How to Manage Grief Over the Holidays

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Transcript

Host: Tessa Lackey:

Welcome to Prescribed Listening by the University of Toledo Medical Center. I'm your host, Tessa Lackey. In today's episode, we're breaking down what's going on with aspartame and it being listed as a possible carcinogen by the World Health Organization. If you followed any of this over the last couple months, it's been kind of confusing between what the FDA has been saying and how you should really be responding to aspartame and how you use it. And if you're a diet soda person, this is an episode you're going to want to hear as aspartame is most famously known for being in diet pop.

Some other interesting things that Dr. Srini Hejeebu from UTMC Internal Medicine and I discuss in this episode are how sugar alcohols can impact diabetics, how that 2:00 PM soda might not be giving you the effects that you're hoping it will and some alternatives that you can try to boost your energy and benefit your overall health. So here's our conversation about aspartame.

Dr. Hejeebu, thank you so much for joining us today. So this has been all over the news lately about aspartame and how it's being listed as a possible carcinogen which means that it could cause cancer. So WHO says that aspartame is an artificial chemical sweetener widely used in various foods and beverage products since the 1980s, including diet drinks, chewing gum, gelatin, ice cream, dairy products such as yogurt, breakfast cereal, toothpaste, medications like cough drops and chewable vitamins. So what should people be aware of when it comes to aspartame in their diet?

Guest: Dr. Srini Hejeebu:

So it is so readily used in a number of things like you just listed. It's hard to understand. If you actually look at the ingredients of these different products, it may not be listed readily. Some of the sweeteners are table where you can add it to coffee and different things like that. But when it's processed food, what they actually do is combine a number of different sweeteners to get that flavor. And the FDA only requires, depending on the amount that you give, so the higher amount of ingredients are listed in the top five and the sweeteners are less quantity so that you may not exactly see what exactly is in them.

The only one that the FDA requires you to document is saccharin. So saccharin was, in the 1970s, shown to cause urologic cancers in rat models, and so they put that warning out and they took away, there was a rating called safe for consumption basically. And initially they took saccharin off the safe for consumption list. Then after further studies that did not show significant urologic cancers or other cancers, they give them that moniker back saying it is safe for consumption, but they require saccharin to be labeled no matter what amount in the ingredients. So that's why it can be very confusing for consumers when they look for different types of sweeteners.

Host: Tessa Lackey:

So it seems like there's a disagreement between WHO and the FDA on aspartame as a possible carcinogen, WHO being for it and FDA being against it. So what advice would you give people in terms of if it's something that's a higher amount and how to proceed as they are looking at a nutrition list?

Guest: Dr. Srini Hejeebu:

So as a nutritionist, I think definitely more studies are required. I think the World Health Organization came out with this statement that it may be a potential carcinogen, but again, the studies have not completely documented this. So more studies are required. But I think from a consumer standpoint, if we could do things in moderation, we always go a long way. If we take excess of any one particular item, because we don't know the mechanism of these chemicals that affects our body, there may be adverse effects that we don't know yet. There are some things that these artificial sweeteners have shown to cause, but again, nothing is definitive, but there is some changes in the body that are worrisome.

Host: Tessa Lackey:

Okay, so what kind of changes in the body?

Guest: Dr. Srini Hejeebu:

So from my understanding, like aspartame and some of the synthetics, they do affect the gut microbiota. So the gut microbiota is used for homeostasis. So glucose sensitivity, your drive to eat more sweets or your drive to consume more foods may be affected by the effect on the gut microbiota. And the proposed mechanism is what we see, especially in our diabetics, it kind of seems to make sense that diabetics think that they're eating or drinking no calorie substances, but it actually affects their insulin sensitivity, their insulin requirements, their gut hormones that are released to maintain this homeostasis. So yeah, there's quite a bit that we know, but there's a lot we don't know yet.

Host: Tessa Lackey:

Okay. So aspartame is found in a lot of different diet soda. So for those people that have that required two o'clock diet soda, that's just a part of their routine or they're a big soda drinker in general, should people be switching to regular soda?

Guest: Dr. Srini Hejeebu:

So if you remember, the push was, especially with the obesity epidemic, less calories. So initially they were saying, the recommendation was to limit the amount of sugar you're taking in. And so people chose these alternative methods, so the diet sodas. Now, the more information we're getting from these diet sodas and things, they're causing other issues rather than just calorie intake. So the recommendation is no, we don't want you to consume diet sodas and other diet artificial sweeteners. We'd rather you take natural substances, water, non-sugary drinks. When I looked at the studies as far as does diet sodas actually make you lose weight, the overwhelming answer is no, you do not lose weight with diet sodas. The only thing that it was proven was that diet drinks actually help cavities. So dental cavities is prevented because you're taking in less sugar. That's the only thing. Everything else, there's no proven benefit as far as weight loss

Host: Tessa Lackey:

For diabetics, so does diet soda impact diabetics?

