The trouble with sweeteners, of particular concern for Diabetics

Q.Do artificial sweeteners affect patients with type 1 diabetes and patients with type 2 diabetes differently?
A. Approximately 10 to 15 percent of diabetic patients have type 1 (formerly called juvenile) diabetes, and the rest have so-called adult-onset or insulin-dependent (type 2) diabetes. In type 1 diabetes, which may be largely an autoimmune effect early in life, there is a marked decrease in the amount of insulin produced. In patients with type 2 diabetes, especially among those who are overweight, there is still considerable insulin. In many of my earlier studies in the 1960's, we showed an "exhaustion" effect with
hyperinsulinism, leading into diabetes-which is why I call it diabetogenic hyperinsulinism. Thus, aspartame products can affect both types of diabetes, albeit through different mechanisms.

Q. How do you know if your pancreas is being damaged by aspartame?
A. We can check the blood sugar (glucose) in various ways-either randomly or during the course of glucose tolerance testing. A person's blood glucose level may decrease, with a tendency toward hypoglycemia, or it may go up, as a tendency toward diabetes. Of course, this occurs in a cyclic manner because we change metabolically as the day goes along. Early in the evolution of the diabetogenic tendency, elevations may not show up in the morning but they do so later in the day.

In the early 1960's, I devised the afternoon glucose tolerance test; the glucose load is given at noon, and blood glucose and insulin levels are followed. The more dramatic rise in insulin later in the day than in the morning also has been shown in five or six different animal species. In people who are potentially diabetic, one can show these changes by a grossly diabetic glucose tolerance response with a marked increase or decrease in insulin.

In terms of pancreatic enzymes, more studies are required; considerable loss of pancreatic functioning occurs before these changes are evident. Of course, if someone has severe pancreatitis induced by aspartame, it could influence both the secretions and insulin production. A number of patients have shown this dual problem clinically.

Q. What can be done to protect the pancreas from aspartame?
A. I think that aspartame products should be taken off the market because of my belief this artificial sweetener is an imminent public health hazard. I have stated this recommendation to Congress and have mentioned it in many articles and texts.

Q. Can sugar damage the pancreas?
A. Sugar might be one of the contributing factors leading to the exhaustion of the insulin reserve, and, ultimately, to diabetes. Sugar can also cause changes in triglyceride and cholesterol levels and can lead to carbohydrate-induced hypertriglyceridemia (high serum triglyceride levels).

Q. How do sweeteners affect hypoglycemic patients?
A. Sweeteners cause an increased elaboration of insulin, especially as the day goes on and during the night, when the brain is most vulnerable to decreased circulating glucose levels. Glucose is the central nervous system's chief source of energy. It is during the night when many of the complications of hypoglycemia occur.

Q. Why do you think pancreatitis is increasing?
A. There are many causes of pancreatitis; it can be related to alcohol use and other factors. In this case, there has to be more thinking about the contributory role of dietary products containing aspartame. Then there is the matter of pancreatic cancer, the incidence of which has decidedly increased. Whether aspartame or other sweeteners are related to this increase has yet to be determined.

Q. Why do you think pancreatic cancer is on the rise?
A. Cancer of the pancreas is definitely on the increase, but the reasons are not clear. Certainly,if you have a substance that can irritate the pancreas, as with aspartame products, corporate-neutral studies are in order.

Q. Why does type 1 diabetes seem to be on the rise?
A. I think there is a spectrum. Today we use the terms "type 1" and "type 2" diabetes. In my earlier publications on diabetogenic hyperinsulinism, I pointed out that this is probably the same disorder seen in different age groups. The tendency to hyperinsulinism is a biological trait that we have inherited. Before the 20th century, it was a defense mechanism against famine. The extra insulin laid down more body fat, which gave people metabolic protection in times of famine. As we changed our diet radically with the consumption of a large amount of carbohydrates and more calories and a change in our lifestyle and eating habits-this protective mechanism became a pathogenic mechanism culminating in obesity, changes in lipid metabolism, heart disease, and other problems.

Q. How accurate is the glucose tolerance test, and how do sweeteners affect it?
A. The glucose tolerance test must be done under proper circumstances. Patients should consume adequate calories for at least several days before the test. Under general circumstances, it is a helpful test to see whether people have a tendency to diabetes and hyperinsulinism. As noted, the patient's carbohydrate metabolism and insulin release may be more accurately shown later in the day and by conventional morning glucose tolerance testing.

Q. How effective are the hemoglobin A^sub 1C^ tests?
A. An elevated glycosylated hemoglobin level (above 6 percent) can indicate the average increased glucose concentration over the previous several weeks. It is a useful parameter for diabetes control.

Q. How do sweeteners affect glucose levels after we fast and after we eat?
A. Glucose levels can decline if the sweeteners produce a great deal of insulin, or they can go up if a tendency toward diabetes already exists.

Q. What is the ideal glucose level?
A. We are interested not only in the fasting level but also in the ideal level during the greater part of the day when we are active. The ideal glucose level should less than 115 milligrams per deciliter (mg./d1.), but that is not an accurate reflection of what it is during the entire day. Certainly, at random measurements during the day, it should probably be less than 140 mg./d1. This value changes during the course of the day.

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