Kate Taylor

It’s something I hear all the time, “yeah but they are just as bad as sugar aren’t they?” Not entirely no. There is usually a point made about them being artificial, or full of chemicals or that they can cause you to gain weight. Lots of things are artificial, everything is made up of chemicals and in most cases there are many other factors that impact our weight before sweeteners, however we are pretty hung up on how apparently harmful they actually are.

Low calorie sweeteners come in many forms, aspartame, saccharin and stevia are probably the ones most people have heard before. All are around 200 -300 times sweeter than sugar itself, aspartame and saccharin are artificially produced and stevia comes from a plant originating from South America (it still does undergo a small amount of processing though). These and many others are used to sweeten products, namely soft drinks but also cakes and often protein bars which we see becoming more mainstream in individual diets. They are a calorie free solution to food and drinks which are usually very low in physical nutritional quality. Not only that, low calorie sweeteners don’t have the detrimental effect on our teeth that sugar does.

Like most things in life, nothing is straightforward so here goes, keeping it short and sweet (excuse the terrible pun).

Harmful to human health? The research currently says no. If that’s all you needed to know you can stop reading now, but I’ve broken down the science a little bit further for those avid readers.

Without a doubt there have been many studies on low calorie sweeteners with the majority of them, in animals. And there’s the first point to reference, animal studies can’t be applied to humans, we are different species. The studies which started the concern were published in the 1970s and linked the high doses fed to rats with the development of bladder cancer₍₂₎. This has since shown to be incorrect as rats have an increased risk of developing bladder cancer due to their physiology. What is also important to note here is studies in animals are usually conducted where the sweeteners are given at an almost toxic level, far higher than we would ever consume. Only very small quantities of sweeteners are consumed in human diets, as an example around 1/10g is used in place of 35 grams of sugar, which is roughly the amount you’d find in a can of CocaCola_(1).

For any items to enter the food chain, they have to be certified as safe by the European Food Standards Agency (EFSA) – which might I add could potentially change in March 2019 due to Brexit so an update will follow then if it’s needed. They must be safe for human consumption and have maximum limits set for products and ingredients based on average consumption.

There is however, emerging research on low calorie sweeteners in the area of gut health and their potential role in altering our gut microbiota (that’s all the bacteria that make up our gut and help us to stay healthy). Again, the research has been completed in mice and shows that low calorie sweeteners can disrupt the gut microbiota and result in impaired glucose tolerance – which means the body’s ability to regulate glucose (sugar) _(3). But until this can be show in humans, we just need to keep an eye on this one.

They can help those trying to lose weight reduce their calorie consumption. However, this only works if the individual is educated in their food choices. It doesn’t mean it can be replaced with something else high in calories at another point during the day.

There is no evidence to suggest they impact dental health. Sugar sweetened drinks and other items such as cakes and biscuits high in refined sugar in the UK are contributing to the 45,000 multiple teeth extractions in under 18-year olds which were carried out in England and Wales in the last year ₍₄₎. No further comment needed there.

All of the above taken into account we are still a way off the public perception of artificial sweeteners changing. There is still very much a body of thought out there which deems them to be socially unacceptable. When in reality for almost a third of adults who significantly need to reduce their energy intake to lose weight they shouldn’t be.

So in short, as part of a balanced food and beverage intake then I have no issue with my clients consuming products which contain them. If it helps support their long term goal of losing weight then that’s a positive step. If consumption is in excess then this could pose health risks, (but too much kale would also do that) by excess this would mean litres and litres of diet fizzy drinks per day, sweeteners in tea and coffee and a couple of protein bars too. And finally it’s very important not to get into the reward mindset of “well that had no calories so I can have something else instead”. If you are hungry eat, if you aren’t try not to.

And on the horizon for the UK food industry – with calorie reduction being implemented by the UK government are we likely to see more artificial sweeteners in our food products?

References:

1. Evaluating research by understanding the metabolic fate of difference low calorie sweeteners – Dr Berna Magnuson (Canada) – International Sweeteners Association Conference 2018
2. MD Reuber. Carcinogenicity of saccharin. 1978 Environmental Health Perspectives Aug; 25: 173–200.
3. Nettleton JE, Reimer RA, Shearer J. Reshaping the gut microbiota: Impact of low calorie sweeteners and the link to insulin resistance? 2016. Physiology & Behavior. Oct 1;164(Pt B):488-493.
4. Local Government Association, December 2018. https://www.local.gov.uk/about/news/180-operations-day-remove-rotten-teeth-children,

This is something that I’ve been thinking about for a while now. And before anyone reading this gets their back up, please read on first! I’ve been pondering on how I pitch it and what to say predominantly because it’s a sensitive subject. It would be hard not to upset anyone. But that’s the point right, someone will be upset because you can never please everyone. I get it. Fat shaming. Being fat phobic. And generally not appreciating those in bigger bodies is not right, it never was, and never will be. I’ve been a victim of it, my friends have and my family too. Diet culture is damaging to self esteem as well as our body in the physical form. But after all that I still feel we may be in danger of normalising plus sized bodies. I’m not talking about generally carrying a bit of excess fat, this is common and something that isn’t generally anything to be concerned about. I’m talking about being significantly overweight or obese. Are we in danger of making it so ok to be carrying large amounts of excess fat that we lose sight of the health implications. And those implications are that 63% of UK adults are either overweight or obese and with that comes metabolic disease, type II diabetes, increased risk of cardiovascular disease and back problems to name just a few. Let’s also not forget our NHS is in crisis. When is enough, enough and how do we make people understand that whilst there is no ideal body, no universal standard for anyone, carrying significant excess weight can reduce your quality and length of life. Yes, some people will naturally be bigger and some smaller, depending on their genetics and lifestyle.

