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Glucose metabolism responds to perceived sugar intake more than actual intake

240 points by Glench 6y ago

zepto 6y ago
So the Shangri-la diet is likely a placebo - just a very clever one.
- mrfusion 6y ago
  That’s so early 2000s. Are people still doing that diet?
  - zepto 6y ago
    Who knows - it’s just interesting because of the proposed mechanism being about regulation rather than inputs.
protonfish 6y ago
Yet another reason artificial sweeteners are not health food.
- skocznymroczny 6y ago
  Perhaps, but I'd still consider them better than white sugar.
  - 14 6y ago
    Can I ask how you came to this conclusion because I always thought the current belief was these sugars may be a lot worse for people after all. From my understanding the debate was still on going; can I ask why you would prefer sweeteners over white sugar? Edit: I love how you can’t ask a genuine health question here without being down voted. The sugar industry has spent decades brainwashing people and using fake science to push sugar. Even recently I thought there were a lot of concerns over sweeteners hence why I asked the question hoping to gain some insight as why that is not the case. I have always thought sweeteners were worse in many ways but I don’t have any thing backing that up. I was genuinely asking because I am now wondering if I have it wrong about sweeteners. Thank you to those who added some insight.
    - sedgjh23 6y ago
      Simply because sugar is more calorie dense.
      - purerandomness 6y ago
        That's not making them inherently unhealthy.
        weego 6y ago
        Maybe down voted due to context but it's correct. Sugar has 4 calories per gram, same as protein, while fat has 9 calories per gram. Unless you're diabetic or have diabetes markers you really don't have to worry at all about glycemic index so at that point sugars aren't inherently bad, it's just their ubiquity as a favour enhancer
    - JauntTrooper 6y ago
      The medical community does not consider artificial sweeteners to be worse than added sugar. The common artificial sweeteners are generally considered safe for consumption, and moderate use instead of added sugar can help achieve a healthy weight to reduce the risk of heart disease and diabetes, as well as better dental health. Artificial sweeteners have been studied for decades, and there is no sound evidence they are carcinogenic. There are some other potential negative effects on health though, which are being studied. One concerning correlation is that people who consume diet soda regularly are more likely to be overweight. These articles provide a good overview: [0] https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936 https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h... [1] https://www.health.harvard.edu/blog/artificial-sweeteners-sugar-free-but-at-what-cost-201207165030 https://www.health.harvard.edu/blog/artificial-sweeteners-su...
    - skocznymroczny 6y ago
      Even excluding things like insulin levels, I think the main advantage of artificial sweeteners is that they reduce the amount of tooth cavities, because the bacteria in the mouth feed on sugar, but don't feed on sweeteners.
- tedunangst 6y ago
  How do you reach this conclusion? They didn't test artificial sweeteners. They tested reading sugar on a label. If anything, logically one would expect this confirms the opposite. An artificially sweetened beverage will say zero sugar on the label.
fanzhang 6y ago
Not sure if this study will replicate: The study had about 30 participants, with 15 in each arm, so that's not a lot of statistical power to begin with. Both the low-glucose-label and high-glucose-label arms showed a spike in actual measured blood sugar after ingestion. The difference in blood glucose between the two arms was just about 10%. The naïve p-value between the two arms was barely significant at 2%, 6%, and 2%, but the p-values were taken from a complex model that probably has p-hacking problems and needs p-value correction. I would wait for the replication study before believing in this effect. If the effect is real, they only need to double their sample size to get a t-stat of 3 instead of 2, which would give a much more convincing p-value of 0.2% instead of the 2-6% right now. I applaud the authors for exploring this theory though, and encourage replications to push the p-value down.
- bfieidhbrjr 6y ago
  This isn't the only study, and this isn't new information they've found.
  - eganist 6y ago
    > This isn't the only study, and this isn't new information they've found. Do you have the others? They're not readily googlable- I've tried.
    - TACIXAT 6y ago
      This is what it made me think of. IIRC spitting out a sports drink was the same or more effective compared to actually consuming it during exercise. https://www.runnersworld.com/nutrition-weight-loss/a20832306/when-and-why-to-swish-n-spit-your-sports-drink/ https://www.runnersworld.com/nutrition-weight-loss/a20832306... Also see citations 7,8,9 in the Nature article.
    - bfieidhbrjr 6y ago
      Jason Fung in, I think, his second solo book, has a list of citations.
- 6y ago
bfieidhbrjr 6y ago
Jason Fung talks about this in his books. Independent studies find artificial sweeteners raise insulin. Industry studies mysteriously find no link. Also, injected glucose doesn't raise insulin like swallowing it. The world is a big weird place.
- hoka-one-one 6y ago
  Doesn't Jason Fung recommend starving yourself to stay lean?
  - voisin 6y ago
    That is an interesting take on his position. He recommends intermittent fasting as a way to keep insulin levels down. There are dozens and dozens of studies on this, many posted here to HN. Highly recommended reading.
  - bfieidhbrjr 6y ago
    Even for 2020 that's a pretty obtuse misreading of what he says. Please let me know what stocks you're long on so I can short them?
    - hoka-one-one 6y ago
      Not sure why you're responding in this manner but sorry if I offended you, I really didn't mean to. Maybe you see something in his work that I don't.
      - bfieidhbrjr 6y ago
        I know you haven't read his work because he specifically deals with the starvation thing multiple times.
        deleted 6y ago
        [deleted]
        deleted 6y ago
1123581321 6y ago