Guest: Dr. Srini Hejeebu:

Especially diabetics, so I am really concerned about the gut microbiota and how the homeostasis, so insulin sensitivity, gut hormones such as GLP-1. If those are affected, that affects how blood sugars are affected in a diabetic. So yes, it's very concerning. So I actually recommend not to use diet sodas for my diabetic patients. I would prefer they drink regular soda if they're going to drink a soda, but I would prefer that they mainly use water and other unsweetened beverages. We know diabetics also have issues with weight, so I'm very concerned about what these effects are that we know some information, but there's a lot of information we don't know on how it affects their long-term health. There's been some issues with cardiovascular disease with some of these sweeteners. So I am concerned that especially in my high risk population, I tend to say, "Please don't use diet drinks if possible. If you occasionally want a soda occasionally, that's fine," but for the most part I try to steer them away from the diet drinks and diet sodas.

Host: Tessa Lackey:

And if it's every now and then that they're drinking a regular soda, how often a week would you say is good?

Guest: Dr. Srini Hejeebu:

Again, I like the word moderation. If you look at the FDA guidelines on sugar content, there's 25 grams for women, 35 for men. I'm not really sure why there's a discrepancy between men and women, but somewhere around there is what you should consume. Obviously, if you can do less like 10 grams of sugar per day, that's reasonable. And it's the same thing with the diet sodas. If you can limit it, periodic everyone has a craving, and if you could limit it, that's helpful.

Now, the other thing that these artificial sweetness do is change the drive in the brain. Again, it's not completely proven, but there's more drive to increase more sugary substances when you take diet sodas, eat more carbohydrates, it affects the brain in ways that we really are not completely sure yet, but it's in that direction where you're requiring more sugar, it makes you eat more. And I think that's the mechanism of why you don't lose weight with diet drinks.

Host: Tessa Lackey:

So for me personally, I'm someone that I try to use natural sweeteners when I'm able to sometimes just if you're going to go out for a burger, just a soda, that's what the recipe calls for. But for most of the time, for me personally, that's what I use. So I mostly use stevia, raw cane sugar, honey or maple syrup. My understanding of stevia is that it's from a stevia leaf, so that it's natural, but that sometimes manufacturers add another sugar called erythritol in it, and that erythritol takes it up a whole nother notch and makes the sugar sweeter. So for those who are trying to use natural sweeteners or are purchasing different beverages or foods that appear to be healthier, so is something like stevia or like a soda sweetened with stevia, is it okay to use?

Guest: Dr. Srini Hejeebu:

Yeah, so that's, again, we go back to that moderation. Anything in moderation is really good. If you want to use the natural ones, I think the other one besides stevia is the monk fruit extract, and also sugar cane sugar. Those are very good because of the natural occurring. Again, we want to use natural sugars. Natural sugar is okay, but when you overdose on even the natural sugars, you can get yourself in trouble. Anything in moderation would be a good idea. And I think you're absolutely correct, stevia would be a better option than the synthetic sweeteners.

Host: Tessa Lackey:

But no matter what, sugar is still sugar.

Guest: Dr. Srini Hejeebu:

Sugar is still sugar, it affects everything, so you want to limit it as much as possible within reason.

Host: Tessa Lackey:

So what are some other sugar substitutes that you've seen that you would either recommend people use instead or that they should stay away from?

Guest: Dr. Srini Hejeebu:

So when I look, I think there is six sweeteners that are approved by the FDA. I think neotame, advantame, sucralose, saccharin are some of the few. Aspartame is I think 75 to 80% of the sweeteners used in all of our products. I think that's why we've seen such news about that when the WHO came out and thought that it was potentially carcinogen. Neotame is the one that we see a lot for diabetic. So for the diabetics, they've been using neotame in their products saying it's diabetic safe. Again, that's unsure whether it truly would be beneficial or less harm for a diabetic compared to aspartame.

Host: Tessa Lackey:

Interesting, interesting. And is that bold on the back normally and the nutrition label?

Guest: Dr. Srini Hejeebu:

See, that's the issue, the labels don't have to put the sweetener on there because of the amount that they use. So it goes by the ingredient amounts. So the top five, so whatever the product is, the sweetener is actually on the lower end of amount used, so it doesn't appear on the nutrition label.

Host: Tessa Lackey:

That's so frustrating. I mean, you would think that's something that they would have to put on there, I mean, because it's in there ultimately.