The very recent study by Mattarak published in June this year (2018) does raise some alarm bells. Whilst it’s not overly new in terms of thinking the physical statistics on people underestimating their weight and therefore underestimating their risk of disease is staggering.

• Underestimating body weight was more common in men and those (of both genders) in a lower socio-economic group.
• Men were also less likely to be trying to lose weight
• And those who did underestimate their overweight or obesity were 85% less likely to try and lose weight than those who accurately knew how much they weighed. 85%!!

We need to find a way for everyone to be comfortable talking about weight. No, it doesn’t define us, who we are or what we think. But it can impact how we live.

We need to not make weight the main driver. Of course, it will be part of many peoples journey, but there needs to be other goals, other priorities. Cooking, moving, improved mental health, learning to build new habits. In my private consultations I always encourage my clients to have other goals, than just being weight focussed.

Those promoting nutritional brands, supplements or methods offering a short term fix with no scientific backing need to continue to be called out. So, us as health professionals can keep promoting the right stuff whilst not being bogged down in one stop solutions that don’t work. It’s not ok.

People need to be patient, something we seemed to have lost since social media appeared and technology ruled our lives. Change takes time.

We as health professionals need to be honest with our patients and clients about a subject which is always the elephant in the room yet is causing so much pain to them and to others. We need to be compassionate and help them understand positive changes that can and will help them in the long term. And collectively we need to find a solution which can positively impact those in lower socio economic groups, these are the group of people who need this education the most. #foodforthought

We’ve been getting itchy feet about going on holiday as it’s been quite a while. I’m such an avid traveller that having such a big break between trips actually made me extra excited about this one. I took full advantage of a week away from social media, only responding to messages from friends and family. It really helped. We all know the accounts that are filled with sunny beaches and feet by the pool whilst we are hitting the daily grind, no one needs that in their life. So instead, here’s just a quick summary of our trip with all the foodie highlights.

Lamb tagine with prunes and walnuts

We arrived to the longest immigration queue I’ve ever seen, about an hour and twenty minutes to get through but once we finally got out of the airport the sun was setting which was stunning. A short cab ride later we arrived at the beautiful Riad Nashira, where we were staying for three nights. We were tired but instead of chilling at the riad we opted for their restaurant recommendation and went to a cute little Italian/Moroccan fusion restaurant. When you arrive in Marrakech most hotels recommend a guide take you for your first few trips as the medina of Marrakech can be quite daunting, and very easy to get lost in. We arrived at what looked like a door in the wall but once inside it opened up into the beautiful space with trees and mismatched furniture. We both opted for tagines, one lamb, one chicken. The couscous that arrived with it, I simply cannot even explain how good it was. Pretty sure it had butter added to it as it a rich yellow colour and the flavour was absolutely divine. The lamb was soft and fell apart as I ate it, and the dried fruit gave an added depth of sweetness.

Sunday. Breakfast at Riad Nashira was brilliant. So much to choose from, I didn’t know where to start. Fresh fruit, eggs, bread, quiche, salad, coffee, tea and juice, basically everything, a little bit like a buffet. Weirdly the Moroccans love cake at breakfast time, we didn’t add that into our feast. We then went out exploring, the hotel guide showed us how to get to the medina. All the little alleyways and streets look exactly the same so it’s easy to see how people get lost. We sampled our first mint tea in the Kasbah district. The sugar is insane and was unexpected. In Morocco they also pour mint tea from a height so that it forms a foam on the surface. Note: ask for it without any sugar, we also skipped lunch. We then visited the secret gardens of Marrakech. We were pretty tired on our return so headed to Café Arabe which is perfect for drinks with a view but the food was average. We fancied going for a glass of wine which is why we opted for this location, reviews were mixed but sometimes you’ve just gotta go with it. Being a Muslim country alcohol isn’t routinely served, many restaurants and hotels do have a licence though.

Food delivery truck in the Kasbah district of Marrakech

Tagines cooking our lunch at Ouzoud Falls

Monday. An all day trip to Ouzoud Falls, three hours each way, took up most of the day. This is a trip I would recommend to anyone, we also ate more tagines, couscous and Khobz (this is the handmade bread which is sold by street vendors and in restaurant they supply by the bucketload to your table). It has a crisp crust but is soft in the middle, it can be made with any type of flour. Dinner was at Nomad. We had tried to get in here for lunch the day before but it was fully booked. Despite it being freezing, even though they had patio heaters, the sunset was gorgeous and the food very tasty. I opted for the Moroccan spiced lamb burger, we had a side of green beans which were crunchy, garlicky and I finished the entire bowl! Nomad is just around the corner form the spice quarter, and that’s one thing about Morocco that is inspiring, their use of spices gives so much flavour.

Moroccan spiced lamb burger at Nomad 

Tuesday: a 3 hour bike tour around the city with an orange juice stop in the square while we watched the henna ladies and snake charmers, followed by shopping in the souks. Bartered and got a gorgeous Moroccan rug. We lunched at Le Jardin, (by the same owner as Nomad). The kefta tagine had been on my list of foods to try, minced beef with eggs, a bit like shakshouka but with meat instead of veggies, also with couscous.

What’s very prevalent is fruit juice. There are markets stall selling it everywhere, its automatically poured at breakfast and is on every restaurant menu. It’s no surprise with alcohol not being served, but I couldn’t help to think about all the sugar. And also meat, there is lots of meat, be very prepared for that. And for for everyone trying to sell you everything, takes a few days to get used to.

Foodie highlights

• Mint tea, lamb tagine, lamb burger at Nomad, kefta tagine, and bike tour with a pit stop for juice!

Non-foodie highlights

• Bargaining in the souks, Ouzoud Falls, beautiful Riad Nashira

More to come on our next stop in the beach side haven of Essauira soon…..