Glucose metabolism responds to perceived sugar intake more than actual intake

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.

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/

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.

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::"

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.

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.

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.

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...

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.

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.

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?

And is it more glucose going in to the blood, or less being processed out?

Then where does this actual glucose come from?

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.