Artificial Sweetener May Exacerbate Inflammatory Bowel Disease

A popular sweetener could result in bacterial overgrowth and symptom worsening among patients with Crohn disease.

High sugar intake is known to increase the risk for several diseases, so many individuals supplement it with artificial sweeteners. However, multiple studies also point to potential adverse events related to intake of artificial sugars.

In a new study published by Inflammatory Bowel Diseases, intake of sucralose (Splenda) worsened gut inflammation among mice models of Crohn disease over a 6-week period. These findings were not observed among mice without inflammatory bowel disease (IBD).

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The authors noted that approximately 10% to 15% of patients with Crohn disease report that artificial sweeteners worsen symptoms.

The researchers discovered an increase in Protobacteria in the gut of mice that drank water supplemented with sucralose.

Specifically, sucralose intake caused intestinal overgrowth of Escherichia coli, in addition to increased bacterial infiltration of the gut wall in these mice, according to the study.

Sucralose intake also increased myeloperoxidase activity in mice with IBD but not in control animals, suggesting that artificial sweetener intake may only negatively affect those with IBD. The authors noted that myeloperoxidase is an enzyme in white blood cells that neutralizes microorganisms.

These results suggest that the high burden of E. coli resulted in more intense myeloperoxidase activity to combat the bacteria, according to the study.

The authors hypothesize that sucralose consumption could increase myeloperoxidase activity among patients with IBD and worsen symptoms.

"Our findings suggest that patients with Crohn's disease should think carefully about consuming Splenda or similar products containing sucralose and maltodextrin," said lead author Alex Rodriguez-Palacios, DVM, MSc, DVSc, PhD. “This study demonstrates that the sweetener induces changes in gut bacteria and gut wall immune cell reactivity, which could result in inflammation or disease flare ups in susceptible people. On the other hand, the study suggests that individuals free of intestinal diseases may not need to be overly concerned."

The artificial sweetener includes the potentially indigestible sucralose and a digestible maltodextrin, according to the authors. Sucralose is approximately 600 times sweeter than sugar and is commonly used as an alternative.

"This is perhaps the closest we can get to provide experimental evidence that these ingredients together induce biological changes known to cause inflammation which could be harmful over time to susceptible animal subjects," Dr Rodriguez-Palacios said. "Our next step would be to run experiments directly in patients, but that is more difficult to conduct given the large variability that is inherent to human genetics, microbiome and diet."

Overall, these findings suggest that the sucralose sweetener may promote dysbiosis and myeloperoxidase activity among patients with IBD, according to the authors.

Additionally, the authors note that it could be possible to gauge gut health and disease progression through fecal biomarkers that measure Protobacteria and myeloperoxidase, according to the study.

"Our findings were due solely to the administration of a minor component of the diet," said the senior author Fabio Cominelli, MD, PhD. "This suggests that other dietary habits or additives may lead to similar microbiota alterations. For instance, diet emulsifiers used as food additives have also been shown recently to alter the gut microbiota and promote colitis in mice. Other scenarios could put Crohn's disease patients at risk of having exaggerated inflammation as well. This could include unexpected foodborne bacterial infections which would further recruit myeloperoxidase-containing leukocytes to the intestinal tract and the resultant inflammation."