I'm type 1. I used to believe artificial sweeteners caused the body to raise its blood sugar because the drink is perceived to be sweet, but when I got a CGM I was able to verify that they do not. I'd be interested in a switched label test with CGMs and T1s because a potential insulin response would be absent. I realize this study is qualified (type 2, preprandial < 200mgdl, lab setting, fake labels, short term) and laud the potential connection between stress and elevated fasting glucose (seems similar to the connection between sleep and elevated glucose.) I've read the study and am just adding a personal anecdote to the thread.
- mtgx 6y ago
  Some do, some don't: https://www.youtube.com/watch?v=CYfqvTZWilw https://www.youtube.com/watch?v=CYfqvTZWilw
- arleny 6y ago
  I could be wrong, but it seems like there's a distinction between perceived sugar (amount of sugar in drink) as mentioned in the study and perceived sweetness (how sweet the drink tastes) which is what you're referring to.
  - 1123581321 6y ago
    You’re right. I tried to make my disclaimer thorough enough. :) However, unless there’s something particular about the visual vs. the taste path, there should be some overlap. I think the anticipation (stress) is the part of this study with the most interesting implications to me.
    - arleny 6y ago
      Agreed. My girlfriend is t1 diabetic and during periods of stress (recently, starting a new job) her blood glucose becomes much more sporadic.
- milesvp 6y ago
  I’ve done a certain amount of research around GI due to my wife twice having gestational diabetes, and it was hard to find good numbers in general, but I couldn’t find any numbers related to artificial sweetners. I did find a lot of people claiming artificial sweetners didn’t cause a rise in glucose, which makes sense because the only way to get glucose would be for the liver to release glucose as a response. What I don’t know definitely is whether or not artificial sweetners cause an insulin response (though there seems to he a growing body of evidence that some do cause the pancreas to produce insulin). There also seems to be a growing body of evidence that artificial sweeteners cause gut bacterial changes ( which, as I write this, makes me wonder if my current gastro intestinal drama might be related to a recent reintroduction of diet soda in my diet...). I will say as an anecdote, that I find intermittent fasting (skipping breakfast and late lunch) much easier when I have diet soda than when I have tea with sugar in the morning.
dvduval 6y ago
And neither artificial sugar or real sugar are necessary additives and our taste buds are adaptive. I tend to get my sugar from fruit.
- curryst 6y ago
  This is incredibly true. Cutting soda (I was drinking diet soda) out of my diet has really changed how I taste. I used to love crappy sour gummy candy, and I can't stand it anymore. It's far too sweet, and there's not really a remarkable flavor beyond syrupy sweet and a vaguely fruit-like flavor. It doesn't even taste like really sweet fruit to me, the sweet and fruit flavors seem disjointed. I do have a sweet tooth for fruit smoothies, though, which are probably not a ton better in terms of sugar content. I do no sugar added, but there's still a ton of sugar in enough fruit to blend and fill a cup. Hell, even cheese tastes sweet to me sometimes, depending on the kind of cheese.
  - hypertele-Xii 6y ago
    Blended fruit provide fiber along with their sugar content which... decreases their glycemic index or whatever. (the sugar is less bad)
  - dvduval 6y ago
    And having been like this for a few years, it even seems strange to me that fruit wouldn't be the first thing you would think of when it comes to getting sugar. And I'm not directing this at you. I'm just saying I used to drink soft drinks a lot too and now it doesn't even cross my mind. I do drink wine and beer and I know there's some sugar in those.
  - aksss 6y ago
    14 grams of sugar is equivalent to a tablespoon. I find it helpful to remember that imagery when looking at the ingredients of something I’m about to eat - would I want to shovel a tablespoon of sugar (or more) in my mouth right now? The thought tends to dissuade me and I have become a little more conscious of my sugar intake that way. It’s shocking how much sugar is in the processed “food” we buy. A 16oz strawberry açaí refresher from Starbucks has 32 grams of sugar. :P
chrisin2d 6y ago
Interesting. It is somewhat analogous to how thirst satiation is inhibited (partly) by gulping liquid as well as gut fluid osmolality.
mabbo 6y ago
I wonder if this might account for the 'aspartame migraine' phenomenon. If the body is reacting in a way to handle a sugar overload coming, but there's no sugar overload... what happens? I know that personally, if I drink an artificially sweetened soft drink, I am usually smacked with a headache that lasts hours. I'd never heard of the effect before, but after 2 or 3 attempts at a coke zero, I was done with them for life. And to be clear, I would really like to switch because my sugar intake probably isn't healthy.
- Someone1234 6y ago
  Have you encountered it with non-caffeinated aspartame drinks too? Coke Zero is very high in caffeine.
- anu7df 6y ago
  I have the same reaction with coke zero, but I am perfectly fine with diet coke. Not sure why.
- tharkun__ 6y ago
  It's not just aspartame. When I played soccer as a kid, coach would give us a little "fructose bar" at half time to boost us for the second half of the game. I would always get a headache from it so I started turning it down.
asar 6y ago
Very interesting study, but it's important to mention that all participants (n=30) had type 2 diabetes. I'm really wondering if stress played a bigger factor in their blood glucose levels, which has been observed to cause a release of glucose from organs into the blood. In this study participants played video games for 90 minutes after drinking the test beverage. I think playing video games can be very stressful for a lot of people, they also switched games every 15minutes. Participants also knew that the beverage might contain sugar, which if your a type 2 diabetic might be enough to cause stress(?). In figure 4 they show the effect on the blood glucose levels for the low vs high sugar beverage groups. I think an easy way to learn about the effects on ones own body for this is to buy a blood glucose meter and test themselves before and after drinking beverages with artificial sweeteners.
- tedunangst 6y ago
  Video games was a different previous study.
