "is it also ok for your gut microbiome". I personally have no idea. What's your take on this?
WHO has recently announced that it “may cause cancer”. Interested in your response.
I'm expecting to write about this when the report actually comes out on July 14. (Can't judge before that!)