sugar

A lot of people ask which is worse PCOS – sugar or artificial sweeteners? Like a lot of topics in nutrition, it can complicated. Since insulin resistance is thought to be the root cause of PCOS, using artificial sweeteners sounds like a good idea for managing PCOS. These sweeteners don’t have any (or many) calories. This should keep insulin levels lower. But do artificial sweeteners improve our health? Let’s first take a look at sugar. 

What we know about sugar

1. Sugar or sweeteners with calories such as honey, high fructose corn syrup, agave, maple syrup, brown sugar, or cane sugar will cause blood sugar to go up quickly. This causes the pancreas to produce insulin so that the sugar can get into the cells. Excess insulin drives a lot of PCOS symptoms. Having sugar as part of a meals with protein and fiber can help prevent blood sugar and insulin from spiking. Check out this blog on Nutrition Basics: Macronutrients for more information.

2. We know that a lot of people consume a lot of sugar, especially in drinks such as soda, juices, iced tea, lemonade, and prepared coffees. There’s also a lot of added sugar in cereal, yogurt, and bars.

3. Sugar is found in so many products because it makes food taste good and we humans like it. It is a cheap food additive, especially as high fructose corn syrup. Sometimes people may be taking in more sugar than they realize.

4. Eating too much sugar can contribute to higher weight, higher cholesterol, fatty liver, and cardiovascular disease. Most people know that having too much sugar is not good for our health. This is why people are interested in trying an alternative like artificial sweeteners.

What are artificial sweeteners? 

The artificial or non-nutritive sweeteners which are “generally regarded as safe” (GRAS) according to the FDA include saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotame, and advatame. Steviol glycosides (Stevia) and Luo hun guo fruit extract (monk fruit) are approved as food “additives”, but not as “sweeteners”. The products are sweeter than sugar without calories. Some people like that Stevia is marketed as a more “natural” product. It is still processed and more research needs to be done on it to see if it is a better choice than the other products. Here is a link for more information about the history and safety of these non-nutritive sweeteners from the FDA.

What we don’t know about non-nutritive (artificial) sweeteners

While the artificial sweeteners are regarded as safe for people to consume, there are still a lot of questions about how these products affect us long term.

1. How do they affect the gut microbiota? Gut microbiome research is very new and is thought to have a large effect on our health including how we metabolize foods. Some research indicates that some artificial sweeteners can negatively impact the gut microbiome. This may affect weight and insulin resistance. If we have a more “unhealthy” make up of bacteria in our intestines, we may gain more weight or have blood sugar go up quicker than if we had more “good” bacteria in our gut.

2. Do they increase our cravings for sweets? When are used to everything we eat or drink tasting sweet, it may cause us to want more sweets. There is also a theory that since artificial sweeteners are sweeter than sugar but have no calories, we are more likely to seek out extra calories to compensate later in the day. 

3. Do artificial sweeteners affect blood sugar, insulin or metabolism? Research is not conclusive about how artificial sweeteners impact weight or insulin resistance, but it’s possible that these products are contributing to some of the very conditions that people are trying to avoid by using them. This could be due to how these sweeteners are affecting insulin receptors or hormones that affect fullness.

4. If something is labeled “sugar free”, will you eat more of it? In my experience, people tend to eat a larger quantity of foods (or drinks) if they are labeled “sugar free”. It could be that foods sweetened with artificial sweeteners aren’t as satisfying as the “real” version so people need more of the sweet food to satisfy a craving. Or it could be that psychologically people feel like can overeat these products and they won’t impact their health. The problem is that these cookies, cakes, ice creams, and candies made with artificial sweeteners (usually) still do have carbohydrates in them and will raise blood sugar and insulin, especially if eaten in large quantities. 

So which is better, sugar or artificial sweeteners? Overall, I think it’s best to have small amounts of “real” sweeteners, preferably as part of a meal.

My Recommendations

1. Try to get used to less sweet drinks. If you are used to sweet beverages (artificial or regular sugar), start by diluting them with water or seltzer. Or try water with lemon, berries, cucumbers. There are a lot of flavor seltzers out now you may like.

2. If you want to sweeten coffee, plain yogurt, or oatmeal, try using a little of the “real” sugar (could be honey, maple syrup, or brown sugar too). 1 teaspoon of sugar is only 5 grams of carbohydrates which is not enough to impact blood sugar.  

3. If you want something sweet, go for what you really want. Enjoy it. If you allow yourself to eat what you really want without guilt, you will probably find you need less of it. Avoiding sugar completely is not necessary and trying to completely avoid it may cause you to binge on it. 

Bottom line: I don’t recommend that people with PCOS frequently use artificial sweeteners. More research needs to be done on artificial sweeteners and their effects on metabolism. I suggest reserving the sweet tastes for foods you really enjoy and try to cut back on some of the incidental sweets (sugar or artificial) you may be taking in. Check out this review article from December of 2018 in the Journal of Endocrinology and Metabolism for a review of recent research on how non-nutritive sweeteners affect metabolism.

Are you interested in learning more about nutrition and how it affects PCOS? Click PCOS Nutrition to contact me about nutrition counseling!