PCOS NUTRITION CENTER BLOG

Are artificial or non-nutritive sweeteners good for folks with PCOS?

Maybe you heard too much sugar isn’t great for people with PCOS and find using low calorie sweeteners as a sweet alternative.  While artificial sweeteners have been shown to be ‘Generally Recognized as Safe,’ or GRAS, in moderation, the safety use of low-calorie sweeteners has been controversial as more research has come out about the impact artificial sweeteners have on increasing health risks.

What are Artificial Sweeteners?

Do you have PCOS and rely on artificial sweeteners to sweeten your food and beverages instead of caloric sweeteners? Non-caloric artificial sweeteners, such as aspartame (Equal, e.g., Diet Coke) and sucralose (Splenda, e.g., Pepsi One) have been around for several decades now and were invented to be low-calorie alternatives to sugar. Saccharin, the oldest artificial sweetener known as Sweet’N Low, was banned by the FDA in 1977 due to increased cancer cases. Neotame (NutraSweet) was approved in 2002. These chemical are widely found in thousands of food and beverage products across the United States.

Newer research has shown artificial sweeteners are not as great as once thought and can actually lead to increased health risks. Here are just a few reasons why artificial sweeteners may not be great for people with PCOS.

Potential Increase in Weight Gain

Some studies suggest that artificial sweeteners can increase appetite, which may promote weight gain. Prospective cohort studies have linked diet soda consumption to increased weight gain and increased waist circumference, independent of BMI. If this is true, this is definitely the opposite effect for which these chemicals were designed for. People with PCOS suffer enough from increased carbohydrate cravings. Artificial sweeteners may make it worse.

Observational studies have shown that diet soft drink consumption is associated with increased caloric intake from other foods (An, Beisich). Why? Because artificial sweeteners are so sweet, they encourage sugar cravings and sugar dependence. It has even been shown that repeated exposure to artificial sweeteners trains flavor preference for them.

And it’s easy to see why.

Saccharin is about 300 times sweeter than regular old table sugar.

Neotame is the most potent sweetener on the market, at 7,000 times the sweetness of sugar.

Aspartame is the world’s most widely used artificial sweetener that is about 200 times sweeter than sugar.

Interestingly, there is little scientific evidence supports a role for diet soft drinks in reducing weight gain.

View more studies on artificial sweeteners and weight gain

Artificial Sweeteners Increase Risk for Stroke and Dementia

A prospective study involving 2888 participants aged >45 years and 1484 participants aged >60 years for incident dementia found artificially sweetened soft drink consumption was associated with a higher risk of stroke and dementia.

Increased Risk for Heart Disease and Diabetes

People who regularly consume artificially-sweetened food and beverages have an increased risk for negative health outcomes, including type 2 diabetes, metabolic syndrome and cardiovascular disease, compared with those who do not. The data is worse for artificially flavored soft drinks. Findings from a variety of studies show that routine consumption of diet sodas, even one per day, can be connected to higher likelihood of heart disease, stroke, diabetes, metabolic syndrome and high blood pressure.

A study in post-menopausal women indicated elevated risk for cardiovascular disease events, cardiovascular disease mortality and overall mortality among women who consumed 2 or more diet soft drinks daily (vyas).

Recently, participants in a study consumed two packets three times a day of either aspartame, sucralose, saccharin or stevia.  All participants wore continuous blood sugar monitors. People who consumed saccharin and sucralose had significant spikes in blood sugar after the glucose tolerance tests.

Artificial Sweeteners Affect Gut Bacteria

Poor gut health is linked to the development of PCOS. In the last study mentioned, stool and saliva samples from the participants showed that all four sweeteners significantly altered the abundance, activity and types of bacteria in the gut and mouth. When the researchers transplanted stool samples from people eating saccharine, sucralose, glucose and no supplement into the digestive tracts of mice, they found that transplants from the saccharine and sucralose groups resulted in an increase in the mouse’s blood sugar after eating. The researchers suggest the sweeteners themselves do not raise blood glucose, but “seem to impair the body’s ability to manage glucose levels after eating through mechanisms mediated by the microbiome.”

Previous studies show that women who have higher testosterone levels also have higher rates of bad or less diverse gut bacteria.

Exposure to BPA

BPA, also known as bisphenol A, is found in many plastic bottles and cans.  BPA can leach into the liquid causing it to become toxic.  BPA has been shown to be a hormone disrupter, and contributes to infertility.

How to Sweeten Food without Artificial Sweeteners

So maybe you are rethinking about that diet pop or soda drink.

If you have been relying on several diet soft drinks each day, or add several of those little packets to your food or beverage, you may want to start thinking about cutting back. While some of my clients have cut them out all at once cold turkey, others have found cutting back on them gradually as one way to start.

If you want to sweeten your food without using artificial sweeteners there are several ways to do so. The first is with plain old sugar.  Yes, you read correctly. There is no harm in using a small amount of table sugar each day to sweeten a food or two.  Similar natural sweeteners include honey, coconut sugar, and maple syrup which contain antioxidants.

Other ways to sweeten foods is with spices (cinnamon for example), herbs (fresh mint is very refreshing in unsweetened iced tea) and fruit (lemon or oranges in water).

What about Stevia?

Stevia (Truvia, Sweet Leaf, PureVia,) is a sweetener made from the Stevia rebaudiana Bertoni plant native to South America.  Numerous stevia containing products claim it is “natural”, or perhaps not an artificial sweetener at all since the natural compounds in the stevia plant are not altered during the extraction, processing and purification process.

But is stevia a good alternative to the artificial sweeteners mentioned above? It may be still too new to tell. Stevia is as much as 350 times sweeter than table sugar and there’s isn’t a large body of evidence on its safety. Many don’t like the bitter aftertaste stevia provides. Stevia use has been shown to affect the gut microbiome.

Bottom Line: Artificial sweeteners have been shown to impair the body’s ability to regulate glucose levels, can increase risk for developing a stroke or long-term chronic conditions and can affect the gut microbiota. For these reasons, I recommend people with PCOS should limit their use of artificial sweeteners or avoid them altogether.  For a safe alternative, use real, natural ways to sweeten foods (of course also in moderation).

Sources

1. Suez J.Personalized microbiome-driven effects of non-nutritive sweeteners on human glucose tolerance. Cell. 2022.
2. Yang Q. Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience 2010. Yale J Biol Med. 2010;83(2):101–108.
3. Swithers SE. Artificial sweeteners may contribute to obesity, diabetes, CVD. Trends Endocrinol Metab. 2013; doi: 10.1016/j.tem.2013.05.005.
4. Fowler SP. Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring). 2008 Aug;16(8):1894-900. doi: 10.1038/oby.2008.284. Epub 2008 Jun 5.
5. Fowler SP, Williams K, Hazuda HP. Diet soda intake is associated with long-term increases in waist circumference in a biethnic cohort of older adults: the San Antonio Longitudinal Study of Aging. J Am Geriatr Soc. 2015;63:708–715.
6. Vyas A. Diet drink consumption and the risk of cardiovascular events: a report from the Women’s Health Initiative. J Gen Intern Med. 2015;30:462–468
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9. Pase, M. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia
10. A Prospective Cohort Study. Stroke. 2017
11. Suez, J., Korem, T., Zeevi, D. et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 514, 181–186 (2014).