  - asar 6y ago
    You're right, thanks for noticing.
acituan 6y ago
A similar anticipatory mechanism exists for thirst quenching. We feel a decrease in thirst the moment we drink water but in reality it takes tens of minutes for the osmotic landscape to change with that newly ingested water.[1] I also think it is overeager to take this result and run with it to condemn artificial sweeteners. It has been known for long that they can indeed increase cravings and cautioned against for dieters. However, the initial intake of food is only one part of the glucose metabolism. How much actual glucose is left in your bloodstream, muscles and liver (in the form of glycogen) will keep effecting your energy metabolism for days if you've ingested real, bioavailable sugars, with all the downstream consequences e.g. for weight loss. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014472/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014472/
- _1100 6y ago
  I remember my old track coach using this during practices. We would swish the water around in our mouths to get rid of that bad taste you get when you’re thirsty, but he always warned us that the second we swallowed too much that practice was over because you get a stomach ache if you sprinted with all that water sloshing around.
  - dalacv 6y ago
    I have a theory that it isn't actually the water causing the ache, but rather the air that you drink while drinking the water. I've tried it and it works. See for youself: you have to drink a little bit differently (turn the water bottle upside down and be careful when drinking not to get air in. if you do, turn your head up and make sure you are only swallowing water.)
    - why-el 6y ago
      I think both you and the parent post are correct. I heard similar advice playing soccer: when you drink water during a game, what you usually do is drink it fast (and in a hand wavy way where the bottle is in the air). So the speed allows for more water and air, and thus you feel cramps. If you were to drink it slowly, which will reduce the air most likely, then you have less risk, but as a kid playing soccer, the urge to go back to the field is is too great. :)
slothtrop 6y ago
Interestingly I had read that erythritol, which does not ferment in the gut, does not impact blood sugar in any way, in contrast to other sweeteners. Requires a larger body of research.
a3n 6y ago
If the participants are consuming the same amount of sugar, then for those that have a higher label and have a higher glucose rise, where does the "extra" glucose come from? And is it more glucose going in to the blood, or less being processed out?
- aksss 6y ago
  I was under the impression it was being released from the body’s existing stores.
riazrizvi 6y ago
Which is a good thing; you experience this as a mild energy boost when you have sweetened tea vs non-sweetened tea, say. The body perceives a sweet flavor and anticipates a deposit of glucose. You have a physiological process that manages economic use of glucose. When it registers a deposit, it permits a withdrawal/release into your blood, where it can be delivered to your muscles and mind for energy. The problem with sugar, is when you have excessive sugar in the blood. Excessive sugar is potentially lethal, because glucose can cross the blood-brain barrier. the brain has a protein like substance, chemically similar to egg white, and when you mix too much sugar with egg white, you get meringue. meringue brain is bad. so in healthy individuals, we get insulin spikes, to flush the glucose from our blood when we have too much. sure it robs you of energy but it saves your brain. in type 2 diabetics their insulin safety mechanism can’t be relied on. If you’re healthy you don’t need to worry about extra glucose released by your body from its stores. instead be reassured that you understand why you feel more perky when your drink is sweetened. But if you have sweetener in your tea, and then you have a sugary snack, that’s worse than the sugary snack alone. You’re more likely to generate harmful levels of blood glucose because your body will preemptively elevate blood glucose before you even get to the snack. moral of the story, don’t eat food high in real sugar or flour. as always.
- a3n 6y ago
  > meringue brain is bad. Quote of the year.
- WalterSear 6y ago
  The study found the difference was due to to labeling - flavour was controlled for.
- snapetom 6y ago
  Would this study be evidence that artificial sweeteners do not reduce the chance of Type 2 because there's still an insulin response?
  - riazrizvi 6y ago
    It depends on how sweeteners impact your unhealthy habits. If sweeteners help you fix your diet, help you eliminate unhealthy food so that your insulin levels remain in narrow healthy ranges, then they help. But they do elevate blood sugar levels, so if you still eat harmful levels of dietary sugar, then they would increase the chance of Type 2. It might be better to train your taste preferences to prefer less sweet food, then you’re less likely to lapse because you stop anticipating sweet food. Susan Pierce in the book Bright Line Eating, recommends that approach.
gregw2 6y ago
Is it just me or are the images and text contradictory? The text of this article says that the drink was, in reality, 62 grams of sugar and portrayed via the label as either 0 grams or 124 grams. However, the image of the nutritional label shows the actual drink was 15 grams (but 62 calories) or 30 grams (124 calories). Which is it? 124 grams of sugar doesn't pass the sniff test for anyone who is passing familiar with the basic fact there are 35-40 grams of sugar in a 12-oz can of soda. Was this noticed or not? Were questions asked whether people had a sense of how much sugar (or calories) are in a soda? Did people perceive they were getting a extremely-high-sugar beverage (124g) or a low-sugar beverage (30g)? Does that affect the psychological dynamics in a material way? I am a little disappointed in the quality of peer review coming out of Nature here...
regularfry 6y ago
This reminds me of heroin addicts who can cope with a higher dosage in a familiar setting than in an unfamiliar one.
nxc18 6y ago
