As the war on sugar continues, it’s little surprise that artificial sweeteners are fast becoming a preferred option. After the UK introduced a Sugar Tax in 2018 that penalises drinks with a high sugar content, it’s understandable that manufactures of these drinks as well as those who create sugary confections and other consumables are turning their attentions towards alternatives that allow them to keep their products tax free.
But are artificial sweeteners just as bad as the sugar they replace? There has been a lot of noise surrounding the subject over the last few years, and it’s important for dental professionals to know the facts.
Obesity, sugar and additives
One of the driving forces behind the introduction of the Sugar Tax is the current obesity crisis taking place in the UK. According to statistics from the House of Commons Library, the rate of dangerous obesity in the UK has exploded from 19% of the population in 1993 to 29% in 2016, with 64% of the population being classed as overweight (weighing more than they should for their height and age, but not yet fully within the danger zone). Furthermore, this same set of statistics reveals that one in every five children is obese at the age of eleven.[i]
Obviously, this is unacceptable, and while there may be a number of reasons to blame, diet, the increased intake of sugar and ready availability of sweet treats is likely to be one of the leading factors.
As we all know, obesity can lead to a number of problems, including heart diseases, certain cancers and diabetes.[ii] But does cutting sugar and switching to artificial additives help people lose weight? Unfortunately, this is one of those issues that seems to have two conflicting bodies of evidence.
Research presented by the Canadian Medical Association Journal that took a huge pool of associated research, some of which was performed over a 10-year period, actually found that when people consumed beverages sweetened with artificial additives such as aspartame on a daily basis they were at an increased chance of developing heart disease and becoming obese.[iii] However, one thing that is important to take into account when reviewing this information is that these studies are hardy going to track every single item of food or drink that these subjects consumed during this time, and many of them focus purely on drinks. Yes, subjects may have had a diet cola, but is it just as likely they consumed this alongside unhealthy foods and other things that may be full of sugar? It’s impossible to tell where the weight gain stems from.
On the flip side, the evidence in favour of artificial sweeteners as a means of weight management seems logical, at least. If you consider an average can of fizzy drink can contain around 140 calories, then it makes sense that by swapping to an alternative with an artificial sweetener that provides zero or very few calories that weight loss can be better managed. However, as the previous study suggests, this is not necessarily a black and white issue. In fact, other studies have suggested that because artificial sweeteners activate certain parts of our brains that cause hunger, people make up the calorific deficiency by eating more food. However, there’s also the argument that as diet drinks are marketed towards people who are likely to be wanting to lose weight already, their calorific intake may be coming entirely from bad food choices and this is just cause and effect data misinterpretation. As you can see, the issue is a difficult one to decipher.
As dental professionals, perhaps the more pressing issue is the impact both sugar and artificial sweeteners can have on oral health. Sugar is undoubtedly bad for our teeth, causing increased incidence of decay – but are artificial sweeteners as bad?
Again, this seems like a contentious issue. Some studies put forward the argument that these substances are just as bad for teeth as they soften the tooth enamel, leaving teeth more prone to decay.[iv]
Conversely, other sources claim that because oral bacteria feed off of sugar, artificial sweeteners are a much better option as they do not allow this process to take place, thus inhibiting plaque formation. Furthermore, some artificial sweeteners such as xylitol have been found to have benefits for oral health due to antibacterial properties.[v]
What should you suggest?
In the end, it’s clear that more independent research needs to be carried out to determine whether artificial sweeteners are in fact safe or harbouring some unpleasant health effects. It could very well be a case of “better the devil you know” and sugar may be less damaging, or artificial sweeteners could be being falsely maligned.
Due to this uncertainty, professionals should recommend patients stick to drinks that don’t contain either of these things, such as milk or water. We may one day know whether we can trust artificial sweeteners fully, but until then it’s better to be safe than sorry.
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[i] The House of Commons Library. Obesity Statistics Briefing Paper, Number 3336 6th August 2019. Link: file:///Users/writer/Downloads/SN03336.pdf
[iii] Time Magazine. Artificial Sweeteners Are Linked to Weight Gain—Not Weight Loss. Link: https://time.com/4859012/artificial-sweeteners-weight-loss/ [Last accessed August 19].
[iv] Oral Health CRC. The Potential of Sugar-Free Beverages, Sugar-Free Confectionary and Sports Drink to Cause Dental Erosion. Link: http://www.oralhealthcrc.org.au/sites/default/files/Dental%20Erosion%20Briefing%20Paper_FINAL2015.pdf [Last accessed August 19].
[v] New York Times. Sweet Tooth. Link: https://www.nytimes.com/2012/09/11/science/are-sugar-substitutes-bad-for-teeth.html [Last accessed August 19].