Artificial sweeteners linked to ‘marked effects’ on small intestinal microbiome
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CHICAGO — Greater consumption of artificial sweeteners, specifically those that do not contain aspartame, resulted in “marked effects” on the duodenal microbiome profile, according to data presented at Digestive Disease Week.
“As physicians, we see a number of patients who consume artificial sweeteners for a variety of reasons,” Ruchi Mathur, MD, director of clinical research and clinical operations for medical associated science and technology at Cedars-Sinai Medical Center, told Healio. “Many of these patients report GI issues such as bloating and altered bowel habits. These symptoms are seen more with the use of sugar alcohols and sugar-derived sweeteners like sucralose than with amino acid-derived sweeteners like aspartame.”
To determine whether a possible link exists between artificial sweeteners, the small intestinal microbiome and these gastrointestinal symptoms, Mathur and colleagues assessed duodenal microbiome profiles of patients who consumed artificial sweeteners vs. those who did not.
They enrolled patients who were undergoing upper endoscopy without colon prep and divided them into groups of non-consumers of artificial sweetener (n = 55), aspartame-only consumers (n = 9) and mixed artificial sweetener consumers (n = 35). Researchers isolated microbial DNAs and sequenced V3/V4 libraries from duodenal aspirates obtained via protected double lumen catheters. Additionally, they performed Operational Taxonomic Unit clustering, taxonomic analysis and MetaCyc function predictions using CLC Microbial Genomics Modules.
According to study results, taxonomic profile and functional potential of the duodenal microbiome varied significantly between patients who consumed mixed artificial sweeteners vs. those who did not consume artificial sweeteners, with significantly lower microbial diversity reported among mixed artificial sweetener consumers (P = .04).
“The group who consumed aspartame alone did not have a significant change in small bowel microbial diversity, whereas the non-aspartame sweetener group showed a decrease in diversity,” Mathur said.
The researchers also reported that the relative abundance of Firmicutes, the predominant duodenal phylum, was 2.38-fold higher among artificial sweetener consumers vs. non-consumers, whereas the relative abundance of Proteobacteria, Bacteroidetes and Fusobacteria were reportedly lower.
Additionally, the relative abundance of 145 bacterial features diverged greatly between artificial sweetener consumers and non-consumers, including a 2.50-fold higher abundance of Streptococcus among artificial sweetener users. Mathur and colleagues noted that only 86 bacterial features differed significantly between the aspartame users and non-consumers.
“In this first-ever study of the effects of artificial sweeteners on the small intestinal microbiome, we found that artificial sweeteners are associated with marked effects on microbial profiles and predicted microbial metabolic pathways,” Mathur said. “These effects are more pronounced for the non-aspartame sweeteners.”
The researchers also noted that relative abundance of known duodenal disrupters, Escherichia and Klebsiella, were surprisingly lower in both the mixed artificial sweetener and aspartame groups vs. non-consumers.
Further, Mathur and colleagues reported that duodenal microbial metabolic potential functions in artificial sweetener consumers were unique, with significant variations in 386 pathways compared with non-consumers. In comparison, the microbial functional potential of the aspartame group was akin to non-consumers, with just one function — cylindrospermopsin biosynthesis — enriched in the aspartame group.
“We need to confirm our findings in a larger cohort before we make any recommendations,” Mathur told Healio. “At this time, it appears that aspartame has the least impact on the small intestinal microbiome. Perhaps this translates to fewer, or less severe, GI symptoms [but] more confirmatory work needs to be done.”
She added: “The small bowel is the most important site of the intestinal tract. Signals in the small intestine are likely of more relevance to human metabolic conditions than signals from elsewhere in the intestine. These findings indicate that artificial sweeteners indeed impact the microbiome of the small intestine. Given the small intestine’s relevance, this warrants further investigation.”
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Mathur R, et al. Abstract 1868: The consumption of artificial sweeteners is associated with alterations in microbial communities and their metabolic potential in the small bowel. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago (hybrid).
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