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Effects of Sucralose Ingestion versus Sucralose Taste on Metabolic Responses to an Oral Glucose Tolerance Test in Participants with Normal Weight and Obesity: A Randomized Crossover Trial

November 24, 2020

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Nichol AD, Salame C, Rother KI AND Pepino MY.

Nutrients 2020, 12, 29; doi:10.3390/nu12010029

Objective

  • To test the hypothesis that sucralose differentially affects metabolic responses to labeled oral glucose tolerance tests (OGTTs) in participants with normal weight and obesity.

Background

  • A recent study found that the ingestion of sucralose before an OGTT increased the plasma insulin response and decreased whole-body insulin sensitivity in people with obesity. However, it is unknown whether this effect was mediated by the perception of sucralose sweet taste in the mouth or by sucralose post-oral effects.
  • The primary goals of this study were to distinguish the acute effects of sucralose ingestion from the perception of the sweet taste of sucralose per se on the metabolic response to glucose ingestion, and to compare such acute effects of sucralose in people who are normal weight and those who are obese.
  • A secondary goal of the study was to assess plasma sucralose concentrations achieved after sucralose ingestion.

Methods

  • This study utilized a randomized crossover design, and evaluated participants on three separate study visits.
  • Participants (10 with normal weight and 11 with obesity) without diabetes underwent three dual-tracer OGTTs preceded, in a randomized order, by consuming sucralose or water, or by tasting and expectorating sucralose (e.g., sham-fed; sweetness control).
  • Indices of β-cell function and insulin sensitivity were estimated using oral minimal models of glucose, insulin, and C-peptide kinetics.

Findings

  • Compared with water, sucralose ingested resulted in a 30 ± 10% increased glucose area under the curve in both weight groups.
  • In contrast, the insulin response to sucralose ingestion differed depending on the presence of obesity showing a decrease within 20–40 min of the OGTT in normal-weight participants but an increase within 90–120 min in participants with obesity.
  • Sham-fed sucralose similarly decreased insulin concentrations within 60 min of the OGTT in both weight groups.
  • Sucralose ingested increased insulin sensitivity in normal-weight participants by 52 ± 20% but showed no effect in participants with obesity.
  • Sucralose did not affect glucose rates of appearance or β-cell function in either weight group.

Conclusions

  • The authors suggest these results demonstrate that sucralose is not metabolically inert and that is differentially affects glucose metabolism in people with obesity and those of normal weight.
  • According to the authors, the results of this study underscore a physiological role for taste perception in postprandial glucose responses, suggesting sweeteners should be consumed in moderation.

Points to Consider

  • It should be noted that the study sample included participants that do not normally consume low-calorie sweeteners. This may or may not have had an effect on intestinal glucose uptake following ingestion and/or glycemic response to oral load.
  • While these findings contradict data which previously reported that sucralose passes through the body and is excreted unchanged, the findings of this study do not provide evidence of any adverse safety effects.
  • These modest findings in a controlled setting do not negate the findings larger, more robust studies designed to specifically assess the safety of sucralose. Such studies have found that sucralose has no effect on carbohydrate metabolism and no effect on short- or long-term blood glucose control or on serum insulin levels, making it suitable for people with diabetes.
  • Sucralose has a long standing record of safety, which a large body of evidence substantiating its safety. The approval process includes the rigorous review of multiple studies, including both human and animal investigations, in order to establish the safety status.
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