Artificial sweetener may be cause of digestive issue
Q: I bought some diet jellybeans that used sucralose as the artificial sweetener. After eating a bunch of them I developed lots of gas and diarrhea that I think may have been from the jellybeans. Is this possible?
A: Many types of sugar (lactose, sucrose, fructose, galactose, glucose, others) are contained in foods we eat (starches, sugars, fruits, dairy products, legumes, and others). These sugars are processed/broken down to the sugar glucose (glucose is from the Greek work for sweet) in our gastrointestinal (GI) tract and liver. Glucose is then delivered by our blood to our body’s cells which use it as their main source of energy. The process of utilizing glucose as an energy source is regulated (called glycemic control) by insulin and other hormones (including glucagon amylin, GPL-1, GIP, epinephrine, cortisol and growth hormone).
Multiple non-nutritive sweeteners (NNS’s) are approved by the FDA as food additives safe for consumption. Some of these NNS’s are made from natural sources (luo han guo [monk] fruit extract and stevia) and some are synthetic (aspartame, acesulfame potassium, neotame, saccharin, sucralose and advantame). NNS’s are, in general, "hundreds of times sweeter" than regular sugar, meaning someone can taste the sweetness of the NNS’s at concentrations hundreds of times lower than the concentration needed to taste the sweetness in sugar. NNS’s do not provide nourishment, so there are essentially no calories from ingesting them. This sweet taste without calories makes them attractive to add to foods as "diet sweeteners."
Despite being noted as "safe" to use as food additives, there are some possible concerns in consuming large amounts of NNS’s. For example, consuming large amounts of NNS’s may (for many of these there are some studies showing the issue occurs, and some studies questioning the finding):
Compromise glycemic control (possibly limiting the weight loss from their use)
Be a risk factor for developing cardiovascular disease
Trigger migraine headaches (in some susceptible people)
Make it easier for someone to get intoxicated from a given amount of alcohol
Cause GI issues (discussed further below)
Change the GI microbiome (the makeup of the bacteria that normally lives in our stomach and intestines)
Rarely cause allergic reactions
Cause other possible issues.
Since today’s question was specifically about possible GI issues from NNS’s, I will go into that in more detail below.
Osmotic laxatives are a type of medication made up of poorly absorbed compounds that work by passing through the GI tract unabsorbed/unmetabolized to the colon where they ‘pull’ water in from the surrounding colonic tissue, hence softening the stool and making it easier to have a bowel movement. Therefore, these medications may, especially if used in larger doses, cause diarrhea and other GI symptoms (bloating, nausea, cramping, flatulence, others).
A large percentage of the NNS’s pass through the GI tract without being absorbed into the body (for example 85 percent of sucralose passes through to the colon) with the small amounts absorbed subsequently excreted into the urine. In some patients their gut bacteria may partially break down the NNS, causing a buildup of nitrogen gas potentially causing bloating and even stomach cramps (if there is excessive bloating). The large amount of NNS that passes through to the colon may act as an osmotic laxative, potentially causing diarrhea and other side effects. These effects may be different from person to person because of differences in each patient’s microbiome as well as possible different susceptibilities to developing these issues.
The bottom line is that NNS’s should be consumed in moderation. If you suspect that you are having adverse effects from a NNS additive-containing food you are eating it is likely a good idea to stop eating the suspect food and avoid other foods that contain that same NNS. Although someone may have symptoms from multiple different NNS’s, since they all have different chemical structures it is also possible someone may tolerate one kind of NNS better than another.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
This article originally appeared on MetroWest Daily News: artificial sweeteners can cause gi tract issues for some people
