What Artificial Sweeteners do to your Microbiome | New Trial

Summary

A large randomized trial on artificial sweeteners followed nearly 400 overweight or obese participants for a year, comparing weight maintenance between two groups: one using sweeteners and the other using sugar. The study showed a modest benefit for sweeteners in maintaining weight loss, with the sweetener group keeping an average of 1.6 kg off, and up to 3.7 kg for the most compliant participants. The microbiome also showed positive shifts, but gastrointestinal side effects were common. Despite dropouts and limitations, the study suggests that sweeteners may be more effective than sugar for weight maintenance.

Takeaways

• 😀 The trial lasted one year and involved almost 400 participants, including 341 adults and 38 children, all overweight or obese.
• 😀 Participants underwent two phases: a 2-month weight loss phase followed by a 10-month weight maintenance phase.
• 😀 In the weight loss phase, all participants lost an average of 10 kilos with a low-calorie diet.
• 😀 During the maintenance phase, one group used artificial sweeteners, and the other avoided them, both reducing sugar intake to under 10% of their total calories.
• 😀 The sweetener group managed to keep off 1.6 kilos more than the sugar group by the end of the year.
• 😀 The most compliant participants in the sweetener group kept off an extra 3.7 kilos compared to the sugar group.
• 😀 There was no significant difference in the weight loss outcomes in children due to lower sample size and compliance issues.
• 😀 Artificial sweeteners may positively affect the microbiome, particularly increasing beneficial short-chain fatty acid-producing bacteria, potentially aiding weight maintenance.
• 😀 No significant differences in physical activity, cholesterol, blood pressure, or liver fat were found between the two groups.
• 😀 Side effects such as gastrointestinal issues (pain, cramps, gas) were more common in the sweetener group, possibly due to sugar alcohols like sorbitol.
• 😀 The study suggests that artificial sweeteners are more effective than sugar for weight management, especially for people who consume a lot of sugary foods and cannot easily switch to water or tea.

Q & A

What was the main objective of the large randomized trial on artificial sweeteners?

The main objective of the trial was to assess how artificial sweeteners compared to sugar in terms of their effect on weight maintenance after an initial weight loss phase, among overweight or obese adults and children.

How did the trial design differ for adults and children?

The trial involved a two-phase process for adults: a two-month weight loss phase followed by a 10-month weight maintenance phase. The children's results were less conclusive due to a smaller sample size and possibly lower compliance.

What was the weight loss result after one year for the sweetener group compared to the sugar group?

By the end of the year, the sweetener group maintained an extra 1.6 kilos (about 3-4 pounds) of weight loss compared to the sugar group. The most compliant participants in the sweetener group kept off an average of 3.7 kilos.

How did the study ensure participants were following the diet protocols?

Participants' compliance was monitored through food records, where they logged their food intake, and by measuring biomarkers of artificial sweeteners in their urine.

What impact did the use of artificial sweeteners have on the microbiome in this study?

The study found that participants in the sweetener group showed an increase in bacteria that produce short-chain fatty acids, which are generally associated with positive outcomes like increased energy expenditure and satiety.

Why did some of the study's results lose statistical significance by the 1-year mark?

The loss of statistical significance for some results, such as BMI and cholesterol levels, could be attributed to fewer participants remaining in the study as well as potential reductions in compliance over time.

What concerns did the study raise regarding side effects of artificial sweeteners?

The study reported more gastrointestinal issues, such as gut pain, cramps, loose stools, and gas, among those in the sweetener group. These symptoms could be linked to both sweetener consumption and methane-producing bacteria in the gut.

How did sweeteners affect metabolic markers such as insulin and glucose levels?

The study found no significant difference between the sweetener and sugar groups in terms of metabolic markers like insulin, glucose, blood pressure, and liver fat, suggesting that artificial sweeteners don't negatively impact glucose metabolism or related markers.

What was the issue with the high dropout rate in the study?

The study had a high dropout rate of 40%, primarily due to logistical challenges during the COVID-19 pandemic. This could introduce bias into the results, as participants who dropped out may have been different from those who completed the trial.

What are the potential benefits and risks of switching to diet soda instead of regular soda?

Switching to diet soda from regular soda can be beneficial for weight loss, as diet soda helps reduce calorie intake compared to sugary sodas. However, there are uncertainties about the long-term effects of consuming large amounts of diet soda, and it may not be a perfect substitute for water or other healthier drinks.