Guest: Dr. Srini Hejeebu:

Correct, I think if you had an extensive list of the label, so you'd have to dig, dig, dig to try to find every single ingredient, and you may see it down at the bottom. And in the FDA, that's their recommendation that the top five get the top billing and then the rest kind of get filtered in. And again, even the aspartame is combined with others, like you said, stevia, they add an additional sweetener to make that sweet. So when they use smaller amounts and then add additional things, that amount gets smaller and smaller.

Host: Tessa Lackey:

Yeah, which the concept of making sugar sweeter to me just blows my mind a little bit. I mean, I understand that we as people, and then everyone has their own sugar tooth and everything too, but sugars, I mean if you were just buying sugar, it's sweet enough.

Guest: Dr. Srini Hejeebu:

Well, and that's the funny thing is that they measure it against sucrose. There's actually a level that they measure the sweetness of the ingredient. And so you're right, sugar is sugar, I'm not really sure why you need to keep making it sweeter and sweeter, but that's what people crave.

Host: Tessa Lackey:

Yeah. So what are some side effects that if someone is being impacted negatively by any of these sweeteners that they might notice and should talk to their doctor about?

Guest: Dr. Srini Hejeebu:

So I think there's no obvious side effect. You're going to have less energy if you tend to consume these artificial sweeteners. You may see a little bit of weight gain, you're craving more sweets or you're craving more carbohydrates. One of the sweeteners does actually trigger migraine headaches. So you can have migraine headaches from some of these sweeteners. We see these when people tend to go off sodas or diet sodas, try to wean themselves off, initially they get a lot of headaches. It's that artificial sweetener that may be the potential cause of it.

Host: Tessa Lackey:

Hold on, let's dig into this really quick. So for people that are trying to drink less soda, for example, it's not the caffeine, it's the sugar?

Guest: Dr. Srini Hejeebu:

We think it is a combination. So there is some component of the caffeine that your body requires. Again, it's another substance that your body's used to having all the time. And then on top of that, you have these artificial sweeteners that your body needs, and it may trigger migraine headaches or other low-grade headaches that people suffer from.

Host: Tessa Lackey:

So even just saying what you were saying before about how drinking a soda makes you feel fatigued and then it makes you crave carbohydrates, it sounds like it's the opposite effect of what people are intending for.

Guest: Dr. Srini Hejeebu:

Absolutely.

Host: Tessa Lackey:

You drink a Diet Coke or you drink something in general caffeinated to keep yourself moving, but actually it's just weighing you down and making things worse?

Guest: Dr. Srini Hejeebu:

Exactly. So you're getting the opposite effect. And so that's why I think you could just do better with the unsweetened natural drinks. Water is better than some of these artificial things.

Host: Tessa Lackey:

So with that two o'clock slump, if anyone's using a soda or anything like that, is making a cup of coffee better or should you just be hitting the water harder?

Guest: Dr. Srini Hejeebu:

Hitting the water probably a little bit harder. There's a lot of supplements out there of caffeine boost and things like that. Those have their own side effects, correct, so you may be causing additional problems just to kind give you a little bit of pep. I know there's a lot of caffeine drinkers out there that need that afternoon, that's because they need it because your body, you've been used to it and that's why you need that extra boost in the afternoon.

Host: Tessa Lackey:

Would you say it's almost like your body is saying, "Hey, I need something," but you're not giving it exactly what it potentially needs?

Guest: Dr. Srini Hejeebu:

Correct.

Host: Tessa Lackey:

Okay, okay. The migraine thing blows my mind a little bit. So personally, I get migraines and I go through a process for migraines myself, and I have a bunch of different diet triggers and whatnot, and then stress. But soda is an interesting, or having a certain sugar being a migraine trigger is very interesting.

Guest: Dr. Srini Hejeebu:

Absolutely. And again, when you keep your headache diary, you can actually see exactly what you consumed. And there may be a link to that.

Host: Tessa Lackey:

Yeah, for anyone that is a migraine sufferer, and if you do go through any kind of a diet or a tracking plan it actually really, really helps. But yeah, being able to do that and to see exactly like, "Oh yeah, I had a soda every day at two o'clock and I got a headache," I mean, would you say you would know it is a migraine from a soda, for example, if it's like 15 minutes or so after?

Guest: Dr. Srini Hejeebu:

Correct, exactly. So by the time you absorb it and ingest it gets to the brain and triggers that and you will absolutely be able to correlate it with after that consumption, yeah.

Host: Tessa Lackey:

Yeah, okay. And if you are suffering from migraines, you should talk to your doctor and go through the process and figure out>

Guest: Dr. Srini Hejeebu:

Absolutely, absolutely. And like you did, I think the headache diary is the key and it's everything that you consume. Not only medications, food items, drink items, perfumes, because some of these, when we looked at these artificial sweeteners are in perfumes too, so that you can actually be having that as a trigger to the migraines.