Just want to let people know, it is possible to lose weight while drinking diet soda and artificially sweetened tea. I personally lost 120 lbs (and counting) while drinking lots of sweet-n-low and aspartame-sweetened soda. Anecdata isn’t data but I’d argue a study of 30 participants barely counts as useful data either. Maybe the artificial sweeteners mess with glucose metabolism, maybe not. Maybe these things are more variable person-to-person than expected. If you’re trying to lose weight, and you’re having problems with diet soda, maybe make a change. But if you’re drinking diet soda and artificial sweeteners, and also finding success, don’t let random low-sample-size studies scare you off.
- C19is20 6y ago
  Try 'Durianrider' on YouTube. His style can be abrasive, and he's very polarising (and the purely nutrition videos may be buried in the Social Media bs), but I too eat more sugar and am losing weight. When I 'diet', I gain weight. When I eat a lot, weight falls off me. YM(!)MV, of course.
- tharkun__ 6y ago
  Also I wonder why one needs to drink any soda at all. What's wrong with water? Simple plain water, not even carbonated. I don't get why so many people out there "can't drink it". Apparently it doesn't taste good. WTF? I mean yes you can taste differences in different waters based on mineral content and such but you get used to it. It's the _difference_ from what you're used to that makes it bad usually (again exceptions exist where the water just tastes bad - find other water). Ever been to Iceland? If not go look up what their water is like.
  - nxc18 6y ago
    Carbonated water can be particularly refreshing. I find it can do wonders to settle my stomach if I’m not feeling well. As a weight loss tool, diet soda is a great alternative to snacking between meals. Water, coffee, and tea all also offer that same benefit. IME it is easier to prepare cold soda than it is to prepare cold coffee and tea, at least with the devices I have in my kitchen. I do drink plenty of unadulterated water, but its not an either/or situation. It is in fact possible, to enjoy water, coffee, tea, and soda, all in the same day. Some people will even throw beer and wine into the mix, but certainly if you wouldn’t drink soda, you would never consider beer, which is heavily caloric, tainted with poison, and carbonated. I looked up Iceland’s water - apparently it smells of egg/sulfur. I don’t know why you asked me to look that up.
silverpepsi 6y ago
I think any good study has to consider habitual use. Spiking blood sugar in false anticipation once means nothing. How about daily? The body learns from its mistakes. For me, I could never drink diet pop, but when I discovered Coke Zero it was amazing. Finally I could cut my sugar intake. Tastes delicious with a meal, or even after a meal. Over time, I noticed if I've been fasting a lot of hours and then consume one - it won't taste good at all. My body seems to have become keenly aware that it is not contributing a single calorie of the energy it is dying for.
- tremon 6y ago
  The body learns from its mistakes. Are you sure about that? If the body could truly learn on such fast turnaround times, we wouldn't have an obesity epidemic, I think.
  - beagle3 6y ago
    The body learns associations. There are reproducible experiments with rats who develop a liking for chalk water after sugar is added to it; and it takes them a couple of weeks to stop liking it when sugar is out. There are some experiments showing the same is true with humans, with a time constant of 3-6 weeks. From memory, relevant papers are from Michel cabanac. Seth Robert’s “what makes food fattening” is a great overview of related results, whether or nit you agree with his take.
ineedasername 6y ago
There's a lot to dig into here that's wrong: One fundamental problem with this is the lack of baseline determination of glucose sensitivity. People with diabetes, especially type 2, have different sensitivities & levels of insulin production. A group with greater or lesser averages on those factors would strongly influence results. They don't even appear to have accounted for medication dosage, merely whether or not the person was on biguanide. Or even mention weight, another significant factor for insulin sensitivity. Second is the glucose increase: Glucose tests have margins of error, an issue not addressed here, and the difference in glucose levels this study measure were small considering that factor, about 20 points. Specifically: Even a blood-drawn lab test has a total error of about 8%. If that's tge type of test they did, then an 8% swing could reduce the results to insignificance. If they used a rapid test, even the sort used in a doctor's office, it's even worse: those are considered accurate if it produces results that are within 15% of what a lab test would produce, meaning +/- 15% of a value that already has a total error of 8%. There's just too much wrong with a study like this that's poorly controlled with ~15 people in each group. And unfortunately there's a decent chance we'll see headlines soon along the lines of "Diabetes: Think sugar matters? think again ::lol lol we made a pun::"
anonuser123456 6y ago
As I read this study, the take away I have is: Food labeling with sugar causes increased stress for T2 diabetics. The stress response increases blood sugar. This all sounds sort of 'ho-hum duh'. Am I missing something?
etangent 6y ago
Warning: very low-power study
deleted 6y ago
[deleted]
PIKAL 6y ago
The guy on YouTube called high intensity health is a keto diet evangelist who wears a real time glucose monitor to study more closely what’s going on biologically with ketosis and blood sugar. He’s reported that being in stressful situations, like being late at the airport, can spike your glucose even when you’re in ketosis and kick you out of ketosis. I’ve experienced this too with the resurgence of inflammatory symptoms that are usually gotten rid of by ketosis.
- diydsp 6y ago
  Some great GCM experiment(er)s out there. This guy commits to a 2 week test of potato starch, sharing screenshots, etc. I dig HIH, too, for his info, but I stop at vegan intermittent fasting vs. full-time carnivorous keto. https://youtu.be/YvJGvoJtokA https://youtu.be/YvJGvoJtokA
qwerty456127 6y ago
> blood glucose levels increase when participants believe the beverage has high sugar content Then where does this actual glucose come from?
nikolay 6y ago
There's no news. Insulin production starts ramping up even when you start thinking about eating and before putting any food in your mouth. It takes time for its release, so, all this is trying to predict when you'll need it. Still there's no single mechanism.

