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Living with Lupus

Artificial Sweeteners, Cutting Sugar, and Lupus

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Tips and Tricks for Cutting Out Sugar: Should you use Artificial Sweeteners?

When cutting out sugar, artificial sweeteners are used by many as a common substitute. However, whether they have any benefit at all is controversial.

Systemic Lupus Erythematosus is (SLE) is a disease caused by the immune system attacking the body’s own cells. The heightened state of the immune system that leads to these attacks is called inflammation, and sugar intake is a well-known promoter of inflammation. So, cutting out sugar is helpful for people with lupus, and will also help with weight. But are artificial sweeteners a good substitute, or do they do more harm than good?

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Sugar and Artificial Sweeteners

Sugar is linked to obesity, which affects the immune system. Sugar also changes the microbiome, which is linked to immune system health and proper regulation of the immune system. Changes to the microbiome can cause what is known as “Leaky bowel” syndrome, a condition where tiny particles slip between the cells of the intestines into the bloodstream and cause the immune system to overreact to the “invasion.” You can read more about leaky gut here

Refined, processed sugar, like fructose, is quickly processed by the body and linked to many additional health problems, including heart disease, depression, low moods, lack of focus, and inflammation. The lack of focus might be so extreme as to be the classic “brain fog” of lupus. The spikes of glucose in the bloodstream caused by fructose and processed sugar consumption can trigger lupus flares. It also contributes to tooth decay. You can read more about tooth decay and lupus here

Artificial sweeteners work by having a chemical structure that fit onto the taste receptor that detects ‘sweetness.’ The body is then fooled into thinking that it is tasting sugar, and you taste the sensation of “sweet.” However, unlike sugar, they do not become calories in the body and do not feed sugar-loving bacteria. In fact, most of them pass right through, chemically unchanged. They are empty sweetness, with no nutritional value and, usually, no toxic byproducts. Some artificial sweeteners can be broken down, but usually for fewer calories than sugar. 

Many people use artificial sweeteners to replace sugar in their diets in the hopes that they will consume fewer calories and less sugar without giving up the taste. People in lower income areas may not have easy access to foods that are not sweetened with refined sugars, and the appetite-sating qualities of sugar or sweetness might encourage poor eating habits. If they don’t have access to fresh fruit, artificial sweeteners might be the only option for reducing sugar intake without severe and frustrating lifestyle changes. 

However, the effects of artificial sweeteners are more complicated than just reducing sugar intake.

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Artificial Sweeteners and Health

Studies involving what we put into our bodies and their effects on our health are notorious for being confusing. This is because the effect of diet on health can be very complicated and can change depending on how the diet interacts with one’s lifestyle. Overall, experts agree that refined sugar, especially when it is taken in the form of sugary beverages such as juice or soda, is awful for one’s health. However, whether artificial sweeteners are better or worse appears to be less certain.

While artificial sweeteners might help replace sugar and reduce sugar intake, whether they provide the same benefits as just cutting out sugar entirely is unclear. There are studies that indicate that the proposed benefits of artificial sweeteners do not pan out, at least as far as metabolic syndrome and diabetes are concerned.  In fact, some sweeteners may even trigger the symptoms of these diseases

Aside from the fact that artificial sweeteners are sometimes sweeter – and more desirable – than even healthy sweet foods like fruits, they also might completely undercut the effects of dieting. In fact, artificial sweeteners may create conflicting signals in the body, which leads to metabolism changes that encourage weight gain and diabetes. The body tastes sweet foods, which signals that there will be sugar to process, only to have no sugar actually coming in. The body produces hormones such as insulin to store the sugar in the body’s tissues, leading to low blood sugar which can then cause problems in the body. The body senses this lower blood sugar and sends signals to make up for the calories it isn’t getting. As it gets used to the fake sugar, the body encourages increased eating.  The person eats more, chooses sweet food over nutritious food, and ends up gaining weight anyway. Some of these artificial sweeteners are also potentially addictive (at least in rats,)  so it may be difficult to cut out sweet so-called “diet” foods once started.

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However, the health harms of artificial sweeteners have been, historically, overstated. Studies on aspartame have shown that, although some individuals are sensitive to aspartame, and the sweetener is broken down into potentially toxic substances, there is not enough of those substances to cause any issues in most people. It seems to cause seizures in animals, but human studies have not backed this up. 

The use of artificial sweeteners was linked to increased risk of cardiovascular disease, though it is unclear if it is the diet or lifestyle of the people or the artificial sweetener itself that is to blame. 

According to the FDA, there is no clear evidence of artificial sweeteners causing cancer in humans, despite studies in rats showing a higher risk of bladder cancer. Rat urine, especially in male rats, is different than human urine, and this difference is what allows the artificial sweetener, in this case, saccharine to damage the bladder walls. This only occurs in rats, not humans. 

Stevia is a little more complicated.