Host: Tessa Lackey:

For migraines? Oh my gosh, yeah. Well then migraines itself, I mean, it can be anything from the temperature to, there's just so many different things. It's a very frustrating life for migraines.

Guest: Dr. Srini Hejeebu:

It's really difficult. And when I tell my patients create a diary, they look at me like, "What do you mean? I get a headache every day." But literally you need to pinpoint it because not everyone is the same. You can have one trigger and someone else can have something completely different. So we are still understanding headaches, so it's fascinating.

Host: Tessa Lackey:

Yeah, I think for me, being able to do that and bring that to my doctor really, really helped. And I mean, just to be able to learn for myself like, "Oh, these things also trigger my migraine." So for example, for me, I'm very sensitive to garlic and onion and onion actually gives me migraines And garlic and onion is in everything, everything. But keeping focused on sugar substitutes and whatnot as well, so what are some ways to sweeten things up that can still be healthier for you and might not be any of these other less impactful sugar substitutes?

Guest: Dr. Srini Hejeebu:

So I think we go back to our natural, natural occurring, natural occurring fruits, some of these natural occurring sweeteners that are available. I think those are the best options. But I always say even for my fruit eaters in moderation, you can overdo it on fruit also. And remember there is calories associated with natural occurring sugar. So we want to limit calories too. So it's not a consume as much as you can of these, but it's in moderation. But if you can avoid the processed baked desserts, if you will, those are the ones that the pitfalls. Eating a natural substance would be better and healthier.

Host: Tessa Lackey:

Okay, this is a little bit of an out there question. So have you heard of WaterTok?

Guest: Dr. Srini Hejeebu:

I have not.

Host: Tessa Lackey:

Okay, so WaterTok, it's one of those categories on TikTok that a lot of people have been doing different videos on and people have been making essentially a mixed drink, but it's water, so they're using different syrups and different powdered things and whatnot, and it makes a sweeter different water. I have different family members that are really, really into this right now. So with things like drink mixes and stuff like that, is that something that if you're trying to drink more water that it's good to use? Or would you say maybe avoid those?

Guest: Dr. Srini Hejeebu:

I'd probably avoid those because it's the same sweeteners that we've been talking about. Remember, aspartame comes in different forms. Some of these other sweeteners are not able to be used in baking, because of the heat. So you'll see it in gelatins and yogurts and things like that. The stevia is available as a table aspartame, I think.

Host: Tessa Lackey:

I think monk fruit is, you can buy it at the grocery store as well too.

Guest: Dr. Srini Hejeebu:

Correct, I think so stevia comes as Truvia, I think aspartame, you can see it in Equal and NatraTaste. I was just looking up some of these things that you can add to your water and things like that. So you just have to be careful. Again, it's the same concept. Even though it's not a diet beverage, but when you add the sweetener, it's become a diet beverage, right? So it's the same thing. So if you can limit to just plain old water.

Host: Tessa Lackey:

I'm a big lemon person too if you're able to do lemons.

Guest: Dr. Srini Hejeebu:

Absolutely, that's a great idea. It gives it a little bit of taste that does not cause any of the other side effects.

Host: Tessa Lackey:

And then they make the different water bottles where you can make different infusions and whatnot too. I've heard different people who will put their strawberries and whatever else they want in there, they'll put it in a water bottle the night before, and then it's all the good flavors are mixed in there too.

Guest: Dr. Srini Hejeebu:

Exactly, that's a great way to get some flavor. I know a lot of my patients will say, "I hate water because there's no taste," you're right, there's no taste. But if you can add some of those natural occurring, absolutely, that'd be a great idea.

Host: Tessa Lackey:

Yeah, yeah. Awesome, okay. So the moral of the story here, whether you're higher risk and you have a cardiovascular issue or a diabetic or you're just in general living a general healthy person, natural is more the way to go, but in moderation, things like diet soda and eating these other sweeteners is okay?

Guest: Dr. Srini Hejeebu:

Correct.

Host: Tessa Lackey:

Okay. So Dr. Hejeebu, if someone is looking to schedule an appointment with you as a primary care doctor, how can someone get ahold of you?

Guest: Dr. Srini Hejeebu:

They can call us at our offices at (419) 383 5614. It's the Comprehensive Care Center on Glendale, and there's a number of providers that can assist and kind of help you with this process.

Host: Tessa Lackey:

Thank you again, Dr. Hejeebu, for joining us today to talk about aspartame and sugar alcohols. You can schedule an appointment with Dr. Hejeebu at the phone number listed in our show notes or that he just listed at the end of the episode. And if you like this episode and you want to hear more from us, you can subscribe to us on your favorite podcast platform. See you next time.