240 points by Glench 6y ago

zepto 6y ago

So the Shangri-la diet is likely a placebo - just a very clever one.

mrfusion 6y ago
That’s so early 2000s. Are people still doing that diet?
- zepto 6y ago
  Who knows - it’s just interesting because of the proposed mechanism being about regulation rather than inputs.

protonfish 6y ago

Yet another reason artificial sweeteners are not health food.

skocznymroczny 6y ago
Perhaps, but I'd still consider them better than white sugar.
- 14 6y ago
  Can I ask how you came to this conclusion because I always thought the current belief was these sugars may be a lot worse for people after all. From my understanding the debate was still on going; can I ask why you would prefer sweeteners over white sugar? Edit: I love how you can’t ask a genuine health question here without being down voted. The sugar industry has spent decades brainwashing people and using fake science to push sugar. Even recently I thought there were a lot of concerns over sweeteners hence why I asked the question hoping to gain some insight as why that is not the case. I have always thought sweeteners were worse in many ways but I don’t have any thing backing that up. I was genuinely asking because I am now wondering if I have it wrong about sweeteners. Thank you to those who added some insight.
  - sedgjh23 6y ago
    Simply because sugar is more calorie dense.
    - purerandomness 6y ago
      That's not making them inherently unhealthy.
      - weego 6y ago
        Maybe down voted due to context but it's correct. Sugar has 4 calories per gram, same as protein, while fat has 9 calories per gram. Unless you're diabetic or have diabetes markers you really don't have to worry at all about glycemic index so at that point sugars aren't inherently bad, it's just their ubiquity as a favour enhancer
  - JauntTrooper 6y ago
    The medical community does not consider artificial sweeteners to be worse than added sugar. The common artificial sweeteners are generally considered safe for consumption, and moderate use instead of added sugar can help achieve a healthy weight to reduce the risk of heart disease and diabetes, as well as better dental health. Artificial sweeteners have been studied for decades, and there is no sound evidence they are carcinogenic. There are some other potential negative effects on health though, which are being studied. One concerning correlation is that people who consume diet soda regularly are more likely to be overweight. These articles provide a good overview: [0] https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936 https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h... [1] https://www.health.harvard.edu/blog/artificial-sweeteners-sugar-free-but-at-what-cost-201207165030 https://www.health.harvard.edu/blog/artificial-sweeteners-su...
  - skocznymroczny 6y ago
    Even excluding things like insulin levels, I think the main advantage of artificial sweeteners is that they reduce the amount of tooth cavities, because the bacteria in the mouth feed on sugar, but don't feed on sweeteners.
tedunangst 6y ago
How do you reach this conclusion? They didn't test artificial sweeteners. They tested reading sugar on a label. If anything, logically one would expect this confirms the opposite. An artificially sweetened beverage will say zero sugar on the label.

fanzhang 6y ago

Not sure if this study will replicate: The study had about 30 participants, with 15 in each arm, so that's not a lot of statistical power to begin with. Both the low-glucose-label and high-glucose-label arms showed a spike in actual measured blood sugar after ingestion. The difference in blood glucose between the two arms was just about 10%. The naïve p-value between the two arms was barely significant at 2%, 6%, and 2%, but the p-values were taken from a complex model that probably has p-hacking problems and needs p-value correction. I would wait for the replication study before believing in this effect. If the effect is real, they only need to double their sample size to get a t-stat of 3 instead of 2, which would give a much more convincing p-value of 0.2% instead of the 2-6% right now. I applaud the authors for exploring this theory though, and encourage replications to push the p-value down.

bfieidhbrjr 6y ago
This isn't the only study, and this isn't new information they've found.
- eganist 6y ago
  > This isn't the only study, and this isn't new information they've found. Do you have the others? They're not readily googlable- I've tried.
  - TACIXAT 6y ago
    This is what it made me think of. IIRC spitting out a sports drink was the same or more effective compared to actually consuming it during exercise. https://www.runnersworld.com/nutrition-weight-loss/a20832306/when-and-why-to-swish-n-spit-your-sports-drink/ https://www.runnersworld.com/nutrition-weight-loss/a20832306... Also see citations 7,8,9 in the Nature article.
  - bfieidhbrjr 6y ago
    Jason Fung in, I think, his second solo book, has a list of citations.
6y ago

bfieidhbrjr 6y ago

Jason Fung talks about this in his books. Independent studies find artificial sweeteners raise insulin. Industry studies mysteriously find no link. Also, injected glucose doesn't raise insulin like swallowing it. The world is a big weird place.

hoka-one-one 6y ago
Doesn't Jason Fung recommend starving yourself to stay lean?
- voisin 6y ago
  That is an interesting take on his position. He recommends intermittent fasting as a way to keep insulin levels down. There are dozens and dozens of studies on this, many posted here to HN. Highly recommended reading.
- bfieidhbrjr 6y ago
  Even for 2020 that's a pretty obtuse misreading of what he says. Please let me know what stocks you're long on so I can short them?
  - hoka-one-one 6y ago
    Not sure why you're responding in this manner but sorry if I offended you, I really didn't mean to. Maybe you see something in his work that I don't.
    - bfieidhbrjr 6y ago
      I know you haven't read his work because he specifically deals with the starvation thing multiple times.
      - deleted 6y ago
        [deleted]
      - deleted 6y ago

