The truth about sugar-free drinks

Dietitian, Jessica Pieterse, details the advantages and disadvantages of drinking sugar-free drinks

Sugar-free drinks initially sounded like a gift to all the people wanting to lose weight and to people living with diabetes needing to control glucose levels. However, there has been talk that sweeteners may be causing harm. So, what should you believe now?

What does sugar-free mean?

For a drink, sweets or food to be sugar-free, normally a form of sugar alternative has been used. Let us clarify first what sweeteners are out there.

Possible benefits

Sugar-free drinks normally contain a type of non-nutritive sweetener, like sucralose, as the manufactures want to lower sugar and kilojoule content. This could be helpful in dropping a person’s overall kilojoule intake for the day and so aiding weight loss.

Having a lower sugar content means the food item should cause less of a rise in blood glucose levels after consuming the drink. This is advantageous for people living with diabetes and anyone needing to stabilise blood glucose levels.

A word of caution

Some sugar-free drinks don’t substitute sugar with a no-kilojoule alternative but rather a ‘healthier natural’ version of sugar. Examples are honey, palm sugar, agave nectar, etc.

Often these alternatives are misleading. They generally have very similar sugar contents to regular sugar and the glycaemic index may be lower but often by a small fraction that it’s almost not noteworthy enough.

Some of these sugar substitutes are marketed as a healthier option due to more vitamins, minerals or food components, like flavonoids, in them compared to sugar. This benefit is levered off too much by marketers as you would often need to eat buckets of the sugar alternative to consume enough of a specific food component to reap the health benefit of it. Simply, it’s impractical volumes for health claims to be attached to the sugar alternatives.

The genetic factor

Sugar-free drinks may reduce sugar intake, but this is not enough according to genetics. One gene, called TAS1R2, can indicate the genetic predisposition of having a sweet tooth. There are three variations of the TAS1R2 gene. People with one of the variations will crave more and seek out sweet foods, based on how these people taste sweetness.

What may surprise people is that simply avoiding sugar is not the complete solution here. People with the TAS1R2 higher-risk variation continue ‘feeding’ their sweet tooth when they consume drinks with sweeteners as the food item is still sweet.

Scientific research

Some journal articles have found possible negative effects of artificial sweeteners. Unfortunately, most studies are not good quality. Either the study is done on animals and not humans; has a small population group tested; or poor research procedures.

Some articles mention that artificial sweeteners may alter the gut bacteria or microbiome in a way that leads to glucose intolerance, but evidence was not strong enough for confirmation of this theory.

Some studies suggest some artificial sweeteners can be linked to increased cancer risk. Again, studies were not robust enough.

There tends to be large numbers of anecdotal or self-reported negative experiences of consuming artificial sweeteners. Unfortunately, clear conclusions can’t be made from such person-to-person encounters.

There are not enough published, good quality scientific reports documenting harm from intake of artificial sweeteners in doses that doesn’t exceed acceptable daily intake. Regulatory associations, such as Canadian Food and Drug Regulations, therefore, allow artificial sweeteners in food items under certain regulations.

What should I do?

So, as the jury may still be out regarding sugar-free drinks, it is best to follow these tips for a healthier you:

• Drink water as your main source of hydration. Aim for about six to eight glasses a day. Ways to help you drink more water can be:
  • Find a water bottle with marks on it to remind you to drink water at certain intervals during the day.
  • Take a bottle with you in your car and aim to finish one bottle on the way to work as well as another bottle on the way home.
  • Set regular goals for yourself during the day to drink water. For example, drink another glass by lunch or by the end of a meeting.
  • Download an app that notifies you at regular intervals throughout the day to drink water.
  • Always have water available on your desk.
  • Add lemon slices, mint or fruit to the water to make it more desirable if needed.
  • Pour yourself water as you arrive in meeting rooms and order water as you arrive at a restaurant.
  • During winter, you can count a black herbal tea with no honey or sugar as a glass of water. Herbal teas that count are rooibos, camomile, peppermint and other herbal teas. Teas that contain caffeine, such as normal tea or green tea, won’t count as a water.
• Teach yourself to enjoy drinks that are less sweet to reduce sugar cravings.
  • Dilute fruit juice, iced tea and fizzy cold drinks with water.
  • Reduce your sugar intake in hot beverages by half a teaspoon every two weeks.
• Try have sugar-free drinks only on the odd occasion to reduce intake.
• Read labels on drinks so you are aware of what you are drinking.

References

1. Alternative sweeteners factsheet. The National Diabetes Services Scheme by Australian Government and Diabetes Australia. com.au https://www.ndss.com.au/wp-content/uploads/fact-sheets/fact-sheet-alternative-sweeteners.pdf
2. Suez J, Korem T, Zeevi D, Ziberman-Schapira G, Thaiss CA, Maza O, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014 Sept; doi: 10.1038/nature13793
3. Carmel E. Smart. ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes
4. Health Canada. Saccharin artificial sweeteners. https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/food-additives/sugar-substitutes/questions-answers-saccharin-artificial-sweeteners.html
5. Health Canada. Sugar-substitutes. https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/food-additives/sugar-substitutes.html
6. Health Canada. Sugar-alcohols-polyols-polydextrose-used-sweeteners-foods-food-safety. https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/food-additives/sugar-substitutes/ sugar-alcohols-polyols-polydextrose-used-sweeteners-foods-food-safety.html
7. Health Canada. Aspartame. https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/food-additives/sugar-substitutes/aspartame-artificial-sweeteners.html
8. Mahan Escott Stump. Krauses Food and Nutrition Care Process
9. Omotayo O. Erejuwa, Siti A. Sulaiman and Mohd S. Ab Wahab. Fructose Might Contribute to the Hypoglycemic Effect of Honey. Molecules 2012, 17, 1900-1915; doi:10.3390/molecules17021900
10. Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners. J Acad Nutr Diet. 2012;112:739-758
11. Chamoun E, Mutch DM, Allen-Vercoe E, Buchholz AC, Duncan AM, Spriet LL et al. A review of the associations between single nucleotide polymorphisms in taste receptors, eating behaviors, and health. Critical Reviews in Food Science and Nutrition. 2018; 58(2): 194–207.

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