Are Artificial Sweeteners a Hidden Trigger of Inflammatory Bowel Disease?

SEPTEMBER 13, 2014
Michael R. Page, PharmD, RPh
Inflammatory bowel disease (IBD), which includes conditions such as Crohn's disease and ulcerative colitis, is an incurable, potentially debilitating condition that disproportionately affects industrialized countries.

The factors behind the increased prevalence of IBD in these countries remains unknown, although some researchers point to the "hygiene hypothesis," which points to autoimmunity mediated by a lack of exposure to pathogens.1
 
With rapid industrialization occurring in China, epidemiologists are observing a predictable increase in the prevalence of IBD, similar to the increase in prevalence that occurred in the United States over the past century. Between 2000 and 2010, researchers in China reported a 12-fold increase in the incidence of IBD among children living in Shanghai.1,2
 
These results were followed by multicenter analyses, such as a 17-hospital nationwide study in which investigators identified several factors associated with the rising prevalence of IBD. These factors included smoking, appendectomy, stress, socioeconomic conditions, use of nonsteroidal anti-inflammatory drugs, oral contraceptive use, breastfeeding, infections, stress, family sanitary conditions, spicy food intake, and refined sugar intake.1,3
 
The last 2 factors, sugar intake and spicy food consumption, have also been identified as a factor in the pathogenesis in IBD in studies across Europe and the United States, although reductions in the incidence of IBD were not observed with restriction of sugar intake.1
 
Importantly, however, sugars in the context of these studies included artificial sweeteners, which may have an effect on gut bacteria that promotes the development of IBD. Supporting this link was the introduction of the artificial sweetener sucralose, which was closely followed by a spike in the incidence of IBD in several regions, including Alberta, Canada; Brisbane, Australia; Northern California; and Southeastern Norway.

In each of these regions, the spike in new cases followed each country's regulatory approval of sucralose.1
 
Sucralose has demonstrated bacteriostatic effects and limits the ability of bacteria to process normal sugar through inhibition of 2 key enzymes: invertase and sucrose permease. Given these effects, it may be appropriate for at least 1 country to reverse the approval of sucralose to observe the impact of this change on the incidence of IBD.1,4
 
References
1. Qin X. May artificial sweeteners not sugar be the culprit of dramatic increase of inflammatory bowel disease in China? Chin Med J (Engl). 2014;127(17):3196-3197.
2. Wang XQ, Zhang Y, Xu CD, et al. Inflammatory bowel disease in Chinese children: a multicenter analysis over a decade from Shanghai. Inflamm Bowel Dis. 2013;19(2):423-428.
3. Wang YF, Ou-Yang Q, Xia B, et al. Multicenter case-control study of the risk factors for ulcerative colitis in China. World J Gastroenterol. 2013;19(11):1827-1833.
4. Omran A, Ahearn G, Bowers D, Swenson J, Coughlin C. Metabolic effects of sucralose on environmental bacteria. J Toxicol. 2013;2013:372986.


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