1123581321 6y ago

I'm type 1. I used to believe artificial sweeteners caused the body to raise its blood sugar because the drink is perceived to be sweet, but when I got a CGM I was able to verify that they do not. I'd be interested in a switched label test with CGMs and T1s because a potential insulin response would be absent. I realize this study is qualified (type 2, preprandial < 200mgdl, lab setting, fake labels, short term) and laud the potential connection between stress and elevated fasting glucose (seems similar to the connection between sleep and elevated glucose.) I've read the study and am just adding a personal anecdote to the thread.

mtgx 6y ago
Some do, some don't: https://www.youtube.com/watch?v=CYfqvTZWilw https://www.youtube.com/watch?v=CYfqvTZWilw
arleny 6y ago
I could be wrong, but it seems like there's a distinction between perceived sugar (amount of sugar in drink) as mentioned in the study and perceived sweetness (how sweet the drink tastes) which is what you're referring to.
- 1123581321 6y ago
  You’re right. I tried to make my disclaimer thorough enough. :) However, unless there’s something particular about the visual vs. the taste path, there should be some overlap. I think the anticipation (stress) is the part of this study with the most interesting implications to me.
  - arleny 6y ago
    Agreed. My girlfriend is t1 diabetic and during periods of stress (recently, starting a new job) her blood glucose becomes much more sporadic.
milesvp 6y ago
I’ve done a certain amount of research around GI due to my wife twice having gestational diabetes, and it was hard to find good numbers in general, but I couldn’t find any numbers related to artificial sweetners. I did find a lot of people claiming artificial sweetners didn’t cause a rise in glucose, which makes sense because the only way to get glucose would be for the liver to release glucose as a response. What I don’t know definitely is whether or not artificial sweetners cause an insulin response (though there seems to he a growing body of evidence that some do cause the pancreas to produce insulin). There also seems to be a growing body of evidence that artificial sweeteners cause gut bacterial changes ( which, as I write this, makes me wonder if my current gastro intestinal drama might be related to a recent reintroduction of diet soda in my diet...). I will say as an anecdote, that I find intermittent fasting (skipping breakfast and late lunch) much easier when I have diet soda than when I have tea with sugar in the morning.

dvduval 6y ago

And neither artificial sugar or real sugar are necessary additives and our taste buds are adaptive. I tend to get my sugar from fruit.

curryst 6y ago
This is incredibly true. Cutting soda (I was drinking diet soda) out of my diet has really changed how I taste. I used to love crappy sour gummy candy, and I can't stand it anymore. It's far too sweet, and there's not really a remarkable flavor beyond syrupy sweet and a vaguely fruit-like flavor. It doesn't even taste like really sweet fruit to me, the sweet and fruit flavors seem disjointed. I do have a sweet tooth for fruit smoothies, though, which are probably not a ton better in terms of sugar content. I do no sugar added, but there's still a ton of sugar in enough fruit to blend and fill a cup. Hell, even cheese tastes sweet to me sometimes, depending on the kind of cheese.
- hypertele-Xii 6y ago
  Blended fruit provide fiber along with their sugar content which... decreases their glycemic index or whatever. (the sugar is less bad)
- dvduval 6y ago
  And having been like this for a few years, it even seems strange to me that fruit wouldn't be the first thing you would think of when it comes to getting sugar. And I'm not directing this at you. I'm just saying I used to drink soft drinks a lot too and now it doesn't even cross my mind. I do drink wine and beer and I know there's some sugar in those.
- aksss 6y ago
  14 grams of sugar is equivalent to a tablespoon. I find it helpful to remember that imagery when looking at the ingredients of something I’m about to eat - would I want to shovel a tablespoon of sugar (or more) in my mouth right now? The thought tends to dissuade me and I have become a little more conscious of my sugar intake that way. It’s shocking how much sugar is in the processed “food” we buy. A 16oz strawberry açaí refresher from Starbucks has 32 grams of sugar. :P

chrisin2d 6y ago

Interesting. It is somewhat analogous to how thirst satiation is inhibited (partly) by gulping liquid as well as gut fluid osmolality.

mabbo 6y ago

I wonder if this might account for the 'aspartame migraine' phenomenon. If the body is reacting in a way to handle a sugar overload coming, but there's no sugar overload... what happens? I know that personally, if I drink an artificially sweetened soft drink, I am usually smacked with a headache that lasts hours. I'd never heard of the effect before, but after 2 or 3 attempts at a coke zero, I was done with them for life. And to be clear, I would really like to switch because my sugar intake probably isn't healthy.

Someone1234 6y ago
Have you encountered it with non-caffeinated aspartame drinks too? Coke Zero is very high in caffeine.
anu7df 6y ago
I have the same reaction with coke zero, but I am perfectly fine with diet coke. Not sure why.
tharkun__ 6y ago
It's not just aspartame. When I played soccer as a kid, coach would give us a little "fructose bar" at half time to boost us for the second half of the game. I would always get a headache from it so I started turning it down.

asar 6y ago

Very interesting study, but it's important to mention that all participants (n=30) had type 2 diabetes. I'm really wondering if stress played a bigger factor in their blood glucose levels, which has been observed to cause a release of glucose from organs into the blood. In this study participants played video games for 90 minutes after drinking the test beverage. I think playing video games can be very stressful for a lot of people, they also switched games every 15minutes. Participants also knew that the beverage might contain sugar, which if your a type 2 diabetic might be enough to cause stress(?). In figure 4 they show the effect on the blood glucose levels for the low vs high sugar beverage groups. I think an easy way to learn about the effects on ones own body for this is to buy a blood glucose meter and test themselves before and after drinking beverages with artificial sweeteners.

