As consumers seek ways to improve their dietary behaviors, one area that continues to be controversial is the role of artificial sweeteners. Artificial sweetening ingredients such as saccharine, sucralose, monk fruit, stevia leaf & allulose are added to a wide range of foods to offer a sweet treat without the guilt. But are they really benign when it comes to causing insulin response and possible insulin resistance (or a reduced insulin sensitivity)?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014832/#ref7

In the attached 2020 study, the authors attempt to asses the way artificial sweeteners affect insulin resistance on patients with type II diabetes (T2D). The study, conducted in India, divided people who were diagnosed with T2D into (2) groups: Group A were artificial sweetener users; Group B were not. Both groups had blood drawn (in a fasted state) to measure their fasting glucose and fasting insulin levels, then had their insulin resistance calculated based on HOMA-IR.

Results

The HOMA-IR values for Group A and B ranged from 0.9–24.33 and 0.12–10.83 with mean values 7.39 and 2.6, respectively, showing that the ones who used artificial sweeteners had a higher insulin resistance. The study also showed that the duration of use of artificial sweeteners had a direct impact on insulin resistance.

Implications

While this test is directional, much more research in this area is needed, especially with the frequency and availability of artificial sweeteners expanding at such a rapid rate. This study, however, does suggest caution regarding the use of artificial sweeteners if you are in one of the following three groups:

1. Diabetic, especially T2D. We know there is a high correlation between T2D and obesity, so artificial sweeteners may be introduced into a diet with the thinking that you can enjoy tasty foods without further reducing the body’s sensitivity to insulin. That thinking may be incorrect. Given that it appears both volume and duration affect insulin sensitivity, a person with T2D that regularly incorporates artificial sweeteners into his/her diet may further impair insulin sensitivity and exacerbate the metabolic affects of T2D.
2. Intermittent Fasting. The power of intermittent fasting on improving insulin sensitivity and metabolic syndrome is well-documented. However, if, during the fasting period, a person consumes artificial sweeteners (such as in diet colas, flavored water, tea or coffee), the benefits of a fast will be greatly diminished and the likelihood of insulin resistance will likely increase. Because of my own uncertainty around whether artificial sweeteners raise insulin, I switched my electrolyte consumption (stevia is the artificial sweetener) to only be consumed with my meals so as not to break a fast.
3. Caloric Reduction for Weight Loss. It’s not uncommon for people to go on a lower calorie diet to lose weight, choosing to drink fluids in lieu of eating food. However, even if the fluids consumed are “0 calorie”, if they have artificial sweeteners, the body may be reacting to that consumption by releasing insulin due to the sweet taste, which will blunt any affect of weight loss. I’m not suggesting caloric restriction is the best way to lose weight, but if you do choose this path, use caution with how much artificial sweetener is consumed in your reduced-calorie diet.