Studies imply that it is safe, but in rats it reduced fertility and raised the possibility of other issues in the rats. In the lab it can be turned into a cancer promoting mutagen, though it is unclear whether it does so in the body. Many nations consider it unacceptable for use in food, and the FDA classes it as a “dietary supplement.” Whether this is justified is unclear. 

Other sweeteners have no major health controversies attached to them. Complicating matters, some studies have also shown benefits:

A 2018 study concluded that stevia, the extract of Stevia rebaudiana Bertoni, isn’t linked to serious health problems. It did cause weight loss, but this was possibly due to the lower sugar intake effecting the gut microbiome, which is an effect that can be seen in studies with other sweeteners as well. The gut microbiome is powerfully linked to weight and inflammation, so this is something to note.

This article by Healthline seems to refute the anti health claims and concludes that artificial sweeteners are beneficial if used to reduce the amount of sugar in the diet.  It is a complicated issue and there is compelling evidence both ways. Adding to this complexity is the fact that studying one sweetener does not tell you much about all of the others because they are chemically distinct

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Artificial Sweeteners and Inflammation 

Artificial sweeteners may cause the gut wall and bacteria in the gut to react in ways that increase inflammation. This correlation appears to be unclear. Other studies show anti-inflammatory properties, mainly because the sweetener reduces a person’s sugar intake which is linked to lower inflammation. In the 2005 study in the Journal of Clinical Nutrition, this was not considered to be a particularly strong anti-inflammatory effect if there was an effect at all.

It may be a person-to-person thing, with different people reacting differently to artificial sweeteners. In this case study of a 54-year-old woman with an autoimmune disease (Hashimoto’s thyroiditis,) excessive consumption of artificial sweeteners may have caused or contributed to her disease, increasing inflammation. Her hormone and antibody levels returned to normal after removing sugar substitutes from her diet.

Artificial sweeteners such as aspartame are generally considered to be safe for people with lupus to eat. Artificial sweeteners are noted to be a potential cause of migraines along with food or a lack of caloric intake from food.

However, nutrition is a complicated issue that is difficult to study in humans, and with evidence pointing in both directions, one can conclude that it is the overall diet and the genetics of the patient, not the use of the artificial sweetener itself, that has the most effect on the body. Cutting out refined sugar is known to reduce inflammation, as well. The immune system is a complicated, multi-organ system that protects us from harmful substances, microbes, bacteria, and viruses. Normally, the immune system is in balance, taking out pathogens but stopping before it harms the body. Sugar is one of the substances that can disrupt that balance.

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Cutting Sugar from the Diet

The autoimmune protocol diet currently does not recommend artificial sweeteners, though it allows these sweeteners to be used in moderation. You can read about calorie tracking and calorie-restricted diets here. 

There are some people who are sensitive to sugar who might find artificial sweeteners useful, but they are a poor dietary replacement and will not help you lose weight or fend off other problems such as diabetes. They also do have the advantage of not contributing to tooth decay because the bacteria in the mouth cannot use them. Since tooth problems are common for people with lupus, it is a well- appreciated effect. It’s hard to separate the food nutrition from the health behaviors in the case of artificial sweetener. Artificial sweeteners might be all right in small amounts (such as reducing sugar added to a morning coffee,) but regular consumption will be of little help. It’s hard to separate the food nutrition from the health behaviors in the case of artificial sweetener.

Cutting sugar from the diet is important, but sugar itself is not bad. In fact, the body does need some sugar to function. Sweet whole foods such as fruit contribute vitamins and fiber along with sugar, making them acceptable parts of even a lower-sugar diet. If you can eat fruit, it is highly recommended that you do so instead of consuming artificially sweetened foods. Fruits also tend to be rich in antioxidants such as vitamin C, making them a win-win option.

You should still exercise caution – fruit juices are not healthy and eating too much fruit can still cause a sugar overload in the body and the inflammation that comes along with excessive consumption of sugar.

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Tips for Cutting Back on Sugar

Cutting back on sugar has many health benefits but is tricky. Here are some tips and tricks for how to manage it without artificial sweeteners.

  • Read labels and keep an eye out for sugar in products you might not be expecting to find sugar in.
  • Use less sugar and use more flavoring from extracts or spices to compensate.
  • Sweet potato and other natural sweet but low-sugar food options can help replace sugar in the diet in a nutritious and tasty way. 
  • Cut out soda and soft drinks, even the ‘diet’ kind. A little is fine, but daily consumption of soft drinks changes your metabolism more than you realize and drinking sugars (or sugar substitutes,) has no benefit for the body. 
  • Brushing teeth, even after eating fruit, is highly recommended to combat tooth decay.

Overall, it seems that using artificial sweeteners is firmly in the “use it if you need it” category. Eating plenty of fiber, protein, and healthy fats while keeping an eye on the amount of food being eaten may be able to offset some of the disadvantages of artificial sweeteners. Plus, it’s overall healthier for you.

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