tedunangst 6y ago
Video games was a different previous study.
- asar 6y ago
  You're right, thanks for noticing.

acituan 6y ago

A similar anticipatory mechanism exists for thirst quenching. We feel a decrease in thirst the moment we drink water but in reality it takes tens of minutes for the osmotic landscape to change with that newly ingested water.[1] I also think it is overeager to take this result and run with it to condemn artificial sweeteners. It has been known for long that they can indeed increase cravings and cautioned against for dieters. However, the initial intake of food is only one part of the glucose metabolism. How much actual glucose is left in your bloodstream, muscles and liver (in the form of glycogen) will keep effecting your energy metabolism for days if you've ingested real, bioavailable sugars, with all the downstream consequences e.g. for weight loss. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014472/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014472/

_1100 6y ago
I remember my old track coach using this during practices. We would swish the water around in our mouths to get rid of that bad taste you get when you’re thirsty, but he always warned us that the second we swallowed too much that practice was over because you get a stomach ache if you sprinted with all that water sloshing around.
- dalacv 6y ago
  I have a theory that it isn't actually the water causing the ache, but rather the air that you drink while drinking the water. I've tried it and it works. See for youself: you have to drink a little bit differently (turn the water bottle upside down and be careful when drinking not to get air in. if you do, turn your head up and make sure you are only swallowing water.)
  - why-el 6y ago
    I think both you and the parent post are correct. I heard similar advice playing soccer: when you drink water during a game, what you usually do is drink it fast (and in a hand wavy way where the bottle is in the air). So the speed allows for more water and air, and thus you feel cramps. If you were to drink it slowly, which will reduce the air most likely, then you have less risk, but as a kid playing soccer, the urge to go back to the field is is too great. :)

slothtrop 6y ago

Interestingly I had read that erythritol, which does not ferment in the gut, does not impact blood sugar in any way, in contrast to other sweeteners. Requires a larger body of research.

a3n 6y ago

If the participants are consuming the same amount of sugar, then for those that have a higher label and have a higher glucose rise, where does the "extra" glucose come from? And is it more glucose going in to the blood, or less being processed out?

aksss 6y ago
I was under the impression it was being released from the body’s existing stores.

riazrizvi 6y ago

Which is a good thing; you experience this as a mild energy boost when you have sweetened tea vs non-sweetened tea, say. The body perceives a sweet flavor and anticipates a deposit of glucose. You have a physiological process that manages economic use of glucose. When it registers a deposit, it permits a withdrawal/release into your blood, where it can be delivered to your muscles and mind for energy. The problem with sugar, is when you have excessive sugar in the blood. Excessive sugar is potentially lethal, because glucose can cross the blood-brain barrier. the brain has a protein like substance, chemically similar to egg white, and when you mix too much sugar with egg white, you get meringue. meringue brain is bad. so in healthy individuals, we get insulin spikes, to flush the glucose from our blood when we have too much. sure it robs you of energy but it saves your brain. in type 2 diabetics their insulin safety mechanism can’t be relied on. If you’re healthy you don’t need to worry about extra glucose released by your body from its stores. instead be reassured that you understand why you feel more perky when your drink is sweetened. But if you have sweetener in your tea, and then you have a sugary snack, that’s worse than the sugary snack alone. You’re more likely to generate harmful levels of blood glucose because your body will preemptively elevate blood glucose before you even get to the snack. moral of the story, don’t eat food high in real sugar or flour. as always.

a3n 6y ago
> meringue brain is bad. Quote of the year.
WalterSear 6y ago
The study found the difference was due to to labeling - flavour was controlled for.
snapetom 6y ago
Would this study be evidence that artificial sweeteners do not reduce the chance of Type 2 because there's still an insulin response?
- riazrizvi 6y ago
  It depends on how sweeteners impact your unhealthy habits. If sweeteners help you fix your diet, help you eliminate unhealthy food so that your insulin levels remain in narrow healthy ranges, then they help. But they do elevate blood sugar levels, so if you still eat harmful levels of dietary sugar, then they would increase the chance of Type 2. It might be better to train your taste preferences to prefer less sweet food, then you’re less likely to lapse because you stop anticipating sweet food. Susan Pierce in the book Bright Line Eating, recommends that approach.

gregw2 6y ago

Is it just me or are the images and text contradictory? The text of this article says that the drink was, in reality, 62 grams of sugar and portrayed via the label as either 0 grams or 124 grams. However, the image of the nutritional label shows the actual drink was 15 grams (but 62 calories) or 30 grams (124 calories). Which is it? 124 grams of sugar doesn't pass the sniff test for anyone who is passing familiar with the basic fact there are 35-40 grams of sugar in a 12-oz can of soda. Was this noticed or not? Were questions asked whether people had a sense of how much sugar (or calories) are in a soda? Did people perceive they were getting a extremely-high-sugar beverage (124g) or a low-sugar beverage (30g)? Does that affect the psychological dynamics in a material way? I am a little disappointed in the quality of peer review coming out of Nature here...

regularfry 6y ago

This reminds me of heroin addicts who can cope with a higher dosage in a familiar setting than in an unfamiliar one.

nxc18 6y ago

Just want to let people know, it is possible to lose weight while drinking diet soda and artificially sweetened tea. I personally lost 120 lbs (and counting) while drinking lots of sweet-n-low and aspartame-sweetened soda. Anecdata isn’t data but I’d argue a study of 30 participants barely counts as useful data either. Maybe the artificial sweeteners mess with glucose metabolism, maybe not. Maybe these things are more variable person-to-person than expected. If you’re trying to lose weight, and you’re having problems with diet soda, maybe make a change. But if you’re drinking diet soda and artificial sweeteners, and also finding success, don’t let random low-sample-size studies scare you off.

