Anthony L. Komaroff, M.D.
— DEAR DOCTOR K: I'm trying to lose weight, so I've switched to artificial sweeteners. But are they really a good alternative to sugar?
DEAR READER: Sugar may be the most important dietary cause of obesity in America today. When you consume it as part of a whole food, such as fruit, it's digested along with other nutrients. These nutrients, such as fiber and antioxidants, help control sugar's effect in your body.
But when you add table sugar to a food or beverage, it's stripped of these other nutrients. As a result, the sugar can cause spikes in your blood sugar and insulin. This can pave the way for heart disease, diabetes and liver damage.
The FDA has approved five artificial sweeteners. These are acesulfame, aspartame, neotame, saccharin and sucralose. (Plant-derived stevia is not counted in the same "artificial sweetener" category.)
When artificial sweeteners were first introduced, there was concern that they might increase the risk of cancer. That has never been proven. But artificial sweeteners may cause headaches and other unpleasant reactions in some people.
I have a number of patients who drink large amounts of sodas or soft drinks with artificial sweeteners each day. They don't take in many calories, but they sure take in a lot of gas -- and their belly responds accordingly. It is not the artificial sweetener that has made them belch, burp and other things. But it has encouraged them to "gas up."
Like you, most people use artificial sweeteners because they want to lose weight. And in the short term, artificial sweeteners may help to do just that.
But there's concern that over the longer term, artificial sweeteners may actually promote weight gain. How so? Artificial sweeteners are hundreds to thousands of times sweeter than table sugar. If you get used to the mega sweetness of artificial sweeteners, then healthful, satisfying foods that are less sweet -- such as fruits and vegetables -- may not seem sweet enough. You might then respond by not eating enough of these healthy foods.
We have more information on healthy food choices in our Special Health Report, "Healthy Eating: A Guide to the New Nutrition." You can find out more about it at my website, AskDoctorK.com. We describe in detail what foods are healthy and what foods are not. We also teach you how healthy eating can easily be delicious, as well.
If artificial sweeteners are helping you lose weight right now, that's great. But over time, try to lessen your dependence on them. Instead, go for fresh fruit and other natural sources of sweetness.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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