C19is20 6y ago
Try 'Durianrider' on YouTube. His style can be abrasive, and he's very polarising (and the purely nutrition videos may be buried in the Social Media bs), but I too eat more sugar and am losing weight. When I 'diet', I gain weight. When I eat a lot, weight falls off me. YM(!)MV, of course.
tharkun__ 6y ago
Also I wonder why one needs to drink any soda at all. What's wrong with water? Simple plain water, not even carbonated. I don't get why so many people out there "can't drink it". Apparently it doesn't taste good. WTF? I mean yes you can taste differences in different waters based on mineral content and such but you get used to it. It's the _difference_ from what you're used to that makes it bad usually (again exceptions exist where the water just tastes bad - find other water). Ever been to Iceland? If not go look up what their water is like.
- nxc18 6y ago
  Carbonated water can be particularly refreshing. I find it can do wonders to settle my stomach if I’m not feeling well. As a weight loss tool, diet soda is a great alternative to snacking between meals. Water, coffee, and tea all also offer that same benefit. IME it is easier to prepare cold soda than it is to prepare cold coffee and tea, at least with the devices I have in my kitchen. I do drink plenty of unadulterated water, but its not an either/or situation. It is in fact possible, to enjoy water, coffee, tea, and soda, all in the same day. Some people will even throw beer and wine into the mix, but certainly if you wouldn’t drink soda, you would never consider beer, which is heavily caloric, tainted with poison, and carbonated. I looked up Iceland’s water - apparently it smells of egg/sulfur. I don’t know why you asked me to look that up.

silverpepsi 6y ago

I think any good study has to consider habitual use. Spiking blood sugar in false anticipation once means nothing. How about daily? The body learns from its mistakes. For me, I could never drink diet pop, but when I discovered Coke Zero it was amazing. Finally I could cut my sugar intake. Tastes delicious with a meal, or even after a meal. Over time, I noticed if I've been fasting a lot of hours and then consume one - it won't taste good at all. My body seems to have become keenly aware that it is not contributing a single calorie of the energy it is dying for.

tremon 6y ago
The body learns from its mistakes. Are you sure about that? If the body could truly learn on such fast turnaround times, we wouldn't have an obesity epidemic, I think.
- beagle3 6y ago
  The body learns associations. There are reproducible experiments with rats who develop a liking for chalk water after sugar is added to it; and it takes them a couple of weeks to stop liking it when sugar is out. There are some experiments showing the same is true with humans, with a time constant of 3-6 weeks. From memory, relevant papers are from Michel cabanac. Seth Robert’s “what makes food fattening” is a great overview of related results, whether or nit you agree with his take.

ineedasername 6y ago

There's a lot to dig into here that's wrong: One fundamental problem with this is the lack of baseline determination of glucose sensitivity. People with diabetes, especially type 2, have different sensitivities & levels of insulin production. A group with greater or lesser averages on those factors would strongly influence results. They don't even appear to have accounted for medication dosage, merely whether or not the person was on biguanide. Or even mention weight, another significant factor for insulin sensitivity. Second is the glucose increase: Glucose tests have margins of error, an issue not addressed here, and the difference in glucose levels this study measure were small considering that factor, about 20 points. Specifically: Even a blood-drawn lab test has a total error of about 8%. If that's tge type of test they did, then an 8% swing could reduce the results to insignificance. If they used a rapid test, even the sort used in a doctor's office, it's even worse: those are considered accurate if it produces results that are within 15% of what a lab test would produce, meaning +/- 15% of a value that already has a total error of 8%. There's just too much wrong with a study like this that's poorly controlled with ~15 people in each group. And unfortunately there's a decent chance we'll see headlines soon along the lines of "Diabetes: Think sugar matters? think again ::lol lol we made a pun::"

anonuser123456 6y ago

As I read this study, the take away I have is: Food labeling with sugar causes increased stress for T2 diabetics. The stress response increases blood sugar. This all sounds sort of 'ho-hum duh'. Am I missing something?

etangent 6y ago

Warning: very low-power study

deleted 6y ago

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PIKAL 6y ago

The guy on YouTube called high intensity health is a keto diet evangelist who wears a real time glucose monitor to study more closely what’s going on biologically with ketosis and blood sugar. He’s reported that being in stressful situations, like being late at the airport, can spike your glucose even when you’re in ketosis and kick you out of ketosis. I’ve experienced this too with the resurgence of inflammatory symptoms that are usually gotten rid of by ketosis.

diydsp 6y ago
Some great GCM experiment(er)s out there. This guy commits to a 2 week test of potato starch, sharing screenshots, etc. I dig HIH, too, for his info, but I stop at vegan intermittent fasting vs. full-time carnivorous keto. https://youtu.be/YvJGvoJtokA https://youtu.be/YvJGvoJtokA

qwerty456127 6y ago

> blood glucose levels increase when participants believe the beverage has high sugar content Then where does this actual glucose come from?

nikolay 6y ago

There's no news. Insulin production starts ramping up even when you start thinking about eating and before putting any food in your mouth. It takes time for its release, so, all this is trying to predict when you'll need it. Still there's no single mechanism.